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Volume 3 No 27; 10 July 2009

Environmental noise and public health: an evidence review

A critical review of the state of knowledge about the effects of environmental noise on public health has been published by the HPA on behalf of an ad-hoc expert group established by the Department of Health and the Department of Environment, Food and Rural Affairs [1].

Environmental Noise and Health in the UK has been published in draft form with an invitation to stakeholders to comment (before 17 August 2009) [2]. Concerned primarily with the impact of external sources, such as road vehicles and aircraft, on the general outdoor environment (and not noise generated within vehicles or buildings, such as factory noise, or noise from music or neighbours [3]), the objective is to provide policy makers with a critical review of the best information currently available.

An important aspect of the report's context is the European Union Environmental Noise Directive, adopted in 2002, which has led to the production of "noise maps" of urban areas in the UK, which are discussed in the report.

Besides discussing the well-established link between exposure to noise and annoyance (and the apparently changing public attitudes to environmental noise), the draft report examines, in particular, the evidence linking noise with cardio-vascular disease, mental illness and the impairment of development of cognitive functions among children. Key findings are that there has been an increase in evidence of an association between environmental noise and raised blood pressure and coronary heart disease. However, evidence that environmental noise damages mental health remains inconclusive.

A number of research recommendations are made and it is also suggested that an Expert Advisory Committee on Environmental Noise and Health be established to advise government. Further details and discussion of the contents of the report will be presented in next week's Health Protection Report.

References

1. HPA on behalf of the ad hoc Expert Group on the Effects of Environmental Noise on Health. “Environmental Noise and Health in the UK – draft for comment.” Available at http://www.hpa.org.uk/webw/HPAweb&HPAwebPrinterFriendly/Page/1246433632961?p=1246433632961.

2. Those wishing to comment on the report should follow the procedure given on the HPA website
at: www.hpa.org.uk/noise.

3. Except to the extent that evidence from research on the effects on health of noise from these sources can form part of the context in which environmental noise is considered.

Confirmed measles cases in England and Wales – an update to end-May 2009

The total number of laboratory confirmed cases in England and Wales in the first five months of 2009 was 865. More than 200 cases were ascertained with onset in May, similar to the total for April and exceeding all of monthly totals observed since 2007 (see figure).

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

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

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

23

-

5

127

Mar 09

20

3

7

2

26

48

3

12

21

2

144

Apr 09

22

5

11

48

28

61

12

22

39

1

249

May 09

23

12

19

41

11

47

11

17

46

15

242

Total 2009

142

28

45

92

76

228

30

87

106

31

865

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 at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1223019390211.

A new secure website has been developed to provide rapid access to CfI measles test results for local units. Staff who require access should ask the local unit director to contact CfI (Mrep@hpa.org.ukMrep@hpa.org.uk) for a username and password.

Reporting of healthcare-associated infections by private sector healthcare service providers

A first report on the state of development of reporting of healthcare-associated infections (HCAI) by independently-run healthcare facilities has been published by the Health Protection Agency [1].

The report is specifically concerned with independent sector (IS) healthcare providers' reporting of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile infection (CDI) - the two categories of HCAIs that are the subject of mandatory reporting by hospitals within the NHS. The report discusses the background to the involvement of the IS providers in reporting of MRSA bacteraemias and CDI and the past and present hurdles encountered in the process.

The inclusion of the IS providers within the NHS reporting scheme is in recognition of their increasing role in the provision of patient care in the National Health Service (NHS). Ongoing work between the Department of Health (DH), the HPA, the Independent Healthcare Advisory Services (IHAS) and the IS infection control leads has led to the initiation of reporting by the IS of MRSA bacteraemia and CDI on a voluntary basis. Cases have been included in the web-based HCAI data capture system, managed by the HPA. Reporting by the IS started in 2008 with 40 providers and now includes 165 providers.

While the HPA's objective is to ultimately publish data from IS providers alongside the NHS acute Trusts, several important issues discussed in the report mean that this is still a work in progress. Therefore data from the NHS and the IS are presently considered as separate publications.

Reference

1. HPA. Commentary on reporting of Clostridium difficile infections and meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia from the Independent Sector in England. Available at: http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1246607809613?p=1191942126522

Pandemic flu: weekly surveillance report and UK situation, 9 July 2009

The latest HPA Weekly Pandemic Pandemic Flu Update [1] notes the following developments as at 9 July, at the end of the second month of the UK outbreak:

  • GP consultation rates in England for individuals presenting with flu-like illness show increased rates - now above the threshold level for normal seasonal flu activity;
  • 5-14 year olds remain the age group predominantly affected; and
  • the majority of cases continue to be mild with 12 deaths in England to date, all with underlying risk factors.

Following the move away from laboratory testing for confirmation of swine flu cases to clinical diagnosis [2], the level of influenza in the community is being monitored using a range of surveillance mechanisms, enabling the Agency to continue to monitor influenza trends, check for any change in the virus, and identify trends in activity.

Graphical representations to show how primary care surveillance of flu-like illness is providing a good comparator to laboratory confirmations (daily reporting of laboratory confirmed cases alongside weekly and daily primary care surveillance reports for flu-like illness) are presented in the 9 July Weekly Pandemic Flu Update [1] .

HPA and Department of Health website guidance

The Swine Influenza home page on the Agency website (www.hpa.org.uk/swineflu) highlights respiratory hygiene advice and links (via a topics menu on the right of the web page) to sub-sections covering:

  • Advice for the public (http://www.hpa.org.uk/swineflu/public), including information about schools and travel, and a link to the NHS Choices website;
  • Information for health professionals (http://www.hpa.org.uk/swineflu/professionals), including summary advice on the clinical features, treatment and testing, links to more detailed information; a link to the CMO letter of 2 July that explained the change to the treatment phase; HPA advice on treatment and prophylaxis; FRC details; and the Department of Health Swine Flu Clinical Package (see below);
  • Epidemiological data (http://www.hpa.org.uk/swineflu/epidata), including the latest w eekly epidemiological update , an archive of weekly and daily reports, and descriptions of the current surveillance mechanisms;
  • Press releases and media updates (http://www.hpa.org.uk/swineflu/press); and
  • Key links (http://www.hpa.org.uk/swineflu/links) which includes NHS Choices, Directgov and other links offering relevant advice to members of the public and businesses.


The Information for Health Professionals main page provides advice on clinical diagnostic criteria and a link to the Department of Health's Swine Flu Clinical Package which comprises a set of tools for use in a pandemic situation by frontline healthcare professionals. These tools have been designed to support GPs, community nurses, midwives, health visitors, ambulance crews, emergency department doctors, nurses and those working outside their usual specialty area (eg junior doctors or surgeons working in influenza cohort wards) and further information about when they should be deployed will be given at a later phase of a pandemic when there is increased demand for clinical care.

References

1. "Weekly pandemic flu update (9 July 2009)", (HPA press release of 10 July 2009). HPA website: National Press Releases.

2. "Treatment approach announced for pandemic flu", Health Protection Report [serial online] 2009; 3(26): news. Available at: http://www.hpa.org.uk/hpr/archives/2009/news2609.htm#h1n1.