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Volume 2 No 8 ; 22 January 2008

 

Clostridium difficile infection: how to deal with the problem - a board to ward approach

Guidance on Clostridium difficile infection (CDI): how to deal with the problem - a board to ward approach is now available for consultation on the HPA website until 23 April 2008.  The guidance on prevention and management of CDI has been updated by a subgroup of the Steering Group on Healthcare Associated Infections (SG-HCAI) at the request of the Department of Health (DH) and updates existing guidance published in 1994. 

The revised guidelines are based on a comprehensive review of the literature and expert opinion and identify best practice and key recommendations for the NHS to ensure the control of CDI.

The guidance and details of how to submit your comments can be found at http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1204186173530?p=1204542909719

Report on a national outbreak of Vero cytotoxin-producing E. coli O157

The HPA's final report on a national outbreak of Vero cytotoxin-producing Escherichia coli O157 (VTEC) in June and July 2007 has recently been published [1]. The report confirmed the effectiveness of, and the need for, the current arrangements for response and investigation following such outbreaks.

The investigation initially concerned three cases of VTEC O157 identified over a two-day period by the Greater Manchester Health Protection Unit. Cases were subsequently identified in five English NHS regions and Wales [1, 2]. A case control study co-ordinated by the HPA's Local and Regional Services (LARS) Division and Food, Water and Environment (FWE) laboratories network indicated that a particular type of chicken and herb unleavened bread sandwich ('wrap'), supplied by a single supermarket chain, was the source of the outbreak. It was not, however, possible to determine how the contamination of the wraps occurred or to pinpoint a single ingredient source.

The success of the outbreak investigation illustrated the benefits of the FWE network's operation since there remains a risk that such fresh, ready-to-eat products may be infected with VTEC, even when strict production controls and processes are in place, as there were in this case, the report notes. No accepted best practice for the preparation of ready-to-eat salad and herb products was identified and the report recommends a review of the means of decontaminating such foodstuffs after they are harvested.

References
1. Q Syed, on behalf of the Outbreak Control Committee. National outbreak of Vero cytotoxin-producing Escherichia coli O157 infection associated with lemon and coriander chicken wraps in England & Wales, June-July 2007. Manchester: HPA, 2008. Available at http://www.hpa.org.uk/infections/topics_az/ecoli/O157/outbreak_01_07.pdf

2. HPA. National outbreak of Vero cytotoxin-producing E. coli O157 VTEC infection, England and Wales: June to July 2007. Health Protection Report, [serial online] 2007 [cited 21 February 2008]; 1 (31): news. Available at http://www.hpa.org.uk/hpr/archives/2007/hpr3107.pdf.

Confirmed measles, mumps and rubella cases in 2007: England and Wales


The number of cases of measles in England and Wales in 2007 (971 cases compared with 740 in 2006) was the highest recorded since the current surveillance began in 1995. Confirmed cases of both mumps (1442) and rubella (27) were lower than in 2006 (4381 and 32, respectively).

Of the measles cases, only around 20% (672/3310) of the notified cases tested by oral fluid were confirmed (a further 342 measles cases were confirmed by a method other than testing of oral fluid, see table). Similarly, 20% of notified mumps notifications that were tested (1062/5333) were confirmed compared to only 1% of rubella notifications.

Measles cases in 2007 were mainly associated with prolonged outbreaks in travelling and orthodox Jewish communities where vaccine uptake has been historically low. In addition, there have been numerous smaller outbreaks in nurseries and schools. Most outbreaks have been associated with wild type virus D4 genotype (MVs/Enfield.GBR/14.07). The majority of the measles cases (79%) were in children less than 15 years of age: 90 cases in those under one year, 312 cases in 1 to 4 year olds, 237 in 5 to 9 year olds and 128 cases in the 10 to 14 year age group.

During 2007, London region (424), South East (102), and East of England (159), together reported 73% of the cases: although 136 and 62 cases were reported from Yorkshire and Humberside and the East Midlands respectively. The remaining 88 cases were reported from the North West (31 cases), West Midlands (26 cases), Wales (13 cases), the North East (12 cases) and the South West (six cases).

Table: Total confirmed cases of measles, mumps and rubella, and oral fluid IgM antibody tests in notified cases: weeks 1-52/2007

 

 

 

Oral fluid IgM antibody positive results

Confirmed cases

Notified cases

Number tested

% tested

Total positive

Recently vaccinated

Oral fluid

Other tests

Total

Measles

3698

3310

90

672

44

628

343

971

Mumps

7274

5333

73

1062

14

1048

394

1442

Rubella

1100

909

83

12

3

9

18

27

The number confirmed cases of mumps fell from 4381 reported in 2006 to 1442 in 2007. The number of mumps cases confirmed in the last two quarters of 2007 was almost half of those in the first two quarters. Despite this decline (figure), the rate of diagnosis is still high in the age group born between 1980 and 1992, which accounted for 66% of all mumps cases. Only 157 cases were reported in children under 15. Cases were identified in all regions, with North West region having the largest number (246) and Wales having the fewest cases (15).

Only 27 rubella cases were confirmed in 2007. Most of these were aged between 20-29 years (14 cases). London reported 11 of the 27 cases. Five of the reported rubella infections were in women of child bearing age.

Figure: Notified and confirmed mumps cases by quarter: England and Wales

Figure: Notified and confirmed mumps cases by quarter: England and Wales

Department of Health good practice guide: Genitourinary medicine: 48-hour access

The Department of Health has published a good practice guide for primary care trusts containing recommendations to help support genitourinary medicine clinics reach their 48-hour access targets by March 2008 [1]. The recommendations build on the 10 High Impact Changes for Genitourinary Medicine 48-hour Access (HIC) guidance published by the Department in December 2006 [2].

References
1. Genitourinary medicine 48-hour access: getting to target and staying there, best practice guidance,. London: Department of Health, 2008. Available at http://www.dh.gov.uk/publications.

2. 10 high impact changes for genitourinary medicine 48 hour access. London: Department of Health, 2006. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/
DH_074104

References
1. Genitourinary medicine 48-hour access: getting to target and staying there, best practice guidance,. London: Department of Health, 2008. Available at http://www.dh.gov.uk/publications.