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Volume 3 No 35; 28 August 2009

 

 

 

 

Revised publication schedule for mandatory MRSA bacteraemia and Clostridium difficile surveillance

Currently the HPA publishes data on MRSA bacteraemia and Clostridium difficile infection for NHS acute Trust hospitals in England on a quarterly basis, producing counts for a time period up to and including the previous quarter.

As of the 2 November 2009, the HPA will move to monthly reporting, with tables of counts published approximately two weeks after the prior month's data is signed off by Trust CEOs. The publication of counts in a more timely fashion will benefit those concerned with infection control and performance management from the Trust level through to the Department of Health.

On the first working week-day of each month the HPA will publish four tables showing 13 months of counts per acute Trust inclusive of the month covered in the last Trust sign off.
In summary, the four tables published will be:
  1. Monthly MRSA bacteraemia counts by acute Trust
  2. Monthly C. difficile counts by acute Trust (patients aged 2 years and over)
  3. Monthly C. difficile counts by acute Trust (patients aged 65 years and over)
  4. Monthly C. difficile counts by PCO (patients aged 2 years and over).

On an annual basis the HPA will publish a complete set of tables at the end of each financial year. The format/level of detail will be the same as currently published quarterly.

The HPA will produce a quarterly commentary on epidemiology trends based on the four tables produced monthly, but the current quarterly publication format will end with the forthcoming September publication.

Changes to the content or schedule of the HPA publications will be announced 60 days in advance.

The first monthly publication will be on the 2 November 2009 and on the first working week-day of the month thereafter. While the content will differ, the quarterly publication schedule will remain the same and the first of the new format commentaries will be published on 3 December 2009. The annual content for the financial year (f/y) 2009/10 will be published in June 2010. See table 1 for the publication schedule framework.

Table 1: Monthly, quarterly, and annual publications framework

Monthly

Quarterly commentary (in Health Protection Report)

Annual

Publication date

Data period (13 months up to...)

Publication date

Data period (9 quarters up to...)

Publication date

Data period

2 November 2009

September 2009

1 December 2009

October 2009

3 December 2009

Q3 2009

4 January 2010

November 2009

1 February 2010

December 2009

1 March 2010

January 2010

19 March 2010

Q4 2009

1 April 2010

February 2010

3 May 2010

March 2010

1 June 2010

April 2010

18 June 2010

Q1 2010

1 July 2010

May 2010

16 July 2010

F/y 2009/10

2 August 2010

June 2010

1 September 2010

July 2010

17 September 2010

Q2 2010

1 October 2010

August 2010

1 November 2010

September 2010

1 December 2010

October 2010

17 December 2010

Q3 2010

 

 

 

 

 

PVL-SA infections in England and Wales: 2005-2008 data and revised algorithm for referral of suspected cases

Since 2005, the HPA has undertaken an enhanced case ascertainment programme to monitor Panton-Valentine Leukocidin-positive Staphylococcus aureus (PVL-SA) in England and Wales and has published data annually on the number identified among cultures referred to the HPA Staphylococcus Reference Unit [1,2]. Provisional figures for 2007 were published in the Health Protection Report alongside updated guidance on the diagnosis and management of PVL-SA [2,3].

The table shows the finalised figures for the number of PVL-SA identified from 2005 to 2008. In each of the four years, the majority of PVL-SA remain susceptible to meticillin.  Whilst the numbers show an upward trend, the most recent figures suggest the rate of increase may be slowing. What is not clear is whether the overall increase in PVL-SA is due to improved awareness and case recognition, allied to pro-active close contact tracing, or whether it reflects a genuine increase in PVL-SA nationally. Systematic surveillance-based studies funded by DH will provide more robust data for monitoring trends to investigate the prevalence of PVL-SA in the community.

Number of PVL-SA identified by the HPA's Staphylococcus Reference Unit

Year

No. (%) PVL-MSSA

No. (%) PVL-MRSA

Total PVL-SA

Relative increase year-on-year

2005

107 (48%)

117 (52%)

224

 

2006

337 (68%)

159 (32%)

496

2.2-fold

2007

729 (60%)

477 (40%)

1206

2.4-fold

2008

1013 (58%)

724 (42%)

1738

1.4-fold

In 2005, the HPA's Staphylococcus Reference Unit invited laboratories to submit isolates of non-multi-resistant MRSA (in particular ciprofloxacin susceptible strains) in an effort to improve ascertainment of PVL-MRSA. Experience has shown that ciprofloxacin resistance is emerging in some strains of PVL-MRSA identified in the UK [4,5] and only around 20% of quinolone-susceptible MRSA referred to SRU are PVL-positive, ie ciprofloxacin susceptibility among MRSA is not a specific predictor of PVL status.

Pending formal revision of the referral criteria, and in the light of these observations, we advocate a revised algorithm for referrals based on clinical syndrome rather than one based on susceptibility profiles. SRU therefore invites the referral of MSSA or MRSA for PVL-testing from patients with the following clinical features suggestive of PVL:
  • boils or abscesses, especially where these are recurrent
  • necrotising skin and soft tissue infections
  • necrotising pneumonia, purpura fulminans or necrotising fasciitis
  • isolates from close contacts of PVL cases (where the antibiogram corresponds with that of the PVL-SA found in the index case).

Suitable isolates should be forwarded for investigation to: Staphylococcus Reference Unit, Centre for Infections, HPA, 61 Colindale Avenue, London NW9 5HT [5], accompanied by the appropriate request forms (available at http://www.hpa.org.uk/cfi/lhcai/services.htm#RequestForm) which should be completed as fully as possible, including clinical information and antibiotic susceptibility data.

References

1. Community MRSA in England and Wales: definition through strain characterisation. Communicable Disease Report 2005; 15(11) 17 March.
2. Health Protection Agency. Diagnosis and management of PVL-SA infections in England and Wales: an update. Health Protection Report 2008; 2(33): news.
3. Guidance on the diagnosis and management of PVL-associated Staphylococcus aureus infections (PVL-SA) in England. HPA website: Home > Topics > Infectious Diseases > Infections A-Z > Staphylococcus aureus > Guidelines >  Staphylococcus aureus Guidelines.
4. Ellington MJ, Perry C, Ganner M, Warner M, McCormick Smith I, Hill RL, et al. Community Associated MRSA with the PVL toxin in England and Wales: Clinical and molecular epidemiology. Eur J Clin Micro Inf Dis, in press (DOI 10.1007/s10096-009-0757-x).
5. Staphylococcus Reference Unit, LHCAI. Contact Dr Angela Kearns (tel: 0208-3277227; e-mail: angela.kearns@hpa.org.uk).

 

 

 

 

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

In July the number of laboratory-confirmed cases of measles in England and Wales declined for a second consecutive month to only 47 cases. This decline coincided with the school holidays and has also been observed in previous years (see figure).

Cases with onset dates in July decreased in all regions with three regions (North West, West Midlands, and South West) reporting no cases in this period. For the first month this year, London reported the highest number of cases.

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

-

7

102

Feb 09

41

-

3

-

3

52

1

23

-

5

128

Mar 09

20

3

7

2

26

48

3

12

21

2

144

Apr 09

22

7

11

49

26

63

12

22

40

1

253

May 09

25

13

24

44

11

49

11

18

47

15

257

Jun 09

29

9

20

17

4

35

9

4

30

5

162

July 09

15

6

1

3

-

5

-

-

13

4

47

Total 2009

189

46

71

116

78

272

39

92

151

39

1093


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

The majority of confirmed cases this year have been in children and young adults aged 1 to 18 years (81%).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.

Pandemic (H1N1) 2009: UK situation at 3 September 2009

 

 

 

The HPA Weekly National Influenza Report of 3 September 2009 (week 36) [1] has summarised the UK (and international) situation as follows:
  • Pandemic influenza activity continued to decrease across most regions of the UK and in all age groups, while remaining at levels higher than expected for the time of year;
  • Pandemic influenza activity continued to decrease across most regions of the UK and in all age groups while remaining at levels higher than expected for this time of year;
  • In week 35 (week ending 30 August), GP consultation rates decreased in England and Northern Ireland but increased slightly in Wales and Scotland; however all rates were below the normal winter seasonal baseline thresholds (where defined);
  • The National Pandemic Flu Service (NPFS) continued to issue antiviral drugs to people in England with an influenza-like illness who called or logged onto the internet site. There was a general decrease in the number of assessments, and antiviral collections, over the previous week;
  • Interpretation of data to produce estimates on the number of new cases continues to be subject to a considerable amount of uncertainty with the move to NPFS. HPA modelling gave an estimate of 4500 (range 2500 – 10,000) new cases in England in week 35. The estimated number of new cases had decreased in all regions and age groups;
  • The main influenza virus circulating in the UK continued to be the pandemic (H1N1) 2009 strain, with few influenza H1 (non-pandemic), H3 and B viruses detected through sentinel and non-sentinel surveillance. At 3 September 2009, in the UK, no pandemic viruses had been found to be resistant to the antiviral drugs oseltamivir or zanamivir;
  • The majority of pandemic influenza cases continued to be mild. The cumulative number of deaths reported due to pandemic (H1N1) 2009 in the UK was 70. A total of 348 new patients were hospitalised with suspected pandemic influenza in week 35 (up to 8am Monday 31 August), a decrease of 65 from the previous week. The highest hospitalisation rates have consistently been in the under-5-year age group. Hospitalisation rates have remained fairly stable and low in recent weeks in all age groups;
  • According to the European Centre for Disease Prevention and Control (ECDC), by 1 September, 2944 deaths due to pandemic influenza had been reported globally. This represents an increase of 13% from the previous week, compared to a 21% increase in the week previous to that. In week 34 Ireland, Northern Ireland and Norway reported medium levels of influenza activity while all other European countries reported low levels.

Schools advice

Advice relating to schools was expanded under the Advice for the Public section within the HPA website swine flu pages, including answers to frequently-asked questions and other guidance documents.  Further information was published by the Department of Children, Schools and Families [2,3].

UK planning assumptions

Department of Health/Cabinet Office updated planning assumptions for the UK pandemic for the period up to May 2010 were circulated [4].

References
1. HPA. Weekly National Influenza Report: week 36 (3 September 2009, PDF 111 KB), HPA website: www.hpa.org.uk/swineflu/surveillance&epidemiology.
2. HPA. Swine flu: Back to school advice: September 2009, http://www.hpa.org.uk/HPA/Topics/InfectiousDiseases/InfectionsAZ/1244763940922/.
3. Department of Children, Schools and Families. Human influenza pandemic: frequently asked questions, DCSF website: http://www.teachernet.gov.uk/educationoverview/
flupandemic.
4. The Sottish Government. Swine flu: UK planning assumptions (3 September 2009, PDF 80 KB). See: www.scotland.gov.uk/.

HPA website relaunch

Changes to the design and information architecture of the Health Protection Agency website (www.hpa.org.uk), introduced on Wednesday 2 September, aim to improve accessibility and allow the content to be more speedily updated.

A change to the page layout should be noted: the left-hand navigation panel now displays the structure of the content at the level immediately below the page being viewed (except at the lowest level when it displays the content structure at the same level, ie it lists "sybling" pages).

HPR readers are invited to visit the new site and complete the online survey which can be accessed via the HPA Website Feedback link at the bottom of the home page. The HPR microsite (www.hpa.org.uk/hpr) is not affected and remains available via a link at the bottom left-hand corner of the home page.

 

 

 

 

Corrigendum: Immunisation report in HPR 3(34), 28 August 20009

A report on vaccine coverage in infants born to hepatitis-positive mothers in England was omitted from last Friday's bulletin (Health Protection Report, 3(34), 28 August 2009). The issue was re-published on 2 September, including the report, "Annual neonatal hepatitis B vaccine coverage data in England: 2006/07- 2008/09". An amended PDF version of the entire issue can be downloaded at: http://www.hpa.org.uk/hpr/archives/2009/hpr3409.pdf.