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Global Travel – who goes?
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Global Links of NDM to the UK
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Kumarasamy et al., Lancet Infect Dis 2010 10:597-602
15 million Visitors to the UK 2011
Country
USA
Italy
India
Brazil
Greece
Israel
China
Nigeria
Pakistan
Rank (by
number)
1
7
16
19
25
31
33
34
48
Visitors (000)
2,484
1,526
350
276
225
164
149
142
65
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Visitors to the UK by Purpose –
potential for MDR GN household spread
14,000
12,000
Visitors (000)
10,000
8,000
Holiday
VFR
Business
Other
6,000
4,000
2,000
0
2005
2006
2007
2008
Year
2009
2010
2011
Potential Impact of Overseas Patients
Patient Number
Total completed NHS
admission episodes in
England 2011*
Total admissions UCLH**
Total overseas**
14,890,844
127,364
1631
Total transferred from
another NHS provider**
19
Total transferred from a
private provider**
8
Total overseas patients
transferred from private
provider**
0
Total projected overseas
patient admissions
*HES Data
** P. Wilson Pers Comm
Patient No’s
190,751
Carbapenemase-producing Enterobacteriaceae
in the UK (n = 1659)
Imported & ‘home grown’
Early cases often imported
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Neil Woodford: AMRHAI, Unpublished data
Currently very limited knowledge
on basic epidemiology.
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CRO carriage rates in specific high risk
groups allowing targeted screening?
Duration of carriage?
Optimal method of patient screening – rectal
swabs – reliability of self swabbing?
Optimal laboratory screening method?
Transmission rates in home/hospital?
Efficacy of decolonisation and isolation?
Cost effectiveness of interventions?
Concerted Action Required: ALL Sectors
Cross Cutting
Antibiotic Policy
Improved Global
Intelligence
Antimicrobial
Stewardship
Surveillance
Targeted & Structured
Centralised
Reporting
•incl private sector
Simpler
cheaper
laboratory
tests
Aggressive Infection
..Control
• Screening
• Isolation
• Reinforced Hand
..Hygiene
• Contact precautions
Unified Strategic
Policy in DH/NHS
Renewed
Political
Drug Pipeline
Commitment & Investment
Focussed Clinical
Research
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What is the key priority ?
Refocus NHS Infection
Prevention and Control
onto MDR GNB
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Serious threat to routine
care in the NHS
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