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Volume 3 No 22; 5 June 2009

HPR Home | Archives | 2009 news

Confirmed measles cases in England and Wales: update to end-April 2009

April saw the fourth consecutive monthly increase in measles cases in England and Wales with 226 laboratory-confirmed cases reported with onset dates in that month (see table). This was the largest monthly total since the current method of monitoring the disease was introduced in 1995. The total number of confirmed measles cases to the end of April 2009 is 602 compared to 354 cases in the same period in 2008.

During April, cases were reported from all regions (except Yorkshire and the Humber) with new outbreaks confirmed in the North East region and Wales, whilst the South East and North West regions continued to identify new cases associated which previously identified outbreaks (see table). As in previous months, molecular sequencing confirmed that almost all cases had a D4 genotype identical to one of several strains circulating in the UK. Most cases are linked to clusters in schools and nurseries with some linked to traveller communities.

Confirmed cases of measles by region and month of onset, England and Wales:
January 2009 to April 2009

Month	Lond-on	East Mids	East of Engl'd	North East	North West	South East	South West	West Mid's	Wales	York & Humb	Total
Jan 09	37	8	5	1	8	20	3	13	-	8	103
Feb 09	40	-	3	-	3	52	1	24	-	5	128
Mar 09	20	3	7	2	27	48	3	12	21	2	145
Apr 09	22	4	9	46	26	55	12	16	36	-	226
Total 2009	119	15	24	49	64	175	19	65	57	15	602

Figure 1: Number of laboratory confirmed cases in England and Wales by month of onset: January 2007 to April 2009

With increasing numbers of cases it remains critical to undertake the appropriate risk assessment of all potential cases and contact tracing of any vulnerable contacts if necessary. Updated guidance on post exposure prophylaxis is available in the HPA website [1].

The majority of confirmed cases this year have been in children and young adults aged 1 to 18 years (80.4%). This is same group targeted by the MMR catch-up campaign announced by the Chief Medical Officer in August 2008. A regional breakdown of cases by age is available [2].

Two cases identified in April were healthcare professionals working with children. Last year a case of measles confirmed in a doctor who worked on an oncology ward in London prompted a letter from the Director of Immunisation at the Department of Health to be sent to the chief executives of all Strategic Health Authorities and acute and foundation trusts. The letter reinforced the advice in Immunisation against Infectious Disease , 2006 (the "Green Book") [3] that trusts should ensure that all staff working with vulnerable patients have documented immunity to measles. Satisfactory evidence of immunity would be either having received two doses of measles containing vaccines, or a positive antibody test.

References

1. Post-exposure prophylaxis for measles: revised guidance, May 2009. HPA website: Measles/Guidelines.
2. Number of laboratory confirmed measles cases in England and Wales, 30 April 2009. HPA website: Measles/Epidemiological data.
3. Department of Health. Immunisation against infectious disease, 2006. Available at http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_4097254.

HPA consultation document on limitation of human exposure to radon

The Health Protection Agency is considering revising recommended action levels for radon gas in existing dwellings and other buildings and has published a consultative document describing alternative ways that this might be achieved [1,2]. This follows advice the Agency issued last year on the desirability of installing basic radon preventative measures in all new buildings in the United Kingdom [3].

Publication of the consultative document follows an in-depth review of the latest scientific evidence by the Agency’s independent expert Advisory Group on Ionising Radiation (AGIR) that has recommended there should be greater emphasis on reducing the average indoor radon concentration throughout the UK rather than the current focus on “high radon areas” [4].

At present, government policy in England consists of offering free radon measurements in areas of the country where 5% or more of homes are above an Action Level (currently 200 becquerels per cubic metre of room air, averaged over a year, approximately 10 times the average UK domestic radon level) and encouraging householders to take remedial measures where the Action Level is exceeded. Those parts of the country where there is a 1% or more probability that the Action Level may be exceeded are designated Affected Areas.

On the advice of the Advisory Committee, the Agency recommends in the consultative document that the value of the Action Level and the concept of Affected Areas should be reconsidered and invites comment on different approaches to achieving this end.

The consultation exercise ends on 3 September 2009.

References

1. “Health effects of radon exposure”. HPA press release, 2 June 2009.
2. HPA-RPD. HPA Advice on the Limitation of Human Exposure to Radon(consultation document). Downloadable from HPA website: Radiation/Publications/Consultation exercises.
3. “Health Protection Agency Board gives advice on radon measures for new homes”. HPA press release, 21 May 2008.
4. HPA-RPD (2009). Radon and Public Health. Report of the Independent Advisory Group on Ionising Radiation (RCE 11), June 2009. Downloadable from the HPA website at: Documents of the HPA: Radiation, Chemical and Environmental Hazards.

Influenza A/H1N1 (‘swine-lineage’): UK situation at 5 June 2009

On Friday 5 June, the number of confirmed cases of swine-lineage influenza A/H1N1 in the United Kingdom was 486: 363 in England, two in Northern Ireland, 119 in Scotland and two in Wales (table 1) [1].

Table 1: Confirmed cases by Region and Devolved Administration, United Kingdom at 5 June 2009

Region*	Confirmed cases
East of England	36
East Midlands	8
London	108
North East	2
North West	14
South East	61
South West	13
West Midlands	113
Yorkshire & Humberside	4
Unknown**	4
Total England	363
Northern Ireland	2
Scotland	119
Wales	2
TOTAL UK	486

Assumed mode of transmission

A second out-of-season Weekly National Influenza Report [2] was published, indicating that at 3 June (week 23), of the 381 cases confirmed at that time:

77 were assumed to have acquired the virus abroad,
39 were assumed to be secondary cases (following contact with a case who acquired it abroad),
132 were assumed to be tertiary cases (acquired through contact with a secondary or sporadic case),
14 were sporadic cases (no known travel history or contact with a known case), and
the determination of the route of transmission was pending in 119 cases.

A second analysis by UK epidemiologists of the situation in the UK, as at 31 May, was published by the European Centre for Disease Control (ECDC) [3].

References

1."Update on confirmed swine flu cases", (HPA press release of 5 June 2009). HPA website: National Press Releases.
2. "HPA Weekly National Influenza Report", 3 June 2009 (week 23). HPA website: Swine Influenza Epidemiological Data.
3. ECDC, "Epidemiology of new influenza A(H1N1) virus infection in the United Kingdom, April - June 2009", Euro Surveill. 14(22), 4 June 2009. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19232.

Public health responses to Legionnaires disease

New guidance on public health responses to community clusters and outbreaks of Legionnaires’ disease has been published by Scotland’s Health Protection Network. Although primarily concerned with the investigation of clusters/outbreaks where the source of infection is assumed to be in Scotland, the guidance is comprehensive and of wider interest, covering issues such as when outbreak control teams should be convened (or incident control teams, in the case of single nosocomial cases, for example) and their composition. It also reviews other related public health risk assessment and control measures, including water system sampling and post-incident remedial measures and precautions to be taken when restarting systems considered to be putative sources of legionella infection.

The guidance was prepared by a working group comprising consultants in public health medicine, environmental health officers, epidemiologists, microbiologists, the Health and Safety Executive, specialist engineers and Scottish Government health directorates; it also involved the Health Protection Agency in England and the European Working Group for Legionella Infections (EWGLINET). Training materials in support of the guidance are being planned.

Reference

1. "Guideline on management of legionella incidents, outbreaks and clusters in the community. Health Protection Network Scottish Guidance 2", March 2009. Downloadable from the Health Protection Scotland website at: http://www.documents.hps.scot.nhs.uk/about-hps/hpn/legionella-guidelines.pdf.