News Archives |
Volume 3 No 19; 15 May 2009
- Influenza A/H1N1 (‘swine-lineage’): UK situation at 15 May 2009
- World Hepatitis Day – hepatitis C diagnosis increasing in England
Influenza A/H1N1 (‘swine-lineage’): UK situation at 15 May 2009
As at 1500 hours on Friday 15 May, the number of confirmed and possible cases of swine-lineage influenza A/H1N1 in the United Kingdom was 82, broken down by region as follows [1]:
Region |
Total confirmed cases, 15 May |
East of England |
9 |
East Midlands |
2 |
London |
47 |
North East |
1 |
North West |
6 |
South East |
5 |
South West |
3 |
West Midlands |
3 |
Yorkshire & Humberside |
- |
Total England |
76 |
Northern Ireland |
1 |
Scotland |
5 |
Wales |
- |
TOTAL UK |
82 |
Two hundred and seventy one cases were under laboratory investigation in the UK. (The figure for cases under investigation changes on a daily basis as some of those under assessment are discounted and new are added. This figure was correct at the time stated.)
Due to the time-lag between the reporting of symptoms, taking swabs, testing and the confirmation of results, some of the new cases reported daily may have recovered and may have become symptom-free. At the time stated, all symptomatic patients were recovering at home. Close contacts of these cases were receiving antivirals as a precautionary measure .
Advice remains that individuals returning from affected areas who become unwell within seven days of their return or contacts of a confirmed or probable case of swine flu who are exhibiting symptoms should stay at home and contact their GP or NHS Direct on 0845 4647. Individuals will be assessed and, if necessary, testing and treatment will be provided.
General infection control practices and good respiratory hand hygiene can help to reduce transmission of all viruses, including swine flu. This includes:
- covering your nose and mouth when coughing or sneezing, using a tissue when possible.
- disposing of dirty tissues promptly and carefully.
- maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people.
- cleaning hard surfaces (eg door handles) frequently using a normal cleaning product.
- making sure your children follow this advice.
- where antivirals are prescribed, it is important that the specified course of treatment is followed and completed, even though in some cases this medication may cause nausea.
An analysis by HPA and Health Protection Scotland epidemiologists of the swine influenza situation in the UK, as at 11 May, has been published by the European Centre for Disease Control (ECDC) [2].
HPA guidance
Key guidance documents currently available on the HPA website include:
- the case definition for use by health professionals [3];
- "Algorithm S5" for health professionals on the management of returning travellers [4];
- practical advice for health professionals investigating individuals with possible swine influenza infection [5];
- "Algorithm P5" for health professionals on the management of suspected cases [6];
- advice on exclusion from schools and workplaces [7]; and
- information for the media on face masks and related information for health professionals [8].
Further information
A daily update on the number of confirmed cases in the UK, and the number under laboratory investigation, is published on the Swine Influenza pages of the Agency website at (www.hpa.org.uk/swineflu), where there are links to specific areas dedicated to information for the general public, healthcare professionals, and the press and media.
References and links
1. 'Update on confirmed swine flu cases', HPA press release, 15 May 2009.
2. ECDC, "Epidemiology of new influenza A(H1N1) in the United Kingdom, April - May 2009", Eurosurveillance, Volume 14, Issue 19, 14 May 2009. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19213.
3. Swine flu case definition (version 2.0, updated 9 May), available from the Swine Influenza Information for Health Professionals pages on the Agency website.
4. Algorithm for the management of suspected cases of swine influenza (returning travellers and visitors from countries affected by swine influenza A/H1N1 or contacts) (version S5, updated 12 May), available from the Swine Influenza Information for Health Professionals pages on the Agency website.
5. Standard practical advice for investigating individuals with possible swine influenza infection (version 2, updated 5 May), available from the Swine Influenza Information for Health Professionals pages on the Agency website.
6. Actions and post exposure prophylaxis for close contacts of probable or confirmed human case(s) of swine influenza A/H1N1 (version P5, updated 13 May 2009), available from the Swine Influenza Information for Health Professionals pages on the Agency website.
7. Advice on exclusion from schools and workplaces (updated 7 May 2009), available via the Swine Influenza public advice pages.
8. Information for the media on face masks (updated 29 April 2009), available via the Swine Influenza public advice pages; further information on this topic being available on the Information for Health Professionals pages.
World Hepatitis Day – hepatitis C diagnosis increasing in England
Hepatitis C - a theme of World Hepatitis Day on 19 May, 2009 - has been a serious global public health problem for many years [1]. Current mathematical models suggest that around 191,000 individuals aged 15-59 years with antibodies to hepatitis C virus were living in England and Wales in 2003 [2]; this equates to around 142,000 individuals in this age group living with chronic hepatitis C infection.
In 2008, the number of laboratory confirmed diagnoses of hepatitis C infection in England reported to the HPA was 8,107; a rise of seven per cent on the previous year. Overall, this brings the cumulative total number of laboratory-confirmed diagnoses of hepatitis C infections that have been reported to the HPA, between 1992 and 2008, to 70,390 (figure 1). Laboratory confirmed diagnoses of hepatitis C infection are received from all regions in England, and since 1995 there has been a steady increase in the number of reports received (table 1). As in previous years, the highest figures were reported from the North West and the lowest figures from the North East (table 1). It should be borne in mind, however, that a level of under-reporting is associated with these data which varies from region to region.
Figure 1. Cumulative laboratory reports of hepatitis C infection from England: 1992 to 2008
Table 1. Laboratory reports of hepatitis C infection by English region: 1995 to 2008
Region |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
2007* |
2008 |
Total |
| East Midlands | 128 |
151 |
182 |
181 |
196 |
189 |
151 |
241 |
322 |
381 |
463 |
273 |
380 |
614 |
3852 |
| Eastern | 125 |
224 |
374 |
542 |
565 |
552 |
430 |
351 |
408 |
522 |
584 |
606 |
614 |
670 |
6567 |
| London | 203 |
263 |
257 |
334 |
299 |
263 |
316 |
331 |
388 |
744 |
807 |
1182 |
1010 |
939 |
7336 |
| N. East | 2 |
13 |
40 |
58 |
110 |
130 |
114 |
136 |
228 |
238 |
281 |
240 |
136 |
159 |
1885 |
| N. West | 206 |
135 |
110 |
626 |
1056 |
897 |
1061 |
1369 |
2004 |
1849 |
1488 |
1255 |
1626 |
1587 |
15269 |
| S. East | 314 |
584 |
662 |
928 |
800 |
603 |
571 |
531 |
494 |
405 |
320 |
385 |
812 |
1066 |
8475 |
| S. West | 312 |
411 |
478 |
443 |
714 |
851 |
722 |
831 |
697 |
929 |
684 |
853 |
1035 |
1093 |
10053 |
| West Midlands | 36 |
145 |
225 |
559 |
638 |
612 |
552 |
666 |
514 |
554 |
582 |
500 |
621 |
682 |
6886 |
Yorks. |
66 |
77 |
156 |
141 |
236 |
392 |
236 |
305 |
474 |
584 |
1025 |
1427 |
1351 |
1297 |
7767 |
| Total | 1392 |
2003 |
2484 |
3812 |
4614 |
4489 |
4153 |
4761 |
5529 |
6206 |
6234 |
6721 |
7585 |
8107 |
68090 |
The number of monthly reports has fluctuated throughout the year (figure 2) and although laboratory reports underestimate the true numbers of infections in England, they provide a reliable indication of trends in national testing. Trends in testing can also be analysed using data from sentinel laboratories participating in the Sentinel Surveillance of Hepatitis Testing Study [3]. Figure 3 shows the number of people tested for anti-HCV and the proportion testing positive by year in 18 sentinel laboratories with complete data from January 2005 to the end of December 2008. These data also support the view that testing has increased over the last two years, and that the proportion of people tested who were found to be anti-HCV positive has declined over the same period. This falling yield of positives as hepatitis C testing/screening is being extended is consistent with improved access to testing for groups at lower risk of infection.
Figure 2. Five month moving average of laboratory reports of hepatitis C infection from England: January 1996 to December 2008
Figure 3. HCV tested and percentage positive by year: 2005 - 2008:* data from 18 centres in the Sentinel Surveillance of Hepatitis Testing Study.
The sustained increase in reports of laboratory confirmed cases for HCV infection indicate that hepatitis C diagnosis and testing are continuing to increase, suggesting that more diagnosis is taking place and that more infected individuals are being identified.
The continued increase is likely to be a reflection of increased awareness and testing. Both the Department of Health and voluntary sector campaigns are likely to have contributed to this increase over recent years. However, there is no room for complacency when dealing with this infection as, despite current efforts to improve prevention, diagnosis, and treatment of infected individuals, routine national data sources in England (including transplants, deaths and hospital admissions) all show HCV-related end stage liver disease to be rising [2].
Continued efforts to further increase testing in prisons, specialist drug services, and primary care would all contribute to increasing diagnosis. Further work is also required across the statutory and voluntary sector to continue to increase awareness of hepatitis C amongst healthcare professionals and individuals at current risk of, or with past exposure to, hepatitis C. In most UK areas, clear pathways have been established to enable individuals diagnosed with chronic hepatitis C infection to access specialist care. However, these pathways need to be available in all health economies and to incorporate patients diagnosed in a wide range of settings. By strengthening local networks between people from different agencies who are caring for and supporting those with hepatitis C, the number of people starting and remaining on effective treatment can be maximised.
References
1 WHO. Hepatitis C - global prevalence (update). Weekly Epidemiological Record. 2000; 3 : 18-19.
2. Hepatitis C in the UK - HPA annual report 2008, http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1228894676145.
3. Health Protection Agency. Quarterly report from the sentinel surveillance study of hepatitis testing in England: data for October to December 2008 (quarter 4). Health Protection Report [serial online] 2006; 3 (16): immunisation. Available at: http://www.hpa.org.uk/hpr/archives/2009/hpr1609.pdf.