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HEALTH PROTECTION TEAM
Public Health Unit
Issue 43
April 2007
December 20
Notifications of Infectious Diseases
Disease
DYSENTERY
CAMPYLOBACTER
CHICKENPOX
FOOD POISONING: total
AEROMONAS
Feb 07
0
20
316
9
3
Mar 07
1
36
227
17
5
CRYPTOSPORIDIUM
E COLI O157
ENTAMOEBA
GIARDIA
SALMONELLA
YERSINIA
LEGIONELLOSIS
LEPTOSPIROSIS
LISTERIA
LYME DISEASE
MALARIA
MEASLES
MENINGOCOCCAL INF
MUMPS
Q FEVER
RUBELLA
SCARLET FEVER
TB RESP
TB NON RESP
TYPHOID
VIRAL HEPATITIS: total
HEPATITIS A
HEPATITIS B ACUTE
HEPATITIS C
HEPATITIS B CHRONIC
WHOOPING COUGH
1
3
0
0
1
1
0
0
0
3
1
0
1
6
0
0
1
1
0
0
13
0
1
10
2
3
3
2
0
0
5
2
0
0
0
3
1
0
0
8
0
1
0
1
0
0
14
0
0
9
5
0
Health Protection Team
NHS Grampian
Summerfield House
2 Eday Road
ABERDEEN
AB15 6RE
Tel: 01224 558520 Fax: 01224 558566
e-mail: [email protected]
Dr Helen Howie, CPHM (CD & EH)
Dr Diana Webster, CPHM (CD & EH )
Dr Maria K. Rossi, CPHM (CD & EH)
Dr Susan MacPhee, CPHM, Screening
Co-ordinator
Dr Anne Reid, Medical Officer
Jayne Leith, HP Nurse Specialist
Fiona Browning, HP Nurse Specialist
Susan Duthie, TB Specialist Nurse
Fiona Aitken, Public Health BBV Nurse
Specialist
Janet Bruce, Sexual Health Improvement Coordinator
Jackie Williams, BBV & Sexual Health
Improvement Trainer
Richard Abel, Emergency Planning Officer
Diane McGregor, Administrator
Julie Anderson, Secretary
CONTENTS
You’ve got “Food Poisoning”
Whooping cough notification
Advice to pregnant women during the lambing season
Outbreaks of diarrhoea/vomiting in Care Homes
Health Protection Scotland – TB Study Day 29.05.07
Lyme Disease – risk from tick bites
Completion of laboratory request forms
Immunisation Update:
Free “Green Books” for Immunisers
Printing error – 2006 “Green Book”
New local arrangements for assistance with immunisation queries
Hib and MenC vaccine for patients with an absent or dysfunctional spleen
“YOU’VE GOT FOOD POISONING”
Not all outbreaks of gastro-intestinal illness in the community are food-related
e.g. Norovirus is predominantly airborne. The Health Protection Team and
the Environmental Health Officers who investigate such cases face
unnecessary difficulties when they are dealing with patients who have been
informed by a health professional that they have “food poisoning”.
It would assist the investigating officers if patients are made aware that foodrelated infection cannot be confirmed until environmental investigations have
been completed.
WHOOPING COUGH NOTIFICATION
Colleagues are reminded that a clinical suspicion of a case of whooping
cough should be notified as soon as possible to the Health Protection Team
(01224 558520) without waiting for laboratory confirmation. If it is to be of
benefit, Public Health action required for vulnerable contacts (immunisation,
chemoprophylaxis) should be commenced within 21 days of the onset of
symptoms in the index case, therefore prompt notification of suspected cases
is essential.
ADVICE TO PREGNANT WOMEN DURING THE LAMBING
SEASON
Pregnant women who come into close contact with sheep during lambing may
risk their own health and that of their unborn child from infections such as
chlamydiosis, toxoplasmosis and listeriosis, which are common causes of
abortion in ewes.
To avoid the possible risk of infection, pregnant women are advised that they
should:
 Not help to lamb or milk ewes
 Avoid contact with aborted or newborn lambs or with the afterbirth
 Avoid handling clothing, boots etc. which have come into contact with
ewes or lambs.
 Seek medical advice if they experience fever or ‘flu like symptoms where
they may have acquired infection from the farm environment.
The leaflet “While you are pregnant: How to avoid infection from food and
from contact with animals” is available free of charge to GPs and midwives
from the Scottish Executive Health Department, Public Health Division,
Branch 1, 3E(S), St. Andrews House, Edinburgh, EH1 3DG.
OUTBREAKS OF DIARRHOEA AND/OR VOMITING IN CARE
HOMES.
Viral, or presumed viral, diarrhoea and vomiting has been common this winter
and practices are requested to inform the Health Protection Team (tel. 01224
558520) if a cluster of cases is found. Early involvement of this team in the
management of such outbreaks will ensure that the appropriate control
measures are applied and that the spread of the illness is minimised.
HEALTH PROTECTION SCOTLAND TB STUDY DAY
29th May 2007
At
The Royal College of Physicians and Surgeons, Glasgow.
Registration forms available from Rebecca Flanagan at HPS (0141 300
1170). Cost £15. Lunch included. For more information contact Susan
Duthie (01224 558520)
LYME DISEASE – RISK FROM TICK BITES
The Health Protection Agency has issued a reminder of the risks of tick bites
when visiting forested woodland and heathland areas. The peak times for tick
bites are late spring, early summer and autumn and Lyme Disease has been
acquired in several popular holiday destinations such as the Lake District and
the Scottish Highlands.
Lyme Disease is a notifiable condition, caused by a spirochete, Borrelia
burgdorferi and is transmitted to humans by the bite of infected Ixodes
(deer/sheep) ticks. The transmission of the spirochete does not occur until
the tick has been in place for 36-48 hours. Typical symptoms include fever,
headache, fatigue, and a characteristic skin rash (expanding, erythematous
with central, ‘bull’s eye’ clearance) called erythema chronicum migrans. The
skin rash develops between 3 and 32 days following the tick bite. If Lyme
Disease is left untreated, other manifestations may occur and these may
include large joint polyarthritis (usually asymmetrical), aseptic meningitis,
peripheral nerve root lesions, radiculopathy, meningoencephalitis and
myocarditis.
Lyme Disease diagnosis is based on symptoms, physical findings (e.g., rash),
and a history of probable exposure to ticks - common among forest walkers,
forestry workers, farmers and gamekeepers. Laboratory testing is helpful in
the later stages where confirmation of the disease is by demonstration of
elevated IgM antibody. Most cases of Lyme Disease can be treated
successfully with a few weeks of antibiotics, usually doxycycline or amoxicillin.
Patients with complications may require treatment for months. Patients
diagnosed or suspected to be suffering from Lyme Disease should not be
given steroids or any other immunosuppressant since this may result in
serious complications.
Preventive advice to individuals who are potentially at risk should include
using insect repellent, wearing long trousers and removing ticks promptly.
Individuals taking forest walks in tick-infested areas should inspect exposed
skin for ticks every few hours and, if possible, at the end of the day's outdoor
activity should completely check their bodies. Clothes should also be
checked.
Ticks can be removed by gently gripping them as close to the skin as
possible, using fine-toothed tweezers, and pulling steadily away from the skin.
Some veterinary surgeons and pet supply shops sell inexpensive tick-removal
devices, which are useful for people frequently exposed to ticks.
Colleagues are requested to notify cases of Lyme Disease to the Health
Protection Team. Monitoring of notifications will help to identify high-risk
areas and enable us to offer appropriate advice to the public.
COMPLETION OF LABORATORY REQUEST FORMS
The NHSGrampian policy can be found at:
http://intranet.grampian.scot.nhs.uk/foi/files/NHSGLABSPOL001.doc
Incomplete or incorrect completion of request forms and/or sample labels
ultimately represents a threat to patient safety. National guidelines exist for
“Patient Sample and Request Form Identification Criteria” and external
governance of laboratory services, through the process of accreditation,
requires that each of the laboratory specialties follow and enforce these
guidelines in the acceptance and processing of test requests.
When completing request forms it is essential that the following details
should be included
 Patient’s Full Name
 Date of birth
 Full ten digit CHI number or Hospital Unit number, if available
 Specimen type(e.g. blood, urine, marrow, sputum) and where appropriate
(e.g. pathology samples and swabs for microbiology) anatomical site
 Investigations required
 Date and time of collection
 Clinical history – relevant to the tests being requested
 Patient location / destination of report
Inclusion of the following information is desirable but not essential
 Requesting practitioner


Patient’s home address
Laboratory specialty to which the sample is being submitted
As well as maintaining and improving standards of information provided in test
requesting, the laboratories also have a duty to improve efficiency, safety and
turnaround within the mechanisms by which test requests are made and to
reduce risk of transcription errors during receipt and processing of requests.
IMMUNISATION UPDATE (APRIL 2007)
FREE “GREEN BOOKS” FOR IMMUNISERS
NHS health professionals who are routinely involved in immunisation are each
entitled to a single free copy of The Green Book. In order to receive a copy,
please e-mail the following information to [email protected] for
the attention of Cate, requesting a copy.
 Name
 Work address
 Job title +/- professional registration number
Practice Managers may wish to draw up a list of eligible staff and submit a
block order.
PRINTING ERROR – 2006 “GREEN BOOK”
Please note – the first line on page 282 should read “The dTaP/IPV vaccine,
which contains a lower dose of diphtheria antigen….”
IMMUNISATION QUERIES - CHANGED ARRANGEMENTS
The Health Protection Team receives hundreds of telephone calls each year
requesting advice in connection with immunisation. In order to enable us to
manage this workload more efficiently we are commencing a 6 month trial
period of restriction on the hours during which we will accept immunisation
queries.
From Tuesday 1st May 2007, telephone calls concerning immunisation
queries will only be accepted between the hours of 9 a.m. and 11 a.m on
Tuesdays, Wednesdays and Thursdays.
No telephone queries will be accepted outwith these hours with the exception
of those relating to post-exposure rabies vaccine.
The answers to 76% of the queries in 2006 were found in “The Green Book”
alone and colleagues are reminded that the “The Green Book” should always
be consulted before assistance is sought from the Health Protection Team.
Staff should also note that it is not always possible to provide an immediate
answer to more complex queries, as some further research may be
necessary. Where our help is needed it is therefore advisable to place the
query in advance of the patient’s scheduled attendance, rather than asking for
advice at the actual time of vaccination.
HIB AND MENC VACCINE FOR PATIENTS WITH AN ABSENT
OR DYSFUNCTIONAL SPLEEN
Changed recommendations
Prior to 2006 it was recommended that patients with an absent or
dysfunctional spleen should receive a single dose of Hib vaccine and a single
dose of MenC vaccine. “The Green Book” 2006 now recommends that a
booster dose of Hib/MenC should be given after at least 2 months.
Haemophilus influenzae b immunisation
Vaccination against Haemophilus influenzae b(Hib) is recommended for all
post-splenectomy patients. Those who were fully immunised with Hib as part
of the routine childhood programme should be offered one additional dose of
Hib-containing vaccine. Unimmunised individuals aged 10 years and over
should receive two doses of combined Hib/MenC vaccine, 2 months apart.
(Green Book, 2006)
Meningococcal immunisation
Meningococcal C conjugate vaccine is recommended for all people with an
absent or dysfunctional spleen.
Children under one year should be vaccinated according to the UK schedule,
receiving two doses in infancy and a booster dose at 12 months.
Children over one year of age and adults should be given two doses of
Hib/MenC vaccine two months apart.
Those who were fully immunised with MenC as part of the routine childhood
programme, who then develop splenic dysfunction should be offered one
additional dose of MenC vaccine.
Unimmunised individuals aged 10 years and over should receive two doses of
combined Hib/MenC vaccine, 2 months apart. (Green Book, 2006)
When travelling to a high risk area for meningococcal infection, patients will
still require the additional protection conferred by the polysaccharide A and C
or quadrivalent (A,C,W,Y) vaccines.