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News Archives

  

Volume 2 No 34; 22 August 2008

 

Patients exposed to chickenpox by infected healthcare workers

The importance of susceptible healthcare workers being vaccinated against chicken pox has been underlined by an incident, in the north-west of England, that required screening of patients to determine whether any had been put at risk.

Two members of staff working in a genito-urinary clinic were found to have been infected (in one case as a result of contact with a family member with herpes zoster; the aetiology of the other case being unknown). The two staff members had reported rashes before being diagnosed with chickenpox on the 15 August. The Trust implemented action to identify all patient contacts within the period of 48 hours prior to the onset of the rashes, up until the staff members were excluded from work.

A risk assessment carried out by infection control staff revealed that there had been 97 patient contacts during the period of potential infectivity. Of these 97 patients, 15 were potentially vulnerable (pregnant or HIV positive). Serological testing, carried out with the participation of the local microbiology laboratory, and patient contact and questioning excluded all but three of these patients from further follow up. These patients were seen in a specially organised clinic to further evaluate their requirement for VZIG (Varicella Zoster Immunoglobulin).

Although in this case further testing and assessment did not result in any patients meeting the criteria for VZIG administration [1], the incident illustrates the importance of protecting staff and patients, particularly in areas where vulnerable patients are treated. The Chief Medical Officer recommended [2] in December 2003 that employers should test all health care staff employed in healthcare settings with direct patient contact who have a negative history of chickenpox, and vaccinate those found to be susceptible.

Adherence to this guidance is particularly important for staff engaged in the care of immuno-compromised patients and for those working in maternity, neonatal or paediatric areas.

Staff working in infectious disease units who are susceptible to chickenpox form a group in whom risk of passing on infection is high. About 10% of adults in this country remain vulnerable to chickenpox and chickenpox is highly infectious.

As a result of this incident the Trust involved in this incident is reviewing its staff screening policy and is considering serological testing of all staff who work in areas with vulnerable patients.

The local Health Protection Unit recommends that Trusts review their occupational health policies to ensure compliance with the 2003 recommendation and consider the need for additional measures where high risk patients are managed.

The NHS Occupational Health Clinical Effectiveness Unit [3] is developing a national guideline on the management of chicken pox and shingles in the workplace, scheduled for completion early in 2009. This will comprise evidence-based background information and guidance leaflets for healthcare professionals, employers and employees.

References

1. Department of Health (2006). Immunisation against infectious disease - the Green Book, p. 421-442. Available at: http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_4097254

2. Department of Health. Chickenpox (varicella) immunisation for health care workers, PL-CMO (2003)8. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Professionalletters/
Chiefmedicalofficerletters/DH_4065215.

3. Varicella Zoster Virus in the workplace: occupational aspects of management – a national guideline (in preparation). NHS Occupational Health Clinical Effectiveness Unit, http://www.nhsplus.nhs.uk/web/public/default.aspx?PageID=333.

S. Agona PT39: increase in new salmonella strain in UK and Ireland (update 2)

Investigation of an outbreak of Salmonella Agona PT 39 infections – that has so far affected England and Wales, Scotland, Northern Ireland, the Republic of Ireland, Finland, France and Sweden – is continuing [1,2,3].

As of 21 August, 141 individuals have been notified as S. Agona PT 39 cases. These occurred in: England (80 cases), Scotland (31 cases), Ireland (11 cases), Wales (10 cases), Northern Ireland (one case),  Finland (one case), France (one case) and Sweden (two cases). Testing is underway to identify whether other individuals, also infected with salmonella species, have the outbreak strain (Pulse Field Gel Electrophoresis (PFGE) profile designated as SAGOXB.0066). Of the 141 cases, 127 are confirmed as the outbreak strain with the remaining 14 awaiting definitive analysis.

The international outbreak control team, led by the Republic of Ireland, includes the Health Protection Agency and other public health agencies in the UK and Europe. The investigation is looking at the consumption of sandwiches and other food stuffs containing meat products produced by Dawn Farm Foods in the Republic of Ireland. Dawn Farm Foods has an extensive product distribution list that covers distribution to the UK, Republic of Ireland and many European countries. Production has stopped at the implicated part of the factory and product re-calls of selected batches of cooked meats have also taken place. Identified products will have been supplied to intermediary distributors and subsequently used by the catering sector. Some of these were known to have been distributed to the UK. A full list of products withdrawn by Dawn Farm Foods has been published on the website of the Food Safety Authority of Ireland (www.fsai.ie).

References

1. HPA. Salmonella Agona PT39: increase in new salmonella strain in UK and Ireland. Health Protection Report [serial online] 2008; 2(31): news. Available at: http://www.hpa.org.uk/hpr/archives/2008/hpr3108.pdf.

2. O'Flanagan D, Cormican M, McKeown P, Nicolay N, et al. A multi-country outbreak of Salmonella Agona, February-August 2008. Euro Surveill. 2008; 13(33):pii=18956. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18956.

3. HPA. Salmonella Agona PT39: increase in new salmonella strain in UK and Ireland – an update. Health Protection Report [serial online] 2008; 15 August 2008, 2(33): news. Available at: http://www.hpa.org.uk/hpr/archives/2008/hpr3308.pdf.

Consultation on application of ICRP Recommendations in the UK

The Board of the Health Protection Agency is consulting stakeholders on its response to the latest recommendations on ionising radiation protection from the International Commission on Radiological Protection (ICRP).

In 2007, ICRP published new recommendations taking account of the conclusions of an extensive review of developing knowledge on biological and physical effects of ionising radiation and of trends in the setting of radiation safety standards. The 2007 Recommendations also aim to improve and streamline the presentation of ICRP Recommendations, last published in 1991.

The HPA consultation document [1], containing the Agency's proposed response to the recommendations, is directed principally towards radiological protection professionals and to those, in Government and in non-government bodies, with specific responsibility in this area.

Key elements of the HPA response are recommendations that:
•  the linear, no-threshold model should remain the basis for setting radiological protection standards and criteria;
•  no changes should be made to current dose limits in the UK;
•  a maximum "dose constraint" (exposure limit) for the public should remain at 0.15 millisieverts per year for new nuclear power stations while comments are invited as to whether this constraint should be extended to the design of all new ionising radiation sources.

Following consideration of the comments received during three-month consultation period, the Agency will issue formal advice and recommendations for the UK.

Reference

1. HPA Advice on the Application of ICRP's 2007 Recommendations to the UK. Available at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1205741916373.