11 April 2014
Next update: 17 April 2014
Updated NICE guidance on needle and syringe programmes
In February 2009, the National Institute for Health and Care Excellence (NICE) first issued guidance on the provision of Needle and Syringe Programmes (PH18) for the distribution of new sterile injecting equipment to people who inject drugs . A survey of needle and syringe programmes commissioners and providers undertaken jointly by NICE and Public Health England in 2013 asked about the implementation of this guidance and an analysis of this data by the Centre for Public Health at Liverpool John Moores University has been published; it indicates that though this guidance had been widely used by commissioners and providers there were some issues with its implementation .
As part of its guidance review process, NICE in 2012 decided to update PH18. The update process has now been completed, and the updated guidance (PH52) published .
In addition to a restructuring of the guidance and other minor changes throughout – for example, parts of the guidance concerning the public health monitoring of needle and syringe programmes provision have been strengthened – there have been two major additions.
The first addition relates to the provision of needle and syringe programmes (NSP) to young adults. The original guidance focused on the provision of NSP to those aged over 18 years. The updated guidance includes a section on responding to the needs of the much smaller number of people aged less than 18 years who inject drugs.
The second major addition focuses on the provision of NSP to people who inject image and performance enhancing drugs (IPEDs) – such as anabolic steroids and melanotan. The original guidance was principally focused on meeting the needs of people who inject psychoactive drugs (such as heroin and crack). It did not specifically consider the needs of those who inject IPEDs. In recent years there has been increasing public health concern about the use and injection of IPEDs , and about the extent of blood borne virus and other infections in this population [5,6,7]. People who inject IPEDs are now the largest group of people using needle and syringe programmes in some areas and the updated guidance has a section specifically related to meeting the needs of this population.
To support the implementation of this guidance, PHE is co-hosting with NICE and the Local Government Association a seminar Evidence into practice and policy: needle and syringe programmes – protecting people and communities in Birmingham on the 19 May (further information and registration details can be found at www.phe-events.org.uk/eipbirmingham).
"Needle and syringe programmes: providing people who inject drugs with injecting equipment (update)" (PH18), February 2009, http://guidance.nice.org.uk/PH18.
2. Bates G, Jones L, McVeigh J (April 2014). "Analysis of survey data on the implementation of NICE PH18 guidance relating to needle and syringe provision in England", Centre for Public Health, Liverpool John Moors University (Liverpool).
3. "Needle and syringe programmes: providing people who inject drugs with injecting equipment (update)" (PH52), April 2014,http://guidance.nice.org.uk/PH52.
4. Advisory Council on the Misuse of Drugs (September 2010). "Consideration of the anabolic steroids" (London: Home Office).
5. Hope VD, McVeigh J, Marongiu A, Evans-Brown M, Smith J, Kimergård A, et al (2013). "Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study". BMJ Open. September 12; 3(9).
6. Hope VD, McVeigh J, Marongiu A, Evans-Brown M, Smith J, Kimergård A, et al (2014). "Injection site infections and injuries in men who inject image- and performance-enhancing drugs: prevalence, risk factors, and healthcare seeking". Epidemiol Infect. April 8: 1-9.
7. PHE (November 2013). "Shooting Up: Infections among people who inject drugs in the UK 2012: an update".
Ebola virus disease in West Africa
An outbreak of Ebola virus disease (EVD) in West Africa has continued to expand geographically  since first being recognised in Guinea in early February 2014. This is the first time that EVD has been proven in this part of Africa. The virus responsible is similar to a strain of Ebolavirus (previously known as Zaire ebolavirus) last detected in the Democratic Republic of Congo in 2009.
To date , Guinea has reported 158 cases including 101 deaths, occurring in several regions across the country. Cases have also been confirmed in neighbouring Liberia (five confirmed and 20 suspected), where initial cases were exposed in Guinea. Mali reports six suspected cases of EVD in Bamako (the capital) and neighbouring Koulikoro Region. In Sierra Leone no suspected cases have been confirmed. However, there were two probable cases who had died while in Guinea.
People are not at risk of becoming infected unless they have direct contact with blood/body fluids/tissues of dead or living infected persons or animals (non-human primates, other mammals and bats). Airborne transmission has never been documented.
An updated risk assessment has been published by ECDC . The risk for tourists, visitors or UK expatriates remains very low. Neither Guinea nor Liberia are frequent travel destinations for UK citizens and most are business travellers rather than tourists. It remains unlikely, but not impossible, that travellers infected in Guinea or Liberia could arrive in the UK while incubating the disease and develop symptoms after their return. Anyone returning from affected areas who has a sudden onset of symptoms such as fever, headache, sore throat and general malaise within three weeks of their return should seek rapid medical attention and mention their recent travel.
In the event of a symptomatic person with a relevant travel history presenting to health care, the PHE Imported Fever Service (0844 7788990) should be contacted by infectious disease clinicians or microbiologists in order to discuss testing.
2. WHO update, 10 April.
3. ECDC Risk Assessment, 8 April.
Vaccine update for immunisation practitioners
The latest Vaccine Update bulletin for immunisation practitioners and other healthcare professionals provides information about the possible future addition of meningococcal B vaccine to the national child vaccination programme following publication of a Joint Committee on Vaccination and Immunisation (JCVI) position statement recommending this , subject to satisfactory supply arrangements being negotiated.Other themes covered in Vaccine Update 214 are:
1. Vaccine Update (issue 214, April 2014). Downloadable from the PHE website: https://www.gov.uk/government/organisations/public-health-england/series/vaccine-update.
2. DH/PHE guidance, 21 March 2014. “Meningococcal B vaccine: JCVI position statement”, 21 March 2014.