News Archives |
Volume 4 No 18; 7 May 2010
Anthrax cases in IDUs in the UK – an update (2)
Since the first case was reported in Glasgow in December 2009, cases of anthrax in heroin users have continued to occur [1]. To date there have been 42 confirmed cases of anthrax in heroin users in the UK, 14 of which were fatal.
Thirty-nine cases have been reported in Scotland (from eight Health Boards) and three in England (two in London and one in Blackpool). No cases have yet been reported from Wales or Northern Ireland. Updates on cases reported in Scotland are published on the Health Protection Scotland website [2] and numbers of cases confirmed in England are published on the HPA website [3].
As cases continue to be diagnosed it is clear that contaminated heroin is still in circulation. Clinicians and microbiologists are encouraged to remain alert to the possibility of anthrax in heroin users with appropriate signs and symptoms. Guidance on the investigation and management of cases - including advice on clinical presentations, control of infection, and laboratory investigations - has been developed with Health Protection Scotland and is available on the HPA website [3].
References
1. Anthrax cases in IDUs in Scotland, Health Protection Report 4(1). Available at: http://www.hpa.org.uk/hpr/archives/2010/news0110.htm#anthrx.
2. Health Protection Scotland website. http://www.hps.scot.nhs.uk/anthrax/index.aspx.
3. HPA website. Topics › Infectious Diseases › Infections A-Z › Anthrax › Anthrax: information on 2010 outbreak, http://www.hpa.org.uk/HPA/Topics/InfectiousDiseases/InfectionsAZ/1265637163487.
Occupational cancer in Great Britain
To date, estimates of the burden of occupation on cancer mortality in the UK have been largely based on historical US data [1]. A current Health and Safety Executive-sponsored research project aims to produce an updated estimate of the current burden of occupational cancer specifically for Great Britain (together with an estimate of the future burden based on recent and current exposures, and a method for updating this in future).
A second report generated by this project has been published [2], representing a first attempt at a detailed quantification of the burden of cancer due to occupation specifically for GB. The estimation was carried out for occupational exposures classified by the International Agency for Research on Cancer (IARC) as group 1 (established) and 2A carcinogens (probable).
Whereas Doll and Peto concluded in 1981 that 4% of all US cancer deaths might be attributable to occupation (with an uncertainty range of 2% to 8%), the key conclusions of the new research are that, of cancer deaths in GB, 5.3% (8023) were attributable to occupation in 2005 (men: 8.2% (6,366); women 2.3% (1,657)). Attributable estimates for total cancer registrations were 13,694 (4.0%). Occupational attributable fractions were over 2% for mesothelioma, sinonasal, lung, nasopharynx, breast, non-melanoma skin cancer, bladder, oesophagus, soft tissue sarcoma and stomach cancers.
Asbestos, shift work, mineral oils, solar radiation, silica, diesel engine exhaust, coal tars and pitches, occupation as a painter or welder, dioxins, environmental tobacco smoke, radon, tetrachloroethylene, arsenic and strong inorganic mists each contributed 100+ registrations. Of cancer registrations in men, 56% were attributable to work in the construction industry (mainly mesotheliomas, lung, bladder and non-melanoma skin cancers) and 54% of cancer registrations in women were attributable to shift work (breast cancer).
The authors refer to several sources of uncertainty in the estimates, including exclusion of other potential carcinogenic agents, inaccurate or approximate data and methodological issues. However, on balance they conclude that the conclusions are likely to be a conservative estimate of the total attributable burden. Forthcoming reports from the research will present the results for: estimates of disability-adjusted life years, methods to predict future estimates of the occupational cancers with examples based on important hazards, and the results of sensitivity analysis of these estimates to sources of uncertainty and bias.
The research was funded by the HSE but opinions and/or conclusions expressed in it are those of the authors alone and do not necessarily reflect HSE policy.
References
1. In particular, the estimates of Doll and Peto, initially in their report to the US Congress in 1981. In a more recent overview of the epidemiology of cancer, Doll and Peto suggested it is unlikely that occupational hazards account for more than two or three per cent of all fatal cancers in developed countries such as the UK, but that that estimate could be out by a factor of two. See: Doll R and Peto R, The epidemiology of cancer. In: Oxford Textbook of Medicine (fourth edition), 2003.
2. Rushton L, Bagga S, Bevan R, Brown TP, Cherrie JW, Philip Holmes P, et al (2010). The burden of occupational cancer in Great Britain - overview report (HSE Research Report 800). Available at: http://www.hse.gov.uk/research/rrhtm/rr800.htm (3.5 MB PDF).