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Volume 2 No 28; 11 July 2008

 

Recent trends in selected gastrointestinal infections

A review of gastrointestinal disease reports in England and Wales in recent years up to 2007, by the Environmental and Enteric Diseases Department of the HPA's Centre for Infections (CfI), shows that campylobacter continues to be the most commonly reported cause of gastrointestinal infection, followed by rotavirus and salmonella infections (figure 1).

A total of 51,488 cases of campylobacter were reported to the CfI in 2007, representing a 10% increase on the number of cases reported in 2006 (46,769) and the third successive year in which an increased incidence has been observed.

Figure 1. Annual incidence of selected gastrointestinal pathogens (faeces and lower gastrointestinal tract isolations), England and Wales: 1992-2007

Salmonella infections
In contrast to the increase in campylobacter incidence, cases of salmonellosis continue to decline. A provisional total of 12,000 laboratory-confirmed cases were reported in 2007, representing a 4% decrease on 2006 incidence (12,543 reports) and a 62% decline on the peak in incidence in 1997 (31,480 reports). Much of this decline is due to the drop in S. Enteritidis infection (from 22,254 cases in 1997 to 6451 cases in 2007; 71% decrease) and in S. Enteritidis phage type (PT) 4 infection in particular (14,771 cases in 1997 to 1688 cases in 2007; 89% decrease; figure 2). The incidence of S. Typhimurium infection has remained relatively stable over the last three years, although the number of cases reported in each year (1504, 1465 and 1535 cases in 2005, 2006 and 2007 respectively) is consistently higher than the 1332 cases reported in 2004, when incidence was at the lowest level since electronic reporting began.

Figure 2. Annual incidence of salmonella infection, showing the role of S. Enteritidis and S. Typhimurium (faeces and lower gastrointestinal tract isolations), England and Wales: 1992-2007

A provisional total of 828 isolates of Vero cytotoxin-producing Escherichia coli (VTEC) O157 were reported in 2007, representing a 17% decrease on 2006 incidence (1002 isolates).

Cryptosporidiosis
Incidence of cryptosporidiosis declined for the second year in succession in 2007, with 3052 cases reported provisionally compared with 3681 cases in 2006 (17% decrease) and 4529 cases in 2005 (33% decrease). The decrease in incidence reflects in part the absence, since 2000, of the ‘spring peak' in infection traditionally observed in the second quarter of each year (figure 3). The large peak in incidence in the third quarter of 2003 was thought to be associated with foreign travel [1].

Figure 3. Annual incidence of cryptosporidiosis by quarter (faeces and lower gastrointestinal tract isolations), England and Wales: 1992-2007

Rotavirus
Rotavirus continues to be a major cause of diarrhoeal disease in children. The majority of laboratory diagnoses are in children under five years of age. Over 13,000 laboratory confirmed cases were identified in 2007. Rotavirus infection is highly seasonal, with the peak numbers occurring around March of each year. This pattern has remained relatively stable in recent years (figure 4).

Figure 4. Laboratory reports of Rotavirus by season, England and Wales: 2002-2008

Norovirus
Norovirus is a highly infectious pathogen, causing most illness in the winter months and affecting all age groups. The 2007/2008 norovirus season in England and Wales began uncharacteristically early [2, 3] and the number of norovirus laboratory reports this season (6347 from week 27 2007 to week 26 2008) is the highest ever recorded. The high numbers are partly the result of the availability of improved diagnostic techniques, along with greater awareness of infections by both the medical profession and the public.

Figure 5 Laboratory reports of norovirus, England and Wales: 2000-2008

References
1. HPA. Large summer and autumn peak of cryptosporidiosis in England and Wales 2003, Commun Dis Rep CDR Wkly [serial online] 2003, 13(41): news.
Available at: http://www.hpa.org.uk/cdr/archives/2003/cdr4103.pdf.
2. HPA. Norovirus update January 2008, Health Protection Report, [serial online] 2008: 2(2). Available athttp://www.hpa.org.uk/hpr/archives/2008/hpr0208.pdf.
3. HPA. Norovirus update February 2008, Health Protection Report, [serial online] 2008: 2(6). Available at http://www.hpa.org.uk/hpr/archives/2008/hpr0608.pdf.

Corrigendum: COVER data for January to March 2008

In the routine data report "COVER programme: January to March 2008: Quarterly vaccination coverage statistics for children aged up to five years in the United Kingdom" (Health Protection Report, 2(26), 27 June 2008), data for Hib3 at five years has been corrected in Table 3: "Completed primary immunisations and boosters (all antigens) by five years: January to March 2008".

Please refer to the latest version online at: http://www.hpa.org.uk/hpr/archives/2008/hpr2608.pdf