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Volume 4 No 5; 5 February 2010

Anthrax alert for heroin users in London


The HPA and NHS London have confirmed that a drug-injecting heroin user has tested positive for anthrax and is being treated in a London hospital, the first case of anthrax seen in an injecting drug user in England since similar cases were first seen in Scotland in December 2009.

Nineteen cases have so far been confirmed in Scotland. Similarities to the cases in Scotland suggest that the heroin, or a contaminated cutting agent mixed with the heroin, is the likely source of infection.

Further information

HPA press notice. Anthrax alert for heroin users in London, 5 February 2010.

Department of Health Central Alerting System. Confirmed case of anthrax infection in an injecting drug user in England, 5 February 2010.

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

Only one case of confirmed measles was reported in December 2009, bringing the provisional total of laboratory confirmed cases for 2009 to 1144, lower than the previous year's total of 1370. This case was confirmed in an infant not yet eligible for routine immunisation who had recent history of travelling to India.

Despite this low level, it is important to continuing monitoring measles activity and prompt notification and testing of cases is essential.

In addition, in December, six measles cases were confirmed in Northern Ireland. These cases have links to an ongoing outbreak in the Republic of Ireland and with an identical measles D4 genotype [1].

Confirmed cases of measles by region and month of onset, England and Wales: January to December 2009

Month

Lond-on

East Mids

East of Engl'd

North East

North West

South East

South West

West Mids

Wales

York & Humb

Total

Jan 09

38

8

6

1

8

21

3

13

-

7

105

Feb 09

41

-

3

-

3

54

1

22

-

5

129

Mar 09

20

3

7

2

28

49

3

13

21

3

149

Apr 09

22

7

12

50

23

61

12

24

40

1

252

May 09

26

13

24

43

11

50

10

18

47

15

257

Jun 09

30

10

20

16

4

34

10

4

29

4

161

July 09

15

6

-

3

-

5

-

-

13

5

47

Aug 09

4

-

2

6

1

-

1

-

5

7

26

Sept 09

2

-

-

1

1

1

1

-

1

3

10

Oct 09

-

-

-

-

-

-

2

1

2

-

5

Nov 09

-

-

-

-

-

-

-

-

1

1

2

Dec 09

-

-

-

-

-

1

-

-

-

-

1

Total 2009

198

47

74

122

79

276

43

95

159

51

1144

Number of laboratory confirmed cases in England and Wales by month of onset: January 2006 to December 2009

Number of laboratory confirmed cases in England and Wales by month of onset: January 2006 to December 2009

 

An age breakdown of cases for 2009 to the end of December by region is available at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1223019390211.

Reference
1. Child hospitalised in measles outbreak. Available at:
http://www.irishtimes.com/newspaper/breaking/2009/1123/breaking79.htm.

EFSA report on human campylobacteriosis caused by poultry meat in the EU


The European Food Safety Authority (EFSA) has published an opinion from its Biological Hazards (BIOHAZ) Panel on the extent to which poultry meat contributes to human cases of campylobacteriosis across the European Union. Campylobacteriosis is the most frequently reported zoonotic illness in the EU. More than 200,00 cases were reported in 24 member states in 2007. The opinion confirms that the handling, preparation and consumption of poultry meat is the major cause, probably accounting directly for 20 to 30% of reported human cases.

The panel recommends more effective EU surveillance, noting a significant level of under-ascertainment and under-reporting. Most surveillance schemes for food-borne diseases depend on patients with symptoms of the disease consulting a primary care physician and subsequently being correctly diagnosed. It also recommends research to improve source attribution and to evaluate the effectiveness of interventions.

Reference
1. EFSA Panel on Biological Hazards (BIOHAZ). Scientific opinion on quantification of the risk posed by broiler meat to human campylobacteriosis in the EU. EFSA Journal 8(1): 1437. Available from: www.efsa.europa.eu.

Pandemic (H1N1) 2009 influenza: health impact assessment for sub-Saharan Africa


 


Global situation

Although in the temperate zone of the northern hemisphere overall pandemic influenza activity continues to decline or remain low in most regions since peaking during late October and November 2009, several areas continue to have evidence of active but declining transmission, particularly in North Africa and in limited areas of Eastern Europe and East Asia, according to the WHO's latest update of the global situation [1].

The WHO noted that:
  • In North Africa, pandemic influenza transmission remains active and geographically widespread but overall activity has been declining since peaking during late December 2009 and early January 2010. During January 2010, a substantial decline in the number of pandemic virus isolations and new cases was observed in Morocco and Egypt, respectively;
  • In South and Southeast Asia, pandemic influenza transmission remains active but geographically localized to regional. The overall intensity of respiratory diseases activity was reported to be low to moderate in most places. In India, influenza activity continued to decline in all regions of the country, however, the most active areas of transmission currently are in the western states. An overall peak in the number of pandemic H1N1 cases was recorded in India during mid December 2009, and the majority of these cases were identified in the northern and western states of India. In Thailand, overall ILI activity remained low, however focal increase in activity were observed in several central and northern provinces;
  • In East Asia, pandemic influenza transmission remains active and geographically widespread across the region, however, overall activity continued to decline. In Japan, overall influenza activity continues to decline but transmission remains higher on the southern island of Okinawa than in other places. In the Republic of Korea (South Korea), rates of ILI continued to decline to near baseline after a substantial wave of activity which peaked during early to mid November 2009. ... In northern and southern China, rates of ILI have returned to levels seen during recent seasons; however, approximately 30% of respiratory specimens tested were positive for influenza suggesting that active transmission of influenza viruses persists. Active transmission of pandemic influenza virus also persists in Hong Kong SAR (China), although at significantly lower levels than an earlier peak of activity during September and October 2009;
  • In Europe, transmission of pandemic influenza virus remains active in a limited number of countries as overall activity remained low in most places. At least seven countries testing more than 20 sentinel respiratory samples reported that more than 20% of samples had tested positive for influenza (Albania, Bulgaria, the Czech Republic, Georgia, Greece, Luxembourg, and Romania); however, in all seven, rates of illness remained well below earlier peaks of activity. Small increases in ILI/ARI have been reported over the past two reporting weeks in Slovakia, Belarus, and the Russian Federation. The overall rate of sentinel respiratory samples testing positive for influenza fell to 14% after reaching a peak of 45% during early November 2009;
  • In the Americas, both in the tropical and northern temperate zones, overall pandemic influenza activity continued to decline or remain low in most places. In Central America and Caribbean, pandemic influenza virus transmission persists but overall activity remains low or unchanged in most places;
  • In temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.

 

UK situation at 4 February 2010

Key points of the Health Protection Agency's Weekly National Influenza Report of 4 February (week 5) [2] covering the UK situation were as follows:
  • Pandemic (H1N1) 2009 influenza activity was generally decreasing across the UK;
  • In week 04 (ending 31 January), the weekly influenza-like illness consultation rate decreased or remained stable in England, Wales and N. Ireland and increased slightly in Scotland;
  • The National Pandemic Flu Service continued to issue antiviral drugs to people in England. The number of assessments and antiviral collections through this service decreased over the past week. The service will continue until 11 February 2010 [3], after which date antivirals will be authorised via health care professionals;
  • A decrease in respiratory syncytial virus detections has been observed recently although GP consultation rates for acute bronchitis increased between week 3 and week 4, mainly in people aged under 5 years and 65 or over;
  • 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. Thirty-eight of 5,174 pandemic viruses tested have been confirmed to carry a mutation which confers resistance to the antiviral drug oseltamivir; three are phenotypically resistant to the drug but retain sensitivity to zanamivir;
  • The weekly number of pandemic influenza cases reported as admitted to hospital has decreased recently. The cumulative number of deaths reported due to pandemic (H1N1) 2009 in the UK is 411;
  • The UK pandemic influenza vaccination programme continues for people at high risk of severe disease, health-care workers and healthy children aged between six months and five years. For further information see the Department of Health website.


Health impact assessment for sub-Saharan Africa

The potential impact of pandemic (H1N1) 2009 on the least developed countries of sub-Saharan Africa is the subject of an HPA report [4] that considers the special vulnerability of populations in the region to severe disease outcomes consequent to widespread pandemic influenza transmission. It notes that while many countries in the region have yet to experience any significant pandemic activity, "it seems feasible that the pandemic virus will spread through sub-Saharan Africa at some point in the near future, possibly following seasonal influenza patterns with increased activity during the next rainy season" .

This modelling and risk assessment of the potential effects of pandemic (H1N1) influenza 2009 in sub-Saharan Africa was commissioned by the UK Government in response to the immediate needs of UNSIC in preparing for the needs of developing countries for the next wave of the pandemic. The purpose of this report is, given the current evidence base, to assess the impact of pandemic (H1N1) 2009 on the least developed countries in sub-Saharan Africa and to estimate the possible impact of the pandemic on progress towards achieving the health related Millennium Development Goals. T he report notes that surveillance systems are weak in many parts of Africa and that there are little data on the impact of the pandemic in the region. The limited evidence base that is available (including comprehensive data from South Africa obtained during the southern hemisphere winter) is used as the basis for extrapolations from data collected in developed countries.

The focus of the report was on  the Millennium Development Goals related to childhood and maternal mortality in the least resourced countries of sub-Saharan Africa whilst taking into account co-morbidities such as HIV/AIDS and TB in addition to the overall poorer health outcomes seen in populations throughout this region. In developed countries, pregnancy has been found to be a significant risk factor for complications and death due to the pandemic strain of influenza currently circulating.  For developing countries, this will result in a higher maternal mortality rate during the pandemic period.  It is possible that the impact of the pandemic could increase the maternal mortality rate, during the pandemic, to a level not seen for 15 to 20 years.  Pandemic (H1N1) 2009 has had the greatest impact on children in developed countries and it is likely that this will remain the case in the developing world.  People of all ages with HIV/AIDS and TB will also be at greater risk should they be infected with pandemic influenza. 

The recommendations proposed by the authors stress the importance of urgently addressing the need to share information between countries.  As the next influenza season begins, studies to monitor the impact of the disease on these populations must be proactively developed and ready for immediate implementation.  Access to vaccine, antivirals and antibiotics for those who most need them should be enhanced.  The authors urge that steps should be taken to build the necessary surveillance infrastructures in these countries.  Reliable surveillance systems are crucial to provide a better understanding of current and future health threats due to influenza as well as other emerging diseases.

The report concludes that pandemic contingency planning should take account of 100-200 deaths per million population potentially occurring in sub-Saharan Africa, compared with the 10 deaths per million seen in developed countries. More specific conclusions are reached relating to mortality rates in pregnant women, children, and patients with TB and HIV/AIDS.

References

1. WHO. Update no. 86 of 5 February 2010 (http://www.who.int/csr/don/en/).

2. HPA. Weekly National Influenza Report: week 5 (4 February 2010, PDF 462 KB), HPA website: www.hpa.org.uk/swineflu/surveillance&epidemiology.

3. Department of Health Central Alerting System. Pandemic H1N1 (2009) Influenza, 27 January 2010.

4. HPA Global Health. "Assessment of the impact of pandemic (H1N1) 2009 influenza in sub-Saharan Africa", produced with the help of the South Africa National Institute for Communicable Diseases, the Medical Research Council Centre for Outbreak Analysis and Modelling at Imperial College London and the London School of Hygiene and Tropical Medicine, 30 January 2010. Downloadable at: http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1256639797918?p=1254510470266