News Archives |
Volume 3 No 37; 18 September 2009
- An international outbreak of Salmonella Oranienburg
- Healthcare-Associated Infections in England annual report 2008/09
- HIV-diagnosed individuals accessing care in the UK: an update
- Pandemic (H1N1) 2009 influenza: UK situation at 17 September 2009
An international outbreak of Salmonella Oranienburg
An investigation into an international outbreak of Salmonella Oranienburg has been concluded without the causative agent being identified.
Between 30 April and 5 August 2009, a total of 54 cases of S. Oranienburg were reported through the national laboratory surveillance system for England, Wales and Northern Ireland. Thirty-eight of these had an identical pattern in Pulse Field Gel Electrophoresis (PFGE) and were identified as the outbreak strain (SORAXB.0017).
Twenty-five of these cases occurred between 4 and 22 May (see figure 1) [1]. The median age of cases was 37 years (mean 40, range 0-75 years) and 47% were female. Cases were identified from all regions with no clear geographical distribution.
Simultaneously, S. Oranienburg cases with an identical PFGE pattern occurred in the USA (n=85), Canada (n=7) and Scotland (n=7). The age and sex profile of these cases was similar to the ones detected in England , Wales and Northern Ireland.
S. Oranienburg is a comparatively rare pathogen and occasional, usually small outbreaks have been reported in the past associated with a variety of different vehicles including black pepper [2], mozzarella [3] and Tyrolean cheese [4], cantaloupe [5] and fruit salad [6], or chocolate [7]. The source of the largest reported outbreak (n=1505) was Japanese semi-dry cuttlefish [8].
The HPA Centre for Infections' Laboratory of Gastrointestinal Pathogens has investigated the outbreak in England using trawl questionnaires (n=13) and shorter follow-up questionnaires (n=9) and the Centres for Disease Control and Prevention (CDC) have administered about 30 standardised questionnaires and conducted open interviews on seven of the USA cases. Findings were compared with information on imports and routine food sampling from the UK Food Standards Agency and the US Food and Drug Administration. All four countries and the European centres of Disease Control (ECDC) regularly communicated their epidemiology and findings electronically and in teleconferences.
Whilst it is highly likely that this outbreak was caused by a common food product - either imported from a third country or from the USA - it was not possible to ascertain a single source in this outbreak. The epidemiology points to a transient problem in early/mid May, and whilst the investigations of this particular outbreak have been concluded, the HPA will continue to monitor S. Oranienburg activity using routine surveillance.
Figure 1. Epidemiological curve of S. Oranienburg (SORAXB.0017) in England, Wales and Northern Ireland
References
1. “Un-seasonal increase in Salmonella Oranienburg in England and Wales”, http://www.hpa.org.uk/hpr/archives/2009/news2309.htm#salmoran.
2. Outbreak of Salmonella oranienburg infection - Norway. MMWR Morb. Mortal. Wkly. Rep. 1982; 31(48): 655-6.
3. Hedberg CW, Korlath JA, D'Aoust JY, White KE, Schell WL, Miller MR, et al. A multistate outbreak of Salmonella javiana and Salmonella Oranienburg infections due to consumption of contaminated cheese. JAMA 1992; 268(22): 3203-7.
4. Allerberger F, Kreidl P, Dierich MP, Klingsbichel E, Jenewein D, Mader C, et al. Salmonella enterica serotype Oranienburg infections associated with consumption of locally produced Tyrolean cheese. Euro. Surveill 2000; 5(11): 123-6.
5. Deeks S, Ellis A, Ciebin B, Khakhria R, Naus M, Hockin J. Salmonella Oranienburg, Ontario. Can. Commun Dis Rep. 1998; 24(22): 177-8.
6. Salmonella Oranienburg infections associated with fruit salad served in healthcare facilities – northeastern United States & Canada, 2006. MMWR Morb. Mortal. Wkly. Rep. 2007; 56(39): 1025-8.
7. Werber D, Dreesman J, Feil F, van Treeck U, Fell G, Ethelberg S, et al. International outbreak of Salmonella Oranienburg due to German chocolate. BMC Infect Dis 2005; 5(1): 7.
8. Miyakawa S, Takahashi K, Hattori M, Itoh K, Kurazono T, Amano F. Outbreak of Salmonella oranienburg infection in Japan. J Environ.Biol. 2006; 27(1): 157-8.
Healthcare-Associated Infections in England annual report 2008/09
Infection prevention and control continues to challenge healthcare workers and remains a high Government priority hence it is encouraging that the latest Healthcare-Associated Infections in England annual report, published at the end of August 2009 [1], covering the financial year 2008-09, shows dramatic reductions in Meticillin Resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile (see figures 1 and 2), as well as reductions in HCAIs following orthopaedic surgery.
These reductions are the result of continuous efforts by NHS staff to strengthen good practice in infection prevention and control. To facilitate further improvements and respond to the needs of the NHS, the HPA will publish mandatory MRSA and C. difficile surveillance data on a monthly basis from the 2 November 2009 [2].
Figure 1. MRSA bacteraemia, by patient presentation, since October 2005
Besides the positive trends illustrated above, other developments highlighted in the report are: the launch of hospital norovirus outbreak surveillance in December 2008; the growth of the Clostridium difficile Ribotyping Network (CDRN); and the successful launch of the DVD An introduction to infection control in care homes.
The annual report for 2008-2009, which is shorter and more concise than earlier editions for the benefit of busy chief executives, was provided to delegates at the Health Protection 2009 conference at Warwick (14-16 September 2009) and has been sent out to chief executives of all acute trusts, to the Department of Health and to those within the Agency known to have an interest in this area in England. The report is also available on the HPA website [2] and can be obtained by contacting Jane Mani-Saada (jane.mani-saada@hpa.org.uk).
More in-depth information and surveillance data will be published on the HPA website [3] and in peer-reviewed journals.
The HPA has multidisciplinary teams that work closely with NHS colleagues, locally, regionally and nationally, providing proactive support, advice and guidance to reduce healthcare-associated infections. However to ensure that we are providing what the NHS require the HPA jointly with the DH are holding a stakeholder engagement event to seek views from NHS colleagues to help improve surveillance of MRSA bacteraemia and C.difficile. An online survey has already been undertaken and results will be discussed at an event due to take place on 9 November 2009 in central London. Further details of the event are available at: http://www.hpa-events.org.uk/HCAImeeting.
References
1. Revised publication schedule for mandatory MRSA bacteraemia and Clostridium difficile surveillance: HPR 3(23), 28 August 20009.
2. Healthcare associated infections in England: 2008-2009 report. Downloadable at: Home > Publications > Infectious diseases > Antimicrobial and healthcare associated infections. http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1252326221795?p=1249920576124.
3. Home › Topics › Infectious Diseases › Infections A-Z › Healthcare Associated Infections > Epidemiological Data: Healthcare Associated Infections.
HIV-diagnosed individuals accessing care in the UK: an update
The latest data on individuals accessing HIV-related care in the UK (SOPHID data) are now available on the Health Protection Agency’s website. In 2008, 61,213 HIV-infected individuals (of all ages) were seen for HIV-related care at NHS specialist services in the UK. This is an increase of 8.5% on 2007 (56,443) and almost a three-fold increase on the number seen in 1999 (20,099). Almost half (48%, 29,631) attended a treatment site in London including 2,845 individuals who were not resident in the capital.
Based on these data and UK population estimates [1], the overall prevalence of diagnosed HIV among 15-59 year old adults in the UK was 1.5/1000 in 2008, with a higher prevalence among men than among women (2.0 per 1000 versus 1.1 per 1000) and a higher prevalence in London than in the rest of the UK; 5.0 per 1000 in London, versus 1.1 per 1000 elsewhere in England, 0.6 per 1000 in Wales, 0.9 per 1000 in Scotland and 0.4 per 1000 in Northern Ireland.
Overall, half (50%, 30,502) of HIV-diagnosed individuals attending care in 2008 were men and women infected via heterosexual sex (11,199 and 19,303 respectively) and 42% (25,569) were men infected through sex between men. A small proportion were infected through injecting drug use (2%, 1,489) or mother-to-child transmission (2%, 1,390). Just over half were white (51%, 31,019) and 37% (22,282) were black-African, where ethnicity was reported (60,308).
The number and proportion of patients prescribed antiretroviral therapy (ART) has increased over the past decade. In 2008, 75% (45,953/60,805) of individuals seen for HIV-related care were prescribed ART; this compares to 71% (39,704/55,757) in 2007 and 69% (12,907/18,653) in 1999. In 2008, the majority (44,028) were prescribed a combination of at least three drugs. The 2008 BHIVA guidelines recommend that treatment discussions commence when a patient’s CD4 cell count falls to ≤350 cells/mm3 [2], (previous guidelines recommended treatment should start when CD4 cells reached 200 cells/mm3). This may have had an impact on the proportion of patients with a CD4 count of 201-350 cells/mm3 who were not prescribed ART, which fell from 28% (3,244/11,770) in 2007 to 21% in 2008 (2,437/11,777). The proportion of patients whose CD4 was ≤200 cells/mm3 and who were not prescribed ART also continued to fall to 14% (712/4,918) from 17% (885/5,134) in 2007.
Detailed SOPHID tables by Strategic Health Authority, and prevention group (including: men who have sex with men, black-African and black-Caribbean populations, young people and injecting drug users) can be accessed on the HIV section of the HPA website at: www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/Page/1201094588844.
About the data source
The Survey of Prevalent HIV Infections Diagnosed (SOPHID) routinely collects clinical and pseudoanonymised patient data from NHS HIV-services in England , Wales and Northern Ireland. This data is combined with HIV data collected by Health Protection Scotland (HPS) and paediatric data (children aged under 15) collected by the National Study of HIV in Pregnancy and Childhood (NSHPC) and the Collaborative HIV Paediatric Study (CHIP).
References
1. Office for National Statistics. Mid-2008 Population Estimates. 2009. Available from: www.statistics.gov.uk
2. Gazzard BG and BHIVA Treatment Guidelines Writing Group. British HIV Association Guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008. HIV Medicine 2008; 9(8): 563-608.
Pandemic (H1N1) 2009: UK situation at 17 September 2009
The HPA Weekly National Influenza Report of 17 September 2009 (week 38) [1] has summarised the UK (and international) situation as follows:
- Several indicators suggest that pandemic influenza activity has started to increase in many areas of the UK, particularly in school-aged children;
- In week 37 (week ending 13 September), the weekly influenza/ILI consultation rates increased in England, Scotland and Northern Ireland but decreased slightly in Wales, 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;
- At least six schools in England and eight in Scotland have observed high absenteeism rates recently. Pandemic influenza has been virologically confirmed in at least one pupil in six (three in England, three in Scotland) of these schools;
- 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 5000 (range 3000 - 11,000) new cases in England in week 37. The estimated number of new cases has remained stable 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. Two of 913 pandemic viruses tested in England have been confirmed to carry a mutation which confers resistance to the antiviral drug oseltamivir, and one of these has been shown phenotypically to be resistant to the drug but retains sensitivity to 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 78. A total of 246 new patients were hospitalised with suspected pandemic influenza in week 37, a slight increase 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 15 September, 3496 deaths due to pandemic influenza had been reported globally. In week 36 Ireland, Malta, Norway and Sweden reported medium activity, while other European countries reported low levels.
Reference
1. HPA. Weekly National Influenza Report: week 38 (17 September 2009, PDF 130 KB), HPA website: www.hpa.org.uk/swineflu/surveillance&epidemiology.