News Archives |
Volume 4 No 48; 3 December 2010
- Foodborne outbreaks of campylobacter associated with consumption of poultry liver pâté/parfait – spotlight on caterers and food safety
- Uptake of seasonal influenza vaccine in England
- Interim report on extension of HIV testing to non-traditional settings
An increase in the number of outbreaks of campylobacter infections associated with consumption of poultry liver pâté/parfait prepared and served at hotels and restaurants was reported in 2009 [1, 2] and this increase has continued in 2010 (see figure). Similarly, cases of infection with campylobacter in England and Wales have also continued to increase in 2010, with 10% more cases reported up to week 41 compared to the same period in 2009.
Foodborne outbreaks of campylobacteriosis by year
Despite almost 60,000 laboratory confirmed cases reported during 2009, foodborne outbreaks of infections are relatively rarely reported. Of 16 foodborne outbreaks of campylobacter infection reported to the HPA electronic Foodborne and non-Foodborne Gastrointestinal Outbreak Surveillance System (eFOSS) in 2010, 15 were associated with catering premises and one with a school, and a total of 357 people were affected with nine hospitalised. Eleven of the outbreaks at catering premises were linked to poultry liver parfait or pâté consumption (ten prepared from chicken livers and one from duck livers) and occurred in five regions of England (East of England, North East, North West, South East, and South West). Eight of these were linked to hotels, with four associated with catering at weddings, two to restaurants and one to a club.
Campylobacter is the principal cause of bacterial gastroenteritis in the United Kingdom and control in poultry meat is a major public health strategy for the prevention of campylobacteriosis [3]. Poultry livers carry a high risk of campylobacter contamination as the bacteria can be present throughout the liver, and may remain as a source of infection if insufficiently cooked [4]. Evidence gained from outbreaks during 2010 revealed that, as in 2009, livers used to make the parfait or pâté were deliberately undercooked allowing the liver dish to remain pink in the centre. Cooking errors included inadequate cooking of livers through searing or sealing, using a bain-marie in an oven, or using a food processor that blends and cooks simultaneously. The Food Standards Agency issued updated advice to caterers on the safe handling and cooking of livers in July 2010, ie livers should be thoroughly cooked before consumption (to a core temperature of 70°C for at least two minutes or equivalent using a meat thermometer to check the core temperature) [5]. However, half of the campylobacter outbreaks associated with consumption of poultry liver pâté/parfait in 2010 occurred after the issue of this advice.
Evidence from HPA eFOSS shows that from 1992 to 2009 a greater proportion of campylobacter outbreaks linked to consumption of poultry liver pâté/parfait occurred during December compared to all other months combined (50% v 19%, P =0.013) [2]. December is the month that most people eat out either with friends and family, or going to parties. Poor practice regarding handling and cooking of liver and other offal presents an unacceptable level of risk to the consumer. Chefs and other caterers can reduce the risk of their customers becoming infected by ensuring that campylobacter is killed through proper cooking and avoiding contamination of ready-to-eat foods from raw poultry and liver and other offal.
The Food Standards Agency (FSA) is reissuing its advice to remind caterers about safe cooking and handling of chicken liver products such as pâté and parfait in the build-up to the festive season [6]. The FSA is also liaising with the catering industry and the British Hospitality Association to raise awareness of the potential risks associated with the mishandling or undercooking of chicken livers.
References
1. Health Protection Agency. Food-borne outbreaks of Campylobacter (associated with poultry liver dishes) in England. Health Protection Report 2009; 3(49); news. Available at: http://www.hpa.org.uk/hpr/archives/2009/news4909.htm#campclp.
2 Little CL, Gormley FJ, Rawal N, Richardson JF. A recipe for disaster: Outbreaks of campylobacteriosis associated with poultry liver pâté in England and Wales. Epidemiol Infect 2010; 138: 1691-4.
3 Food Standards Agency. Food Standards Agency Consultation. Foodborne Disease Strategy 2010-15. London: FSA, 2010. Available at: http://www.food.gov.uk/multimedia/pdfs/consultation/foodbornediseasestrategyeng.pdf
4. Whyte R, Hudson JA, Graham C. Campylobacter in chicken livers and their destruction by pan frying. Letters in Applied Microbiology 2006; 43: 591-5.
5. Food Standards Agency. Caterers warned on chicken livers. 28 July 2010. London: FSA, 2010. Available at: http://www.food.gov.uk/news/newsarchive/2010/jul/livers.
6. Food Standards Agency. FSA reminds caterers about safe preparation of chicken livers. 3 December 2010. London: FSA, 2010. Available at http://www.food.gov.uk/news/newsarchive/2010/dec/liver.
Uptake of seasonal influenza vaccine in England
Vaccine surveillance data show that the uptake of seasonal influenza vaccine in England [1] in eligible groups is lower compared to the same period in 2009 (see table).
Seasonal influenza vaccine uptake at GP surgeries in England: cumulative data to end of October 2010* and 2009| Group | Under 65 years in a risk group |
65 years and over |
||
| Year |
2010 |
2009 |
2010 |
2009 |
| % uptake | 26.3* |
31.1 |
47.5* |
54.4 |
The Director of Immunisation at the Department of Health has written to all NHS colleagues asking for further help to improve the seasonal flu vaccination coverage [2]. Improving seasonal flu vaccine uptake will ensure more vulnerable people are protected. A factsheet for health professionals is included with the letter covering the main issues that have been raised by patients and health professionals.
Seasonal flu vaccine uptake in healthcare workers also remains disappointingly low and Trusts are asked to use the lessons learnt from the recent H1N1 (2009) pandemic to increase seasonal flu vaccination in this group. Vaccinating healthcare workers reduces the risk of transmitting the virus to vulnerable patients as well as offering individual protection.
References
1. Seasonal influenza: immunisation programme for 2010/11. Health Protection Report 2010; 4(22): news. Available at http://www.hpa.org.uk/hpr/archives/2010/news2210.htm#cmo (accessed 02 December 2010).
2. Uptake of the seasonal influenza vaccine. London: Department of Health, 2010. Gateway reference 15154. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/
Lettersandcirculars/Dearcolleagueletters/ DH_121934 (accessed 02 December 2010).
Interim report on extension of HIV testing to non-traditional settings
A review of the interim results of projects that aimed to assess the feasibility, acceptability and effectiveness of extending the scope of the routine offer of an HIV test to non-traditional settings is the subject of a new HPA report [1].
Extending the scope of routine HIV testing - at present offered to all patients attending antenatal clinics and sexually transmitted infection (STI) clinics - was recommended by the Chief Medical Officer for England in 2007 [2]. In 2008, UK guidelines on HIV testing in high-prevalence areas, issued by BHIVA-BASHH-BIS [3], recommended the extension of routine testing to all adults registering in general practice and to all general medical admissions in high-prevalence areas.
More recently, the effectiveness and acceptability of extending the routine offer of a test beyond STI and antenatal clinics has been the subject of eight Department of Health-funded pilot projects begun in 2009. The interim results of these pilots, now published by the HPA [1], have provided evidence that the recommended extension is acceptable to both patients and healthcare staff and is effective in detecting individuals with previously undiagnosed HIV infections.
A final report on the eight pilot projects is due to be produced in early 2011. In the meantime, the HPA's interim report reiterates that HIV testing in primary care and general medical admissions should be prioritised in high-prevalence areas, and among most at-risk populations, in order to reduce late diagnoses and the extent of undiagnosed infection.
It also recommends that efforts should be directed at improving uptake of HIV testing among those attending STI clinics, and at maintaining the high uptake of HIV testing among women attending for antenatal care. Furthermore, e conomic evaluations, including cost-effectiveness studies, are needed to determine the best strategies for expansion of HIV testing in different healthcare and community settings.
References
1. Time to test for HIV: Expanded healthcare and community HIV testing in England, 30 November 2010. Available from HPA website: Publications > Infectious diseases > HIV and sexually transmitted infections.
2. Improving the detection and diagnosis of HIV in non-HIV specialties including primary care, 2007. Chief Medical Officer, Department of Health, 2007.
3. New guidelines on HIV testing in high-prevalence areas [British HIV Association (BHIVA), the British Association for Sexual Health and HIV (BASHH) and the British Infection Society (BIS)], 2008. HPR 2(38), http://www.hpa.org.uk/hpr/archives/2008/news3808.htm#sophid.