• Measles cases in England and Wales: update to end-April 2012
  
  
• National point prevalence survey on HCAIs and antimicrobial use (England, 2011)
  
  
• HPA welcomes pre-entry TB screening programme
  
  

Confirmed measles cases in England and Wales: update to end-April 2012

The number of laboratory confirmed cases of measles with onset dates to the end of April 2012 has reached 447, exceeding the 367 cases for the same period in 2011. Half of all cases in England and Wales with onset in April were part of the North West region outbreak which began in February and has predominately affected children under five years of age (see table) [1-3]. An outbreak in North Wales, that also began in February, is continuing although spread into the local community is more limited with only 12 new cases confirmed in April [3,4]. The South East was the only region to report more cases in April than March; 44 cases were linked to the on-going outbreak that began last September. Measles is beginning to re-emerge in regions where there were no cases previously or very small numbers with clusters reported from the East of England, the West Midlands and London.

Number of confirmed cases of measles with onset in 2012 and number by month of onset and region, January to April 2012: England and Wales

Month	London	East Mids	East of England	North East	North West	South East	South West	West Mids	Wales	York & Humber	Total
Jan	11	–	–	–	3	21	2	1	1	–	39
Feb	7	–	2	–	62	9	2	2	26	–	110
Mar	18	–	4	–	92	23	–	–	9	1	146
Apr	12	–	3	–	75	44	–	5	12	–	152
Total 2012	48	–	9	–	232	97	4	8	48	1	447

Number of confirmed measles cases by month of onset, England and Wales: January 2007 to April 2012

Across Europe, 2012 data on measles from the twenty-nine EU and EEA countries is available to the end of March; 2,283 cases were reported for this period of which 56% were identified in Romania [2]. In addition, a large outbreak is on-going in the Ukraine where between 1 January and 10 May 9: 173 cases have been reported [2]. There have been vaccine shortages in the Ukraine since 2010 and more than one million children are unvaccinated therefore the epidemic is expected to accelerate and spread geographically during the measles peak transmission season from February to June.

The European Football Championship will be jointly hosted by Ukraine and Poland in June 2012 and visitors to the event are encouraged to ensure they are fully vaccinated.

References

1. "Measles cases top the 200 mark in Merseyside outbreak", HPA North West Region press release, 2 May 2012.

2. European Centre for Disease Prevention and Control (ECDC). European measles monthly monitoring (EMMO), 23 May 2012. Stockholm : ECDC; Issue 11:2012.

3. Laboratory confirmed cases of measles, mumps and rubella, England and Wales: January to March 2012. HPR 2012; 6(21): immunisation.

4. "Measles cases in Gwynedd continue to rise", Public Health Wales website (26 April 2012), http://www.wales.nhs.uk/sitesplus/888/news/22686.

National point prevalence survey on HCAIs and antimicrobial use (England, 2011)

The HPA has published a new national point prevalence survey (PPS) on healthcare-associated infection in England, the first such survey to also provide data on antimicrobial use (AMU) and the first to include data from the independent hospital sector [1,2].

There have been three previous HCAI-PPS surveys, the last carried out in 2006. The data in the new report is not directly comparable with that in previous surveys. However, an overall drop in HCAI prevalence (from 8.2 per cent in 2006 to 6.4 per cent in 2011) is indicated.

The English PPS data collection was undertaken by hospital teams between October and November 2011; 103 organisations surveyed 52,443 eligible patients (50,778 from the NHS and 1,665 (3.2 per cent) from the independent sector. The average age of all patients was 69 years old. A total of 4,372 (out of the 52,443, eight per cent) children under 16 years of age were also surveyed.

Key results from the new survey have shown that:

• The prevalence of HCAI was 6.4%. A total of 3,360 patients were diagnosed with an active HCAI with 135 patients having more than one.
• When comparing ward specialties, HCAI prevalence was highest in patients in intensive care units (ICUs) at 23.4 per cent followed by surgical wards at eight per cent.
• The most common types of HCAI were respiratory (including pneumonia and infections of the lower respiratory tract) (22.8 per cent), urinary tract infections (UTI) (17.2 per cent), and surgical site infections (15.7 per cent). Since the last PPS in 2006 there has been a eighteen fold reduction overall in MRSA bloodstream infections - from 1.3 per cent to less than 0.1 per cent in patients; and a five fold reduction in C. difficile infections (from two per cent to 0.4 per cent).
• The prevalence of antimicrobial use was 34.7%.
• Most antibiotic use (53 per cent) in hospitals was in patients receiving treatment for infections which commenced in the community. Thirty percent of surgical prophylaxis was prescribed for greater than one day.

References

1. English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use, 2011: preliminary data, May 2012. Downloadable (with separate appendices and a related Q and A document) from the HPA website: Home › Publications › Infectious diseases › Antimicrobial and healthcare associated infections.

2. “Snapshot survey of healthcare associated infections (HCAI) reveals overall drop in infections down to 6.4 per cent”, HPA press notice, 23 May 2012.

HPA welcomes pre-entry TB screening programme

The HPA has welcomed the decision by the Home Office to replace existing airport-based screening for TB infection with a pre-entry screening programme [1].

Currently, the Department of Health has a policy of chest X-ray screening of migrants at Heathrow and Gatwick airports as part of immigration control. (This applies to individuals who are staying in the UK for six months and are from a country with a high incidence of TB.)

In future, migrants wanting to enter the UK for more than six months – if they are from any of 67 designated countries which have a high prevalence of TB – will need to be screened before they are granted a visa for the UK. The UK Border Agency will build on existing pre-screening undertaken by international partners including the USA, Canada and Australia.

The HPA has been concerned for a number of years that chest x-rays at ports may not be cost effective or an appropriate way of dealing with TB. The main reason for this is that while it is known that TB is more prevalent in those born in certain countries abroad, it is often several years after entry into the UK before the infection manifests itself, making detection in ports by chest x-ray relatively ineffective.

Reference

1. “HPA welcomes pre-entry TB screening programme”, HPA press release 22 May 2012.