Frontline Response to Incidents and Outbreaks

 

Local and Regional Service (LARS) provide support and expertise during outbreaks and incidents around the country which threaten the health of the local community. LARS staff work collaboratively with colleagues in the NHS, local authorities and many other organisations. They are also involved in research projects and training and work closely with the Agency's national specialists.

 

North East

Investigating Lead Levels in Children's Teeth

In September 2005 environmental scientists from the Agency in the North East and researchers from the University of Newcastle called in the tooth fairy to help them find out more about levels of lead in local children.

The project is dubbed the Tooth Fairy Study because it involves asking the parents of children between the ages of six and eight to donate one of their child's milk teeth after it falls out.

Teeth are being used because lead is known to accumulate in them. The research team hopes to collect up to 500 upper middle front teeth which will be sent to a laboratory in Hamburg , Germany , for analysis.

The 15 primary schools taking part represent a cross-section of the community in Newcastle . Parents will be asked to complete a lifestyle questionnaire to help identify any factors responsible for environmental exposure to lead.

In addition to determining the levels of lead found in children in Newcastle the study aims to increase understanding of the substance, its effects on children's health and whether levels vary across the city. The study is expected to take two years to complete.

 

North West

Primary School Hygiene and Hand Washing Initiative Pilot

Infectious diseases that cause gastrointestinal upsets and respiratory conditions are responsible for a significant amount of absenteeism in schools. Good hand hygiene has a well recognised roll in preventing this.

In an attempt to reduce the numbers of school days children lose because of avoidable infections, the Agency in the North West ran a pilot scheme to promote good hygiene among pupils.

The Agency worked with 12 schools in the region, interviewing staff to ascertain the obstacles to good hygiene practice. It found issues such as a lack of soap or hot water often meant children were unable to wash their hands properly.

Staff were also asked for their views on a range of existing educational resources. Based on the findings, the Agency developed a pack that schools could use within the national curriculum. The project used lessons such as art and science to promote understanding of infections, how they spread and what children can do to prevent avoidable illnesses.

The packs were piloted in 10 schools. The feedback was largely positive. Teachers said, "The children were enthusiastic and were still talking about hand washing two weeks later." Even the teachers were washing their hands more thoroughly.

Two of the participating schools also conducted quizzes to evaluate changes in the children's awareness. This showed a 44 per cent increase in knowledge of hand hygiene.

This work will now be piloted in a greater number of schools in another region. The intention is that it can eventually be rolled out nationally.

 

Yorkshire and Humber

First Measles Outbreak in More Than a Decade

South Yorkshire Health Protection Unit (HPU) co-ordinated the response to a severe outbreak of measles across Doncaster in early 2006, when 97 suspected cases occurred.

Prior to this event, only one confirmed case of the disease had occurred in Doncaster since October 1994.

In January 2006, the HPU received reports of measles in the traveller community, in a local playgroup and in one isolated case. Staff found no direct links between the three incidents and, over subsequent weeks, cases were seen across the area and in a range of ages.

During the outbreak Agency staff produced briefings for clinical staff on recognising and treating measles, and providing infection control advice for health professionals and epidemiological reports and information for the Outbreak Control Committee.

Agency staff informed all organisations working with children about the outbreak and liaised with those affected to establish a database of notified cases. They also handled the significant local and national media interest.

The outbreak showed that the number of children without immunity to measles is steadily increasing and that healthcare professionals and parents are now unfamiliar with the disease. The lessons learned from the outbreak are being shared across the Agency and the health community.

 

East Midlands

Bursary First for Students

The Agency in the East Midlands developed a programme which enabled university students to gain formal experience with the Health Protection Agency as part of their degree.

The Agency offered two bursaries for two students in environmental health at the University of Derby and Nottingham Trent University . The bursary enabled them to take a three-month placement with the Agency which formed part of their practical requirements for their degree. The students worked alongside the Agency's experts and completed a project determined by them.
The projects had relevance to real-time working situations and examined important issues and ideas concerning Legionnaires' disease and cryptosporidium, areas that are important to both the local authorities and the Health Protection Units that took part in the projects.

The idea behind this approach was to provide each student with the best possible experience of health protection work on the ground.

An evaluation by the Agency's training officer found that the students, the HPUs and the universities considered the project to be a success, and at least one placement will be offered again, but this time in partnership with a local authority.

The benefits have been reciprocal: one HPU lead has identified the need for employing environmental health officers in HPUs to complement the team's skill mix.

 

West Midlands

Influenza B and Norovirus Infections in Schools

In February 2006 West Midlands HPA began receiving reports of Norovirus (winter vomiting disease) outbreaks in the region's schools. The level of outbreaks reported was in line with seasonal expectations, but within a week the trickle of reports became a torrent.

But the symptoms were not confined to sickness and diarrhoea: parents said their children were also suffering from headaches, lethargy and a 'flu-like illness. It became apparent that some schools had outbreaks of Norovirus, some had influenza B, and some had both.

Many head teachers sought advice from the HPA, which advised them to employ stringent cleaning regimes to eradicate the norovirus. These measures, combined with a reduced teaching staff (due to sickness), meant that many head teachers took the decision to close their schools.

At one point, 20 schools were closed in Birmingham alone. There was huge media attention on the regional HPA from national and regional reporters. However, locally, the media provided a vital public health service, announcing school closures and repeating our advice on caring for sick children.

Both diseases spread quickly across most of the region, but as had been hoped, half-term broke the pattern of the diseases and school attendance returned to seasonal expectations.

 

East of England

First Case of Avian Influenza in the UK

In October, the UK 's first case of highly pathogenic (H5N1) avian influenza virus was found in a bird in quarantine in Essex .

The local Health Protection Unit played an important role in handling the potential human health implications of the incident. Staff carried out a risk assessment, identifying people who had been in contact with the bird and assessing the likelihood of their health being endangered.

Although the risk of infection for these individuals was considered low, Agency staff offered them antiviral medication and advised them on signs and symptoms to look out for that might require further investigation.

The Agency also worked to reassure the public that despite this incident, the risk to the rest of the UK population was still considered to be low. It worked with the media to issue accurate messages to the public, for example, that avian influenza still remains largely a disease of birds, and that all the necessary actions were being taken to protect the public.

This episode required a multi-agency response: the Agency worked with the Department for the Environment, Food and Rural Affairs, the local authority and the State Veterinary Service to handle the incident.

 

London

Sexual Health Report

Sexual health is a key issue for Londoners and the city's health community. Young people in the capital are at greater risk of poor sexual health than their counterparts across the country, and Londoners bear the highest burden of HIV in England . The biggest rise in HIV in recent years has been seen in heterosexuals; nearly all of these infections have been among Black Africans.

In light of this, in June 2005, Health Protection Agency London and the London Health Observatory produced a briefing on sexual health in the capital.

The report, e ntitled Choosing health: A briefing on sexual health in London , highlighted current sexual health issues facing Londoners, and outlined action areas for London 's health-related partnerships.

It focused on three key areas: young people and the importance of education for prevention; men who have sex with men; and better access to services.

The report  has been sent to key stakeholders across London to help them in their work.

 

South East

Drought planning

The start of the present drought in the South East was officially declared by the Environment Agency in November 2004, and current indications suggest the region will continue to be affected by water shortages for a prolonged period of time.

The Agency in the South East has been participating in the planning for a long-term multi-agency response to this problem.

 

One of the Agency's roles has been to carry out a background literature review to identify what is known about the impact of water shortages on public health in the developed world.  

It is also part of the multi-agency 'drought sub-groups' formed by Local Resilience Forums in Kent and Sussex to move joint planning forward.

As part of this, the Agency will be running a regional multi-agency workshop to develop further the evidence on public health impacts and to identify what advice we might offer to the public and the other organisations involved.    

 

South West

Scrap Yard Fire in Bournemouth

A small fire was reported at a car scrap yard in Bournemouth in November last year. The fire was accompanied by multiple explosions from the cars' petrol tanks; all of which caused a high-energy cable running overhead - which was carrying up to 150,000 volts - to collapse, narrowly missing a row of houses.

The incident caused a massive loss of power: a population of more than 200,000 people had no electricity. In the event, however, only 100 people had to be evacuated because of their proximity to the fire.

Local Health Protection Agency staff formed part of the high level emergency response. They worked with the Chemicals Hazards and Poisons Division to establish any threats the fire might pose to public health. They considered the combined effects of the burning contents of the scrap yard, including the metals, oil and petrol, and the dangers of exploding toxic debris.

They also worked with colleagues in the local authorities and health services to establish an outreach emergency team for the people who had been evacuated. This was in order to supply, for example, medication for those with diabetes.

In addition, Agency staff worked with health colleagues to formulate and issue public health messages via the media. The predominant message was to "go in, stay in, tune in" because important updates for the local population would be given on the radio. Further messages issued included asking people to check on their vulnerable neighbours, and for them to minimise journeys because there were no lights on the road.