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Volume 3 No 38; 25 September 2009

HPR Home | Archives | 2009 news

• NICE guidance on improvements to coverage of childhood immunisation programmes
  
  
• World Rabies Day – 28 September 2009
  
  
• Revised publication schedule for mandatory surveillance data: an update
  
  
• Consultation on changes to the LabBase exceedance reporting system
  
  
• Pandemic influenza: UK second wave intensifies
  
  

NICE guidance on improvements to coverage of childhood immunisation programmes

The National Institute for Health and Clinical Excellence (NICE) has published guidance on measures to improve immunisation uptake among children and young people [1]. Intended primarily for health professionals but also likely to be of interest to parents, the guidance refers in particular to groups and settings where immunisation coverage is known to be low. The guidance is framed around six recommendations: the first five apply to all vaccinations for children from birth to 19 years (vaccine programmes; information systems; training; contribution of nurseries, schools and colleges of further education; and targeting groups at risk of not being fully immunised); the sixth focuses on the hepatitis B vaccination programme for infants - an example of a programme targeted at a particular "low-coverage" group.

Further developments related to childhood immunisation programmes are reported in the Commentary section of the COVER report in the Routine Reports section of this issue.

References
1. NHS National Institute for Health and Clinical Excellence. NICE public health guidance 21. Reducing differences in the uptake of immunisations (including targeted vaccines) among children and young people under 19 years. September 2009. Available at: http://www.nice.org.uk/PH21.

World Rabies Day – 28 September 2009

Monday 28 September is World Rabies Day - a global initiative led by the Alliance for Rabies Control to raise awareness and understanding about the importance of rabies prevention worldwide. The Alliance for Rabies Control was formed in 2006, and the World Rabies Day initiative now involves human and animal health partners at the international, national, and local levels, veterinary and medical organizations, and other partners.

The primary message of World Rabies Day is that rabies is a preventable disease, and yet kills 55,000 people needlessly each year, of whom half are children under the age of 15 [1].

Rabies is transmitted to humans mainly by bites, but exposure may also occur through contamination of broken skin or mucous membranes with saliva from an infected animal or bat. Infection with rabies virus causes an acute nervous system disease; encephalomyelitis. It is a fatal condition but it is preventable by vaccination.

In many countries rabies is primarily a disease of children, who are particularly at risk due to their close contact with dogs, the major global source. This is because children are more likely to suffer multiple bites and scratches to the face and head, both of which carry a higher risk of contracting rabies. In addition children are often unaware of the danger that dogs transmit rabies and may not tell their parents when a bite, lick, or scratch has occurred from an infected animal.

Since virtually all human rabies is caused by dog bites, vaccination of canine populations has proved extremely successful in reducing its incidence in humans. In Mexico, for example, a 92% reduction in the prevalence of canine rabies due to vaccination was accompanied by an 82% reduction in the number of reported human deaths from the infection [2]. And in India, following a "catch-spay-vaccinate and release" programme for the street dog popula tion in Chennai, for the first time since records began there have been no human rabies deaths for over a year [3].

For the UK population the key public health issue is for those who may be at risk because of their work (see below) or as a result of travelling to countries where rabies is circulating in animals. Travellers should stay away from stray or unattended animals and, if bitten in a country where rabies is present, wash the wound immediately and seek medical advice; if a person has not had treatment in that country they should still seek medical advice immediately on return, even if the bite was weeks before.

The UK has been free of indigenous classical animal rabies for over a century but occasional cases have occurred in quarantined animals creating a hazard that warrants vaccination of those working with imported animals. The last UK case of indigenously acquired classical rabies in a human was in 1902. Cases occurring since then have all been acquired abroad, usually through dog bites. European Bat Lyssavirus 2 (EBLV2), a rabies-like virus, has been isolated in bats in the UK, and in 2002 a man who was a licensed bat handler died in Scotland from infection with EBLV2 [3]. The Department of Health recommends that those who regularly handle bats, whether a licensed bat handler or not, should be vaccinated against rabies as a precaution. In addition individuals who are bitten or scratched by a bat within the UK should seek medical attention as soon as possible to determine whether they need post-exposure prophylaxis (PEP).

Further information

About PEP: see Chapter 27, Immunisation against infectious disease ("The Green Book") at: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1216022456494).

Expert advice and supply of vaccine and immunoglobulin: from the HPA Centre for Infections (tel: 020 8200 4400).

About World Rabies Day: at the official web site www.worldrabiesday.org and in the Alliance for Rabies Control's September 2009 newsletter http://www.rabiescontrol.net/ARCnewsletter14.pdf

References

1. WHO. Human and Animal Rabies, Rabies: A neglected zoonotic disease. Available at: http://www.who.int/rabies/en/ [accessed on 24 September, 2009].

2. Fooks T and Harkess G. Rabies - a "one health approach", Health Protection Matters, Spring 2008 (number 10), Health Protection Agency. Available at: http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1208245975751?p=1158945066420

3. The Newsletter of the Alliance for Rabies Control, September 2009. http://www.rabiescontrol.net/ARCnewsletter14.pdf

4. Fooks AR, McElhinney LM, Pounder DJ, Finnegan CJ, Mansfield K, Johnson N, et al. Case report: isolation of a European bat lyssavirus type 2a from a fatal human case of rabies encephalitis. J Med Virol 2003; 71(2): 281-9.

 

 

 

 

Revised publication schedule for mandatory surveillance data: an update

The monthly HCAI mandatory MRSA bacteraemia and Clostridium difficile surveillance data schedule [1] requires amendment to take into account guidelines on pre-release access to official statistics.

As these data are official statistics, the HPA intends to abide by the Pre-release Access to Official Statistics Order 2008 which specifies that pre-release access may not be granted for a period in excess of 24 hours prior to publication.

To allow orderly briefing of Ministers within guidelines, to support their capacity to respond to questions arising, it has been decided to amend the publication formula to avoid Mondays and days which follow public holidays. This means the first monthly publication will be on 3 November 2009, with subsequent publications on the first Wednesday of the month thereafter (table 1).

These publication dates have been selected by Dr Christine McCartney, HPA Executive Lead for the Healthcare-Associated Infections and Antimicrobial Resistance Programme, in consultation with specialist officials at the Department of Health.

Table 1: Monthly, quarterly, and annual publications framework

Monthly		Quarterly commentary (in Health Protection Report)		Annual
Publication date	Period covered (months & year)	Publication date	Data period (9 quarters up to...)	Publication date	Data period
Tuesday, 3 November 2009	September 2008 - September 2009
Wednesday, 2 December 2009	October 2008 - October 2009	Thursday, 3 December 2009*	Q3 2009
Wednesday, 6 January 2010	November 2009 - November 2010
Wednesday, 3 February 2010	December 2009 - December 2010
Wednesday, 3 March 2010	January 2009 - January 2010	Friday, 19 March 2010	Q4 2009
Wednesday, 7 April 2010	February 2009 - February 2010
Wednesday, 5 May 2010	March 2009 - March 2010
Wednesday, 2 June 2010	April 2009 - April 2010	Friday, 18 June 2010	Q1 2010
Wednesday, 7 July 2010	May 2009 - May 2010			Friday, 16 July 2010	F/y 2009/10
Wednesday, 4 August 2010	June 2009 - June 2010
Wednesday, 1 September 2010	July 2009 - July 2010	Friday, 17 September 2010	Q2 2010
Wednesday, 6 October 2010	August 2009 - August 2010
Wednesday, 3 November 2010	September 2009 - September 2010
Wednesday, 1 December 2010	October 2009 - October 2010	Friday, 17 December 2010	Q3 2010

* This publication will not appear in the HPR.

Reference

1.Revised publication schedule for mandatory MRSA bacteraemia and Clostridium difficile surveillance, Health Protection Report 3(35), 4 September 2009, http://www.hpa.org.uk/hpr/archives/2009/news3509.htm#schedule.

Consultation on changes to the LabBase exceedance reporting system

An important component of the HPA's communicable disease surveillance arrangements, the LabBase exceedance reporting system, is under review.

The system operates by comparing the number of laboratory reports (for each organism) during a particular week with the number received in the corresponding week, and in the three weeks either side, over the previous five years. "Exceedance reports" are automatically generated when there has been a notable divergence from the expected range of total cases reported.

The current arrangements have been operating for more than a decade during which time LabBase has identified a number of outbreaks, and helped confirm suspected outbreaks, including those involving Salmonella Oranienburg, Salmonella Typhimurium DT120 and Salmonella Typhimurium DT191a.

However, there is currently a feeling both at the Centre of Infections and elsewhere within the Agency that the current system needs to be upgraded. The false positive rate is increasing and utilisation of the system is in decline, threatening to make the system obsolete, with consequent risk that significant outbreaks will be missed.

A number of key decisions have already been taken to improve the system: to use the date of specimen collection (rather than date of upload); to change the geographical areas; and explicitly to include healthcare-associated infections.

Users within the Agency are being consulted about the outputs that should be available from the system and how they should be presented and accessed.

If you work for the Agency and would like to receive a copy of the proposal, please email: edward.wynne-evans@hpa.org.uk.  

Pandemic influenza: UK second wave intensifies

 

 

The HPA Weekly National Influenza Report of 24 September 2009 (week 39) [1] has summarised the UK (and international) situation as follows:

• Pandemic influenza activity continues to increase throughout the United Kingdom, particularly in school-aged children;
• In week 38 (week-ending 20 September), the weekly influenza/influenza-like-illness (ILI) consultation rates increased throughout the UK. Rates were below the normal winter seasonal baseline thresholds in England, Wales and Scotland, but above newly defined provisional threshold levels in Northern Ireland;
• The National Pandemic Flu Service (NPFS) continued to issue antiviral drugs to people in England and the number of assessments and antiviral collections through this service increased over the past week;
• At least 21 schools throughout England have reported outbreaks of ILI since the beginning of the autumn term, with virological confirmation of pandemic influenza in at least one case in 11 of the schools. School outbreaks have also been reported in Scotland and Northern Ireland;
• 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 9000 (range 5000 - 20,000) new cases in England in week 38. The estimated number of new cases has increased 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. Two of 973 pandemic viruses tested have been confirmed to carry a mutation which confers resistance to the antiviral drug oseltamivir; both have been shown phenotypically to be resistant to the drug but retain 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 82. A total of 324 new patients were hospitalised in England with suspected pandemic influenza in week 38, an increase over the previous week. The highest hospitalisation rates have consistently been in the under-5-years age group and the recent increases have been seen particularly in children under 15;
• According to the European Centre for Disease Prevention and Control (ECDC), by 22 September, 4144 deaths due to pandemic influenza had been reported globally. In week 37 Ireland, Sweden and Northern Ireland reported medium activity, while other European countries reported low levels.

Reference
1. HPA. Weekly National Influenza Report: week 39 (24 September 2009, PDF 162 KB), HPA website: www.hpa.org.uk/swineflu/surveillance&epidemiology.