News Archives |
Volume 3 No 28; 17 July 2009
- Revision to pre-surgical assessment of risk for vCJD in neurosurgery and eye surgery units
- Pandemic flu: UK situation at 16 July 2009
Revision to pre-surgical assessment of risk for vCJD in neurosurgery and eye surgery units
Patients are routinely assessed prior to undergoing surgical or neuro-endoscopy procedures to determine whether they may have an increased risk of CJD infection. If this is the case, special infection control precautions should be followed [1].
This pre-surgical assessment process has been revised to fully take account of the latest knowledge of variant CJD (vCJD). Now patients undergoing high risk surgery [2] or neuro-endoscopy should be assessed to identify those who have received transfusions from 80 or more donors since 1980. Any patients so identified have an increased risk of vCJD, and special infection control procedures should be followed. It is estimated that around 50 patients will be identified in this way in the UK each year.
Hospitals are being asked to collate blood transfusion histories for these patients, and conduct risk assessments for patients with uncertain or incomplete transfusion histories. Patients who are found to have an increased risk of vCJD will need to be informed via the HPA Centre for Infections CJD section, which is coordinating the implementation of the revised guidance, and their GP.
The vCJD risk to these patients is uncertain, and depends on the prevalence of subclinical vCJD infection among blood donors, the infectivity in the blood of infected donors, and the number of donors the patients have received blood from.
The HPA's CfI-CJD section should be informed of any patients who are identified prior to high risk surgery or neuro-endoscopy as having received blood from 80 or more donors. Health Protection Units have been asked to ensure that infection control teams are aware of the revised guidance.
Information for healthcare workers and patients is available at: http://www.hpa.org.uk/vCJDpresurgicalassessment.
References/notes
1. Department of Health. "Assessment to be carried out before surgery and/or endoscopy to identify patients with, or at increased risk of, CJD or vCJD" (Annex J of ACDP TSE Working Group guidance).
2. High risk surgery is defined as surgery involving any of the following organs or tissues (high risk tissues): brain, spinal cord, dura mater, cranial nerves (specifically the entire optic nerve and only the intracranial components of the other cranial nerves), cranial nerve ganglia, posterior eye (specifically the posterior hyaloid face, retina, retinal pigment epithelium, choroid, subretinal fluid, optic nerve) and pituitary gland.
Pandemic flu: UK situation at 16 July 2009
The latest HPA Weekly Pandemic Flu Update [1] notes the following developments as at 16 July:
- GP consultation rates in England for individuals presenting with flu-like illness showed increased rates, well above the threshold level for normal seasonal flu activity;
- the under-fives and 5-14 year olds are the age groups predominantly affected;
- the majority of cases continue to be mild, but there had been 26 deaths in England as at 16 July; and
- HPA estimated that there were 55,000 new cases of swine flu during the previous week (within a possible range of 30,000 to 85,000).
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. One of these is the collaborative project between the HPA and the University of Nottingham Division of Primary Care known as QSurveillance®. This is a not-for-profit network over 3,300 general practices covering a total population of almost 22 million patients (more than 25% of the UK population). In the week-ending 12 July, the flu-like illness weekly consultation rate recorded by QSurveillance® reached 86.8 per 100,000, higher than the peak activity in winter 08/09 (see figure 2 in the HPA Weekly Pandemic Flu Update for 16 July [1]).
Given that laboratory testing is no longer routinely recommended, figure 1 (below) graphically illustrates how primary care surveillance such as QSurveillance® is providing a good comparator to laboratory confirmation, showing daily reporting of laboratory confirmed cases alongside daily primary care surveillance reports for flu-like illness.
Figure 1: Comparison of daily laboratory confirmed H1N1v case reports and daily QSurveillance® reports of influenza-like illness, UK*
Department of Health guidance: the National Pandemic Flu Service
In view of the very high demand for primary care, NHS Direct and A and E services in many areas, the Department of Health announced plans to activate, subject to rigorous testing, the National Pandemic Flu Service before the end of July [3].
References
1. "Weekly pandemic flu update (16 July 2009)", (HPA press release of 16 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.
3. Department of Health. "National Pandemic Flu Service", 17 July 2009.
