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HPS Weekly Report
CURRENT NOTES
24 December 2014
Volume 48 No. 2014/51-52
ISSN 1753-4224 (Online)
HPS Weekly Report – Tuesday publishing
48/5101 As from 6 January 2015, the HPS Weekly Report will be
published on Tuesday mornings rather than on Wednesdays.
CONTENTS
CURRENT NOTES
• HPS Weekly Report – Tuesday
publishing658
To ensure prompt access to the contents, readers can subscribe to
Weekly Report alerts at http://www.hps.scot.nhs.uk/ewr/subscribe.
aspx.
• Influenza activity - guidance on
use of antivirals
658
Influenza activity - guidance on use of antivirals
• ECDC Rapid Risk Assessment
of influenza A virus drift
659
• Influenza vaccine supply
arrangements for the 15/16
season
659
• Shingles (herpes zoster)
vaccine –contraindications 659
• FSA guidance on cooking
frozen turkey
659
• EMA advice on the use of
antibiotics in animals - update
660
• EU vector maps - mosquitoes,
sandflies and ticks
661
• Defra survey on holidaymakers’
unintended imports
661
• Travel, transport and the
environment
662
• EPIET and EUPHEM
fellowships, Cohort 2015
662
NOTIFIABLE TABLE
Notifiable diseases 664
Statutory Notification of
Infectious Diseases
Week ended 12 December 2014
666
48/5102 Health Protection Scotland (HPS) uses information from
a range of clinical and virological influenza surveillance schemes to
identify when there is a substantial likelihood that people presenting
with an influenza-like illness are likely to be infected with influenza
virus each flu season.
In Scotland, clinical influenza activity is now increasing. Although
activity is still at a low level, increases in a number of surveillance
indicators including the number of outbreaks in closed settings
(care homes/hospital wards), virological detections, and the number
of severe cases of influenza, indicates community circulation of
influenza is now occurring.
The use of antivirals for the treatment and prophylaxis of seasonal
influenza in the community is covered by the National Institute
of Health and Clinical Excellence (NICE) technology appraisal
guidance, endorsed for use in Scotland by NHS Healthcare
Improvement Scotland (NHS HIS). The terms of this guidance
are that the use of antivirals in the community for prophylaxis and
treatment of patients presenting with influenza-like symptoms are
subject to certain controls. These controls limit the use of antivirals
to circumstances in which there has been documented evidence
that influenza virus is circulating in the community.
In light of the current surveillance picture reported above, the use
of antiviral drugs for the prevention or treatment of influenza is now
recommended in the community. Oseltamivir (Tamiflu) continues
to be recommended, along with zanamivir (Relenza), for the
prophylaxis and treatment of influenza.
Health Protection Scotland and Public Health England have
provided a summary of issues to consider in using antiviral agents
for the treatment and prophylaxis of influenza. This document has
recently been refreshed and republished in December 2014: http://
www.hps.scot.nhs.uk/resp/publicationsdetail.aspx?id=53562.
The latest PHE/HPS review includes previously unpublished data, and adds to the evidence base
for the treatment of influenza in some settings. Issues relating to this are detailed in a letter from
the Scottish Chief Medical Officer (CMO(2014)29) circulated on 18 December at http://www.sehd.
scot.nhs.uk/cmo/CMO(2014)29.pdf.
ECDC Rapid Risk Assessment of influenza A virus drift
485103 The European Centre for Disease Prevention and Control (ECDC) issued a ‘rapid risk
assessment’ on 22 December noting that data gathered since 1 October 2014 indicated that
in the first ten weeks of the 2014-15 influenza season, viruses in EU/EEA countries had been
predominantly A(H3N2) rather than A(H1N1)pdm09 and type B viruses. In previous seasons,
influenza A(H3N2) viruses were associated with more severe disease than A(H1N1) and type B
viruses; they were also associated with several outbreaks in long-term care facilities.
These observations indicate that the 2014-15 influenza season may be associated with a greater
number of cases with more severe disease, given the higher proportion of A(H3N2) strains among
isolates typed to date and the early evidence of drift that is likely to be associated with reduced
vaccine effectiveness. The circulating viruses are susceptible to the antiviral drugs oseltamivir
and zanamivir. Physicians should therefore always consider treatment or post-exposure
prophylaxis with antivirals when treating influenza-infected patients and exposed individuals in risk
groups. [Source: ECDC Rapid Risk Assessment, 22 December 2014. http://ecdc.europa.eu/en/
publications/Publications/RRA-InfluenzaA-H3N2-Dec-2014.pdf]
Influenza vaccine supply arrangements for the 15/16 season
485104 The Influenza vaccine supply arrangements for community pharmacy contractors and
dispensing doctors, and non-prescribing GP practices for the 2015-2016 season in Scotland were
recently announced and are outlined in the two PCA letters issued on 18 December (go to http://
www.sehd.scot.nhs.uk/).
Shingles (herpes zoster) vaccine –contraindications
48/5105 Shingles (herpes zoster) vaccination for 2014/15 is underway, targeting people aged
70 years (routine) and 78 and 79 years (catch-up) in addition to those aged 71 who were not
vaccinated last year. In the current issue of its Scottish Vaccine Update (issued on 15 December),
HPS has reminded clinicians that shingles vaccine is a live attenuated vaccine and is therefore
contraindicated for some patient groups. All patients need to be assessed for immunosuppression
prior to administration of the vaccine.
The current Scottish Vaccine Update can be accessed at http://www.hps.scot.nhs.uk/immvax/
scottishvaccineupdate.aspx.
Full details are provided in Green Book Chapter on shingles (herpes zoster) https://www.gov.uk/
government/publications/shingles-herpes-zoster-the-green-book-chapter-28a.
NHS Education Scotland also provides training materials with further detail at http://www.nes.scot.
nhs.uk/education-and-training/by-theme-initiative/public-health/health-protection/immunisation/
shingles.aspx.
FSA guidance on cooking frozen turkey
48/5106 The Food Standards Agency (FSA) launched ‘Defrost Your Turkey Day’ on December 22
with a view to minimising the risk of Campylobacter or other microbial contamination by way of the
traditional Christmas lunch.
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A recent FSA survey found 62% of the UK public would have turkey at Christmas and, of those
who choose frozen turkey, 69% might defrost it in unsafely in such locations as the bath, garage
or garden shed.
The FSA reiterated its guidance on preparing turkey from frozen:
• the retailer’s recommended defrosting time should be observed. The size of the turkey will
determine how long it needs to be defrosted for (a large 11kg turkey can take up to two-days
to defrost);
• the turkey should be defrosted in the fridge if possible or somewhere cool. Cold temperature
slows the growth of germs on food and will keep it safe and fresh;
• while defrosting, the turkey should be covered, left in the packaging or put it in a container to
hold any thawing juices, and placed it at the bottom of the fridge to avoid cross-contamination;
• the turkey should be defrosted thoroughly, as otherwise it may not cook evenly and harmful
bacteria could survive the cooking process;
• raw turkey should always be put in the bottom of fridge until ready to use. Leaving on the
kitchen counter at room temperature could increase the risk of food poisoning.
It does of course follow that anyone who has not started defrosting the Christmas turkey by now
has left it too late.
The FSA guidance can found at http://www.food.gov.uk/news-updates/news/2014/13366/defrostyour-turkey-properly.
EMA advice on the use of antibiotics in animals - update
48/5107 Further to Current note 48/3205 (at http://www.hps.scot.nhs.uk/ewr/redirect.
aspx?id=59898), the European Medicines Agency (EMA) has published recommendations to
limit the development of antimicrobial resistance (AMR) linked to the use of antibiotics in animals,
thereby minimising at source the risk of transmission of resistance from animals to humans.
The proposed measures focus in particular on promoting the responsible use in veterinary
medicine of antibiotics that are critically important in human medicine such as fluoroquinolones
and third and fourth generation cephalosporins.
The advice (available at http://www.ema.europa.eu/docs/en_GB/document_library/Other/2014/07/
WC500170253.pdf) was developed by an interdisciplinary group of experts coordinated by EMA
and has been sent to the European Commission to inform their action plan against the rising
threats from antimicrobial resistance.
The emergence and steady increase of bacteria that are resistant to several antibiotics has
become a global public health threat. It is a priority for public health authorities worldwide to
strengthen measures for the prevention and control of antimicrobial resistance to keep antibiotics
effective for future generations.
It is hoped that the advice will act as valuable input into the discussions that have now started in
the European Council and the European Parliament on the proposal for revision of the legislation
covering veterinary medicines. [Source: EMA News Release, 19 December 2014. http://www.
ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2014/12/news_detail_002241.
jsp&mid=WC0b01ac058004d5c1]
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EU vector maps - mosquitoes, sandflies and ticks
48/5108 Newly updated vector maps show the latest data on the geographical distribution of
ticks, phlebotomines (sandflies) and exotic mosquito species in Europe, as of October 2014.
New information about the presence of exotic mosquito species in Europe is available in the
updated mosquito maps, specifically about the Aedes albopictus in Bulgaria, France, Germany,
Greece, Slovenia and Switzerland and regarding Aedes japonicus in Austria, Hungary, the
Netherlands and Slovenia.
The maps are the outcome of the collaborative work of VectorNet – a joint initiative of the
European Food Safety Agency (EFSA) and the European Centre for Disease Prevention and
Control (ECDC) that started in May 2014. The project supports the collection of data on vectors,
related to both animal and human health. ECDC and EFSA create a common database on the
presence and distribution of vectors and pathogens in vectors in Europe and the Mediterranean
through developing a network of experts and organisations from the medical and veterinary
domains. The project aims to extend the network of medical entomologists and public health
professionals, already established during the VBORNET project, and include veterinary
entomologists and veterinarians.
The updated maps can be accessed at http://ecdc.europa.eu/en/healthtopics/vectors/vector-maps/
Pages/vector-maps.aspx. [Source: ECDC News, 22 December 2014. http://ecdc.europa.eu/en/
press/news/Pages/News.aspx]
Defra survey on holidaymakers’ unintended imports
48/5109 As increasing thousands of holidaymakers prepare to jet off on a Christmas escape, new
figures showed that many are unaware of the risks of bringing plants, meat and dairy products
back to the UK from outside the EU. A Defra-commissioned survey found that:
• 25% were not aware of the restrictions on bringing in meat and live plants, while 37% did not
know the rules on dairy products;
• 58% of respondents didn’t realise pests and diseases could be carried on meat products;
• 64% didn’t realise dairy products could carry disease; and
• approximately half of those surveyed who had brought back restricted products had not gone
with the intention of doing so.
Holidaymakers wanting to bring gifts back for friends and family from countries outside the EU
may not be breaking the law intentionally, but it can be easy to impulse buy. There are, however,
strict rules in place to protect Britain from pests and diseases that affect plants and animals. This
is vitally important to safeguard the economy, the environment and our health. Disease outbreaks
can lead to bans on UK exports and have a major impact on natural habitats and native species.
What might seem like a harmless looking plant cutting could be harbouring a destructive pest or
disease. For example, Asian Longhorn Beetles can travel on plants and on wood packaging, and
will attack and kill a range of hardwood trees. The beetle was brought into Britain in 2012 and swift
action was taken to eradicate it.
The survey also revealed few understood the consequences of breaking the rules. Over 70%
didn’t realise they could face travel delays if they were found carrying restricted products, and
almost 20% didn’t know that they might have the item confiscated. Border staff often inspect
luggage so travellers may be subject to checks on return.
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Information on the rules on what can and can’t be brought back is available at: Bringing food,
animals or plants into the UK (https://www.gov.uk/bringing-food-animals-plants-into-uk/petsand-other-animals). [Source: Defra Press Release, 19 December 2014. https://www.gov.uk/
government/news/christmas-holidaymakers-remember-dont-bring-back-a-bug-in-your-bags]
Travel, transport and the environment
48/5110 Europeans collectively travelled 6.4 trillion kilometres in 2012, according to the Transport
and Environment Reporting Mechanism (TERM) 2014. While car transport made up more than 70
% of this distance, it has continued to decline since 2009. In contrast, air transport has increased
very fast over recent decades.
One factor behind this pattern may be changing consumption habits. Some research suggests
that younger generations prefer to spend their disposable income on long distance travel rather
than consumer products such as cars. Nonetheless, there is a wide variation across the EU. Per
capita car travel peaked in 2004 in the original 15 EU member states, while it continues to grow in
the 13 newer members.
Overall passenger transport demand fell 1.4% in 2012, mainly due to the drop in car passenger
travel. Freight transport volumes also fell in 2012, by 2.1%. Transport’s total energy demand has
also fallen, continuing its year-on-year decline since demand peaked in 2007. Because these
trends may be partly caused by the recession, it is unclear whether this will rebound in coming
years.
Greenhouse gas emissions from transport fell 3.3% in 2012, although they must continue to fall
drastically meet targets over coming decades. Air pollutant emissions from most transport modes
also decreased, apart from air pollution emitted by planes which increased for some pollutants.
However, air quality is still harming health in Europe’s cities. Levels of nitrogen dioxide and
particulates in cities have been exacerbated by increasing proportions of diesel cars. This is
partly a result of fuel tax policies in most European countries, which give preference to diesel over
petrol-driven equivalents. [Source: EEA Highlight, 8 December 2014. http://www.eea.europa.eu/
highlights/more-action-needed-to-reduce]
Further to this, more than 125 million Europeans could be exposed to levels of road traffic noise
above legal guidelines. This causes a range of health problems, according to a new assessment
from the European Environment Agency (EEA). ‘Noise in Europe 2014’, published on 19
December by the EEA, analyses exposure to noise levels and resulting environmental health
problems.
The effects of noise are particularly widespread. For the one in four Europeans exposed to noise
levels above the EU’s threshold for assessment and action, there are both direct and indirect
health effects, the report states. Traffic noise annoys almost 20 million Europeans and disturbs
the sleep of an estimated eight million. Environmental noise is also linked to approximately 43
000 hospital admissions, 900 000 cases of hypertension and up to 10 000 premature deaths per
year, the EEA estimates. [Source: EEA Highlight, 19 December 2014. http://www.eea.europa.eu/
highlights/a-quarter-of-europe2019s-population]
EPIET and EUPHEM fellowships, Cohort 2015
48/5111 The calls for EU-track fellows for 2015 for the European Programme for Intervention
Epidemiology Training (EPIET) and the European Public Health Microbiology Training (EUPHEM)
(EUPHEM) are now open. The EPIET and EUPHEM EU-track fellows will be trained in a
European country other than their own.
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The EPIET programme is recruiting applicants for a two-year training in communicable disease
field epidemiology. The aim of the training is to enable the fellow to carry out activities related to
the surveillance, investigation and control of communicable disease threats.
The EUPHEM programme is recruiting applicants for a two-year training programme in public
health microbiology. The EUPHEM programme will include activities related to the area of public
health microbiology: public health microbiology management, applied public health microbiology
and laboratory investigations, surveillance, outbreak investigation, bio risk management, quality
management, research, communication and teaching.
Applicants must be nationals of an EU member state, Iceland, Liechtenstein or Norway and
should have experience in public health, epidemiology or microbiology.
The fellowship programmes will start 14 September 2015. To submit an application, please read
the calls for application and the rules governing the EPIET and EUPHEM fellowships on the
Fellowships page (http://ecdc.europa.eu/en/aboutus/jobs/Pages/fellowships.aspx).
Read more about the training programmes on the EPIET website and European Public Health
Microbiology Training (EUPHEM) website. [ECDC News, 17 December 2014. http://ecdc.europa.
eu/en/press/news/_layouts/forms/News_DispForm.aspx?List=8db7286c-fe2d-476c-913318ff4cb1b568&ID=1137]
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Notifiable diseases
Part 2 (Notifiable Diseases, Organisms and Health Risk States) of the Public Health etc.
(Scotland) Act came into effect on 1 January 2010 and sets out new duties for registered medical
practitioners, NHS boards and directors of diagnostic laboratories. GP practices should familiarise
themselves with the Scottish Government guidance on the new notification requirements at: http://
www.scotland.gov.uk/Topics/Health/Policy/Public-Health-Act.
Registered medical practitioners report notifiable diseases based on ‘clinical suspicion’. As such,
notifications may not be subject to laboratory report confirmation. The published figures will record
therefore how many diseases have been clinically suspected. Patient notifications can, however, be reclassified. When, for example, a suspected (and notified)
tuberculosis case is subsequently reported as negative by a laboratory (and found not to be a
health protection risk) it would subsequently be removed from the disease totals.
Diseases to be notified by registered medical practitioners with effect from 1 January 2010:
Notifiable Diseases which come into effect on 1 January 2010
*Anthrax
*Meningococcal disease
*Botulism
Brucellosis
*Cholera
Mumps
*Necrotising fasciitis
*Paratyphoid
*Clinical syndrome due to E. coli
O157 infection (see note 1)
*Diphtheria
*Haemolytic Uraemic
Syndrome (HUS)
*Haemophilus influenzae
Type b (Hib)
*Measles
*Pertussis (Whooping Cough)
*Severe Acute Respiratory
Syndrome (SARS)
*Smallpox
Tetanus
Tuberculosis (respiratory or
non-respiratory) (see Note 2)
*Tularemia
*Plague
*Poliomyelitis
*Typhoid
*Viral haemorrhagic fevers
*Rabies
*West Nile fever
Rubella
Yellow Fever
It is recommended that those diseases above marked with an * require urgent notification, i.e.
within the same working day.
Note 1: Escherichia coli O157
Clinical suspicion should be aroused by (i) likely infectious bloody diarrhoea or (ii) acute onset non-bloody
diarrhoea with a biologically plausible exposure and no alternative explanation. Examples of biologically
plausible exposures include:
• contact with farm animals, their faeces or environment;
• drinking privately supplied or raw water;
• eating foods such as undercooked burgers or unpasteurised dairy products;
• contact with a confirmed or suspected case of VTEC infection.
Further guidance is available at: http://www.hps.scot.nhs.uk/giz/e.coli0157.aspx.
Where a case is notified as HUS (Haemolytic Uraemic Syndrome) it should NOT also be notified
as ‘Clinical syndrome due to E. coli O157 infection’.
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Note 2: Tuberculosis
For the purposes of notification, respiratory TB or non-respiratory TB should be taken to have
the same meanings as the World Health Organisation definitions of pulmonary TB and nonpulmonary TB respectively:
Pulmonary TB is tuberculosis of the lung parenchyma and/or the tracheobronchial tree.
Non-pulmonary TB is tuberculosis of any other site.
Where tuberculosis is clinically diagnosed in both pulmonary and non-pulmonary sites, this should
be treated as pulmonary TB.
Registered medical practitioners have been advised to contact their local NHS Board Health
Protection Team for advice should they have any doubts about the diagnosis of suspected cases.
Non-notifiable diseases
Registered medical practitioners are no longer required to notify the diseases listed below.
• Bacillary dysentery
• Chickenpox
• Food poisoning
• Scarlet fever
• Viral hepatitis
These diseases are now covered by a list of notifiable organisms details of which will be reported
by laboratories to health protection teams.
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665
Statutory Notification of Infectious Diseases
Week ended 12 December 2014
A National Statistics release
Infectious Disease
Anthrax
Botulism
Brucellosis
Cholera
Clinical Syndrome E. coli O157
Diphtheria
Haemolytic Uraemic Syndrome (HUS)
Haemophilus Influenzae Type B (Hib)
Measles
Meningococcal Infection
Mumps
Necrotizing Fasciitis
Paratyphoid Fever
Pertussis
Plague
Poliomyelitis
Rabies
Rubella
Severe Acute Respiratory Syndrome
(SARS)
Smallpox
Tetanus
Tuberculosis: Respiratory
Tuberculosis: Non-respiratory
Tularemia
Typhoid Fever
Viral Haemorrhagic Fevers
West Nile Fever
Yellow Fever
TOTAL
Total from
Current
Current Previous
first week
week
week
week
of year:
last year
2013
1
1
3
1
1
5
1
1
174
2
81
1
7
3
493
7
6
10
11
1100
22
5
1
13
2
2
23
Amendments: Nil
AA Ayrshire & Arran
FF Fife LO Lothian
TY Tayside
5
4
26
220
147
7
2262
Total from
first week
of year:
2014
2
1
5
9
2
4
2
54
66
315
9
10
409
24
1
219
124
5
2
1263
Source: Health Protection Scotland,
NHS National Services Scotland
BR
FV
LN
WI
NHS BOARD ABBREVIATIONS
Borders
DG Dumfries & Galloway
Forth Valley
GR Grampian Lanarkshire
OR Orkney Western Isles
GGC Greater Glasgow & Clyde
HG Highland SH Shetland
Correspondence to: The Editor, HPS Weekly Report, Health Protection Scotland, Meridian Court,
5 Cadogan Street, Glasgow, G2 6QE, Scotland
T 0141-300 1100
F 0141-300 1172
E [email protected]
W http://www.ewr.hps.scot.nhs.uk/
Printed in the UK. HPS is a division of the NHS National Services Scotland.
Registered
as a newspaper
© Health
Protection Scotland 2014 24 December 2014
666
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48 No.2014/51-52