News Archives |
Volume 3 No 20; 22 May 2009
- Latest results of HPA study on vCJD-related abnormal prion proteins in extracted tonsils
- Publication schedule for MRSA and Clostridium difficile quarterly reporting
- Epidemiology and risks of tick-borne Lyme borreliosis
- Influenza A/H1N1 (‘swine-lineage’): UK situation at 22 May 2009
Latest results of HPA study on vCJD-related abnormal prion proteins in extracted tonsils
In 2004, the Health Protection Agency launched the National Anonymous Tissue Archive (NATA) to determine prevalence of asymptomatic vCJD in the population by looking for the prion protein associated with vCJD in extracted tonsils. The tonsils are one of the sites in the body where, once infected, vCJD prions can accumulate (other sites include the spleen, appendix, lymph nodes, spinal cord and brain).
Awareness of the prevalence of vCJD in the population is important to determine the level of public health risk and to limit the impact of infection or plan healthcare interventions for people who may develop the disease.
Newly published results from the study [1, 2] suggest there may be fewer undetected asymptomatic cases of vCJD in the population than were previously expected.
The survey will eventually collect and analyse 100,000 samples of discarded tonsil tissue but no evidence of the abnormal prion protein has been found in any of the 63,000 tonsil samples analysed to date.
When the archive was established it was estimated that up to 50 of the 100,000 samples could contain the abnormal prion protein.
References
1. Prevalence of disease related prion protein in anonymous tonsil specimens in Britain: a cross-sectional opportunistic survey, J Clewley et al, BMJ 2009; 338: b1442.
2. "Latest research into prevalence of vCJD consistent with findings of existing studies" (HPA press release, 22 May 2009). HPA website: National Press Releases.
Publication schedule for MRSA and Clostridium difficile quarterly reporting
In conjunction with the Department of Health, the Health Protection Agency has agreed dates for the next four quarterly MRSA bacteraemia and Clostridium difficile (C. difficile) publications (see table 1). It has also been agreed that both data sets will be published simultaneously (rather than 'decoupled' as they have been for the past three quarters [1]).
In addition, from quarter two 2009 (period covered: April-June 2009) onwards, a quicker turnaround time for the production of quarterly reports is to be implemented (ie data will be extracted the next working day after each Trust signs off its data). As a result, there will be no opportunity for data changes after sign-off. It is therefore imperative that all data are complete and accurate on the HCAI Data Capture system prior to the sign-off dates outlined below.
Table 1. Schedule for production and publication of MRSA and C. difficile quarterly reports
Quarterly tables affected |
Period covered |
Sign-off |
Data extracted |
Data published |
| All (MRSA bacteraemia / C. difficile / Primary Care Organisation) |
Jan-March 09 |
15 April |
1 May |
18 June |
April-June 09 |
15 July |
16 July |
10 Sept |
|
July-Sept 09 |
15 Oct |
16 Oct |
3 Dec |
|
Oct-Dec 09 |
15 Jan |
18 Jan* |
March 2010** |
References
1 Accelerated publication schedule for MRSA bacteraemia data, Health Protection Report [serial online] 2009; 2(33): news, 15 August 2008.
Epidemiology and risks of tick-borne Lyme borreliosis
The HPA has released provisional epidemiological data on Lyme disease in England and Wales in 2008 [1] and issued a seasonal warning about the potential risk of tick bites that may be associated with some outdoor activities [2].
There were 813 reported cases of Lyme disease (Lyme borreliosis) in 2008, a slight increase compared with 794 cases in 2007, according to the provisional epidemiological data. As in previous years, the majority of cases were acquired in the UK. Over half the reports were from the southern counties of England, especially the South East and South West health regions, a pattern reflected in reports in previous years. The age groups with the highest number of cases were the 25-44 and 45-64 year age groups, probably reflecting the ages of visitors to areas where the infected ticks are endemic.
Case numbers have increased annually since 2003, due in part to an increase in awareness and improvements in reporting and case ascertainment. In recent years, migrants from central and eastern European countries (regions with high prevalence of Lyme borreliosis) have also contributed to higher incidence of infection identified (but not necessarily acquired) in the UK. Infections contracted abroad increased significantly in 2007: nearly one fifth of all infections being acquired overseas, particularly from central and eastern Europe and southern Scandinavia.
Many of the infections, which are more likely to occur during late spring, early summer and autumn, are contracted while people are participating in outdoor activities such as walking, mountain biking, trekking or camping. Areas which tend to be more affected include Exmoor, the New Forest, the Lake District, Yorkshire Moors, and other National Parks, although smaller wooded and heathland areas in many other parts of the country can also harbour infected ticks. Any habitat, large or small, in which ticks are present should be regarded as having a potential risk, although not every tick infested area has a high risk of Lyme borreliosis, and most ticks do not carry the bacteria.
Further information
Information about Lyme borreliosis and tick bite prevention is available at: www.hpa.org.uk/infections/topics_az/zoonoses/lyme_borreliosis/default.htm.
References
1. "Lyme borreliosis in England and Wales: 2007 and 2008" (epidemiological data), 20 May 2009. HPA website: Lyme borreliosis/Lyme disease.
2. "Panning a trip outdoors as the weather warms up?" (HPA press release, 20 May 2009). HPA website: National Press Releases.
Influenza A/H1N1 (‘swine-lineage’): UK situation at 22 May 2009
On Friday 22 May, the number of confirmed and possible cases of swine-lineage influenza A/H1N1 in the United Kingdom was 117, broken down by region as follows [1]:
Region |
Total confirmed cases, 22 May |
East of England |
11 |
East Midlands |
2 |
London |
65 |
North East |
1 |
North West |
6 |
South East |
11 |
South West |
3 |
West Midlands |
7 |
Yorkshire & Humberside |
- |
Total England |
106 |
Northern Ireland |
1 |
Scotland |
10 |
Wales |
- |
TOTAL UK |
117 |
One hundred and sixty nine 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.)
Travel advice
The HPA issued a reminder to travellers about the importance of taking simple health precautions against swine influenza when travelling abroad during the half term school break. It noted the situation in the 41 countries, recommended that travellers should check the Foreign and Commonwealth Office for information specific to the country they were visiting, advised travellers to follow general infection control practices and gave information on what travellers should do if they become ill while travelling or on their return journey [2].
Mexican situation update
In light of new information showing a reduced prevalence of swine flu and hospital admissions in Mexico, reflected in the recently revised travel advice from the Foreign and Commonwealth Office - which no longer advises against all but essential travel to Mexico - the Agency has reviewed its policy of Health Protection Agency staff meeting all flights from Mexico.
HPA staff will no longer continue to routinely meet flights from Mexico. Leaflets and posters produced by the Health Protection Agency, the Department of Health and the UK Borders Agency giving general advice on swine flu will continue to be made available for returning travellers at all ports of entry. Contact tracing of individuals deemed to be at risk of swine flu following a flight will be carried out on the basis of risk, as is the case for all other communicable diseases.
A report on the development of the swine influeanza outbreak in Mexico has been posted on the Agency website [3].
HPA guidance
Some of the key guidance documents available on the HPA website were updated or supplemented during the past week, including the following:
- the swine flu case definition (version 2.0, updated 9 May) unchanged [4], has been supplemented by proposals for a Classification of Swine Flu Cases that would provide a common terminology for use in describing individual cases [5];
- "Algorithm S5" for health professionals on the management of returning travellers was updated [6];
- practical advice for health professionals investigating individuals with possible swine influenza infection was updated [7];
- "Algorithm P5" for health professionals on the management of suspected cases was updated [8];
- advice on exclusion from schools and workplaces [9] was supplemented by further guidance for boarding schools [10]; and
- information for the media on face masks and related information for health professionals was supplemented by special advice relating to aerosol generating procedures in healthcare environments [11].
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, 22 May 2009). HPA wesbite: National Press Releases.
2. 'Swine flu: travel advice for the half term break' (HPA press release, 21 May 2009). HPA website: National Press Releases.
3. 'Mexican situation update', (HPA press release, 21 May 2009). HPA website: National Press Releases.
4. Swine flu case definition (version 2.0, updated 9 May), available from the Swine Influenza Information for Health Professionals pages on the Agency website.
5. Classification of Swine Influenza Cases (19 May), available from the Swine Influenza Information for Health Professionals pages on the Agency website.
6. 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 16 May), available from the Swine Influenza Information for Health Professionals pages on the Agency website.
7. Standard practical advice for investigating individuals with possible swine influenza infection (version 3, updated 16 May), available from the Swine Influenza Information for Health Professionals pages on the Agency website.
8. Actions and post exposure prophylaxis for close contacts of probable or confirmed human case(s) of swine influenza A/H1N1 (version P5, updated 16 May 2009), available from the Swine Influenza Information for Health Professionals pages on the Agency website.
9. Advice on exclusion from schools and workplaces (updated 7 May 2009), available via the Swine Influenza public advice pages.
10. Managing a flu-like illness in a boarding school during the current swine flu outbreak (version 2, 21 May 2009). available from the Swine Influenza Information for Health Professionals pages on the Agency website
11. The use of personal protective equipments (PPE) by healthcare workers in close contact with possible, probable and confirmed cases of swine flu during the pre- and pandemic phases (15 May 2009), available via the Swine Influenza Information for Health Professionals pages.