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Volume 3 No 36; 11 September 2009

 

 

 

 

Mandatory HCAI reporting data for second quarter 2009

The latest quarterly report on meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile infections in hospital patients in England (for the April to June 2009 period) has been published as part of the Department of Health's mandatory surveillance programme for healthcare-associated infection. Newly published data comprises:
  • Quarterly (April to June, 2009) counts of MRSA bacteraemia, by trust; and
  • Quarterly (April to June, 2009) counts of C. difficile, by age group, acute trust and primary care organisation

MRSA bacteraemia (patients of all ages) [1]

Data for April to June 2009 show that 509 reports of MRSA bacteraemia were recorded between April and June 2009, which is a 26.7% decrease on the 694 cases recorded for the previous quarter (January to March 2009). This has been a 39.3% decrease on the 839 cases reported for the corresponding quarter in 2008 (April to June, 2008).

C. difficile (patients aged 2-64 years of age, and over 65 years) [2]

There has been a 18% decrease in the number of cases (6855) of C. difficile reported among all patients aged 2 years of age and over in April to June, 2009, compared to the 8357 cases reported in the previous quarter (January to March, 2009). This has been a 37% decrease on the number of cases (10,883) reported in the corresponding quarter of 2008 (April to June).

Note
The quarterly report referred to above is the last of the current quarterly publications format; the next quarterly publication, in December 2009, will include enhanced epidemiological commentary. Data will be published monthly from 2 November, 2009 [3].

References
1. Quarterly results from the mandatory surveillance of MRSA bacteraemia: June 2009. HPA website: Staphylococcus aureus > Mandatory Staphylococcus aureus bacteraemia surveillance scheme.
2. Clostridium difficile infection Quarterly Reports:  June 2009. HPA website: Clostridium difficile > Epidemiological Data > Clostridium difficile Mandatory Surveillance > Results of the mandatory Clostridium difficile reporting scheme.
3. Revised publication schedule for mandatory MRSA bacteraemia and Clostridium difficile surveillance: HPR 3(23), 28 August 20009.

 

 

 

 

New requirements and recommendations for Hajj pilgrims

The National Travel Health Network and Centre's annual guidance for Hajj pilgrims, issued on 4 September [1], takes account of new visa requirements introduced by the Saudi Arabia Ministry of Health [2] in response to the influenza H1N1 (2009) pandemic.

The NaTHNaC guidance (available on its website http://www.nathnac.org) has been produced in conjunction with the UK Department of Health and the Foreign and Commonwealth Office (FCO). The FCO has also produced a short leaflet which, as well as summarising the the new visa requirements, provides other, more general guidance useful for UK pilgrims both before and during this year's event, which takes place between 25 and 29 November [3].

The two main changes to the Saudi Ministry's requirements are:
  • All pilgrims performing Hajj are required to have received vaccination against the 2009-2010 seasonal influenza at least two weeks before arrival in Saudi Arabia. Proof of vaccination is required in order to obtain a visa and no exceptions will be allowed. A written record of vaccination, authorised with the vaccinator's official stamp, should be provided. If a traveller is in possession of an International Certificate of Vaccination or Prophylaxis booklet, seasonal influenza vaccine can be recorded in the ‘Other Vaccinations' pages of the booklet. (Travellers are reminded that vaccination against seasonal influenza is not likely to protect against pandemic influenza.)
  • Vaccination against pandemic (H1N1) 2009 influenza will also be required by all pilgrims at such time as the vaccine becomes universally available within their home country. (However, the Saudi authorities recognise that this is unlikely to apply for this year's pilgrimage.)

Further to these requirements, the Saudi Arabia Ministry of Health and the World Health Organization are also recommending that the elderly (those over 65 years), children under 12, pregnant women and patients with chronic diseases should postpone their participation in Hajj and Umrah this year due to the risk of acquiring pandemic influenza during the pilgrimage.

The Hajj pilgrimage to Makkah (Mecca), Saudi Arabia is attended by over two million Muslims each year. All adult Muslims, who are physically and financially able to do so, have a religious obligation to make the pilgrimage once in their lifetime. The Hajj takes place between the eighth and thirteenth day of the last month of the Islamic lunar calendar and therefore falls at different dates each year. Umrah is a shorter, non-compulsory pilgrimage for Muslims that can be performed at any time.

Details of the other vaccination requirements and related health recommendations for Hajj and Umrah are included in the new NaTHNaC guidance [1].

References
1. National Travel Health Network and Centre. Advice for Hajj pilgrims. Clinical update 4 September 2009. Available at: http://www.nathnac.org/pro/clinical_updates/hajj_040909.htm.
2. Kingdom of Saudi Arabia. Ministry of Foreign Affairs. Additional new health requirements must be provided by the Hajj pilgrimages during the season of 1430 Hijri.
3. Foreign and Commonwealth Office. Advice to British Hajjis.

 

 

 

 

Investigation report on a foodborne norovirus outbreak associated with shellfish

An investigation report on the outbreak of illness that affected 529 people who had eaten at the Fat Duck restaurant in Bray, Berkshire, during January and February this year, has been published the Health Protection Agency [1].

The investigation was conducted jointly by the Agency and environmental health officers from the Royal Borough of Windsor and Maidenhead, with Berkshire East Primary Care Trust also involved. (Delay in publication of the final report was due to higher priority being given to work related to the swine flu pandemic.)

The outbreak investigations focused on: laboratory testing of diners with symptoms of diarrhoea and vomiting (where possible); analysis of detailed questionnaires sent to others who reported similar illness; investigation of illness among staff; examination of the restaurant environment and food processing, handling and supply; and laboratory testing of food samples.

Putting together findings from all these parts of the investigation, the report's conclusions were that:
  • There was a large outbreak of food poisoning among diners at the Fat Duck Restaurant in January and February 2009, with more than 500 reporting illness - over 15% of those dining there during this period;
  • The organism responsible was norovirus which was probably introduced via shellfish (more diners who ate shellfish dishes reported illness). Oysters were served raw; razor clams may not have been appropriately handled or cooked; tracing of shellfish to source showed evidence of contamination and there have been reports of illness in other establishments associated with oysters from the same source;
  • The outbreak continued for at least six weeks (between January 6 and February 22) because of ongoing transmission at the restaurant - which may have occurred through continuous contamination of foods prepared in the restaurant or by person-to-person spread between staff and diners or a mixture of both;
  • Several weaknesses in procedures at the restaurant may have contributed to ongoing transmission including: delayed response to the incident; staff working when they should have been off sick and use of the wrong environmental cleaning products. Delays in notification of illness may have affected the ability of the investigation to identify the exact reason for the norovirus contamination.

The restaurant co-operated fully with the investigation and was able to re-open in March having followed recommendations to: review the food management system to minimise risk of cross-contamination; identify early warnings of increased staff or customer illness and ensure prompt notification to the Royal Borough of Windsor and Maidenhead Environmental Health team; and use a variety of education tools to support understanding in those staff whose first language is not English.

Wider recommendations to other restaurants and food-handlers are that norovirus is an important cause of food poisoning and is easily spread so there needs to be scrupulous attention to food and personal hygiene especially when handling shellfish.

Restaurants that suspect food-poisoning among staff or diners should quickly seek advice and support from their local authority's environmental health team and the Health Protection Agency. This can prevent incidents becoming prolonged outbreaks and reduce the number of diners and staff affected.

Reference
1. Foodborne illness at The Fat Duck restaurant. Downloadable at: Home › Publications › Infectious diseases ›Infection control › Foodborne illness at The Fat Duck restaurant (PDF 2.3 MB).

Further information on norovirus
http://www.hpa.org.uk/HPA/Topics/InfectiousDiseases/InfectionsAZ/1191942172966/

Pandemic (H1N1) 2009: UK situation at 10 September 2009

 

 

 

The HPA Weekly National Influenza Report of 10 September 2009 (week 37) [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;
  • In week 36 (week ending 6 September), GP consultation rates decreased in England and Wales, stayed stable in Northern Ireland and increased slightly in 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. The number of assessments and antiviral collections through this service remained stable over the past week;
  • Interpretation of data to produce estimates on the number of new cases continued to be subject to a considerable amount of uncertainty due to the operation of the NPFS. HPA modelling gave an estimate of 3000 (range 1500 – 6500) new cases in England in week 36. 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 confirmed 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 75. A total of 238 new patients were hospitalised with suspected pandemic influenza in week 36 (up to 8am Monday 7 September), a decrease of 110 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 8 September, 3491 deaths due to pandemic influenza had been reported globally. This represents an increase of 19% from the previous week, a similar increase to that seen in previous weeks. In week 35 widespread, increasing activity was reported from Sweden, while most other European countries reported low levels.

Further schools advice

Following the advice for schools made available on the Advice for the Public section of the HPA website swine flu pages in the first week of September [2], further guidance for local authority education departments [3] was published for use in schools and early years settings to help reduce the spread of infection among pupils and staff during the 2009-2010 school year.

References
1. HPA. Weekly National Influenza Report: week 37 (10 September 2009, PDF 114 KB), HPA website: www.hpa.org.uk/swineflu/surveillance&epidemiology.
2. HPA. Swine flu: Back to school advice: September 2009.
3. HPA. Preparing for swine flu: guidance and resources for schools, early years and other educational settings (11 September 2009, PDF 2.7 MB). Downloadable at: Home › Topics › Infectious Diseases › Infections A-Z › Swine Influenza (influenza A H1N1v) › Swine flu: advice for the public ›Swine flu: Back to school advice: September 2009.