Immunisation |
Published on: 26 February 2010 |
Topic Archives: | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001
Laboratory reports of Haemophilus influenzae by age group and serotype, England and Wales: fourth quarter, and quarters 1-4 inclusive, 2009 (2008)
Fourth quarter 2009 (2008)| Type | Age |
Total |
||||
<1y |
1-4y |
5-14y |
15+ |
n.k. |
||
| b | –(2) |
1(–) |
–(2) |
12(13) |
–(–) |
13 (17) |
| nc | 13(12) |
9(5) |
2(2) |
66 (73) |
–(–) |
90 (92) |
| a,e,f | 2(1) |
1(1) |
–(1) |
14(15) |
–(–) |
17 (18) |
| not typed | 3(1) |
2(4) |
2(2) |
37(55 |
1(–) |
45 (62) |
| Total | 18 (16) |
13 (10) |
4 (7) |
129 (156) |
1 (–) |
165 (189) |
Quarters 1-4 inclusive 2009 (2008)
| Type | Age |
Total |
||||
<1y |
1-4y |
5-14y |
15+ |
n.k. |
||
| b | 6 (10) |
4 (3) |
–(7) |
26 (52) |
–(–) |
36 (72) |
| nc | 41 (42) |
27 (15) |
3 (7) |
279 (242) |
–(3) |
350 (309) |
| a,e,f | 4 (5) |
5 (2) |
2 (6) |
46 (47) |
–(–) |
57 (60) |
| not typed | 17 (12) |
10 (8) |
9 (8) |
169 (188) |
2 (3) |
207 (219) |
| Total | 68 (69) |
46 (28) |
14 (28) |
520 (529) |
2 (6) |
650 (660) |
Laboratory-confirmed cases of measles, mumps and rubella,
England and Wales: October to December 2009
Data presented here is for the fourth quarter of 2009 (ie October to December 2009). Cases include those confirmed by CfI oral fluid testing (IgM antibody tests and/or PCR) and national routine laboratory reports (table 1). Analyses are by date of onset. Regional breakdown figures relate to Government Office Regions rather than regional health authorities (pre-April 2002 definitions).
Quarterly figures for cases confirmed by oral fluid antibody detection only from 1995 and annual total numbers of confirmed cases by health region and age are available from:
http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733778332,
http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733841496, and
http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733752351.
Table 1. Total confirmed cases of measles, mumps and rubella, and oral fluid IgM antibody tests in notified cases: weeks 40-53/2009
Confirmed cases |
||||||||
Notified cases |
Oral fluid testing
|
|||||||
Number tested |
% tested |
Total positive |
Recently vaccinated |
Confirmed infections |
Other samples |
Total |
||
| Measles | 519 |
394 |
76% |
20 |
14 |
6 |
2 |
8 |
Mumps |
3009 |
1659 |
55% |
659 |
7 |
652 |
312 |
964 |
Rubella |
157 |
101 |
64% |
– |
– |
– |
– |
– |
Measles
Only eight cases of measles were confirmed in the fourth quarter, compared to 81 in the previous quarter [1]. This brings the provisional total of laboratory confirmed measles cases for 2009 to 1,144, lower than the 2008 total of 1,370 cases but higher than 2007 (990 cases). The ten-fold decrease in measles incidence between the current and previous quarter was also reflected in a decrease in the overall proportion of oral fluid samples tested that were confirmed as measles infections (1% vs 10%).
Only five English regions and Wales identified cases in the fourth quarter (Wales 3, South West 2, Yorkshire and the Humber 1, South East 1 and West Midlands 1).
Two cases identified in this quarter were associated with travel to the Asian subcontinent. Another two had contact within a family. All eight cases were children aged less than 15 years (three under one year; three aged 1 to 4 years; one aged 5 to 9 years; and one aged 10 to 14 years). Only one case reported receiving a measles containing vaccine.
Mumps
Nine hundred and sixty-four confirmed mumps cases with onset dates in the fourth quarter of 2009 were reported compared to 1,161 and 3,271 the two previous quarters [1] (figure). This brings the provisional total number of laboratory-confirmed mumps infections to 7,628 for the whole of 2009. Cases continue to occur predominantly in individuals born between 1980 and 1991 [1,2], the cohort known to be at highest risk due either to not having been routinely offered MMR vaccination in childhood, or having only received one dose (table 2 and figure). Although the highest number of cases were observed in the 15-19 age group, 70 % were aged 18 and 19 (born 1990 and 1991).
Table 2 Confirmed cases of mumps by age group and region, England and Wales: weeks 40-53/2009
Age group |
|||||||||
| Region | <1 |
1-4 |
5-9 |
10-14 |
15-19 |
20-24 |
25+ |
n.k. |
Total |
North East |
1 |
– |
1 |
2 |
30 |
21 |
15 |
– |
70 |
North West |
1 |
3 |
16 |
18 |
88 |
70 |
54 |
– |
250 |
Yorks. & Humber |
1 |
2 |
3 |
12 |
44 |
34 |
22 |
1 |
119 |
East Midlands |
– |
2 |
1 |
3 |
26 |
31 |
21 |
– |
84 |
West Midlands |
– |
– |
3 |
6 |
20 |
24 |
13 |
1 |
67 |
East of England |
– |
– |
– |
1 |
11 |
21 |
29 |
1 |
63 |
London |
– |
9 |
12 |
12 |
22 |
25 |
34 |
1 |
115 |
South East |
– |
4 |
4 |
2 |
21 |
20 |
44 |
1 |
96 |
South West |
– |
– |
1 |
– |
30 |
22 |
11 |
1 |
65 |
Wales |
– |
1 |
– |
– |
11 |
15 |
8 |
– |
35 |
Total |
3 |
21 |
41 |
56 |
303 |
283 |
251 |
6 |
964 |
Number of laboratory confirmed mumps cases in England and Wales by year of birth and quarter 
Rubella
No rubella cases were identified this quarter, compared to one case with confirmed infections in the previous quarter [1]. The provisional total of laboratory confirmed rubella infections for 2009 is eight.
References
1. HPA. Laboratory confirmed cases of measles, mumps and rubella, England and Wales: July to September 2009. Health Protection Report [serial online] 2009; 3(47): immunisation. Available at: http://www.hpa.org.uk/hpr/archives/2009/hpr4709.pdf.
2 . HPA. Laboratory confirmed number of mumps cases in England and Wales: update to end-November 2009 Health Protection Report [serial online] 2010; 4(2): news. Available at:http://www.hpa.org.uk/hpr/archives/2010/news0210.htm#mmps.
Tetanus in England and Wales: 2005 to 2008
Tetanus is caused by a neurotoxin produced by Clostridium tetani, an anaerobic spore-forming bacillus. Tetanus spores are widespread in the environment, including in soil, and can survive hostile conditions for long periods of time. Transmission occurs when spores are introduced into the body, often through a puncture wound but also through trivial, unnoticed wounds, through injecting drug use, and occasionally through abdominal surgery. Tetanus is not transmitted from person to person. The incubation period of the disease is usually between three and 21 days, although it may range from one day to several months, depending on the character, extent and localisation of the wound.
Tetanus immunisation was introduced in the 1950s and became part of the national routine childhood programme in 1961. Since then, vaccine coverage at two years of age has always exceeded 70% in England and Wales and since 2001 has been 94%, just below the World Health Organization (WHO) target of 95%. The objective of the immunisation programme in the UK is to provide a minimum of five doses of tetanus-containing vaccine at appropriate intervals for all individuals. As there is no herd immunity effect, individual protection through vaccination is essential. In most circumstances, a total of five doses of vaccine at the appropriate intervals are considered to give satisfactory long-term protection, and routine boosters every 10 years are no longer recommended [1].
Tetanus is usually confirmed by a clinical diagnosis alone, although three diagnostic laboratory tests are available: detection of tetanus toxin in a serum sample, isolation of tetanus bacillus from the infection site, and demonstrating low levels or absent antibody to tetanus toxoid in serum. The first two tests may provide laboratory confirmation, whereas the third can only support the diagnosis.
Data sources for the enhanced surveillance of tetanus include notifications, reference and NHS laboratory reports, death registrations, and individual case details such as vaccination history, source of infection, and severity of disease obtained from hospital records and from general practitioners. This report updates a previous review of tetanus cases reported in England and Wales in the four-year period 2001 to 2004 [2].
Seventeen cases of tetanus were reported between 2005 and 2008. Cases were aged between 23 and 85 years, with the 25-44 year and 45-64 year age groups being most commonly affected (table 1). The 65 years-and-over age group, which historically has been the most affected [3], accounted for only four of the 17 cases. Nine of the 17 cases were female, supporting previous findings that tetanus incidence rates for men and women may no longer differ significantly [3]. Sixteen cases were reported in England (four in London) and one in Wales.
Five cases aged 29 to 53 years were reported in injecting drug users (IDUs). Four of these five occurred in 2005, and one case in 2007. Two cases in heroin users were reported within a day of each other (one in the West Midlands, one in London) suggesting a possible batch contamination or common source. In 2003/04, a large cluster of 25 cases of tetanus in IDUs was reported in the UK (23 cases in England and Wales). In this incident the clustering of the place from which the heroin was supplied, compared with the residence of IDUs was consistent with contaminated heroin having been distributed from Liverpool [4].
Year |
||||||
2005 |
2006 |
2007 |
2008 |
Total |
||
| Total number of cases | 6 |
3 |
4 |
4 |
17 |
|
| Source of information | Notified | 3 |
– |
4 |
7† |
14† |
| Other sources* | 3 |
3 |
– |
1 |
7 |
|
| Age breakdown | 15-24 years | – |
1 |
– |
– |
1 |
25-44 years |
1 |
1 |
2 |
1 |
5 |
|
45-64 years |
3 |
– |
1 |
3 |
7 |
|
65+ years |
2 |
1 |
1 |
– |
4 |
|
| Injecting drug users (IDUs) | 4 |
– |
1 |
– |
5 |
|
Amongst non-IDUs, seven of the 12 cases had a definite history of injury. These were most commonly sustained in the home, garden or workplace and included four penetrating wounds by nails/gardening equipment, two in which an animal bite was thought to be the predisposing injury, and one scaffolding injury.
Three deaths, all individuals aged over 64 years, were reported. One had received a primary course of three doses of tetanus toxoid 14 years previously but no booster doses; the immunisation status of the other two cases was not known although both were born before routine childhood immunisation began in 1961. Only one was known to have received tetanus immunoglobulin (TIG).
None of the 17 cases had completed the recommended five doses of tetanus vaccine although eight were born before 1961. Three were unvaccinated, and seven had an unknown immunisation status (four were born before 1961). Of the remaining seven cases, four recalled that they had been vaccinated but could not provide any details (including number of booster vaccinations) and three were partially immunised (had received two, three and four doses respectively).
References
1. Salisbury D, Ramsay M, Noakes K (2006). Immunisation against infectious disease (the ‘Green Book'). London: The Stationary Office, Available at: http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_4097254
2. HPA. Tetanus in England and Wales: 2001 to 2004. Communicable Disease Report weekly August 2005; 15 (34): Immunisation. Available at: http://www.hpa.org.uk/cdr/archives/2005/cdr3405.pdf
3. Rushdy AA, White JM , Ramsay ME, Crowcroft NS. Tetanus in England and Wales 1984-2000. Epidemiol Infect 2003; 130: 71-7.
4. Hahne SJM, White JM , Brett M, George R, Beeching NJ, Roy K, et al. Tetanus emerges in injecting drug users in the UK [letter]. Emerg Infect Dis 2006; 12(4): 709-10. Available at: http://www.cdc.gov/ncidod/EID/vol12no04/05-0599.htm.