• New HPA/CIEH enteric fever operational guidelines
  
• Legionnaires cluster associated with a hotel in Spain
  
• International outbreak of Salmonella Newport
  
• Migrant health: challenges and obligations conference
  
• Invitation for EUPHEM fellowship applications
  
  

New HPA/CIEH enteric fever operational guidelines

New guidelines for the  public health management of enteric fever in England have been published jointly by the HPA and the Chartered Institute of Environmental Health, replacing, with effect from 1 February 2012, the previous guidance developed in 2004 [1].

The guidelines have been revised by a multi-disciplinary working group to provide a systematic approach to the public health management of enteric fever, based on expert consensus and available evidence from other non-endemic countries.

Significant changes from previous guidance include:

• algorithms to guide risk assessment;
• rationale for risk assessment and management now defined by both risk group and travel history;
• simplified microbiological clearance schedules for cases and contacts;
• targeted co-traveller screening and utilisation of “warn and inform” approach for contacts;
• management of convalescent and chronic carriers.
  

A half-day seminar for those involved in implementation of the guidelines is to be held on 10 February 2012 in London [2].

References

1. Public health operational guidelines for typhoid and paratyphoid (enteric fever): a joint policy from the Health Protection Agency and the Chartered Institute of Environmental Health (January/February 2012). Downloadable from the HPA website: Publications › Infectious diseases › Gastrointestinal illness reports and guidance › Public Health Operational Guidelines for Typhoid and Paratyphoid (Enteric Fever).

2. “Launch of new guidelines for the public health management of enteric fever”, 10 February, 2012, http://www.hpa-events.org.uk/EF12.

Legionnaires cluster associated with a hotel in Spain

The HPA has been monitoring a cluster of legionnaires' disease (LD) cases identified among English holiday makers and associated with the same accommodation site in Costa Blanca, Spain. As at 3 February [1], 11 confirmed cases in UK residents (including three deaths) had been associated with the Diamante Beach Hotel in Calpe, Costa Blanca, since January 2012, with a number of Spanish cases also reported.

The Spanish health authorities implemented control measures at the hotel, including disinfection of the water system, which was considered the most likely source of infection. British guests at the hotel were offered alternative accommodation and advised to be aware of the signs and symptoms of the infection as soon as the association between the hotel and the UK cases was confirmed. In England and Wales, GPs were alerted to the incident and encouraged to look for LD symptoms in returning travellers and the Department of Health issued an alert to NHS health professionals and A&E departments.

Further information is being issued in HPA press releases [1].

Reference

1. "Update on legionnaires cluster associated with a hotel in Spain”, 3 February 2012 (1400 hrs).

International outbreak of Salmonella Newport

Salmonella Newport is consistently reported as one of the top six most frequently isolated serovars of Salmonella enterica in England and Wales. Between 2000 and 2010, an average of 223 cases were reported per annum (range 124 – 662), the maximum being reported in 2004 following a national outbreak attributed to the consumption of lettuce at restaurants and takeaways.

In November 2011, as part of a local food survey, the HPA Food Water and Environment (FWE) Laboratory in Preston isolated salmonella from a ready to eat sliced water melon fan. The HPA Laboratory of Gastrointestinal Pathogens (LGP) subsequently confirmed the strain to be Salmonella Newport. Pulse Field Gel Electrophoresis (PFGE) was used to characterise the incident strain. Scrutiny of the international molecular databases confirmed that the PFGE profile of the incident strain had not been reported before.

In late December 2011, Health Protection Scotland reported four cases of S. Newport, all young children. PFGE analysis showed that the strains isolated from these cases conformed to the profile that had recently been identified in the watermelon isolate. The LGP conducted PFGE analyses on clinical isolates referred to the reference laboratory from December onwards.

An outbreak control team (OCT) meeting was convened on 16 January with membership from Health Protection Scotland, HPA, Public Health Wales, and the FSA in attendance. A teleconference including colleagues from Robert Koch Institute (RKI, Germany) was held on 19 January. The OCT-agreed case definition for a confirmed case is: a person with abdominal symptoms (diarrhoea and/or vomiting), with a laboratory confirmed isolate of S. Newport exhibiting the outbreak PFGE profile. Epidemiological investigations are being coordinated by the Department of Gastrointestinal, Emerging and Zoonotic Infections. These involve assembling the descriptive epidemiology of the outbreak and interviewing reported cases with a bespoke hypothesis generating questionnaire.

As at 31 January 2012: i) 30 cases with the outbreak strain had been identified in England, Wales and Northern Ireland [1]; ii) RKI and the Health Protection Surveillance Centre had confirmed 15 and four cases of infection attributable to the incident strain in Germany and the Republic of Ireland, respectively; iii) the standard questionnaire had been administered by telephone to 15 cases in England conforming to the case definition. Ten of the cases interviewed had confirmed consumption of watermelon in the three days prior to the onset of their symptoms.

Reference

1. "Outbreak of Salmonella Newport", HPA press release, 2 February 2012.

Migrant health: challenges and obligations conference

The health of migrants and health matters associated with migration are crucial public health challenges faced by all governments and societies. In recognition of this, the World Health Organization adopted a Resolution on the health of migrants in May 2008 and subsequently published a consultation report [1] on the subject.

Most recently, an international conference was convened by Cumberland Lodge, an independent educational charity, to review UK progress in this area and to make recommendations for action [2].

Three key themes of the WHO Resolution concern:

• monitoring migrant health
• policy and legal frameworks affecting migrants' health
• migrant-sensitive health systems.

At the conference, Dr Daniel López-Acuña, advisor to the WHO director-general, and Dr Davide Mosca, director of the migration health department at the International Organisation for Migration, set the scene and explained the background to the WHO Resolution. They both praised the UK for organising the event as a first step in self-evaluation. Professor Dame Sally Davies, chief medical officer for England and chief scientific adviser for the Department of Health, also addressed the conference in a talk that covered migrant health needs, protecting and monitoring the health of all sections of the community, and planning for migrant health within the new NHS structure and Inclusion Health Programme.

Other speakers and participants included those working within the NHS, academics, lawyers, those from organisations with experience of working with refugees, asylum seekers, and other vulnerable migrant groups, as well as senior civil servants.

Consideration was given to the need for, amongst other issues: cross-working across government departments, clarity of guidance on accessibility and entitlements, sensitivity to cultural and language needs, collection of data that is useful for monitoring and informing policy, and learning from ideas and policies that are working well in other European countries.

A full report of the conference will be published jointly by the HPA and Cumberland Lodge.

References

1. Health of migrants – the way forward, report of a global consultation, WHO report and conference, Madrid, Spain, 3-5 March 2010.

2. “Migrant health: challenges and obligations”, 25-27 January, Cumberland Lodge, Windsor, Berkshire, UK; http://www.cumberlandlodge.ac.uk/programme/Reports/migrant_health. The event was organised in association with the Health Protection Agency and with support from the Special Trustees of the Hospital for Tropical Diseases.

Invitation for EUPHEM fellowship applications

The European Centre for Disease Prevention and Control (ECDC) has issued a call for applications for two-year Fellow positions in the European Public Health Microbiology Training Programme (EUPHEM) – a new programme that commenced in 2008 that is running parallel to the EPIET (intervention epidemiology) programme [1].

“Public health microbiology” is a cross-cutting discipline that spans the fields of human, animal, food, water, and environmental microbiology, with a focus on human health and disease. EUPHEM aims to develop a European network of public health microbiologists to strengthen communicable disease surveillance and control and invites applications from laboratory scientists with ability to work effectively across disciplines, particularly with epidemiologists and clinicians. The deadline for applications is 26 February, 2012 [1].

Reference

1. ECDC website: www.ecdc.europa.eu/en/aboutus/jobs/Pages/fellowships.aspx.