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Volume 5 No 4; 28 January 2011

HPA launches Migrant Health Guide

A new online resource for primary care practitioners who look after patients who have come to live in the UK from abroad has been launched by the Health Protection Agency [1].

The majority of the half-million migrants who arrive in the UK annually [2], mostly young adults who come to work or study, have a similar risk profile to that of the indigenous UK population. Some however have increased health needs, for example related to their country of origin or their experiences before, during and after migration.

The HPA Migrant Health Guide (www.hpa.org.uk/migranthealthguide), a discrete sub-site within, and significant addition to, the main Agency website, brings together information likely to be required by GPs and nurses when they assess or treat such patients. It recognises that although most migrants are healthy, the major burden of some infections reported in the UK (eg TB, HIV, malaria, enteric fever and chronic hepatitis B) falls on those who are non-UK born and come from countries with a high incidence of these infections [3,4].

The online resource aims to support primary care practitioners in their key role of recognising and managing a range of different health issues that may affect some migrant patients. Guidance is provided to assist with the diagnosis and treatment of relevant infectious diseases, and non-infectious health issues (such as nutritional deficiencies, anaemia, and mental health) are also covered.

The principal parts of the 700-page Migrant Health Guide website are as follows:
  • a General Information section that includes: a site guide, and a page explaining migrant entitlements to medical, dental and hospital care in the NHS. This section also covers language interpretation, cultural competence, religion and identification of particularly vulnerable migrants;
  • a Countries A-Z section comprising more than 100 country-specific sub-sections, each arranged in five pages covering: a country home page (with key country-specific messages, language details, etc) and four further pages concerned with children's and women's health, infectious diseases and nutritional/metabolic concerns, respectively;
  • a Health Topics section divided into two areas: Infectious Diseases and Other Health Concerns;
  • an Assessing Migrant Patients section which comprises two aspects: assessing the needs of new migrant patients, and assessing patients with symptoms, which includes, for example, algorithms to assist practitioners in the initial management of symptomatic migrant patients (covering dermatology, diarrhoea, fevers, respiratory disease, etc).

The Migrant Health Guide has been developed with input from many individual primary care practitioners and has been endorsed by both the Royal College of General Practitioners and the Royal College of Nursing. It is intended for use by busy practitioners during a 10-minute consultation and ultimately aims to address the health needs of migrants to the UK promptly and effectively by supporting the practitioners who care for them.

The HPA welcomes feedback on the site (to: tmhs@hpa.org.uk), especially suggestions for improvement so that it may evolve according to practitioner needs and to reflect global movements of people in the future.

References

1. “New online resource launched to help GPs and nurses care for migrant patients”, HPA press release, 26 January 2011.

2. Office for National Statistics: Migration Statistics 2009. Available at: http://www.statistics.gov.uk/pdfdir/miga1110.pdf.

3. HPA: Migrant health: infectious diseases in non-UK born populations in England, Wales and Northern Ireland: a baseline report – 2006 (November 2006).

4. HPA: Foreign travel-associated illness – a focus on those visiting friends and relatives: 2008 report. HPA website: Home › Publications › Infectious diseases › Travel health.

High vaccine coverage maintained in second year of Human Papillomavirus (HPV) immunisation programme

A joint Department of Health and HPA annual report evaluating HPV vaccine coverage in England during the second year of the immunisation programme has been published by the Department of Health [1]. Seventy-six percent of the routine cohort, females aged 12-13 years, completed the three-dose course of HPV vaccine during the 2009/2010 academic year. During 2009/2010 an additional four school years (females aged 14-18 years) were targeted in an accelerated catch up campaign [2] with the highest coverage achieved in the youngest cohorts (see table) .

During the first two years of the HPV programme over 60% of all females born between 1 September 1990 and 31 August 1997 completed the three-dose course of HPV vaccination (see table). This is expected to increase over the coming years.

Routine and catch-up HPV vaccine coverage in England for 2009/10 and total coverage for all cohorts in 2008/09 and 2009/10
Cohorts Vaccine Coverage

Cohort
(Dates of birth)

Age (Years)

Number in cohort

Dose 1

Dose 2

All three doses

Routine Cohort 7
(1 Sep 1996 to 31 Aug 1997)

12-13

304073

84.3 %

82.3 %

76.4 %

Catch Up Cohort 6
(1 Sep 1994 to 31 Aug 1995)

14-15

305232

77.5 %

75.2 %

68.5 %

Catch Up Cohort 5
(1 Sep 1993 to 31 Aug 1994)

15-16

309727

77.6 %

75.0 %

68.6 %

Catch Up Cohort 4
(1 Sep 1992 to 31 Aug 1993)

16-17

319340

58.1 %

53.1 %

41.7 %

Catch Up Cohort 3
(1 Sep 1991 to 31 Aug 1992)

17-18

323826

55.6 %

50.3 %

38.9 %

ALL COHORTS
2008/09 – 2009/10
(Sep 1990 to 31 Aug 1997)

12-19

2194237

72.4 %

68.6 %

60.4 %

Providing vaccination coverage is sufficiently high, it has been predicted that immunising females before they become infected will eventually result in a 38-82% reduction in cervical cancer incidence [3]. A decline in cervical cancers and pre-cancers as a result of the vaccination programme may not be seen for over 10 years. To make an earlier assessment of the impact of the vaccination programme, HPA is monitoring the epidemiology of HPV infections (vaccine and non-vaccine types).

Clinical trials of the HPV vaccine used in the UK immunisation programme (GlaxoSmithKline's Cervarix®) have reported high efficacy against cervical intraepithelial neoplasia associated with HPV 16/18 and some closely related oncogenic HPV types [4], and duration of efficacy and high immunogenicity for seven years of follow-up [5]. It is also encouraging to see that vaccination of schoolgirls in England seems to be achieving sufficiently equitable delivery to reduce inequalities in cervical cancer prevention [6]. The coverage achieved in the first two years [1] of the HPV immunisation programme, together with these data from clinical trials, supports optimism for the programme achieving its aim of greatly reducing the incidence of cervical cancer in due course.

References

1. Department of Health. Sheridan A, White J. Annual HPV vaccine coverage in England in 2009/2010. Available at: http://www.dh.gov.uk/en/Publichealth/Immunisation/Keyvaccineinformation/DH_104010.

2. Department of Health. Professor DM Salisbury (letter), Acceleration of the HPV vaccination catch-up campaign. 30 January 2009. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents
/digitalasset/dh_094026.pdf

3. Choi YH, Jit M, Gay N, Cox A, Garnett GP, Edmunds WJ. Transmission dynamic modelling of the impact of human papillomavirus vaccination in the United Kingdom. Vaccine 2010 May 28; 28(24): 4091-102. Epub 2009 Nov 10.

4. Paavonen J, Naud P, Salmerón J, Wheeler CM, Chow SN, Apter D et al. Efficacy of human papillomavirus (HPV)- 16/18 AS04-adjuvanted vaccine against cervical infection and pre-cancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet 2009 Jul 25; 374 (9686): 301-14.

5. De Carvalho N, Teixeirab J, Roteli-Martinsc CM, Naudd P, DeBorbae P, Zahaff T, et al. Sustained efficacy and immunogenicity of the HPV-16/18 AS04-adjuvanted vaccine up to 7.3 years in young adult women. Vaccine 2010, 31 August 2010, 28(38): 6247-6255.

6. Desai S, Soldan K, White J, Sheridan A, Gill ON. HPV vaccination coverage. Lancet 2010 Jul 31; 376 (9738): 328-9.

Carbapenemase producers: recognition, infection control and treatment

New guidance on the management of patients who are infected with bacteria that produce a carbapenemase and are resistant to carbapenem antibiotics has been produced by the HPA [1].

The guidance, being issued to all consultant medical microbiologists and infection control specialists across the UK:
  • advises how hospital laboratories can best detect carbapenemase-producing bacteria;
  • stresses how the effective use of good infection control practices, such as screening and isolation of high-risk patients, can help to contain the spread of infection;
  • describes the few treatment options that do remain.

The geographical distribution and epidemiology of major types of carbapenemases are also outlined.

The guidance has been developed in response to enquiries from microbiologists and infection control specialists on the appropriate use of antibiotics following the identification of cases of infection with bacteria resistant to carbapenems, including those with the NDM-1 (New Delhi metallo) beta lactamase enzyme, which was described in a paper co-authored by the HPA and published in the Lancet Infectious Diseases in September 2010 [2].

References

1. “Advice on carbapenemase producers: recognition, infection control and treatment” is available on the HPA website at: Home › Topics › Infectious Diseases › Infections A-Z › Carbapenem resistance › Guidance on carbapenem resistance producers.

2. The paper in Lancet Infectious Diseases detailing the emergence of cases with NDM-1 is available at: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2810%2970143-2/abstract.