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Volume 3 No 25; 26 June 2009

Laboratory confirmed number of mumps cases in England and Wales – update to end of April 2009

Since the beginning of 2009 the number of confirmed mumps cases has risen sharply [1] and 2,886 cases have been confirmed in the period January to April in 2009. This exceeds the annual totals for the previous two years (1,476 and 2,440 cases respectively). However, the number of notified cases for the same period in 2009 is only a quarter of that reported during the first four months of the 2005 epidemic year (see figure 1) [2].

During 2009, cases have been confirmed in all regions in England and Wales, with the North West, South East and South West regions reporting the highest numbers (see table). The proportion of oral fluid sample tests that are positive for IgM or viral RNA is currently 50% nationally [3]. An additional 187 reports (6.7%) with raised IgG have been included in the confirmed cases. These cases probably represent reinfections in individuals with some pre-existing immunity (either natural or vaccine acquired).

Since 2004 to date, the majority of the confirmed cases were linked with outbreaks in universities and the proportion of cases of university age remains high (table and figure 2). Although it is recommended that new entrants to universities and colleges should have had two doses of MMR before commencing their studies [4], many of the confirmed cases were found to have been unvaccinated or to have received only one dose. This is because individuals born between 1985 and 1989 were not eligible for the two-dose MMR schedule.

Evidence of waning immunity after vaccination has been shown in university outbreaks in the USA [5]. In the UK, analysis of protection from vaccination in 2004-5 has suggested there was evidence of declining protection, particularly in those who had only received one dose of vaccine. However, individual protection from vaccination remained high in those who had two doses even though follow up was only for around five years [6]. Therefore, it is recommended that university students who have not received two doses of MMR should complete the course.

Confirmed cases of mumps by age group and region, England and Wales: January - April

 

Age group

Region

<1

1-4

5-9

10-14

15-19

20-24

25+

NK

Total

North East

-

3

1

2

38

54

42

-

140

North West

-

3

3

23

168

181

84

4

466

Yorks. & Humber

-

-

2

12

70

82

32

1

199

East Midlands

-

-

2

8

70

69

34

3

186

West Midlands

-

3

3

2

58

81

32

1

180

East of England

-

-

4

15

80

89

37

2

227

London

-

4

10

21

74

149

86

3

347

South East

-

5

5

11

161

242

106

-

530

South West

-

4

7

19

148

226

98

3

505

Wales

-

1

-

9

32

36

26

1

105

Not known

-

-

-

-

1

-

-

-

1

Total*

0

23

37

122

900

1209

577

18

2886

*Includes samples (oral fluid, serum and other) with detectible IgM, viral RNA or raised IgG levels.

 

Figure 1. Mumps notifications (five weekly moving averages), England and Wales , July - June

Figure 2. Confirmed cases of mumps by year of birth, England and Wales, January - April

References

1. HPA. Mumps increase in university students. Health Protection Report [serial online] 2009; 3(10): news, http://www.hpa.org.uk/hpr/archives/2009/hpr1009.pdf.
2. Savage E, Ramsay M, White J, Beard S, Lawson H, Hunjan R, et al. Mumps outbreaks across England and Wales in 2004: observational study. BMJ 2005; 330(7500):1119-20.
3. Mumps notifications (confirmed cases), England and Wales, 1995 – 2009 by quarter. HPA website: Mumps/Epidemiological data.
4. DH. Immunisation against infectious disease ("the Green Book"). Available at:
http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_4097254.
5. Date AA, Kyaw MH, Rue AM, Klahn J, Obrecht L, Krohn T, et al. Long-term persistence of mumps antibody after receipt of 2 measles-mumps-rubella (MMR) vaccinations and antibody response after a third MMR vaccination among a university population. J Infect Dis. 2008 Jun 15; 197(12): 1662-8.
6. Cohen C, White JM, Savage EJ, Glynn JR, Choi Y, Andrews N, et al. Vaccine effectiveness estimates, 2004–2005 mumps outbreak, England. Emerg Infect Dis [serial online] 2007; Jan. [accessed 11 June 2009]. Available from http://www.cdc.gov/ncidod/EID/13/1/12.htm.

Continuing antimicrobial resistance in gonorrhoea – GRASP 2008 report

Increasingly widespread resistance to anti-microbial agents in gonococcal isolates circulating in the United Kingdom is recorded in the latest report of the Gonococcal Resistance to Antimicrobials Surveillance Programme [1].

Gonorrhoea is the second most common bacterial, sexually-transmitted infection (STI) in the UK and tends to be particularly prevalent among specific population sub-groups including young adults, black ethnic groups and men who have sex with men (MSM). The annual GRASP report records trends in prevalence of the disease in the UK and trends in resistance of gonococcal isolates to specific antimicrobials.

The 2007 report [2] had identified emerging and continuing resistance to a number of antimicrobial agents including ciprofloxacin, penicillin, tetracycline and azithromycin, and the increasing problem of antimicrobial resistance is again a main theme of the 2008 report.

The greatest burden of antimicrobial-resistant gonorrhoea continues to be among men who have sex with men (MSM), highlighting the need to raise awareness and target interventions in this group.

The 2008 report also notes that an apparent outbreak of high-level resistance to penicillin and tetracycline, associated with sexual contact abroad, that had emerged in 2007, was ongoing in 2008.

The apparent drift towards higher minimum inhibitory concentrations (MICs) in third generation cephalosporins, the current recommended therapies for treatment of gonorrhoea, was reported as a key concern in 2008 - particularly as a number of isolates are now classified as being of reduced susceptibility to cefixime and, less frequently, to ceftriaxone. Acknowledging that difficulties are associated with comparing resistance rates between countries, the report notes that gonococcal isolates displaying reduced susceptibility to third generation cephalosporins are particularly prevalent in Asia and have also been documented in Australia, the USA and some European countries. Treatment failures have been reported with cefixime, cefdinir and ceftibuten.

References

1. HPA. GRASP 2008 report: trends in antimicrobial resistant gonorrhoea, June 2009. Available at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1245914959952.
2. “Recent trends and emerging resistance in gonorrhoea – annual GRASP report for 2007”, Health Protection Report [serial online] 2008; 2(37): news, http://www.hpa.org.uk/hpr/archives/2008/news3708.htm#grasp.

Influenza A(H1N1v): UK situation at 26 June 2009

During the week-ending Friday 26 June [1], the ninth week of the UK outbreak, the number of confirmed UK cases of infection with the novel, swine-lineage influenza virus A/H1N1 rose to 4250.

The highest number of cases have been recorded in London (985) and the West Midlands (1516).

Table 1: Confirmed cases by Region and Devolved Administration, United Kingdom as reported by 26 June 2009

Region where sample
was tested *

Confirmed cases at 26 June
(at 19 June)

East of England

205 (72)

East Midlands

63 (18)

London

985 (338)

North East

34 (26)

North West

55 (35)

South East

323 (127)

South West

88 (23)

West Midlands

1516 (748)

Yorkshire & Humberside

95 (44)

Total England

3364 (1431)

Northern Ireland

24 (13)

Scotland

850 (537)

Wales

12 (3)

TOTAL UK

4250 (1984)
* Current testing arrangements mean that the regional breakdown of figures reflects the regional laboratory where samples are tested which may not always be in the region where the patient lives (as a result there may be some small variations in regional figures as cases are reassigned to their home regions).


HPA guidance

The Swine Influenza pages on the Agency website include sections on:

Among significant changes within the Information for Health Professionals pages, the following sections have been updated:

Reference

1. "Update on confirmed swine flu cases", (HPA press release of 26 June 2009). HPA website: National Press Releases.