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Volume 4 No 17; 30 April 2010

HPR Home | Archives | 2010 news

• Polio outbreak in Tajikistan
  
  
• Confirmed measles cases in England and Wales – update to end-March 2010
  
  
• HSL report on factors affecting use of RPE in the workplace
  
  

Polio outbreak in Tajikistan

The World Health Organization Regional Office for Europe has confirmed an outbreak of polio in the south west region of Tajikistan [1-3].

As of 28 April 2010, 171 cases of acute flaccid paralysis (AFP) had been reported, the majority with onset of paralysis within the previous two weeks, although cases have been reported since December 2009. Eighty percent of cases are in children less than five years of age [3]. Twelve deaths had been reported, 10 in children under 15 years of age and two in adults.

Poliovirus type 1 (most closely related to a poliovirus isolated in Uttar Pradesh in India) has been isolated from 32 AFP cases; these are the first cases to be confirmed in the WHO European region since the region was declared polio-free in 2002. A region is certified as polio-free if no indigenous poliomyelitis cases are identified for a period of more than three years despite enhanced AFP surveillance (AFP surveillance requires the reporting and investigation of all cases of AFP in children under the age of 15). Pending the confirmation of autochthonous transmission in the current outbreak in Tajikistan, the European Region's polio-free status may need to be re-evaluated [4].

The last clinical case of polio reported in Tajikistan was in 1997 and the last virologically confirmed case was in 1991. So far all cases have been reported from the south west of Tajikistan which borders Afghanistan (still endemic for polio) and Uzbekistan. Twenty -three cases of AFP have also been reported in Uzbekistan, but so far polio virus has not been isolated from these cases.

ECDC considers the risk of spread of polio within the European Union (EU) as very limited. High levels of vaccination coverage with three doses of polio vaccine are needed to ensure that re-introduction into the EU will not occur [4]. Technical experts from the WHO are in Tajikistan to support the health authorities in the investigation and response to this outbreak. The governments of surrounding countries (Kazakhstan, Kyrgyzstan, Turkmenistan and Uzbekistan) have also been alerted by WHO to intensify surveillance for AFP and to rapidly plan and conduct national polio vaccination campaigns.

The National Travel Health Network and Centre (NaTHNaC) recommends that those travelling to Tajikistan from the UK should have completed their primary vaccination course against polio. In addition, they should receive a booster dose of a polio-containing vaccine if they have not received one in the last 10 years [5].

NaTHNaC also recommends that travellers to countries endemic for polio or that have had imported cases of polio in the last three years, should receive a booster dose of a polio-containing vaccine if they have not received one in the previous 10 years. These countries can be identified on the NaTHNaC Country Information Pages [6].

Polio is a virus transmitted through food and water. Travellers to areas with ongoing polio transmission should practise strict food and water hygiene measures [7].

More information on polio can be found on the polio and immunisation pages of the HPA website and NaTHNaC health information sheet on polio [8].

References

1. World Health Organization Regional Office for Europe. WHO responds to polio outbreak in Tajikistan [press release] 23 April 2010 [accessed 28 April 2010]. Available at: http://www.euro.who.int/mediacentre/PR/2010/20100423_1.

2. World Health Organization Regional Office for Europe. Polio situation update from Tajikistan 29 April 2010 [accessed 29 April 2010]. Available at: http://www.euro.who.int/communicablediseases/outbreaks/20100429_1.

3. World Health Organization Country Office Tajikistan, WHO Regional Office for Europe, European Centre for Disease Prevention and Control. Outbreak of poliomyelitis in Tajikistan in 2010: risk for importation and impact on polio surveillance in Europe? Euro Surveill. 2010; 15(17):pii=19558. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19558.

4. European Centre for Disease Prevention and Control (ECDC). Polio outbreak in Tajikistan. 23 April 2010 [accessed 28 April 2010]. Available at: http://ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f%2D77d4%2D4ad8%2Db6d6%2Dbf0f23083f30&ID=788&RootFolder=%2Fen%2Factivities%2Fsciadvice%2FLists%2FECDC%20Reviews

5. National Travel Health Network and Centre (NaTHNaC). Wild type polio outbreak in south-west Tajikistan. Clinical update 27 April 2010 [accessed 28 April 2010]. Available at: http://www.nathnac.org/pro/clinical_updates/polio_tajik_270410.htm.

6. NaTHNaC website. Country information pages. Available at: http://www.nathnac.org/ds/map_world.aspx.

7. NaTHNaC information sheet on food and water hygiene. Available at: http://www.nathnac.org/pro/factsheets/food.htm.

8. NaTHNaC information sheet on polio. Available at:http://www.nathnac.org/pro/factsheets/polio.htm.

Confirmed measles cases in England and Wales – update to end-March 2010

Only 13 cases of measles with onset dates between January and March 2010 have been confirmed in England and Wales. All were from the southern half of England with six cases identified in the South East region, four in the East of England, two in the South West region and one in London (see table).

Nine of the 13 cases were associated with travel abroad (Ireland (3), India (2), France (2), Italy, and Ethiopia). In addition, a further two cases without any travel history were identified to have measles virus strains not previously seen in the UK, suggesting contact with someone who has been infected abroad, although no contact was identified. None were known to have been vaccinated.

Six of the cases so far this year have been in adults over 20 years of age, including a healthcare worker who has been identified as non-immune in occupational health screening.

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
Jan 10	-	-	-	-	-	-	-	-	-	-	-
Feb 10	-	-	2	-	-	3	-	-	-	-	5
Mar 10	1	-	2	-	-	3	2	-	-	-	8
Total 2010	1	-	4	-	-	6	2	-	-	-	13

An age breakdown of cases for 2010 to the end of March by region is available at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1223019390211.

HSL report on factors affecting use of RPE in the workplace

The Health and Safety Laboratory (HSL) has published the findings of a qualitative study of respiratory protective equipment (RPE) programmes in operation across a number of UK industries, covering: how RPE was selected and used, whether selection and use was in line with best practice and what factors influenced choice and implementation of RPE programmes [1].

Considerable variation was found in RPE programmes across the participating companies, just under half of the participating companies being classified as "proficient", the majority needing to make improvements. A common failing was an over-reliance on workers' common sense to use RPE correctly. The study also found that the majority of participating companies, even some of those classed as proficient, needed some improvement in the areas of management and worker knowledge (especially awareness and understanding of respiratory risks and on general RPE issues, such as the need for fit testing) and knowledge of ongoing monitoring, storage and maintenance requirements (substandard maintenance was a recurring theme).

The research was commissioned to assist in improving the control of respiratory risks across industry, a need for research to understand the behavioural aspects associated with managers' selection and implementation of RPE programmes having been identified. Previous HSE research and anecdotal evidence gathered by HSE inspectors had indicated: a large number of UK employees potentially at risk of developing respiratory disease and a general lack of awareness and concern for respiratory risks amongst employees (for example, in welders - who believed the risks involved to be less significant than that of burns/heat [2] - and poultry farm workers [3]). Organisational-level RPE failings (eg incorrect respirators, lack of training for employees on correct use) have also been identified. A study carried out to develop baseline intelligence on exposure and the control of respirable crystalline silica in key industry sectors found a general need to improve risk assessments. Where RPE was relied upon as a form of exposure control, it required better organisational processes and procedures in place, namely, selection, training, cleaning and maintenance of equipment [3,4].

The research was part of the Executive's RPE Project that aims to reduce respiratory disease by targeting industries, sectors, occupations and processes where there is a risk of respiratory disease. The project involves partnerships with industry to secure good practice in the selection, use and maintenance of RPE.

Although funded by the HSE the report's conclusions do not necessarily reflect HSE policy.

The participating companies [4] were classified into four groups by the authors of the study: learners - companies without fully effective RPE practices, managers in the process of establishing a formal RPE programme; developers - companies with systems in place, and generally aware of what they need to do, but still some way to go with implementation of their RPE programme; the fortuitous - companies with workers protected from respiratory hazards despite a significant RPE knowledge and skills gap at managerial level and the absence of a structured RPE programme; and the proficient - companies with a fit-for-purpose RPE programme, and managers with an acceptable level of RPE competence.

References

1. Bell N, Vaughan N and Hopkinson J (Health and Safety Laboratory) (2010). Factors influencing the implementation of RPE programmes in the workplace (HSE research report 798). Available at: http://www.hse.gov.uk/research/rrhtm/rr798.htm.

2. Murphy O, Alty J, Brown H and Brewer A (2008). Welders attitudes to health and safety - Qualitative research report. Diagnostics social and Market Research, prepared for the COI and HSE.

3. Hopkinson J and Cummings R (2007). Audience scoping study to inform communications with poultry farm workers. HSE report (RSU/08/07).

4. Easterbrook A (2008). Silica baseline survey: summary project report. HSL report (OH/2008/26).

5. Sectors involved were: construction, brick making, quarries, foundries, manufacturing of composite components, metal fabrication and stone masonry. The authors note that the findings were indicative of what might be happening within a particular sector, rather than being a full picture, and that they should only be applied to other industries/sectors with caution.