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Volume 4 No 13; 1 April 2010

Independent review of UK response to pandemic (H1N1) 2009


A strategic and independent review has commenced into the UK response to the 2009 “swine flu” pandemic, involving all four UK administrations [1].

Dame Deidre Hine, a former Welsh chief medical officer, is chairing the review and is scheduled to report to ministers before the summer parliamentary recess. The review will cover the key elements of the response and include interviews with a number of key individuals involved. The HPA will be making active contributions to various elements of the response and will be submitting a number of supporting documents and reports produced during the pandemic.

The review’s findings will be used to inform future planning for pandemics and help ensure that UK government plans remain robust enough to deal with potentially more virulent pandemics in the future.

Although pandemic (H1N1) 2009 infection continues to be present in the UK, it is at its lowest levels since the pandemic was declared in May 2009 [2]. Since then, globally, the WHO estimates there have been at least 16,813 deaths from the pandemic. In the UK, 457 confirmed pandemic-related deaths have been reported to date.


References

1. “Reviewing the UK pandemic response”, Department of Health press release, 25 March 2010.

2. Influenza A/H1N1 (“swine-lineage”): UK situation at 1 May 2009. Health Protection Report 3(17), 1 May 2009.

Announcement of new Clostridium difficile objective

Clostridium difficile is a healthcare-associated infection of major importance with around 30,000 infections being reported annually. Data published by the Health Protection Agency in June 2009 [1] confirmed the early achievement of the Department of Health’s target to reduce C. difficile infection by 30%, which was achieved between financial years 2007/8 and 2008/9. Despite this rapid progress in achieving reductions, there remains a large variation in the numbers of infections between the best and worst performing organisations.

To encourage further progress in the achievement of further reductions in C. difficile infections, the Department of Health has announced a new performance standard: an objective that will be implemented from April 2011 [2].

The methodology for the objective was published on 29 March 2010 [3]; it will apply to Primary Care Trusts (PCTs) as a population-based rate, and to acute trusts as a bed-day rate of trust-apportioned cases. The apportioning of cases to acute trusts is based on the timing of when a specimen was taken and where the patient was located.

The objective is a sliding scale that will require the worst performing acute trusts and PCTs to make the greatest improvement in reducing infection rates while requiring all organisations to make some reductions. The baseline will be calculated later in 2010 and, from this, the extent of the reduction required by each organisation individually will be calculated and published towards the end of the year.

Reference

1. MRSA bacteraemia, and Clostridium difficile mandatory reports, HPR 3 (24).

2. "Health secretary Andy Burnham announces a new C. difficile objective will be introduced to drive down infections and ensure that all NHS organisations strive towards the level of the very best", DH press release, 29 March 2010.

3. DH National Update: C. difficile methodology, 29 March 2010.

Non-executive appointments to HPA board

The Health Protection Agency's Board has announced the appointment of three new non-executive members, and the re-appointment of the current deputy chairman, Professor Charles Easmon, with effect from 1 April 2010.

The appointments, made by the Appointments Commission's Health and Social Care Appointments Committee, are for a period of three years.

The new non-executive Board members are: Dr Tim Wyatt, who will be the Board's Northern Ireland representative; Dr Dipti Patel, an occupational physician; and Professor William Gelletly, who has previously held the role of Advisor to the Board.

Professor Charles Easmon CBE, MD, PhD, MRCP, FRCPath, FMedSci is visiting professor in the Division of Surgery at Imperial College. He trained as a microbiologist and was Fleming Professor and head of the department of medical microbiology at St Mary's Hospital Medical School.

Professor William Gelletly OBE, PhD, CPhys, FInstP held the role of Advisor to the HPA Board before being appointed non-executive director and is emeritus professor of physics at the University of Surrey; he was previously head of the Physics Department and head of the School of Physical Sciences at Surrey. He is a member of a number of international committees concerned with nuclear physics.

Dr Dipti Patel MBBS MRCGP MFOM LLM MFTM RCPS (Glasg) is director of clinical services for the Medical Advisory Service for Travellers Abroad and is clinical advisor to the Statutory Committee of the Royal Pharmaceutical Society of Great Britain. She also holds the post of specialist occupational health physician for both a branch of the Ministry of Defence and the Foreign and Commonwealth Office. Her previous roles include consultant occupational health physician at the BBC and honorary clinical senior lecturer in occupational medicine at Kent Institute of Medicine and Health Sciences.

Dr Tim Wyatt B.Tech, PhD, CBiol, FIBiol, FRCPath, MIHM is consultant clinical microbiologist at both Belfast Health and Social Care Trust and the Public Health Agency (formerly Communicable Diseases Surveillance Centre NI). He also advises the National Institute of Health Research Investment for Innovation, is a member of the CJD Incidents Panel and is already familiar with the HPA as a member of the Agency's Laboratory Exposures Task Force. Dr Wyatt was scientific adviser to the Chief Medical Officer of Northern Ireland in addition to his present consultant clinical microbiology roles.

European Legionnaires’ Disease Surveillance Network established


From 1 April 2010, the European Surveillance Scheme for Travel-associated Legionnaires' Disease (EWGLINET) – established in 1987 and coordinated since 1993 by the Health Protection Agency Centre for Infections in London – will be coordinated and managed by the European Centre for Disease Prevention and Control (ECDC), in Stockholm, Sweden.

Nominated national experts in EU and EAA countries will in future report their travel-associated cases to The European Surveillance System (TESSy), the database established at ECDC for managing European datasets.

Under its new management, the surveillance scheme for EWGLINET has been renamed by ECDC as the European Legionnaires' Disease Surveillance Network (ELDSNet).

The EWGLI website [1] will continue to be maintained by the HPA for the foreseeable future.

All other resources linked to the EWGLINET surveillance scheme and previously available through the EWGLI website – eg access to the European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease [2] – will be transferred to the ECDC website [3].

Further information
E-mail enquiries about the new ELDSNet scheme should be sent to eldsnet@ecdc.europa.eu.

References/links

1. www.ewgli.org.

2. European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease, http://www.ewgli.org/data/european_guidelines.htm.

3. www.ecdc.europa.eu.

BOHRF occupational allergy systematic evidence reviews


Two systematic evidence reviews on occupational allergies - covering asthma (OA) [1] and contact dermatitis and urticaria [2] - have been published by the British Occupational Health Research Foundation. Associated leaflets - summarising the conclusions for, in each case: GPs and practice nurses; occupational health physicians/nurses and safety practitioners; and employers, workers and their representatives) - are due to be published in the near future [3].

The occupational asthma review is an updated version of BOHRF's first evidence review on OA published in 2004. On the strength of that report, the Department of Health introduced two new read codes, prompting GPs with patients of working age presenting with either rhinitis or conjunctivitis (precursors of occupational asthma) to ask what job they do; then prompting the GP with a screen of the jobs most associated with occupational asthma and prompting the GP to refer the patient for serial peak flow measurement. This is the evidence base for practice to give the opportunity to break the cycle of early-stage occupational asthma. The new asthma report reiterates the recommendation regarding serial peak flow measurement, reminding health professionals that occupational factors account for 1 in 6 cases of asthma in people of working age and underlining the importance of early diagnosis, particularly where sensitizers - the most common cause of OA - may be involved. The occupations most commonly associated with OA are: animal handling, baking and pastry making, hairdressing, paint spraying, welding, nursing and jobs in food processing and the chemical and timber industries.

The new BOHRF report on dermatitis was commissioned on the recommendation of the House of Lords Scientific and Technical Committee of Enquiry into Allergy that reported in 2006/7 [4]. It is the first systematic evidence review published anywhere that covers all employment sectors. Key evidence-based recommendations from this review include the need to avoid the promotion of pre-work creams (barrier creams) and, conversely, to actively promote the use of after-work (conditioning) creams. The report also includes important and practical recommendations about glove use.

Baroness Finlay of Llandaff, who chaired the Lords enquiry, introduced the two BOHRF reports at a London conference in March. Other presentations on occupational allergies included research on enzyme sensitisation and evidence-based guidelines for employers faced with the dilemma of whether or not it is safe to employ people who report that they have, or have had, asthma.

Also presented were results of BOHRF-funded research on the testing of a BMJ e-learning module designed to influence GP behaviour in implementing evidence-based guidelines. The e-learning module used the original BOHRF guidelines on occupational asthma (which have been adopted by the Finnish government as their national standard) as a vehicle. The research results clearly demonstrated the difficulty of "reaching" GPs because nearly half of respondents professed never to have heard of the first BOHRF evidence review, despite BOHRF having sent the summary of the evidence to every GP and practice-based nurse in the UK, via their Local Medical Committees.


References

1. BOHRF. Occupational asthma: prevention, identification and management – systematic review and recommendations (review report), 25 February 2010. Downloadable at: http://www.bohrf.org.uk/ [1 MB PDF].

2. BOHRF. Occupational contact dermatitis and urticaria: systematic review and recommendations (evidence review), March 2010. Downloadable at: http://www.bohrf.org.uk/ [500 KB PDF].

3. Further information: admin@bohrf.org.uk

4. House of Lords Select Committee on Science and Technology, 2007. Allergy: Volume 1: report. Downloadable at: http://www.publications.parliament.uk/pa/ld200607/ldselect/ldsctech/166/166i.pdf [740 KB].