• Meningococcal serogroup B infections in England
  
  
• EFSA-ECDC zoonoses report for 2007
  
  
• Advice to pregnant women during the lambing season
  
  
• HPA expands planning and training for CBRNE incidents
  
  

 

Meningococcal serogroup B infections in England

A marked increase in reports of Neisseria meningitidis serogroup B infections has been observed during December 2008 and early January 2009. The provisional total number of meningococcal serogroup B infections during 2008 was 1070, similar to the annual totals for 2007 (1076) and 2006 (1011). The number of cases reported during December and early January (week 2008-49 to week 2009-02), however, is substantially higher (252) than the same period during any of the previous three years (198, 142, and 191) (see figure). Cases are distributed across England (see table).

Laboratory confirmed cases of meningococcal disease: England and Wales, five-weekly moving averages, 1997 to 2009

 

Confirmed meningococcal infections by region weeks 2008-49 to 2009-02

	Serogroup B	Other serogroups	Total confirmed cases
East Midlands	17	–	17
Eastern	26	2	28
London	23	3	26
North East	14	2	16
North West	52	4	56
South & West	27	4	31
South East	26	1	27
West Midlands	32	8	40
Yorkshire & Humberside	35	6	41
Total	252	30	282

 

Overall the number of confirmed meningococcal cases remains low with only 1194 confirmed cases in 2008, lower than 2007 (1256) and continuing the overall downward trend since 1999/2000. A major contribution to the overall reduction has been the sustained fall in serogroup C cases following the introduction of meningococcal serogroup C conjugate vaccine in 1999. Only 22 cases of serogroup C infection were confirmed last year, compared to 989 cases in 1999. Serogroup B infections have historically shown cyclical fluctuations, often related to circulation of specific strains [1]. The increase observed during December 2008 and early January 2009 appears to be associated with a range of serogroup B organisms.

Another explanation for the higher rate of meningococcal infections reported this winter may be the higher influenza activity observed in December. During a UK outbreak in the winter of 1989-1990, a higher proportion of cases of confirmed meningococcal infection were found to have serological evidence of influenza when compared to age-matched controls (OR 3.9, 9% CI 12.0-13.9) [2]. The authors describe a peak in meningococcal infection around two weeks after the increase in influenza; this timing was said to be compatible with temporary impairment in immunity due to the recent influenza infection. Influenza activity in England and Wales peaked in week 51 of 2008 but is now decreasing [3]. Allowing for a slight delay whilst specimens are referred to the HPA Meningococcal Reference Unit, some of the current meningococcal activity may reflect this peak in influenza incidence. However, in the case-control study the attributable risk of meningococcal disease was estimated to be around one case for every 100,000 influenza infections [2] suggesting that other factors may also be involved in the increase in meningococcal activity this season.

References

1. Gray SJ, Tortter CL, Ramsay ME, Guiver M, Fox AJ, Borrow R, et al. Epidemiology of meningococcal disease in England and Wales 1993/4 to 2003/4: contribution and experiences of the Meningococcal Reference Unit. J Med Micro 2006; 55: 887-896.

2. Cartwright KAV, Jones DM, Smith AJ, Stuart JM, Kaczmarski EB, Palmer SB. Influenza A and meningococcal disease. Lancet 1991; 338: 554-557.

3. HPA Weekly National Influenza Report, 21 January 2009 (week 2009-04), http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1232527287207.

EFSA-ECDC zoonoses report for 2007

Campylobacteriosis was the most frequently reported zoonotic disease in humans in the European Union in 2007 – with 200,507 reported confirmed cases and most member states reporting an increased number of cases, according to the latest joint annual report from the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) [1,2].

Salmonellosis was still the second most commonly recorded zoonosis, accounting for 151,995 confirmed human cases in the Community. However, the incidence of salmonellosis continues to follow the statistically significant downward trend of the past four years.

In foodstuffs, the highest proportion of Campylobacter positive samples was once again reported for fresh poultry meat, where on average 26% of samples were found positive. Campylobacter was also commonly detected from live poultry, pigs and cattle. The reported proportions of Campylobacter positive samples remained at high levels and no overall decrease was apparent.

Salmonella was most often found in fresh poultry and pig meat where proportions of positive samples, on average 5.5% and 1.1%, were detected respectively. Some member states reported 0.8% of table eggs positive with Salmonella, while dairy products, vegetables and fruit were rarely found to contain the bacterium. In animal populations, Salmonella was most frequently detected in poultry flocks. 2007 was the first year when member states implemented the new Salmonella control programmes in poultry (Gallus gallus) breeding flocks on a mandatory basis and already 15 member states reported prevalence below the Salmonella reduction target of 1% laid down by Community legislation.

The number of listeriosis cases in humans remained at the same level as in 2006 with 1,554 confirmed cases recorded in 2007. A high fatality rate of 20% was reported among the cases, especially affecting the elderly. Listeria bacteria were seldom detected above the legal safety limit from ready-to-eat foods but findings over this limit were most often found in smoked fish and other ready-to-eat fishery products followed by ready-to-eat meat products and cheeses.

At European Union level, the occurrence of bovine brucellosis remained largely unchanged compared to 2006, while that of bovine tuberculosis and sheep/goat brucellosis seemed to slightly decrease. In humans, 542 confirmed brucellosis cases were reported but with the notification rate decreasing.

References

1. The Community summary report on trends and sources of zoonoses and zoonotic agents in the European Union in 2007, The EFSA Journal (2009), 223. Available at the EFSA website: http://www.efsa.europa.eu/EFSA/efsa_locale-1178620753812_1211902269834.htm.

2. EFSA Press release, 20 January 2009: http://www.efsa.europa.eu/EFSA/efsa_locale-1178620753812_1211902267941.htm.

Advice to pregnant women during the lambing season

At this time of the year, the HPA joins Defra and the National Public Health Service of Wales in reminding pregnant women to avoid close contact with sheep during the lambing season [1].

Pregnant women who come into close contact with sheep during lambing may risk their own health, and that of their unborn child, from infections that can occur in some ewes. Such infections include chlamydiosis (caused by Chlamydophila abortus), toxoplasmosis and listeriosis, each of which is a common cause of abortion in ewes. Q fever may also be transmitted from birthing animals.

Although the number of reports of these infections and human miscarriages resulting from contact with sheep is extremely small, pregnant women should be aware of the risks and ready to take appropriate precautions.

To avoid the possible risk of infection, pregnant women are advised that they should:

• not help to lamb or milk ewes;
• avoid contact with aborted or new-born lambs, or with the afterbirth, birthing fluids or materials (eg bedding) contaminated by such birth products; and
• avoid handling clothing, boots, etc, which have come into contact with ewes or lambs.

Pregnant women should seek medical advice if they experience fever or influenza-like symptoms, or if concerned that they could have acquired infection from a farm environment.

More information and advice is available in the Lambing section of the HPA website http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1191942128199?p=1191942128199

Reference

1. HPA. Defra press release, 7 January 2009 http://www.defra.gov.uk/news/2009/090107b.htm.

HPA expands planning and training for CBRNE incidents

New alliances and working relationships need to be forged between the military and civilian healthcare agencies in order to combat the threat of chemical, biological, radiological, nuclear or explosive (CBRNE) attack on the UK mainland. "The baton is being passed from the military to civilian medical practitioners", Lieutenant-General Louis Lillywhite, Surgeon General of British Armed Forces, told delegates at a recent London conference [1].

Whereas in the Cold War era battle-force protection and operational effectiveness were key objectives, large civilian populations are now the primary target of likely CBRNE attack and protection becomes very much more difficult, the conference was told. Planning must deal with managing and containing large scale attacks in urban areas – a shared task, with all medical practitioners and health agencies bearing equal responsibility, Lieutenant-General Lillywhite said. Interoperability between the different agencies needs significant improvement, and all participants would benefit from a policy of public peer review, shared exercises and assessments.

The threat of a terrorist attack is growing, not diminishing, HPA chief advisor Professor Nigel Lightfoot told the meeting. Al Qaeda has declared an intent to develop terrorist weapons including anthrax and all UK health agencies needed to be fully prepared for CBRNE attacks, he said. None of these major threats can be addressed without comprehensive planning and exercises involving all the relevant agencies. A strategic alliance is required between all NHS agencies and the military, as well as the academic research community and the public sector.

Lightfoot identified a need to involve the Military in future CBRNE emergency response exercises. The involvement of the military was key to successful management of any large-scale catastrophe on the UK mainland, the 2001 Foot and Mouth outbreak having demonstrated the importance of this.

The HPA now has a comprehensive CBRNE training programme aimed at healthcare professionals, emergency planners and NHS managers. The remit of the Agency in this area has expanded from CBRNE to cover a wider scope of health emergencies including SARS, West Nile Fever, Avian Flu and other threats. The HPA is also actively developing new software applications to assist catastrophe planning and training, including new "virtual world" environments.

Reference

1. “Deadly threats....are you prepared? Real life scenarios with the Health Protection Agency and the Ministry of Defence”, Royal Society of Medicine, London, 13 January 2009.