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Volume 3 No 6; 13 February 2009

Web-based real-time surveillance for norovirus hospital outbreaks

The first of a new series of monthly reports on hospital norovirus outbreaks is published in the Infection Reports section of this issue of HPR [1], the output from a web-based, real-time surveillance system recently launched by the Health Protection Agency.

Outbreaks of norovirus in hospitals cause substantial operational difficulties necessitating ward closures at a time of year when there is already an increased demand for hospital services. They also attract considerable media attention each year. The economic impact of these operational difficulties is estimated to be more than £100 million each year to NHS inpatient services [2].

Until this year, there had been no dedicated system for surveillance of hospital-associated norovirus outbreaks despite a clear need for timely and representative information. In consultation with the Infection Prevention Society, and after pilot and local initiatives in the East of England and elsewhere, the HPA launched a voluntary scheme for web-based surveillance of norovirus outbreaks in acute NHS hospitals in December 2008.

The main aims of this system are to provide:

  • a source of timely information to assess the current level of impact of outbreaks in hospitals
  • a useful tool for epidemic intelligence to local infection control and public health teams.

Despite its voluntary nature, the scheme provides features aimed at encouraging participants to report It employs field-tested definitions for cases and outbreaks, and both suspected and laboratory-confirmed outbreak reports are accommodated. These data will be available for users in real time, through an online database; this will enable epidemiological analyses to be conducted for public health purposes providing local, regional and national overviews of the impact of norovirus infection in hospitals. Acute trusts and Health Protection Units (HPUs) can use the system to be alerted to outbreaks occurring in their region. Roll-out to non-acute trusts will be added at a later stage.

The system is designed to be useful for Infection Control Teams (ICTs) at NHS Trusts, who will be the primary reporters to the scheme. Regional laboratories, who all now perform molecular (PCR) diagnostics for norovirus, will be able to report investigated outbreaks through regular (weekly or fortnightly) updates of microbiological results to the HPA Centre for Infections. The HPA will check if these laboratory-reported outbreaks are entered on the system by Infection Control Teams. If they have not yet been entered, the HPA (via the local HPUs) will then contact Trust Infection Control Teams and ask them to report these outbreaks (ie there is internal validation of completion of reporting to this system).

Trusts users will be able to: (i) enter data about their trust; (ii) see in detail the data they have entered; (iii) view summary information on other norovirus outbreaks reported from their region; and (iv) download a spreadsheet with all their data. HPUs, Regional Directors, Regional Epidemiologists and Regional Microbiologists will be able to carry out (ii)-(iv) and be able to access all data on outbreaks reported from their region. In addition to the data being available in real-time for infection control staff and HPUs, the following reports will be made during the height of norovirus season (usually October to March):

  • weekly reports to the National Infection Update teleconference (the notes of this meeting are widely circulated including to Department of Health staff),
  • monthly reports in the Health Protection Report (published online).

Access to the system is via the web address:
http://www.hpa-bioinformatics.org.uk/noroOBK/home.php.

References

1. HPA. Suspected and laboratory-confirmed reported norovirus outbreaks, with regional breakdown: weeks 51/08 to 01/09. Health Protection Report [serial online] 2009, 3(6); enteric infections, http://www.hpa.org.uk/hpr/archives/2009/hpr0609.pdf.

2. Lopman BA; Reacher MH; Vipond IB; Hill D ; Perry C; Halladay T; et al. Epidemiology and cost of nosocomial gastroenteritis, Avon, England, 2002-2003. Emerging Infectious Diseases 2004: 10(10); 1827-34.

Acceleration of HPV vaccination catch-up campaign

The Department of Health has circulated guidance to PCTs, SHAs and HPUs encouraging them to accelerate delivery of the catch-up p rogramme of vaccination against human papillomavirus (HPV) infection that was officially launched in all parts of the United Kingdom last September [1].

The routine immunisation programme in England (offering vaccination to girls aged 12-13 years - school year 8) began in September 2008, together with catch-up targeting girls aged 17-18 - school year 13 - with plans to stagger the catch-up to girls between these years (ie born between Sept 1991 and August 1995) over the next two years (school years 2009/10 and 2010/11).

As a result of the suggested revised timetable detailed in the guidance issued by the Director of Immunisation on 30 January 2009 [2], all girls and young women born between 1 September 1991 and 31 August 1995 should be offered the vaccine next year (school year 2009/10). This will bring forward, by one year, the age of protection from HPV infection by immunisation of girls born between Sept 1993 and August 1995.

References

1. HPA. Roll-out of cervical cancer vaccination programmes in the United Kingdom,
Health Protection Report [serial online] 2009, 2(36): news, http://www.hpa.org.uk/hpr/archives/2008/news3608.htm#hpv

2. Department of Health. Acceleration of the HPV vaccination catch-up campaign. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/
Dearcolleagueletters/DH_094025.