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Volume 4 No 34; 27 August 2010

Increase in Salmonella Java in England

The HPA Laboratory of Gastrointestinal Pathogens (LGP) has confirmed 67 fully-sensitive human cases of Salmonella Java phage type 3B variant 9 (PT3B Var9) infection in England (with LGP receipt dates between 27 July and 26 August 2010).

Those affected range from three to 98 years old with 48% of all cases aged between 20-39 years and 69% of cases female. Cases have occurred in seven of the 10 HPA regions in England and Wales, with most cases occurring in the East of England (43%), London (17%) and the South East (15%). At least nine cases have been admitted to hospital; no deaths have been reported.

Salmonella enterica Paratyphi B variation Java causes gastro-enteritis in humans through the consumption of contaminated food, but it can also be invasive, producing typhoid-like clinical symptoms, and lead to outbreaks.

In response to the increase in cases confirmed in recent weeks, the Gastrointestinal, Emerging and Zoonotic Infections group (GEZI) of the HPA Centre for Infections (CfI) is conducting epidemiological investigations to generate hypotheses for disease transmission.

Between 20 and 24 August, 12 confirmed cases were interviewed at length using a detailed standardised trawling questionnaire; analysis of the data collected identified a number of common (67%) exposures. On the basis of this evidence, a case-control study to examine the exposure to these risk factors is under way.

Lymphogranuloma venereum (LGV) information campaign launched by Terrence Higgins Trust

The substantial rise in diagnoses of LGV seen over the winter of 2009/10 [1] in United Kingdom and Republic of Ireland has been sustained into the first half of 2010. Around 40 diagnoses a month are now being made, with 256 diagnosed in 2010 to the end of June. Virtually all diagnoses were seen in HIV-positive white men who have sex with men (MSM), presenting with proctitis, some of whom have a large number of sexual partners. The cases are geographically dispersed although the epidemic is focused on London and, to a lesser extent, Brighton and Manchester.

Behavioural modification is a key component to the control of LGV and the Terrence Higgins Trust, in collaboration with the HPA, the British Association for Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA), recently launched new information leaflet aimed at increasing awareness amongst MSM [2]; the leafelt contains information on disease presentation, transmission, how to avoid infection and where to obtain testing and advice, and has been targeted at attenders at genitourinary medicine services.

A short THT report for health professionals recording how the infection has emerged in Europe since 2003 and describing its clinical features – symptoms, its three-stage progression, treatment, etc – is also available [3].

References

1. HPA. Substantial increase in cases of Lymphogranuloma venereum (LGV) in UK. Health Protection Report 4(8) (26 February 2010).

2. LGV: a new infection affecting gay and bisexual men. (leaflet for MSM). Available at: http://www.tht.org.uk/
informationresources/publications/gaymengerneralinformation/lgvleafletclinics0125201.pdf.

3. LGV Lymphogranuloma Venereum (report for health professionals) Available at: http://www.tht.org.uk/informationresources/
publications/gaymenshealthpromotion/lgvsectorsummaryreport.pdf.

Confirmed measles cases in England and Wales in 2010: update to end-July

The number of measles cases confirmed in England and Wales with onset in July was 83 bringing the total for the year so far to 208 (table). The increase of cases in July was associated with several events attended by members of the travelling communities. There is also evidence of increase of number of cases outside these communities in at least four areas in the country.

The majority of cases were reported from four regions, London (27%; 57/208), South East region (23%; 48/208), East of England region (20%; 41/208) and North West region (14%; 29/208) (table).

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

Confirmed cases of measles by region and month of onset, England and Wales:
January 2010 to July 2010

Month/ year

Lond'n

East Mids.

Eastern

North East

North West

South East

South West

West Mids

Wales

York & Hum

Total

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

Apr-10

7

–

2

–

5

2

1

–

3

–

20

May-10

28

2

13

1

5

4

1

–

2

1

57

Jun-10

3

–

13

1

10

4

1

–

–

3

35

Jul-10

18

4

9

–

9

32

–

2

–

9

83

Total 2010

57

6

41

2

29

48

5

2

5

13

208

 

Number of laboratory confirmed cases in England and Wales by month of onset:
January 2006 to July 2010


Sixth annual review of infections in UK blood/tissue donors and transfusion recipients

The NHS Blood and Transplant (NHSBT)/Health Protection Agency (HPA) Centre for Infections Epidemiology Unit runs a series of national schemes which provide epidemiological information about bloodborne infections in blood, tissue and cell donors in the UK and the associated risk of transmission via transfusion or transplantation, in order to inform donor selection practices and public health.

The NHSBT/HPA Epidemiology Unit's sixth annual review [1] presents national data for 2009 from all the schemes run by the Unit, and aims to describe the data collected and any trends observed. In addition the report includes the most recent estimated risks of current donation testing strategies not identifying an infectious donation. Information about antenatal samples tested by NHSBT is also presented.

Key information in the 2009 report includes: HBV was the most frequently detected infection in blood donations in 2009 with a significant increase in the number of repeat donors testing positive following the introduction of HBV Nucleic Acid Testing (NAT) in April 2009. However, the overall numbers testing positive remained small.

HTLV was the least frequently detected infection in 2009, but was at its highest frequency since HTLV testing was introduced in 2002: Three HTLV co-infections were also detected in 2009.

Up to date estimates for the residual risk of a viral infection entering the blood and tissue supply, despite donor testing, are included and show that the probability of acquiring hepatitis B, hepatitis C, HIV or HTLV via blood transfusion was very low between 2007 and 2009.

The frequency of infection among surgical bone donors and deceased donors declined in 2009 compared to 2008. There was a small increase in the frequency of infection among cord blood donors in 2009 (four positive donors were identified compared to three in 2008).

The frequency of infection is generally higher in tissue and cell donors as compared to blood donors. This reflects demographic differences between the tissue, cord blood and blood donor populations as well as the ways in which donations are collected.

There were two confirmed reports of bacterial transfusion transmitted infection (TTI) in 2008, involving the transmission of infection to a total of two recipients. There were no confirmed reports of a viral TTI for the fourth consecutive year.

The proportion of antenatal samples tested by NHSBT that were positive for HBsAg declined in 2009 but remained the most frequently detected marker of infection. The frequency of samples reported as negative for rubella antibodies (anti-rubella levels <10IU/ml) increased again in 2009 to 3.4% of all samples tested.

Data from the transfusion-transmitted infection surveillance scheme form part of the UK haemovigilance scheme known as SHOT ("Serious Hazards of Transfusion", http://www.shotuk.org) which aims to build an evidence base on transfusion hazards.

The 2009 annual review additional data (available in slide set and pdf format) [2] and information about the unit's data sources and collection methods [3] are available from the Bloodborne Infections in Blood and Tissue Donors (BIBD) pages of the HPA website and surveillance data are published periodically in the Health Protection Report.

References

1. Safe supplies: testing the nation. Annual review from the NHS Blood and Transplant/HPA Centre for Infections Epidemiology Unit, 2009. Available from the HPA website at Topics >Infectious Diseases >Reference Library >BIBD References and Publications, http://www.hpa.org.uk/infections/topics_az/BIBD.

2. Supplementary data tables, Annual review from the NHS Blood and Transplant/HPA Centre for Infections Epidemiology Unit, 2009. HPA website: BIBD References and Publications.

3. NHS Blood and Transplant/Health Protection Agency Epidemiology Unit: data sources and methods (August 2010). HPA website: BIBD References and Publications.