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Volume 7 No 19; 10 May 2013

Confirmed pertussis (England and Wales), data to end-March 2013

Whilst pertussis activity in England and Wales continues at high levels compared to recent years, overall laboratory confirmed cases first fell in November 2012 and the decrease continued into March 2013. This news report presents current pertussis activity to 31 March 2013, updating the previous report that included data to the end of January 2013 [1].

Pertussis activity has fallen each month from November 2012 but continued at high levels in all age groups aged 1 year or older compared to equivalent periods in previous years (table 1). Provisional data show that in February and March, 576 and 459 cases were newly confirmed respectively, compared with 677 cases in January (figure 1). Whilst the overall number of cases has fallen, large numbers of cases continue to be confirmed in individuals aged 15 years or older with 372 cases reported in March 2013, compared to 195 in March 2012 and 31 in March 2008, the previous peak year (table 1). In those aged 10-14 years there were 62 cases confirmed in March 2013; 42 in March 2012; and 18 in March 2008.

Cases in infants under 1 year of age have stayed low in February and March 2013. In infants under 3 months there were 8 confirmed cases in January and 9 in February; these numbers are lower than the equivalent period in 2012 with 23 cases in February and 28 cases in March. Disease rates do, as expected, continue to be highest in this age group. There have been no reported deaths in infants with laboratory confirmed pertussis in February and March 2013.

Pertussis is a cyclical disease with increases occurring every three to four years and with the previous peak occurring in 2008. The current increased pertussis activity in England and Wales was observed from the third quarter of 2011, predominantly in adolescents and adults. This increase continued into 2012 and extended into infants under three months who are at highest risk of severe complications, hospitalisation and death and exceeded the increased activity observed in 2008.

A level 3 incident was declared in April 2012 to coordinate the response to the ongoing increased pertussis activity [2]. In response to this ongoing outbreak, the Department of Health announced on 28 September [3,4] that pertussis immunisation would be offered to pregnant women from 1 October 2012 in order to protect infants from birth whilst disease levels remain high. It has been confirmed that this programme will be continued in 2013/2014 until further notice, pending further advice from the Joint Committee on Vaccination and Immunisation [5]. All infants under 3 months are now in the cohort born to mothers who were eligible for pertussis-containing vaccine in pregnancy. There has been a fall in confirmed cases of pertussis from July/August 2012 through to March 2013 in infants under 1 year (figure 2), this follows the usual seasonal pattern and cannot be interpreted as a direct programme impact at this time. Confirmed cases have also fallen in all other age groups after peaking in September/October 2012 (figure 2).The situation will continue to be monitored as we move into the summer months when pertussis activity is usually at its highest.

The latest information regarding the uptake of pertussis immunisation in pregnant women is available from the Department of Health [6].

Current high levels of reporting may, in part, be due to increased awareness amongst health professionals improving case ascertainment in older age groups. This is reflected by the increased demand for serology testing which is the predominant method of confirmation in adolescents and adults who typically present with milder features late in the course of the illness. However, it is considered that the increases that have been observed reflect a real change in pertussis activity with waning immunity following vaccination and/or natural infection likely to be important contributory factors [7]. This is supported by the high number of confirmed cases in infants under three months of age in whom ascertainment has been more consistent through time.

High pertussis activity has been observed across all regions in England and Wales. The highest numbers of confirmed cases in February 2013 have been in the South East and the South West regions and in March 2013 have been in the South East, South West and East Midlands (table 2).

Table 1. Provisional number of confirmed cases of pertussis in England and Wales, 2008 to 2013 by age group: February and March

Age group

<3 months

3-5 months

6-11 months

1-4 years

5-9 years

10-14 years

15+ years

All ages

2008 Feb 11 1 2 4 1 10 31 60

Mar

12 4 2 2 18 31 69
2009 Feb 4 4 2 10 22 42

Mar

9
2
2
1
7
27
48
2010 Feb 4 1 1 14 20

Mar

1
1
1
1
7
11
22
2011 Feb 6 4 2 1 4 16 33

Mar

13
2
1
9
24
49
2012 Feb 23 4 1 3 4 33 148 216

Mar

28
6
1
5
42
195
277
2013 Feb 8 5 12 13 60 478 576

Mar

9
1
1
6
8
62
372
459

 

Figure 1. Provisional number of confirmed cases of pertussis in England and Wales, by month: 2011 and 2013

 

Figure 2. Monthly distribution of laboratory confirmed cases in 2012, and January to March 2013, England and Wales, by age group based on provisional data

 

Table 2. Provisional number of confirmed cases of pertussis, England and Wales: February and March 2013, 2012 and 2008 by region

Region

2013 2012 2008

Feb

Mar

Feb

Mar

Feb

Mar

East Midlands

70
57
21
52
5
9

East of England

64
39
14
11
7
4

London

48
55
13
23
5
6

North East

39
23
18
9
2
4

North West

36
37
18
18
6
7

South East

103
91
48
67
19
17

South West

74
57
40
53
10
12

West Midlands

47
31
8
12
4
5
Yorkshire and the Humber
63
44
27
28
0
4
Wales
32
25
9
4
2
1
Total
576
459
216
277
60
69

References

1. Confirmed pertussis cases in England and Wales: update to end-January 2013. Health Protection Report 7(9): news, 1 March 2013.

2. A level 3 incident is the third of five levels of alert under the HPA's Incident Reporting and Information System (IERP) according to which public health threats are classified and information flow to the relevant outbreak control team is coordinated. A level 3 incident is defined as one where the public health impact is significant across regional boundaries or nationally. An IERP level 3 incident was declared in April 2012 in response to the ongoing increased pertussis activity (HPR 6(15), http://www.hpa.org.uk/hpr/archives/2012/news1512.htm).

3. “Pregnant women to be offered whooping cough vaccination”, 28 September 2012. Department of Health website, http://www.dh.gov.uk/health/2012/09/whooping-cough/.

4. "HPA welcomes introduction of whooping cough vaccination for pregnant women as outbreak continues”, HPA press release, 28 September 2012, HPA website: Home › News Centre › National Press Releases › 2012 Press Releases.

5. Department of Health and Public Health England, 10 May 2013. “Whooping cough vaccination programme for pregnant women: extension to 2014”.

6. Department of Health. "Pertussis vaccination programme for pregnant women 2012-2013: provisional national data for February 2013".

7. Campbell H, Amirthalingam G, Andrews N, Fry NK, George RC, Harrison TG, Miller E. Accelerating control of pertussis in England and Wales. Emerging Infectious Diseases 2012; 18(1):38-47.

HSE guidance on new sharps regulations

The Health and Safety Executive has issued an information notice for healthcare employers and employees explaining their legal obligations under the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 that come into force this month [1,2].

The regulations introduce explicit provisions relating to the prevention of sharps injuries in healthcare, including: safe use and disposal; information and training of healthcare workers; and actions to be taken by employers following injury, including post-injury investigation and post-exposure prophylaxis where appropriate. The regulations apply to "healthcare employers", ie those whose main activity is managing, organising or providing healthcare, which includes hospitals, GPs, dental surgeries ambulance services and care homes, and in some cases their sub-contractors if they are involved in providing laundry, cleaning or waste disposal services.

An annex to the information sheet makes clear that the regulations apply to workplaces where the primary activity is the management, organisation or provision of healthcare. They therefore do apply where a provider of occupational health services administers vaccinations on a non-healthcare company's premises. However, they do not apply to situations where the primary activity is not healthcare, eg school nurses employed directly by a school; medical staff providing care in prisons, employed by the prison itself; etc.

References

1. “Health and Safety (Sharp Instruments in Healthcare) Regulations 2013: guidance for employers and employees”, HSE Information Sheet, March 2013.

2. “New regulations on preventing sharps injuries in the healthcare sector”, HSE press release, 9 May 2013.

History of the Health Protection Agency 2003-2013

An “oral history” of the work carried out by the Health Protection Agency – from its establishment in 2003 until its functions were absorbed within Public Health England last month – has been published on the HPA legacy website [1]. The History of the Health Protection Agency 2003-2013 is both a contribution to the history of public health in Britain and a tribute to the efforts of all who worked for the Agency. An introduction provides a fully-referenced short history of the development of public health in Britain from the first legislation in the 19th century, through the post-war development of national communicable disease surveillance and control institutions, leading up to the Agency’s establishment as the national coordinator of all public health protection services, encompassing responses to one-off major incidents, routine infection surveillance at local level and provision of advice on health threats arising from chemical, radiation and environmental hazards. The main part of the document is a transcript of a seminar held in January at which more than a hundred former and then current members of the organisation recalled their experiences.

Reference

1. The History of the Health Protection Agency 2003-2013 [5.2 MB PDF], April 2013. Downloadable from the HPA legacy website: Home › Publications › Corporate.