5 Nations Health Protection Conference
Radisson Blu St. Helen’s Hotel, Dublin, Ireland 14th & 15th May 2013 Final Programme & Abstracts #5nations www.5nations.org.uk 5 Nations Health Protection Conference
Contents Page
Committee 2
Aims and Objectives 3
Scientific Programme 4 - 7
General Information 8
Presentation Abstracts 9 - 31
Poster Abstracts 32 - 62
Chairs and Speakers 63 - 67
Notes 68
Dublin Map INBC
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Conference Organising Committee
Dr Dilys Morgan Mrs Lynda Lewis Gastrointestinal, Emerging and Zoonotic Administrator Infections Communicable Disease Surveillance Centre Public Health England Public Health Wales Colindale, London Cardiff
Dr Gavin Dabrera Dr Lorraine Lighton Trainee Member Consultant in Communicable Disease Public Health England Control Colindale, London Greater Manchester PHE Centre Health Protection Team Dr Meirion Evans Manchester Consultant Epidemiologist Communicable Disease Surveillance Centre Dr Paul McKeown Public Health Wales Specialist in Public Health Medicine Cardiff HSE – Health Protection Surveillance Centre Dublin Dr Kirsty Foster Consultant in Health Protection Dr Joan O’Donnell Public Health England Centre Specialist in Public Health Medicine North East HSE – Health Protection Surveillance Centre Dublin Mrs Yvette Howell Education and Training Coordinator Dr Charles Saunders Public Health England Consultant in Public Health Medicine Colindale, London Fife NHS Board Scotland Dr Jackie Hyland Consultant in Public Health Medicine Dr Lelia Thornton Public Health Medicine Environmental Group Specialist in Public Health Medicine Scotland HSE – Health Protection Surveillance Centre Dublin Dr Neil Irvine Consultant in Health Protection Dr Chris Whiteside Northern Ireland Public Health Agency Consultant in Communicable Disease Belfast Control North Wales Health protection Team Mold
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Aims and Objectives
The aim of the conference is to provide a focus for continuing professional development for Consultants in Communicable Disease Control, Consultants and Specialists in Public Health Medicine / Health Protection and their colleagues in the epidemiology and control of infectious, non-infectious diseases and environmental hazards.
The objectives are:
1. To refresh participants’ knowledge of the recognition, investigation and control of important infections and other environmental hazards.
2. To inform participants about significant new and emerging problems in health protection and advances in methods of their investigation and control.
3. To stimulate discussion of the practical problems that may confront those responsible for carrying out investigations and implementing control procedures.
4. To foster the maintenance and development of professional networks among those working in control of infection and environmental hazards.
5. To contribute to the development of policies and standards.
6. To provide a focus for health protection issues across the Five Nations.
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TUESDAY 14 MAY 2013 09.00 – 18.00 Registration Open 10.00 – 10.15 Welcome and Introduction Address by the Minister of State for Primary Alex White Care in the Department of Health 10.15 – 11.00 Keynote Address Management of acute public threats Michael Ryan 11.00 – 12.30 Outbreak! New Challenges, New Solutions Organisers: Lorraine Lighton & Charles Saunders Chair: Charles Saunders 11.00 – 11.15 Verotoxin producing Escherichia coli O26 and Una Fallon haemolytic uraemic syndrome in two child care facilities; a community outbreak in rural Ireland, May 2012 11.15 – 11.30 An outbreak of Listeria monocytogenes due to Kenneth Lamden consumption of pressed beef 11.30 – 11.45 An outbreak of listeriosis in South Yorkshire Nachi associated with the consumption of pork pies Arunachalam & Corrine Amar 11.45 – 12.00 Flu vaccination in elderly care home residents Leena Inamdar – are we really learning the lessons from past outbreaks? 12.00 – 12.15 Nosocomial transmission of TB in a UK Shaji Geevarghese hospital 12.15 – 12.30 Birmingham or Bradford – TB strain typing Leena Inamdar cluster investigations are resource intensive 12.30 – 13.30 Lunch / Posters 13.30 – 15.00 Surveillance – Seeing the Wood for the Trees Organisers: Meirion Evans & Chris Whiteside Chair: Meirion Evans 13.30 – 13.45 From research to delivery: real time health Martin Schweiger protection surveillance for the London 2012 Olympics & Paralympics 13.45 – 14.00 Confirmed cases of measles in children under Alex Keenan 1 year in North West England, 2007-2012 14.00 – 14.15 Molecular epidemiology of M. tuberculosis in Tara Shivaji Scotland, 2000-2012
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14.15 – 14.30 Epidemiology of M. bovis in humans and Cathriona Kearns cattle, N Ireland, 2000-2012 14.30 – 14.45 Enhanced surveillance of VTEC in England, Lisa Byrne 2009-2012 14.45 – 15.00 How many?! Norovirus surveillance: what we Natalie Adams saw in the first three seasons 15.00 – 15.30 Tea / Coffee / Posters 15.30 – 16.00 Attended Poster Session 16.00 – 17.00 Bloodborne Viruses and Sexually Transmitted Infections – Home and Away Organisers: Neil Irvine & Lelia Thornton Chair: Lelia Thornton 16.00 – 16.15 Developing a best practice guidance toolkit Ian Grey for tattooing and skin piercing practitioners and their premises through multi-agency collaboration 16.15 – 16.30 Coinfection and risk factors for four prevalent Frances Shiely STIs in Ireland 16.30 – 16.45 Home delivered dried blood spot testing - Philip Keel assessing the impact on screening uptake for household contacts of hepatitis B infected pregnant women 16.45 – 17.00 An audit of the clinical pathway for patients Smita Kapadia diagnosed with hepatitis C in Mid Essex between Jan 2007 and Feb 2010 17.00 – 18.00 PHMEG Annual Meeting (The Belville Room) 18.30 – 19.45 Drinks/Pre-Dinner Quiz Organisers: Lorraine Lighton & Paul McKeown Quiz Master: Charles Saunders 19.45 for Conference Dinner 20.00
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WEDNESDAY 15 MAY 2013 08.00 – 13.00 Registration Open 09.00 – 10.15 Vaccine Preventable Diseases: Injecting some common sense into disease prevention Organisers: Kirsty Foster & Joan O’Donnell Chair: Kirsty Foster 09.00 – 09.15 Outbreak of measles in a prison in North James Crick Yorkshire 09.15 – 09.30 The dangers of delaying and defaulting Louise Cullen childhood immunisations: the challenge of schedule change 09.30 – 09.45 Changing epidemiology of mumps in Catherine Coyle Northern Ireland 09.45 – 10.00 Impact of written correspondence with Jillian Johnston General Practitioners on laboratory confirmed pertussis notifications in Northern Ireland 10.00 – 10.15 First evidence of prevalence of Human Corinna Sadlier Papillomavirus (HPV) infection in men who have sex with men (MSM) in Ireland: a stimulus for vaccine review 10.15 – 11.15 Environmental Change and the Four Furies – Fire, Flood, Freeze and ….Wee Beasties! Organisers: Jackie Hyland & Paul McKeown Chair: Colin Ramsay 10.15 – 10.45 Fracking – What is it? Anthony Breslin 10.45 – 11.00 Waterborne verotoxin producing Escherichia Ina Kelly coli outbreaks in the Irish Midlands 2011 and 2012 11.00 – 11.15 Extreme events and health protection: what Virginia Murray are the challenges for public health? 11.15 – 11.45 Tea / Coffee / Posters
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11.45 – 13.00 Hot Topics Organisers: Dilys Morgan & Gavin Dabrera Chair: Dilys Morgan 11.45 – 12.00 Widespread subclinical abnormal prion Noel Gill protein in a second UK survey of archived appendix specimens 12.00 – 12.15 Human Mycobacterium bovis infection in an Musarrat Afza abattoir worker in the UK 12.15 – 12.30 The challenges encountered in the public Ruth Harrell health response to an outbreak of novel coronavirus (nCoV) in the West Midlands 12.30 – 13.00 Influenza H7N9 – is this the start of the John Watson pandemic we have been preparing for? 13.00 Lunch
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General Information Conference Etiquette Delegates are advised that they are not allowed to take photographs of any posters or presentations without the author’s/presenter’s consent. Delegates should also obtain consent from an author before citing any of their work that was presented at the conference.
If you would like to tweet about the conference please use #5nations.
Mobile phones should be switched off or placed on ‘silent’ during sessions. Thank you for your co-operation.
Insurance The Conference Organisers cannot accept any liability for personal injuries or for loss or damage to property belonging to delegates, either during, or as a result of the conference. Please check the validity of your own personal insurance before travelling.
WiFi Access The conference is providing WiFi access free to delegates who have their own devices. Please see the registration notice board for password and log in details.
Posters Posters will be displayed in Pembroke 3. Posters should be put up by 09.00 on Tuesday 14 May and must be removed by 13.00 on Wednesday 15 May. There will be a dedicated poster session on Tuesday 14 May at 15.30 – 16.00 where poster presenters will be given the opportunity to present their work to delegates.
Registration/Information Desk All delegates will receive their name badge, conference documents and all relevant conference information upon arrival at the Radisson Blu.
The Registration and Information Desk will be open at the following times: Tuesday 14 May 09.00 – 18.00 Wednesday 15 May 08.00 – 13.00
Tea/Coffee Breaks and Lunch Arrangements Tea and Coffee points will be located in the foyer outside the Pembroke 1, 2 & 3 and lunch will take place in Talavera Wine Bar.
If you have requested a special diet at the time of registering (other than vegetarian), then your name badge will have a sticker on the back which you should show to the catering staff who will bring you your pre-ordered food.
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Presentation Abstracts
Tuesday 14 May 2013 framework for improving detection, reporting, and response to public Key Note Presentation health emergencies. Key to this objective was the enhancement of eight core national capacities Management of Acute Public covering legislation, financing, Health Threats coordination, surveillance, response, WHERE ARE WE TEN YEARS ON FROM preparedness, risk communication, SARS AND FIVE YEARS ON FROM human resources, and laboratory THE COMING INTO FORCE OF THE services REVISED INTERNATIONAL HEALTH Ten years on from SARS and five REGULATIONS (IHR) years on from the revised IHR have we entered a new era of public Dr. Michael J Ryan health security? While all countries have signed up to the IHR it is clear Adjunct Professor of International that many have not reached the Health, University College Dublin objectives established. In the most The emergence, amplification and recent review carried out by WHO global dissemination of SARS from requesting countries assessment of November 2002 to June 2003 was a whether they had achieved agreed wakeup call to the world and exposed minimum capability levels responses many weaknesses in national ranged from 44% for human and international preparedness, resources to 75% for surveillance. surveillance, response, containment We are faced with ever more and communication. It also complex and convergent risks demonstrated the great courage driven for the most part by our own and determination of medical, behaviour and technologies. These laboratory and public health risks require coherent responses professionals in identifying, tracking that build national and international and containing the disease using public health infrastructure, centuries old methods aided by communications and cooperation modern technologies. The epidemic in a fair and equitable manner. We ended with calls for more investment have underestimated the true cost in public health infrastructure and of doing this and clearly have not cooperation between sectors at made an adequate case for that national and international levels. investment. These aspirations were partially achieved with the agreement on and coming into force of the IHR in 2005 and 2007 respectively. The revised IHR provided a legally binding global
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Tuesday 14 May 2013 109 days with a mean of 35 days (95% CI 27-44). SESSION 1 While the source was not determined, a significant increase in VTEC rates Outbreak! New Challenges, across Ireland was noted during New Solutions this time, with an almost three-fold increase from 199 cases in 2010 to 562 in 2012. Many of these were associated with farming activities VEROTOXIN PRODUCING ESCHERICHIA and private water supplies. COLI 026 AND HAEMOLYTIC URAEMIC Local department learning will be SYNDROME IN TWO CHILD CARE discussed. Local actions resulting FACILITIES; A COMMUNITY OUTBREAK from this outbreak include the IN RURAL IRELAND MAY 2012 introduction of non-0157 VTEC Una Fallon1, Ger Meagher1, Ina testing and a review and inspection Kelly2, David Weakliam1, Caitlin of hygiene policies and practices Ni’Shuileabhan1, Phil Jennings1 in all CCFs in the county. National 1Dept. of Public Health, Health actions include a review of the Service Executive, Dublin Mid- policy of screening asymptomatic Leinster, Tullamore, Co. Offaly, contacts, consideration of the Ireland, 2Dept. of Public Health, evidence of treating prolonged Health Service Executive, South, Cork, shedders, renewed emphasis on well Ireland maintenance and testing and the formation of a multi-agency group Following a case of haemolytic to address rising national VTEC uraemic syndrome (HUS) in a young rates. child, several cases of verotoxin producing E Coli 026 were detected Contact: [email protected] in a rural child care facility (CCF). Three weeks later, another case of HUS was diagnosed in a child attending a different nearby CCF, AN OUTBREAK OF LISTERIA where further VTEC cases were MONOCYTOGENES DUE TO detected. VTEC strains in the two CONSUMPTION OF PRESSED BEEF facilities were indistinguishable. Sam Rowell1, Corinne Amar3, We report on a cohort of 200 from Andrew Fox2, Kenneth Lamden1 whom a screening sample was 1Cumbria and Lancashire Health requested. A Kaplan Meier survival Protection Unit, Lancashire, UK, curve of time to microbiological 2Health Protection Agency Food Water clearance will be presented. There and Environment Laboratory, Preston, were 31 confirmed cases, 20 UK, 3Health Protection Agency probable cases, 4 cases of HUS and Microbiology Services, London, UK 6 hospitalisations. The attack rate was 45% (CCF A) and 32% (CCF B). Outbreaks of listeriosis are The longest time to clearance was uncommon and can be difficult Page 10 5 Nations Health Protection Conference
to investigate because of limited duty to ensure temperature control information on food exposures, it is difficult to provide the level absence of food samples and of evidence required by EHDs complex food distribution networks. to validate this throughout the However the use of discriminative distribution chain. and rapid molecular typing methods Contact: [email protected]. for L. monocytogenes are enhancing uk our ability to identify food sources. Fluorescent amplified fragment length polymorphism (fAFLP) typing made an important contribution to the investigation of an outbreak of AN OUTBREAK OF LISTERIOSIS IN listeriosis in Lancashire and Greater SOUTH YORKSHIRE ASSOCIATED WITH Manchester in July 2012. THE CONSUMPTION OF PORK PIES Four cases of L. monocytogenes, Nachi Arunachalam1, Corrine serotype 1/2a fAFLP type XI.23 Amar1, Wendy Phillips1, Suzanna arose over a two week period. Mathews1, Rosemary McNaught1, Two of the cases died. Case Jarrod Wilkinson2, Nick Wellington3, investigation identified consumption Janice Manning4, Michael Bluff5, of pressed beef (also known as Heather Aird1, Kathie Grant1, Jim beef stew or potted beef) as the McLauchlin1, Adedoyin Awofisayo1, likely vehicle. The outbreak strain Rob Johnston1, Charlotte was isolated from thirteen food Hutchinson1 and environmental samples. The 1Health Protection Agency, likely source was a meat processing England, UK, 2Barnsley Metropolitan factory that supplied shops, cafes Borough Council, Barnsley, UK, and market stalls. There was 3Doncaster Metropolitan Borough insufficient evidence to instigate Council, Doncaster, UK, 4Rotherham a product recall however after a Metropolitan Borough Council, deep clean of the factory no further Rotherham, UK, 5Sheffield City cases arose. The investigation Council, Sheffield, UK uncovered problems unrelated to the outbreak including contamination A case of meningitis in South of foods with other strains of L. East England caused by Listeria monocytogenes, misleading labelling monocytogenes fAFLP type 4.I.74 and unauthorised extension of shelf occurred in July 2012 with a life. possible link to consuming pork pie manufactured in South Yorkshire. The investigation illustrates the National surveillance identified an importance of rapid molecular additional 13 listeriosis cases with typing as a tool for investigating indistinguishable or very similar outbreaks of listeriosis and (fAFLP types i.e. 4.I.74 and 4.I.79) the value of food sampling. An between 2010 and 2012, 8 of unresolved issue is storage of long which occurred in 2012. Excluding shelf life meat products. Although the index case, all cases occurred food business operators have a in South Yorkshire or the East
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Midlands but none in the North West FLU VACCINATION IN ELDERLY CARE also supplied by the manufacturer. HOME RESIDENTS - ARE WE REALLY Food consumption history from LEARNING THE LESSONS FROM PAST nine patients, reported consuming OUTBREAKS? pork pies of different brands: Leena Inamdar1, Jane Reid1, Clare cluster analyses indicated that the Humphreys1, Shirley Brierley2, two L. monocytogenes types were Linda Scott2 significantly associated with pork 1West Yorkshire Health Protection pie consumption (OR: 16.4 (3.20 - Unit, Leeds, UK, 2NHS Airedale, 113.2), p<0.0001). Bradford and Leeds, Bradford, UK Environmental investigations were Introduction: A significant flu conducted by local Environmental outbreak in a care home in Bradford Health Departments at the pork during Christmas 2011 was pie manufacturer and five retailers associated with low flu vaccination identified as potential sources. coverage among the elderly Following extensive microbiological residential care population while testing, L. monocytogenes type nursing care patients were relatively 4.I.79 was recovered from a drain less affected due to good coverage grate and a pork pie collected from of flu vaccination. the manufacturer and from pork pies from two retailers supplied by the Method: An outbreak control manufacturer. As a precaution, the group was convened with antivirals manufacturer voluntarily suspended prescribed for treatment and production, recalled a batch of prophylaxis. Flu vaccination coverage products, conducted a deep clean was reviewed and reasons for poor of their site and reviewed their flu vaccination were explored. production practices. Results: 66 out of 142 residents and A review of national surveillance staff were affected, with 7 Influenza A data in March 2013 did not H3N2 cases virologically confirmed. identify any further cases due to L. There were 7 hospitalisations and monocytogenes types 4.I.74/4.I.79. 10 deaths. 14 of 44 residents had Whole genome sequencing of received flu vaccination. Majority of isolates from both food and patients cases were from the residential unit indicated that types 4.I74 and 4.I.79 who had not received flu vaccine. were indistinguishable. Ongoing Cases in nursing units remained low regulatory and industry efforts are due to better vaccination coverage. needed to decrease the presence None of the staff had received the of L. monocytogenes in ready-to-eat flu vaccine and approximately 30% foods. of staff was affected which severely impacted the business. Cost analysis Contact: nachi.arunachalam@phe. on lost income due to staff sickness gov.uk and empty beds has highlighted need for flu vaccination of staff and residents. The HPA and NHS worked very closely with the care homes
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forum to raise awareness about flu Results: VNTR results from a sputum vaccination, provide staff vouchers sample confirmed that she was part for flu vaccination and develop tools of a cluster of three other cases. for outbreak management. Further investigation established a link between these patients: They Conclusion: Although flu outbreaks had all been admitted to the same are seen every year in care homes, bay on a Clinical Decisions Unit in there needs to be clear ownership of November 2011. the responsibility for flu vaccination administration, particularly to Patient 1 (88 years) was sputum dementia patients in care homes, smear positive 4+ in November with a co-ordinated approach to flu 2011. She was subsequently vaccination of care home residents nursed on the ward of the diseased and staff. These outbreaks present healthcare worker for two months. same old challenges, but do need Patient 2 (82 years) was diagnosed innovative solutions. with pleural TB in May 2012. Patient 3 (22 years) was diagnosed with Contact: [email protected] miliary TB in December 2012. Contacts for all of the patients were identified and a total of 266 patients and staff were invited NOSOCOMIAL TRANSMISSION OF TB for screening. All other contacts IN A UK HOSPITAL were sent information letters with Anne Imkampe, Cathy Southwood, reassuring advice. Shaji Geevarghese, Jharna Conclusion: This is an exceptional Kumbang situation because nosocomial Kent Health Protection Unit, Ashford, transmission of TB is rare in the Kent, UK UK. A healthcare worker acquired Background: We describe the active TB as did at least two patients investigation of a 36-year old white admitted to hospital with unrelated British healthcare worker who was diseases. A detailed investigation diagnosed with smear positive TB in is still underway and the screening December 2012. This resulted in the results are awaited. emergence of a hospital based TB Contact: Shaji.Geevarghese@phe. cluster. gov.uk Methods: Contacts of the healthcare worker within the hospital were identified and a risk assessment was undertaken to select those at significant risk and to offer them screening. An incident control meeting was held which brought together the relevant teams within the hospital.
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BIRMINGHAM OR BRADFORD- Bradford cluster included hard-to- TB STRAIN TYPING CLUSTER reach patients, needing 70 HPA INVESTIGATIONS ARE RESOURCE hours, 30 TB nurses hours, and 6 INTENSIVE TB physician’s hours. Birmingham investigation required 15 TB nurses Leena Inamdar1, Jharna Kumbang2, hours, 3 CCDC hours and 2 chest Rebecca Ingham1, Roger Gajraj2, physician’s hours. Huda Mohammed2, Ruth Frizzell3 1West Yorkshire Health Protection Conclusion: Although Unit, Leeds, UK, 2West Midlands responsibilities were allocated Health Protection Unit, Birmingham, differently, with the local unit UK, 3Bradford Teaching Hospitals assuming a greater operational role Foundation Trust, Bradford, UK in Bradford, both investigations demonstrated the significant Introduction: We describe the resource requirements. No chains impact of TB strain typing cluster of transmission were identified and investigation on Health Protection no evidence uncovered to suggest Units (HPUs) in two different English secondary transmission. There is a regions with similar population need to examine cost-effectiveness demographics and comparable high of cluster investigations to identify burden of TB. appropriate resources needed for Method: Both HPUs undertook such intensive investigations. extensive TB clusters investigations Contact: [email protected] jointly with TB nurses. Cluster investigation questionnaires were completed, with home visits to identify risk factors and epidemiological links between cases. Results: The Bradford cluster had 16 cases of which 8 had same postcode. Potential links investigated included street working, drug use, snooker halls and worship places but none had direct epidemiological links. In Birmingham, clusters had 4-17 cases. One cluster involving six patients had two family members; four with same post code, three students linked to local school. No direct link was established among cases. Investigation included information collection, risk assessment, home visits and incident meetings.
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Tuesday 14 May 2013 relevant Olympic context categories. Results: The enhancements SESSION 2 developed provided alerts to the Olympics team anytime the HPA Surveillance – Seeing the received a report of a case, enquiry Wood for the Trees or outbreak had a linked Olympic context, with associated situation reports automatically triggered. Real-time coincidence alerts also FROM RESEARCH TO DELIVERY: proved an effective tool for exploring REAL TIME HEALTH PROTECTION common factors including location SURVEILLANCE FOR THE LONDON and nationality. Developments 2012 OLYMPICS AND PARALYMPICS delivered for the Olympics can readily be applied to real or Ruth Gelletlie1, Chakib Kara-Zaitri2, simulated national events. Martin Schweiger1 1Dept for Gastrointestinal, Emerging Conclusions: The combined use and Zoonotic Infections, HPA of local HPZones and the national Colindale , 2inFact, Saltaire, West Dashboard provided real time Yorkshire, UK surveillance information for those responsible for managing the health Background: The Health Protection protection aspects of the Olympics. Agency (HPA) accepted responsibility HPZone enabled frontline staff to for providing a health protection play an important role in ensuring service focused on the needs of a safe environment for the Olympics the Olympics and Paralympics to proceed. to cover athletes, support staff, games visitors and the public. A Contact: [email protected] key objective was to ensure that potential threats were identified and prevented or effectively managed. A dedicated HPA team was set up to CONFIRMED CASES OF MEASLES IN research and plan for the event. It CHILDREN UNDER THE AGE OF 1 YEAR was recognized that a national-wide NORTH WEST ENGLAND, 2007 - 2012 real time surveillance system was 1 1 required. Alex Keenan , Sam Ghebrehewet , Roberto Vivancos2 Method: Requirements for the 1Cheshire & Merseyside Health surveillance system were reviewed, Protection Unit, Cheshire & specified and delivered through Merseyside, UK, 2Regional enhanced versions of HPZone and Epidemiology Unit, NW, UK HPZone Dashboard to cover the Olympics. A pre-Olympic Exercise, Introduction: Measles is highly was used to test the enhancements infectious, mainly affecting children. and allowed some fine tuning Prevention is achievable through including more attention to defining vaccination. Maternal antibodies are protective for children under the age
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of 1 year but these wane after the THE MOLECULAR EPIDEMIOLOGY OF first year of birth. COVER data gives MYCOBACTERIUM TUBERCULOSIS IN us information on uptake rates both SCOTLAND BETWEEN 2000 AND 2012 nationally and locally. Within the NW Tara Shivaji1, Fiona Johnston2, the uptake is below the 95% level Amie-Louise Seagar3, Ian F as recommended by the WHO to Laurenson3, Alison Smith-Palmer2 achieve herd protection. 1NHS Highland, Inverness, UK, Methods: Anonymised data were 2Health Protection Scotland, Glasgow, extracted for all confirmed measles UK, 3Scottish Mycobacteria Reference cases under the age of 1 in the NW Laboratory, Edinburgh, UK from 2007 - 2012 inclusive. Background: With an annual Results: incidence of 8.6 cases per 100,000 population in 2011, rates of TB • 196 confirmed cases of measles notification in Scotland are lower under the age of 1 were reported than the UK as a whole. However, in the NW from 2007 - 2012 unlike the rest of the UK, TB inclusive. incidence increased by 38% from • 85% of confirmed cases of 2005-2010. Molecular epidemiology measles were in those aged offers a means of identifying between 6 and 12 months. risk factors and characteristics associated with recent transmission • For 95% of cases, exposure was of TB in Scotland and could offer most likely to have occurred an insight into improving TB control during outbreak situations. practices. Conclusions: We are proposing Methods: This was a retrospective that in outbreak situations MMR be cohort study using Enhanced used as a preventative measure for Surveillance of Mycobacterial children between 6 months and 12 Infections (ESMI) data and molecular months of age in the geographical strain typing data, 24 locus MIRU- area of the outbreak, and that the VNTR profiles of M. tuberculosis. standard immunisation schedule of The two datasets were linked using MMR1 be undertaken again at 13 unique patient identifier codes. We months. compared patient characteristics of Contact: [email protected] clustered and non-clustered strain types. Results: There were 31 strain type clusters involving 2 to 21 individuals. 73% of individuals in a strain type cluster were male. Most cases occurred in the 45-54 year age group. 69% of individuals in a strain type cluster were born in the UK and 82% were of white ethnicity. Homelessness (OR 2.42
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95% CI 1.03 - 5.65) and alcohol Surveillance scheme and animal use (OR 2.33 95% CI 1.32 - 4.10) disease statistics from DARDNI for were significantly associated with Northern Ireland between 2000 and involvement in a strain type cluster 2012 were reviewed. containing 4 or more persons. Results: 22 human cases of M. bovis Conclusions: Large strain type reported 2000-2012 (≈3% of human clusters of TB in Scotland tend to TB cases), mean age 60 years (range be comprised of individuals who are 20-89 years), 50% of cases older white, male, and socially complex. than 60 years. 27% of cases lived Migration from high prevalence on a farm with 27% also consuming countries contribute to the overall unpasteurised products. Annual TB burden but do not appear to incidence of bovine TB in herds significantly contribute to ongoing 7.32% (range 5-10%), annual transmission in Scotland. animal incidence 0.66% (range 0.4- 0.9%). Diagnostic disclosure in live Contact: [email protected] cattle increased sharply (40%) in last 2 years following a significant decrease in previous 7 years. There were 1,386 new reactors herds in N. EPIDEMIOLOGY OF MYCOBACTERIUM Ireland in 2011, but no significant BOVIS IN HUMANS AND CATTLE IN increase in disclosure of disease at NORTHERN IRELAND, 2000-2012. post mortem examination of cattle for human consumption. Cathriona Kearns1, N Clarke2, M Devine1, B Smyth1, L Doherty1, P Conclusion: Eradication of TB in O’Neill1 animals to control human infection 1Public Health Agency, Northern remains a subject of discussion. Ireland, UK, 2Department of Public health response for contacts Agriculture and Rural Development, of infected animals is based Northern Ireland, UK on a risk assessment (NICE TB Guidance). The human epidemiology Introduction: Mycobacterium bovis of M. bovis does not indicate recent can cause TB in humans and is the transmission from animals with principal cause of bovine TB. While current infection in N. Ireland M. bovis infection in animals and suggesting that current public health humans is relatively uncommon, approach is appropriate. it remains an important zoonotic infection. Contact: cathriona.kearns@hscni. net Aim: Review epidemiology of M. bovis in human and cattle populations in Northern Ireland to examine evidence of transmission. Method: Human TB cases caused by M.bovis reported to the Public Health Agency Enhanced Tuberculosis
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ENHANCED SURVEILLANCE OF developed HUS. VEROCYTOTOXIN-PRODUCING The system serves as a repository ESCHERICHIA COLI IN ENGLAND: 2009- for clinical, epidemiological and 2012 microbiological case data and is, Lisa Byrne, Claire Jenkins, Richard therefore, an invaluable public health Elson, Naomi Launders, Bob Adak resource. Over time, surveillance Dept for Gastrointestinal, Emerging will allow analyses of longer term and Zoonotic Infections, HPA trends including emerging subtypes Colindale and risk factors. Bringing England’s surveillance of VTEC in line with In England, verocytotoxin-producing Scotland, Wales and Ireland will Escherichia coli (VTEC) are relatively facilitate co-ordinated public health rare but important gastrointesti- action and the elucidation of the nal pathogens of significant public epidemiology of VTEC and HUS health concern, due to their associa- among these countries. tion with severe disease. Contact: [email protected] In the UK and Ireland, the largest number of cases is reported in England, where laboratory surveillance has been undertaken for over 20 years. Scotland, Wales and HOW MANY?! NOROVIRUS Ireland have undertaken enhanced SURVEILLANCE: WHAT WE SAW IN THE surveillance for several years, while FIRST THREE SEASONS an enhanced surveillance system Natalie Adams, John Harris, Bob was first introduced in England on Adak 1st January 2009. Dept for Gastrointestinal, Emerging The first four years of data and Zoonotic Infections, HPA indicate the incidence of VTEC and Colindale haemolytic uraemic syndrome (HUS) Norovirus is the commonest cause remains highest in children aged of gastrointestinal infections in under 5 years and that adult females the United Kingdom (UK). A recent have a higher incidence than males. national study suggested that there Rates of infection vary regionally are around 3 million cases annually. and are higher in rural areas than Within semi -enclosed settings (e.g. urban areas. The majority of VTEC hospitals, care homes, cruise ships) belonged to serogroup O157 and the virus can cause widespread phage type (PT) 21/28 was most disruption, particularly as it is able frequently detected although PT8 to survive for long periods in the was most common in travel-related environment, has a low infectious cases. Exposure history data dose and immunity to infection is indicate that contact with animals, short-lived. The financial cost to the eating out and consumption of NHS of gastrointestinal outbreaks is beef products are most frequently estimated to be around £115 million reported among cases. A third of per year. cases were hospitalised and 6%
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In 2009 the Health Protection Tuesday 14 May 2013 Agency introduced a voluntary web- based system to collect information on suspected/confirmed outbreaks SESSION 3 of norovirus in England. Each NHS Trust was invited to participate, Bloodborne Viruses and with data entered by infection Sexually Transmitted control staff in hospitals. This is Infections – Home and Away the first comprehensive dataset to demonstrate the impact of norovirus in hospital settings in the NHS in England. DEVELOPING A BEST PRACTICE In the first three seasons there were GUIDANCE TOOLKIT FOR TATTOOING 4,712 outbreaks, 82% of which AND SKIN PIERCING PRACTITIONERS resulted in ward or bay closures AND THEIR PREMISES THROUGH and 68% of which were laboratory MULTI-AGENCY COLLABORATION confirmed. Each outbreak had an Ian Gray1, Ann Lusmore2, Susanne average (mean) length of closure 3 of 9 days and between 23 and 25 Howes 1Chartered Institute of Environmental bed days lost, with 10 patients and 2 between 2 and 3 staff members Health, London, UK, South West affected. London Health Protection Unit, London, UK, 3East Midlands South This system provides clear evidence Health Protection Unit, Leicester, UK of the burden of norovirus outbreaks to National Health Service (NHS) Tattooing and body piercing have hospitals. The system also provides become popular and fashionable a more timely assessment at the throughout the 5 nations with an national level of the incidence and increasing range and availability of impact of norovirus outbreaks to procedures. NHS hospitals in England. However, there are well reported Contact: [email protected] health risks which can be attributed to these procedures. Improper practice and poor infection prevention and control may result in localised skin infections at the site of the tattoo or piercing. There is also the risk of transmission of blood-borne viruses such as hepatitis B and C and HIV which can have serious and long term health consequences. Ensuring practitioners follow safe working practices is important for protection of both clients and practitioners. Despite a variety of legislation being
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introduced, longstanding concerns in STI epidemiology in Ireland have been raised by tattoo and since 2000. Three STIs comprise body piercing practitioners and approximately 90% of notifications; health protection/environmental ano-genital warts (GW), Chlamydia health specialists about the lack of trachomatis (CT) and non-specific robust and consistent guidance on urethritis (NSU). Ireland has no standards of hygiene and safety sexual health strategy. Our objective leading to inconsistency in advice was to compare the risk factors for and variations in standards of four STIs in attendees at two STI practice. clinics and examine the incidence of coinfection. This on-line, interactive Tattooing and Skin Piercing Guidance Toolkit Methods: Diagnostic, demographic has been developed by a multi- and behavioural information on agency steering group comprising attendees at two clinics in southwest representatives from the Chartered Ireland were collected from January Institute of Environmental Health, 1999-July 2009. Chi-squared tests Health Protection Agency (England), examined differences in demographic Health and Safety Laboratory, Tattoo and behavioural characteristics and Piercing Industry Union and also across clinics, stratified by sex. individuals with practical experience Multivariable logistic regression, of working in this area as expert applying backward elimination, advisors, practitioners or regulators. investigated the combination of risk factors associated with first episode The guidance is supported by GW, genital herpes simplex viral extensive documentary evidence infection, NSU and CT. of scientific knowledge, reported research and published literature Results: 22,705 STI patients encompassing expert advice and the (mean age 27yrs), received 26,824 opinions/experience of practitioners diagnoses. 1628 had more than of what works at a practical level. It is one infection. GW was most likely also hoped the toolkit will influence to be associated with a coinfection. development of training standards. Having multiple partners was positively associated with a Contact: [email protected] diagnosis of bacterial infection but not viral infection. Discussion: Our large cohort outlines those at risk in the region, showing COINFECTION AND RISK FACTORS FOR age and gender influences the risk FOUR PREVALENT STIs IN IRELAND and type of infection. Smoking, Frances Shiely1, Kevin Hayes2, Mary alcohol and drug use is also Horgan1 common, all regarded as markers of 1University College Cork, Cork, risk-taking behaviour. The younger Ireland, 2University of Limerick, the age, the higher the risk of Limerick, Ireland acquiring infection, regardless of infection type. Prevention strategies Background: Little has changed
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that target youth, bacterial STIs Methods: Population: HBsAg and high-risk behaviour, including positive pregnant women identified sexual, alcohol and drugs, may be through antenatal screening at a effective in reducing STI incidence London maternity unit during audit in Ireland. This study provides a (01/01/2009- 31/12/2009) and reference for evaluation of the study (01/11/2010-31/12/2011) impact of the HPV vaccine which periods. was rolled out in Ireland in 2010. Audit: Retrospective review of Contact: [email protected] general practitioner (GP) records to determine uptake of screening of HHCs. Study: Home DBS testing for HOME DELIVERED DRIED BLOOD SPOT HHCs who had not previously been TESTING - ASSESSING THE IMPACT ON screened. First dose of vaccine was SCREENING UPTAKE FOR HOUSEHOLD offered to HHCs <16 years; HHCs CONTACTS OF HEPATITIS B INFECTED =>16 years were referred to primary PREGNANT WOMEN. care for vaccination. DBS samples were sent to HPA for HBsAg testing. Philip Keel1, Jessica Flood1, Gwendolene Edwards1, Grainne Results: Audit: 41 women with Nixon2, Kazim Beebeejaun1, Justin 91 known HHCs were identified. Shute3, Andrew Millar4, John Overall 46/91 (51%) were screened, Parry3, Mary Ramsay1, Gayatri (32/53 children; 12/33 partners; Amirthalingam1 2/5 ‘Other adult’) and one HBsAg 1Immunisation, Hepatitis & Blood positive contact (partner) identified. Safety Department, Health Protection Study: 58 women with 169 known
Agency, Colindale, London, UK, HHCs were identified. Overall, 2 North East & North Central London, 167/169 (99%) were screened 3 HPU, London, UK, Microbiological by DBS (86/86 children; 54/56 Services, Health Protection Agency, partners; 27/27 ‘Other adult’). 53 4 Colindale, London, UK, North (31%) contacts screened were HBsAg Middlesex University Hospital, positive (3 (6%) children; 35 (66%) London, UK partners; 15 (28%) ‘Other adult’) Introduction: Despite, national Conclusions: This is the first UK recommendations to screen study to investigate the effectiveness household contacts (HHCs) of of home DBS testing to screen hepatitis B infected pregnant women, household contacts of HBsAg implementation is sub-optimal. positive pregnant women. These Testing of home collected capillary findings suggest home DBS testing blood as dried blood spots (DBS) particularly improved screening offers an alternative to conventional uptake for partners, increasing from follow up in primary care. This study 36% to 96%. aims to assess the impact of using home DBS testing to improve the Contact: [email protected] screening uptake of HHCs.
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AN AUDIT OF THE CLINICAL PATHWAY Documentation on genotype results, FOR PATIENTS DIAGNOSED WITH treatment initiation, outcomes and HEPATITIS C IN MID ESSEX BETWEEN follow up was poor; 33% patients JAN 2007 AND FEB 2010 had no documentation at all. Smita Kapadia1, Louise Teare2 There was no agreed pathway 1Bedfordshirte and Hertfordshire or clinical network. There was a Health Protection unit, Hertfordshire, consistent lack of clarity among UK, 2Mid Essex Hospitals NHS Trust, referring clinicians about when and Chelmsford, Essex, UK where to refer. Aims: To map current arrangements Recommendations: for management of patients 1. Develop and agree a clinical with hepatitis C from testing to pathway across primary and treatment and identify gaps to make secondary care and laboratory recommendations for improving services. services. 2. Develop mechanisms for routine Methods: We identified all positive reporting of data on attendance results for anti-hepatitis C antibodies rates and treatment outcomes. between Feb 2007 and Feb 2010 and conducted a questionnaire 3. Explore patient views on existing survey of the referring clinicians for services and need for a locally every positive patient. A clinician at led hepatology service. the regional specialist hepatology Contact: [email protected] centre was interviewed. Standards: Recommendations from Public Health Hepatitis C Annual Report 2009, NICE guidelines TA 106 and RCGP guidelines 2007. Results: Of the 11075 tests for Hepatitis C, 218 results on 148 patients were positive. 72 of these were new cases, of which only 53/72 (74%) were referred for hepatitis C RNA testing to identify those currently infected. 36 (68%) of these tested positive. Only 83% of RNA positive patients were referred for specialist treatment. Treatment was not commenced in 27% patients (either awaiting results or too unstable). Only 79% had follow up with the specialist centre.
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Wednesday 15 May 2013 Discussion: Following the conclusion of the outbreak, staff from the HPU SESSION 4 completed the work to ascertain the prior MMR status of the under 25s at the time of the outbreak. This Vaccine Preventable showed 89% had a record of at least Diseases: Injecting some one MMR in childhood (50% had common sense into disease two MMRs). When this is taken into prevention account the attack rate in the under 25s in the prison with no record of any previous MMR vaccination was 63%.The relatively high pre-existing OUTBREAK OF MEASLES IN A PRISON vaccination coverage was likely to IN NORTH YORKSHIRE have limited the size of the outbreak. Simon Padfield, James Crick, Contact: [email protected] Richard Firth HPA, York, North Yorkshire, UK Background: This outbreak took place in the context of a small THE DANGERS OF DELAYING Category C/D prison in North AND DEFAULTING CHILDHOOD Yorkshire with a population of 210 IMMUNISATIONS - THE CHALLENGE offenders (median age 26 and OF SCHEDULE CHANGE. mainly white British ethnicity). Louise Cullen, Katrina Callaghan, Description of outbreak: Following Anthony Breslin identification of the index case the Health Service Executive, Donegal, prison were advised to be vigilant Ireland for secondary cases and to isolate early. An outbreak was declared There was an unexpected decline in following the identification of a the uptake of immunisations at 12 second probable case. The prison and 13 months in Ireland, following was advised to cease transfers and the July 2008 amendment to the a strategy of mass vaccination childhood immunisation schedule to was commenced for all the staff allow for the introduction of two new and offenders whose immunisation vaccines. status was unknown. In total 191 In North-West Ireland analysis of offenders and 71 staff received age at immunisation and number MMR vaccination. Active follow up of vaccines received at each visit of the small number of offenders was conducted on a representative who had been transferred to other sample of children (890/3,870) prisons prior to the outbreak being born in the year following schedule declared did not identify any spread change. A cross-sectional survey within the prison system. In total was used to gather information from there were 8 confirmed cases of parents (248/890). measles linked to the outbreak. Defaulters of immunisation were
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not refusing immunisations, but CHANGING EPIDEMIOLOGY OF rather opting to have immunisations MUMPS IN NORTHERN IRELAND at 2, 4, 6 months whilst defaulting Catherine Coyle, Joy Murphy, on those at 12 and 13 months Richard Smithson (MenC and Hib). Furthermore, a Public Health Agency, Northern statistically significant proportion Ireland, UK of defaulters were considerably older at immunisation than the This paper describes the changing non-defaulter group (p<0.001). epidemiology of mumps cases in Defaulters were significantly more Northern Ireland (NI) across three likely to split administration of outbreaks from 2000 to 2012-13. immunisations that should be given Details of the 2000 outbreak have on the same GP visit; 34% split the been previously published (Reaney 6 month immunisations (p<0.001). et al, Commun Dis Public Health The non-defaulter group also 2001; 4: 257-61). Surveillance data delayed and split immunisations to on laboratory confirmed mumps a lesser extent; 22% delayed the 13 cases from 2005 and 2012-13 was month immunisations until over 18 examined. Demography data is months, 6% split administration of obtained directly from the laboratory the 6 month immunisations. system and MMR status is retrieved Several factors were significantly from the electronic Child Health associated with poor immunisation System (CHS). uptake: larger family size (p=0.012), Confirmed case numbers in each moving GP (p=0.025), using a outbreak were: 2000 - 332, 2005 childminder (p=0.012), lack - 852, 2012-13 239 (to date, of awareness of the schedule outbreak ongoing). The ages (p<0.001), not using the parent-held affected have risen. The median immunisation record (p=0.036), age of cases increased from 14 in and concerns with vaccine safety the 2000 outbreak (range 2-68), to (p=0.007). 19 in 2012-13 (range 7-90). The These findings have implications for proportion of cases aged 20-24 policy and practice with regard to years increased from 1.2% of cases provision of effective immunisation in 2000 to 20% of cases in 2005, services for children in Ireland, and to 34% of cases in 2012-13. The above all preventing illness such as M/F ratio has increased from 1.3:1 meningitis. in 2000 to 1.4:1 in 2012-13. Contact: [email protected] The most significant finding is the marked increase in the proportion of cases with two MMRs which increased from 0.9% in 2000, to 19.5% in 2005, to 72% of 2012-13 cases. The epidemiology of confirmed mumps cases in NI is changing with
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higher numbers of older people in 2012. Notifications increased being affected as well as higher monthly from a mean of 9 cases/ proportions of fully vaccinated month (range 5-11), before the cases. The consistently high uptake letter, to a mean of 32 cases/month of MMR in NI has proven protective (range 14-47) after. against large measles outbreaks. Before the GP letter 62.9% of cases This data shows that it has not been were in babies under 3 months. No as effective at preventing mumps change was seen in the monthly outbreaks. The reasons for this number of cases in those under require further exploration. 3 months (mean 6, range 4-8; Contact: [email protected] versus mean 6, range 3-11). Cases increased in all other age groups, with cases over 25 years showing a significant increase from 0.3 cases per month to 12 cases per month. IMPACT OF WRITTEN CORRESPONDENCE WITH GENERAL Conclusions: This study shows a PRACTITIONERS ON LABORATORY marked increase in the number CONFIRMED PERTUSSIS of laboratory confirmed pertussis NOTIFICATIONS IN NORTHERN notifications following written IRELAND communication with GPs, particularly in those over 25 years. Jillian Johnston, Richard Smithson, Lewis Shiliday, Monica Sloan Written communication with primary Public Health Agency, Northern care can have a significant effect Ireland, UK on changing clinical behaviour, improving case ascertainment and Aim: This study aimed to measure the surveillance, thus enabling more impact of written correspondence complete public health actions. with general practitioners (GP) on laboratory confirmed pertussis Contact: [email protected] notifications in Northern Ireland. Method: Surveillance of laboratory confirmed cases of pertussis is carried out by the Health Protection Division of the Public Health Agency (NI). Age-specific laboratory confirmed cases were extracted for 2012. A written letter was sent to all GPs on 12 April 2012 informing them of pertussis and ensuring they considered the diagnosis. Descriptive analyses were performed and comparisons made before and after 12 April. Results: 314 cases were reported
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FIRST EVIDENCE OF PREVALENCE When HPV and HR HPV ware OF HUMAN PAPILLOMAVIRUS (HPV) stratified by age those >30 years INFECTION IN MEN WHO HAVE SEX had a higher prevalence (77%vs50% WITH MEN (MSM) IN IRELAND: A p=0.001 and 45%vs18% p=0.001). STIMULUS FOR VACCINE REVIEW HIV+ subjects were more likely to Corinna Sadlier1, Dominic Rowley1, have any detectable HPV (77%vs60% Deirdre Morley1, Paul Smyth1 ,2, Orla p=0.03), to have HR HPV types 16 Sheils1 ,2, Colm Bergin1 or 18 (44%vs27% p=0.011) or to be 1St James’s Hospital, Dublin 8, infected by >1 HR HPV (10%vs0%, Ireland, 2Trinity College Dublin, p<0.001). Dublin, Ireland Conclusion: A high prevalence of Background: In Ireland, no data exist anal HPV was found in our cohort. on the prevalence of HPV infection Clarifying baseline prevalence of in men. Emerging patterns of HPV HPV infection is important in guiding related disease including anal and prevention strategies in relation to oropharyngeal cancers, particularly HPV vaccination. in at risk groups such as MSM, Contact: [email protected] strengthen the call for universal or targeted vaccination. Documenting the molecular epidemiology of HPV is essential to formulating national vaccine guidelines. Methods: A prospective cohort study was conducted looking at prevalence and predictors of anal HPV infection. HPV was detected using consensus primer solution phase PCR followed by type specific PCR. Results: 194 MSM (mean [SD] age 36 [10] yrs, 51% HIV+) were recruited. Median number of reported sexual contacts in the preceding 12 months was 4 [IQR 2-10]. HIV+ subjects had a mean CD4 count 557 [SD 217] cells/mm3, 84% were on HAART. 31 samples were B-globin negative and thus excluded from further analysis. 113 (69%) had detectable HPV DNA. HPV 16 was detected in 44 (27%) and HPV 18 in 26 (16%) samples. 10 (6%) had both HR HPV types 16 and 18 detected.
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Wednesday 15 May 2013 to the European rate, in 2010, of 0.83 per 100,000. SESSION 5 We have had three waterborne community VTEC outbreaks from Environmental Change and small private regulated drinking the Four Furies – Fire, Flood, water supplies. In August 2011, an Freeze and…wee beasties! outbreak of 38 cases of E. coli O157 resulted in seven hospitalisations, 1 with haemolytic uraemic syndrome Invited Speaker (HUS). In August 2012, out of 250 people on a private housing FRACKING – WHAT IS IT? estate, there were 11 cases of E. coli O157 with 1 hospitalisation. A Anthony Breslin third outbreak in 2012 involved 5 HSE North West, Ireland cases of E. coli O157, plus 2 people The presentation will give the basis with bloody diarrhoea who tested facts on what fracking involves, negative. the different regulatory regimes in During 2012, there were several Europe and the USA, and discuss smaller outbreaks on water supplies the implication for communities in which are exempt from regulation. In the UK and Ireland if exploration a community outbreak of 4 cases, becomes a reality. the index case, who developed HUS, was exposed to a well contaminated with the same VTEC (E. coli 026). Five of seven wells tested as part of this investigation were found to WATERBORNE VEROTOXIN be contaminated with coliforms or PRODUCING ESCHERICHIA COLI E. coli but not VTEC. In another, the OUTBREAKS IN THE IRISH MIDLANDS index case, visiting from an urban 2011 AND 2012 area, was exposed to 7 contaminated Ina Kelly2, Una Fallon1, Margaret private wells. Cosgrove1, Aine McNamara1, David Risks to be discussed include Weakliam1, Caitlin Ni’Shuileabhan1, the complex governance of Irish Phil Jennings1 water supplies, the proportion 1Dept. of Public Health, Health of Irish people served by private Service Executive, Dublin Mid- wells (12.3%), high prevalence of Leinster, Tullamore, Co. Offaly, well contamination, breakthrough Ireland, 2Dept. of Public Health, contamination and severe weather Health Service Executive, South, Cork, events, private water supplies in new Ireland housing estates and the risk of food The Midlands has the highest VTEC businesses switching from public notification rate in Ireland - 29.4 supplies to private pre-existing wells. cases per 100,000 versus 12 per 100,000 in 2012. This is compared Contact: [email protected]
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EXTREME EVENTS AND HEALTH levels, EEHP provides up-to- PROTECTION - WHAT ARE THE date evidence based information CHALLENGES FOR PUBLIC HEALTH? to support the development for adaptation, planning, response Virginia Murray and recovery to extreme events. For Extreme Events and Health Protection this purpose an extreme event can at Public Health England be defined as any extreme weather Climate change is an economic, social event or other natural hazard and environmental challenge that including flooding, drought, cold, cuts across every sector of society heat, earthquakes and volcanic ash resilience, including health and with the potential to cause adverse wellbeing. The Climate Change Act impacts on human health. EEHP (2008) requires the UK Government collaborates closely with climate to publish a National Adaptation change and sustainability partners. Programme, which will include a Contact: [email protected] section on health and wellbeing (including social vulnerability and community resilience), following the publication of a Climate Change Risk Assessment (2012). This identified for health that • Hotter summers are projected to increase the risk of heat-related death and illness. • The number of casualties due to flooding and the impact of floods on mental wellbeing are both projected to increase. • Milder winters are projected to result in a major reduction in the risk of cold-related death and illness. As part of addressing these issues for public health, in January 2011 the HPA set up the Extreme Events and Health Protection Section (EEHP) to provide a focal point for evidence based advice for extreme weather events and other natural hazards at local, national and international levels. By collating relevant inform- ation from within HPA and from academic and other partners at local, national and international
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Wednesday 15 May 2013 spleen, tonsils or lymphoid tissue of the gastrointestinal tract, before SESSION 6 invasion of the central nervous system. Prevalence of vCJD carrier status in the UK population has been Hot Topics estimated through screening archival appendectomy and tonsillectomy specimens. Due to differences between previous studies, a second WIDESPREAD SUBCLINICAL large scale survey of appendix tissue ABNORMAL PRION PROTEIN IN A was undertaken. SECOND UK SURVEY OF ARCHIVED APPENDIX SPECIMENS Methods: Tissue from 2000-2012 appendicectomies was collected from 1 2 Noel Gill , Yvonne Spencer , pathology departments throughout 3 Angela Richard-Loendt , Carole Britain and tested for abnormal prion 1 1 Kelly , Reza Dabaghian , Lynnette protein by immunohistochemistry 3 4 Boyes , Jaqueline Linehan , Marion using the unlinked-anonymous 2 2 Simmons , Paul Webb , Peter technique. Bellerby2, Nicholas Andrews1, David Hilton5, James Ironside6, Jonathan Findings and interpretation: In 32441 Beck3, Mark Poulter4, Simon Mead4, formalin fixed paraffin embedded Sebastian Brandner3 appendix samples, there were 16 1Dept for Gastrointestinal, Emerging positive specimens, a prevalence of and Zoonotic Infections, HPA Colindale 370 per million population (95% , 2Animal Health and Veterinary confidence interval of 191-646 per Laboratories Agency, Weybridge, UK, million). The prevalence in 1941- 3UCL Institute of Neurology, Division 60 birth cohorts was similar to that of Neuropathology and Department of in 1961-1985 cohorts, and in both Neurodegenerative Disease,, London, genders and across the three broad UK, 4UCL Institute of Neurology, geographic areas sampled. PRNP MRC Prion Unit and Department of codon 129 genotyping of the 16 Neurodegenerative Disease,, London, positive specimens revealed a high UK, 5Derriford Hospital, Department of proportion of 129VV compared to the Cellular and Anatomical Pathology,, normal population, and contrasted Plymouth, UK, 6University of Edinburgh, with confirmed clinical cases of National Creutzfeldt-Jakob Disease vCJD who have all carried the PRNP Research & Surveillance Unit., 129MM genotype. This study suggests Edinburgh, UK a remarkably high prevalence of subclinical vCJD prion infection in Background: Dietary exposure in the UK the population compared with the to bovine spongiform encephalopathy 176 vCJD cases to date. The findings prions in the late 1980s and early have important implications for the 1990s led to the emergence of variant measures to control blood and blood Creutzfeldt-Jakob Disease (vCJD). product transmission, and for the This prion disease is distinguished handling of surgical instruments. by accumulation of vCJD prions in Contact: [email protected] Page 29 14th & 15th May 2013
HUMAN MYCOBACTERIUM BOVIS tested positive for latent TB. INFECTION IN AN ABATTOIR WORKER The spouse of the case was IN THE UK later confirmed to have M.bovis pulmonary infection. Musarrat Afza1, Nic Coetzee1, Harsh Duggal1, Jason Evans3, Kabali The VNTR types for the two Nandakumar2, Noel H Smith4 cases were identical and the 11. Health Protection Agency, West spoligotype was a single VNTR Midlands North Health Protection locus variant of the commonly Unit, Stafford, UK, 22. Queens Hospital seen genotype 25:a stable in Burton on Trent Foundation Trust, the local cattle population for Burton upon Trent, UK, 33. Health last10 years. Protection Agency, Birmingham, UK, We found no evidence of 44. Animal Health and Veterinary transmission of TB to work Laboratories Agency, Surrey, UK contacts. It is unlikely that the Mycobacterium bovis (M. bovis) is index case acquired M. bovis the principal agent responsible for infection from the practices tuberculosis in domestic and wild in the abattoir and this was animals. Human M.bovis infection is possibly reactivation of clinically indistinguishable from the latent TB infection due to prevalent form of human TB caused immunosuppression. by M. tuberculosis. Contact: Musarrat.Afza@phe. We describe a public health gov.uk investigation of a case of human pulmonary M. bovis infection confirmed from post mortem samples.
Screening of the patient’s family and THE CHALLENGES ENCOUNTERED work contacts took place in summer IN THE PUBLIC HEALTH RESPONSE 2012. Isolates from the cases were TO AN OUTBREAK OF NOVEL sent to the HPA reference laboratory CORONAVIRUS (nCOV) IN THE for VNTR typing and AHVLA for WEST MIDLANDS genotyping against the specific types found in the cattle from the Ruth Harrell1 ,2, Louise Dyke2, catchment area. Mamoona Tahir2, Roger Gajraj2, Madhu Bardhan2, Musarrat The index case was a British born Afza3, Robert Carr3, Nicholas cattle keeper in a high bovine TB Aigbogun3, Petra Charlemagne2, incidence region. This patient’s Rea Alves2, Keith Neal1, Obaghe other risk factors included Edeghere1, Harsh Duggal3, immunosuppression, unpasteurised Huda Mohamed2, David milk consumption and working in Kirrage4, Sue Ibbotson0 an abattoir which slaughtered TB 1West Midlands Regional reactors. Epidemiology Unit, HPA, Three out of 11 family contacts Birmingham, UK, 2West Midlands and one out of 39 work contacts East HPU, HPA, Birmingham,
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UK, 3West Midlands North HPU, HPA, system was complex, and Stafford, UK, 4West Midlands West emphasised the role of strong HPU, HPA, Kidderminster, UK, 5HPA partnerships in responding to West Midlands, Birmingham, UK a novel disease. This requires consideration as we move into In February 2013, the West Midlands the new structures. East HPU was notified of a positive diagnosis of nCoV in a Birmingham • Public interest in this outbreak resident, who had recently spent was high. This led to difficulties time in Pakistan and Saudi Arabia. in maintaining the level of Subsequently, two close family confidentiality that the family contacts who had not travelled were desired, and affected the delivery confirmed as secondary cases; of the public health response. providing the first clear evidence of Contact: [email protected] person-to-person transmission. We report on the local public health response to this outbreak, which involved the three West Midlands HPUs, in particular the challenges that were identified around contact tracing, coordination and communications: • The public health response required contacts to be traced, interviewed and sampled; blood tests for all (immediately and 21 days later for serology), and nose and throat swabs and sputum samples in symptomatic contacts. The vast majority of contacts were based in the West Midlands and in excess of 100 contacts were traced and sampled. These included family and friends, flight passengers and a range of health care workers. The process of obtaining samples in the community, particularly for symptomatic contacts, was challenging; not least because sampling required FFP3 respirators for personal protection. • The coordination of the different elements of the health care
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Poster Abstracts Outbreak! New Challenges, Consumption of pork was identified New Solutions to be associated with statistically significant risk of acquiring salmonella infection (Risk Ratio: P-1 2.75). AN OUTBREAK OF SALMONELLA The pubs were inspected, advised to AGONA PT39 IN SOUTH YORKSHIRE stop the use of unwashed parsley to garnish advisory notice issued. Nachi Arunachalam1, Wendy Meats slow cooked using ‘Alto-sham’ Phillips1, Rosemary McNaught1, ovens were found satisfactory. Nick Wellington2, Neil Craig3, Samples of raw and cooked Chris Lane1 meat (including pork), parsley, 1Health Protection Agency, England, condiments, surface swabs and UK, 2Doncaster Metropolitan Borough stool samples from all staff (none Council, Doncaster, UK, 3Sheffield City were symptomatic) were taken and Council, Sheffield, UK found to be negative. Tracing back Four cases affected with Salmonella of the origin of key ingredients led Agona PT39 in February 2012 in to international suppliers. Doncaster potentially linked to No case since June 2012. Enhanced eating at a local pub initiated the surveillance and case-case analysis investigation. with other salmonella cases for By June 2012, nine cases were any commonalities is being reported. Five out of six cases from implemented. Doncaster and two out of three Contact: nachi.arunachalam@phe. cases from Sheffield reported eating gov.uk at their local pubs, which belong to the same chain of pubs. Review of historical data showed that P-2 of the 28 cases that were notified in the UK in the years 2010 and 2011, MANAGEMENT OF A MYCOBACTERIUM 15 had occurred in Doncaster and TUBERCULOSIS CLUSTER IN A 4 in Sheffield. 5 out of the 9 cases UNIVERSITY SETTING who had answered questions had John Barber, Bernadette Purcell, reported eating at the pubs. Sofia Saeed A survey of cases and their fellow Surrey & Sussex Health Protection diners in Doncaster in 2012 was Unit, Horsham, UK conducted using standardised Setting and Methods: A cluster of four questionnaire developed using pub students with an indistinguishable menu. 5 cases and 12 contacts strain of Mycobacterium tuberculosis, (including 5 who were symptomatic as identified by 24 loci MIRU- but not tested) participated. VNTR (mycobacterial interspersed
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repetitive unit variable number highlights the importance of strong tandem repeat) genotyping, was working relationships between detected at the University of Sussex, health and educational facilities to of which three were smear positive. ensure that the majority of those Initial close contact screening as identified for screening attend. In part of routine case management addition, more should be done to suggested that transmission of inform students about local health infection to close contacts had care provisions and to inform occurred. More detailed index students about the symptoms of interviews using an adapted cluster TB. More research is needed into the questionnaire suggested a few costs versus benefits of screening epidemiological links between two programmes of this size and into the indexes, though none elucidated possibility for expansion of national an obvious path for infection to the guidelines to include university other two cases. Consequently wider scenarios. The higher resolution of screening was initiated. Following a whole genome sequencing might campus walk-around and scrutiny of provide a better understanding of course lists a group of 236 students transmission patterns. and staff, who were classified into Contact: [email protected] high and low risk, were invited to screening consisting of an interferon-gamma release assay (IGRA) blood test and a ‘typical week P-3 diary’ contact questionnaire for TB AN OUTBREAK OF LEGIONNAIRES’ exposure collecting information on DISEASE ASSOCIATED WITH A DISPLAY demographics, clinical symptoms SPA POOL IN RETAIL PREMISES, and possible transmission sites. STOKE-ON-TRENT, UNITED KINGDOM, Non-attending subjects were JULY 2012 followed up. Nic Coetzee1, Harsh Duggal1, Results: 161 cases were screened Jeremy Hawker1, Sue Ibbotson1, over 2 days (68% of those identified), Tim Harrison2, Nick Phin2, Vasile 10 had a positive screening result Laza-Stanva3, Rob Johnston1, Zafar with a further 3 being borderline Iqbal4, Yasmin Rehman1, Elizabeth positive and 1 being indeterminate. Knapper1, Sandra Robinson1, Of those positive half were born Nicholas Aigbogun1 in the UK. No further definitive 1Health Protection Agency, West epidemiological link was discovered. Midlands, UK, 2Health Protection DNA sequencing of the index cases’ Agency, Colindale, UK, 3University isolates is awaited. Results of Hospital North Staffordshire, Stoke-on- screening were managed following Trent, UK, 4National Health Service, standard UK clinical practice. The Stoke-on-Trent, UK proportion of students registered with a general practitioner was In July 2012 an outbreak found to be less than 70%. investigation was initiated when two confirmed cases of Legionnaires’ Conclusions: This investigation disease in residents of Stoke-on-
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Trent were reported to the West investigation. Midlands North Health Protection Contact: [email protected] Unit. A multi-agency outbreak investigation team directed the response. Control actions including assessment of registered cooling P-4 towers and case interviews regarding A LOCAL PERSPECTIVE OF A NATIONAL potential exposure sources and risk CRYPTOSPORIDIOSIS OUTBREAK locations visited. Duncan Cooper1, Mike Gent2, Adrian During the following two weeks 21 Wesley3, Caoimhe McKerr4, Stephen confirmed cases of Legionnaires’ Morton3 disease (Legionella pneumophila 1NHS Airedale, Bradford and Leeds, serogroup 1) were identified in the Bradford, UK, 2West Yorkshire Health Stoke-on-Trent area of England with Protection Unit, Leeds, UK, 3Health onsets since 2 July 2012. DNA Protection Agency Yorkshire & sequence based typing identified The Humber, Leeds, UK, 4Health a previously unrecognised Protection Agency West Midlands, strain (designated ST1268) in Birmingham, UK 9 patients. No other strain was identified. Aims: To describe the epidemiological investigation and response in West The median age of cases was 64 Yorkshire to a national outbreak of years, 14 cases were male, and Cyptosporidium parvum. there were two deaths during hospitalisation. All cases reported Methods: A rise in cases of Cryptosporidium spp. was noted in visiting a retail store in Stoke-on- rd Trent where a spa pool was on public West Yorkshire on May 23 2012. display. A swab sample from this The outbreak control team initiated: spa pool tested positive for the same • Enhanced case finding and strain as the patients, ST1268. No microbiological testing other samples taken from any of the • Completion of hypothesis other sites tested positive for this generation questionnaires strain. • Mapping of cases against Water Ten days after recognising the Supply Areas outbreak, the investigation team • Informal enquires into concluded that the spa pool at the supermarket supply chains retail store in Stoke-on-Trent was the most likely source of exposure for • Health advice to cases and all cases. Case incidence declined reactive press statements rapidly after draining the spa pool. Results: In total 82 cases of The use of sequence based typing cryptosporidiosis were reported in methodology, sufficient clinical West Yorkshire during May 2012, and environmental samples, and 65 of which were typed as C. accurate case exposure histories parvum. During the outbreak peak were central to the success of this (May 11-18th) there was a higher
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than expected proportion of female case was hospitalised with cases (67% v 50% expected) and Streptococcal Toxic Shock Syndrome adult cases (85% v 58% expected). and subsequently died. A third Case finding quickly spread to other ‘probable’ case was hospitalised parts of Yorkshire (South Yorkshire with cellulitis in the same eight-day 26 cases; North Yorkshire 32 cases) period; bacteriological confirmation and the UK. was not possible. The temporal clustering and age- Method: The home environment sex distribution of cases, and lack and infection control practices of common recreational or travel were assessed. Staff completed a related source, meant a food source questionnaire regarding relevant was suspected. Food questionnaires symptoms. Residents and staff were revealed that 88% of cases screened by throat swab and, if interviewed in West Yorkshire had indicated, skin lesion swab. Infection shopped at a particular supermarket control advice was given and further chain and that 88% had eaten pre- training planned. packed salad items. A national Results: Both confirmed cases were case-control study and investigation typed as emm st1.0 T-Type 1. 100% of supermarket food chains is on- (21/21) residents, 92% (22/24) going. staff, and 91% (10/11) visiting staff Conclusion: This outbreak were swabbed, and all were negative highlighted the difficulty of timely for GAS. No further cases have microbiological testing of perishable occurred. food items as the likely exposure Discussion: Initial risk assessment was 1-9th May, dates of onset 11- indicated potential transmission 16th May, and first outbreak meeting of GAS within a very short time- 24th May. frame in a vulnerable, elderly, Contact: duncancooper10@yahoo. institutional population. Outbreaks co.uk are well-recognised in such settings. Microbiological typing supported transmission within P-5 the home, although emm st1.0 is the most common local type. This INVESTIGATION OF A CLUSTER OF investigation supports the strategy CASES OF GROUP A STREPTOCOCCUS of screening so that treatment can (GAS) IN A RESIDENTIAL CARE HOME be targeted only at known carriage. IN NORTHERN IRELAND, NOVEMBER It also offers insight into logistical 2012 considerations when organising Rachel Doherty, Maureen Mc mass sampling. Cartney, Neil Irvine Contact: [email protected] Public Health Agency, Belfast, UK Introduction: Two confirmed cases of GAS were reported in a residential facility in Northern Ireland. One
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P-6 NHS. It is designed as an algorithm to aid decision making focusing DEVELOPING A RISK ASSESSMENT on the factors that are associated TOOL FOR with transmission namely: the TB EXPOSURE INCIDENTS IN infectiousness of the case, duration HOSPITALS of exposure and characteristics of Clare Humphreys1, Ebere Okereke0 ,1 those exposed to the case. The tool 1City of Bradford Metropolitan District has been piloted across Yorkshire Council, Bradford, UK, 2Health and Humber region and feedback Protection Agency Yorkshire and the from this is currently being collated Humber, Yorkshire and the Humber, to help refine the tool further. UK Contact: [email protected] Risk factors for the transmission of TB are the same whatever the setting, however hospitals present P-7 further challenges. These include: MEASLES OUTBREAK IN A NURSERY: the concentration of susceptible BEWARE THE BUSY SOCIAL LIFE OF patients; exposure opportunities THE MODERN BABY posed by certain types of procedures and opportunities for unwittingly Dan Hungerford1, Lorraine Lighton2, sharing a closed environment (ward) Paul Cleary1, Ruth Philp2, William with an infectious case of TB. A 2010 Welfare2 retrospective review of TB incidents 1Health Protection Agency North in schools, prisons and hospital West, Liverpool, UK, 2Greater settings found that out of these three Manchester Health Protection Unit, settings, most incidents occurred Manchester, UK in hospital settings. However, the In July 2012 there was an outbreak yield of positives per 100 people of measles at a nursery in Wigan. screened was significantly lower in Seventeen confirmed cases and 1 hospitals setting suggesting that probable case were identified. All there may be inconsistencies with cases were under 16 months and contact screening. nearly all under age for routine To help improve the management vaccination. of TB exposure incidents Yorkshire The index case was linked to a and the Humber Health Protection confirmed case in Merseyside. Agency, in collaboration with Initially it was thought that the NHS TB teams across the region, index case had not attended nursery carried out a literature review and during the infectious period until developed an evidence-based risk a further 2 cases were identified 3 assessment tool for TB exposure weeks later. Vaccination was offered incidents in hospitals. The tool is to children over 6 months of age who based on current best practice had not received 2 MMR, any pyrexial guidance, including NICE guidance children were excluded and no new and feedback from experts in the children started. After further cases field of TB from the HPA and the
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the nursery was advised to close. 1West Yorkshire Health Protection Unit, Leeds, UK, 2Yorkshire and Social network diagrams were Humber Regional Epidemiology used to describe and manage this Unit, Leeds, UK, 3Leeds Teaching outbreak, including identification Hospital NHS Trust, Leeds, UK, 4HPS of at risk settings for intervention. Colindale, London, UK, 5Bradford Several cases from the nursery District Metropolitan Council, also attended a playgroup that Bradford, UK, 6FWE Lab, York, UK ran twice a week. Vaccination was offered to children over 6 months of Introduction: Following initial re- age who had not received 2 MMR, ports of 3 cases of Shigella flexneri and the organiser opted to close linked to the same take-away in the community centre running the Bradford, outbreak investigations playgroup for two weeks. Children revealed further cases of the same from the playgroup attended other serotype in Bradford. We describe groups, with resultant onward the usefulness of PFGE and whole transmission risk. genome sequencing when managing this outbreak. A number of timely actions, including, vaccination of contacts, exclusion, Method: Enhanced surveillance and use of social network diagrams further subtyping was undertaken. to understand the outbreak, and Review of Exceedence revealed good MMR uptake in the general slightly higher number of Shigella population ended the outbreak. flexneri cases in Bradford. The children involved had complex Results: There were other Shigella social calendars, the understanding flexneri cases that occurred in of which was important for effective Bradford during the same time, control measures. The closure of initially thought to be part of this the nursery and playgroup may outbreak. These were subsequently have risked wider transmission known to be of a different serotype. through displacement of potentially Some of these cases had travel infectious children. history, but since early results from Contact: [email protected]. local labs indicate only Shigella uk species, initial investigation was influenced by these background cases which were unlinked to the P-8 outbreak. Use of PFGE profiles indicated that only 6 cases were SHIGELLA FLEXNERI OUTBREAK LINKED true outbreak cases, 4 of whom TO A TAKEAWAY IN BRADFORD- ROLE had links to the take-away and 2 OF GENOME SEQUENCING IN LOCAL that did not have any links. It was OUTBREAK MANAGEMENT also noted by the national Reference Leena Inamdar1, Rebecca Ingham1, Lab that there were 3 other cases Louise Coole2, Jane Reid1, Miles elsewhere nationally that had same Denton3, Claire Jenkins4, Sue Ubhi5, or very similar PFGE profiles. Whole Angela Brindle5, Heather Aird6 genome sequencing was used to
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help understand the epidemiology An innovative pro-active approach of Shigella flexneri locally. to prevent further cases in other secondary schools was agreed by Conclusion: Recent advances in the outbreak control team, whereby genome sequencing offer new all nearby secondary schools (n=9) opportunities in managing local were targeted for school-based outbreaks. From a local perspective, immunisation sessions, regardless such techniques can provide useful of whether they had measles cases insights in outbreak control and or not. A prioritisation framework directing use of resources for was used, with priority given to epidemiological investigation. More schools with highest numbers of awareness about the practical fully susceptible children (0 MMRs). applications of these newer methods at local level will help enhance and One immunisation session per focus outbreak investigations. setting was arranged. A total of 802 Children were given MMR during Contact: [email protected] these sessions. Measles notifications from Bolton reduced dramatically in the following weeks, though it is not P-9 possible to directly link this decline WHEN MEASLES MEETS THE to the intervention. WAKEFIELD COHORTS: MANAGING This significant undertaking was A SECONDARY SCHOOL OUTBREAK possible thanks to: the existence -A TRIUMPH OF PARTNERSHIP of a dedicated immunisation AND PROFESSIONALISM OVER THE team and a school nursing team, BARRIERS OF TRANSITION both with extensive experience of Matthieu Pegorie1, Rosemary running school-based clinics, strong McCann1, Graham Munslow1,2 health-professional networks and 1HPA, Greater Manchester, UK, relationships, a sense of ‘pulling 2Bolton Public Health Immunisation together’ of will and resources from Team, Bolton, UK different professional groups, a thriving ‘Healthy Schools’ e-network In November 2012 a measles with its linked social media (twitter), outbreak occurred in a large Bolton and the support of the local media. secondary school. 21 confirmed and 2 probable cases were identified, Contact: [email protected]. aged 11 to 15, the majority were uk unimmunised for measles. Despite control measures, including a school-based immunisation session, new cases from local feeder primary schools were soon identified, indicating significant onward transmission, usually via households.
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P-10 potential contacts, tight timescales and some administrative errors CHALLENGES OF LARGE SCALE complicated the investigation. TB SCREENING IN A FAITH BASED BOARDING SCHOOL Conclusion: Students in the school are from high-risk populations with Helen McAuslane1, Leena Inamdar1, families living in high TB prevalence Rebecca Ingham1, Jane Reid1, Ruth areas. Although the school suggested Frizzell2, Andrew O’Shaugnessy3 that mixing between students in 1West Yorkshire Health Protection different years is unlikely, results Unit, Leeds, UK, 2Bradford Teaching suggest that either there were Hospitals Foundation Trust, Bradford, several small clusters uncovered UK, 3NHS Airedale, Bradford and during this investigation or that Leeds, Bradford, UK more mixing between students Introduction: Following identification occurs than previously thought. of an infectious smear positive Several lessons were learnt when pulmonary TB case in a faith based managing this incident. Excellent boarding school in Bradford, a large multi-agency working and cultural scale screening exercise involving sensitivity are critical during such over 500 people was undertaken complex investigations in faith for the entire school. We describe based settings. the incident and the challenges of Contact: [email protected] organising such a large screening exercise in a resource constrained setting. Method: As there was evidence of transmission between the index case and close contacts, using the stone-in-the-pond approach, a decision was taken to screen the whole school involving over 500 staff and students. Due to high numbers and time pressures due to school holidays, a private lab was commissioned to undertake IGRA testing. Results: Following screening, 8 cases of active TB and over 60 cases of latent TB were identified. These cases were spread across different year groups. The screening day was efficient and ran smoothly due to excellent communication and co- operation between all stakeholders. However, the large number of
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Surveillance: Seeing the Consultants in Communicable Wood for the Trees Disease Control (CsCDC), Consultants in Emergency Medicine and HPA Environmental P-11 Public Health Scientists. IMPROVING THE PUBLIC HEALTH Results: The results demonstrate RESPONSE TO CHEMICAL INCIDENTS: HAZMED has improved the AN EVALUATION OF THE YORKSHIRE surveillance, reporting and AMBULANCE HAZMED SERVICE public health management Helen McAuslane, Mike Gent of incidents in the region. West Yorkshire Health Protection Unit, Feedback from stakeholders was Leeds, UK positive, although awareness of the team was lower outside Background: The HAZMED service West Yorkshire. Key areas for was developed by Yorkshire improvement included training Ambulance Service (YAS) and and communication between West Yorkshire Health Protection agencies. Unit (HPU) in 2005 to improve management of chemical incidents. Conclusions: HAZMED is The remit of the team is to improve a valued resource that has the emergency response to improved the public health casualties at the scene, to expedite response to chemical incidents the public health response and to in Yorkshire and The Humber. The increase intelligence through better report makes recommendations surveillance. for building on the strengths of the service through more The service expanded in 2008 to joint training and developing include the whole of Yorkshire and relationships with partners. The Humber but had not recently been evaluated. An evaluation was Contact: helen.mcauslane@phe. conducted to assess whether the gov.uk service was achieving its objectives. Methods: Data from HAZMED P-12 report forms was extracted from the database and analysed according to EPIDEMIOLOGY OF the type of incident attended and TUBERCULOSIS IN CHILDREN IN public health outcomes such as THE YORKSHIRE AND HUMBER adverse health effects, fatalities and REGION vulnerable people affected. Helen McAuslane, Ebere More detailed information was Okereke obtained via questionnaires sent to Health Protection Agency, Leeds, key stakeholders including HAZMED Yorkshire & the Humber, UK advisors, Fire Service Hazardous Background: Yorkshire and Material and Environmental the Humber has the second Protection Officers (HMEPOs), highest regional TB incidence
Page 40 5 Nations Health Protection Conference rate in UK outside London, with P-13 increasing TB diagnoses in children. Children aged ≤14 years make up ANTIMICROBIAL PRESCRIBING IN THE an increasing proportion of TB COMMUNITY, A REPEATED, CROSS- cases in the region; 9% of TB cases SECTIONAL STUDY diagnosed in in 2011, compared to Julie Arnott, Colin Bradley, Tony UK average of 5%. TB incidence in Fitzgerald children ≤14 years in the region was University College Cork, Cork, Ireland 6.8/ 100,000 in 2011. Introduction: The HPSC uses The aim of this audit is to describe purchased IMS Health sales data the incidence and patterns of for the surveillance of outpatient transmission of TB in children in antibiotic use in Ireland, which has our region and to identify patterns been deemed unsuitable by the and trends to inform prevention and Antibiotic Consumption Surveillance control strategies. Working Group recommendations Methods: Data from the national for SARI in 2003. This study Enhanced TB Surveillance (ETS) aims to demonstrate the benefits database will be extracted for of outpatient antimicrobial incident cases of TB in children aged consumption surveillance. ≤ 14 years diagnosed between 2001 and 2011 (10 years). TB incidence Methods: Repeated, cross- sectional in children will be described by age, study comparing point-prevalent gender, ethnicity, place of birth (UK antimicrobial prescription data or non - UK), area of residence, using a novel antimicrobial socioeconomic status and family consumption surveillance form history of TB. within four community pharmacies Data will also be analysed according in one geographical region of a low to variables of interest including prescribing county (16-21 DID) in BCG vaccination history, site of Ireland. disease, contact with a TB case, time Results: Data for 257 antimicrobial from onset to diagnosis, treatment prescriptions were recorded in week completion within 12 months and 12, 2010; and 248 for week 13, 2011. final treatment outcome. In 2010, local penicillin use was We are interested in understanding similar to national level s, however which populations in the region are was 10% lower in 2011. Narrow- at increased risk of childhood TB spectrum penicillin use was lower and to identify specific opportunities than the national level, favouring for preventing TB transmission to higher levels of broad-spectrum children in the region. penicillins. Less macrolides and Conclusion: The findings from this tetracyclines were observed locally investigation will be used to make with higher usage of sulfonamides/ recommendations for TB service trimethoprim and ‘other antibiotic’ provision and prevention priorities classes. Local cephalosporin use in the region. was over double the national level at 16% in 2010 and 15.5% in Contact: [email protected] Page 41 14th & 15th May 2013
2011, compared to 6% and 5.3% influenza campaign in Wales. respectively. For every narrow- Methods: Immunisation data was spectrum antibiotic dispensed in the automatically extracted directly from community, 10.3 broad-spectrum general practice using the Audit+ antibiotics were prescribed in 2010, Data Quality System and Read which increased to 10.8 in 2011. codes specified by PRIMIS+. Data Public patient antimicrobial usage was provided by 83.7% (n=396) of was high, representing 38.1% of practices in Wales. the Irish population, but resulting in 64% of prescriptions in 2010 and Results: Uptake of influenza 55% in 2011. immunisation in contributing practices was 67.4% for those aged Conclusions: This study 65y and older, however uptake within demonstrates the benefits this group varied by age: 62.9% in of outpatient antimicrobial 65-75 year olds, 73.9% in 75-84 consumption surveillance. With year olds and 70.1% in those aged deviations from national levels 85y and older. locally, areas needing intervention can be detected and local prescribers In patients aged 6m to 64y at can be given feed-back on trends risk, overall uptake was 49.6%, observed. but ranged from 39.2% in chronic liver disease patients to 65.1% in Contact: [email protected] diabetics. Immunisation uptake generally P-14 increased with age in patients at clinical risk, being lowest in 6-23 SURVEILLANCE OF INFLUENZA month olds (18.8%) and highest IMMUNISATION IN WALES: VARIATION in those aged 75-84y (79.5%). IN AGE-SPECIFIC UPTAKE RATES IN Uptake in patients at clinical risk CLINICAL RISK GROUPS who were 65y and older exceeded Julie Arnott, Simon Cottrell, Daniel 75%. Patients aged 75-84 years Thomas, Richard Roberts with immunosuppression were most Communicable Disease Surveillance likely to be immunised (81.8%). Centre, Public Health Wales, Cardiff, Conclusions: Despite the uptake UK target of 75% not being achieved Introduction: Immunisation against overall, this analysis shows that seasonal influenza is freely available uptake in some of the most for those aged 65y and older; and vulnerable patients, who are elderly those aged 6m to 64y who are and at clinical risk, is reassuringly clinically at risk. An uptake target of high and exceeds the target. 75% exists in Wales for both groups, Contact: [email protected] which has not been achieved to date. Aims: To investigate how uptake varied according to age and clinical risk group for the 2012/13 seasonal
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P-15 92 % of those presenting during primary or secondary syphilis were EPIDEMIOLOGICAL CHARACTERISTICS UK-born. A greater understanding OF HETEROSEXUAL CASES IN AN of the epidemiology of syphilis in ONGOING SYPHILIS EPIDEMIC IN heterosexual individuals will enable WALES us to deliver more effective, targeted Claire Midgley1, Jennifer Davidson1, public health interventions. Daniel Thomas1, Julie Arnott2 Contact: [email protected]. 1Public Health Wales, Cardiff, UK, uk 2University College Cork, Cork, Ireland In the late 1990s, cases of infectious syphilis started to increase in north P-16 Wales in men reporting sex with SOURCE ATTRIBUTION OF men (MSM). In 2002, an increase SALMONELLA ENTERICA IN IRELAND was also observed in south Wales USING THE MICROBIAL SUBTYPING following an outbreak in a network METHOD of MSM in a sauna. Consequently, an enhanced surveillance scheme was Niall De Lappe1, Montserrat implemented in Wales, and these Gutierrez2, Jean O Connor1, Sarah data have since been collected and Jackson3, Martin Cormican1 analysed. Between 2002 and 2011, 1National Salmonella, Shigella & 676 cases were reported; 72 % Listeria Reference Laboratory, Galway, (n=487) were in MSM, 17 % (n=114) Ireland, 2Central Veterinary Research were in heterosexual men and 11 % Laboratory, Kildare, Ireland, 3Health (n=71) were in heterosexual women. Protection Surveillance Centre, Over the 10 year period, the number Dublin, Ireland of recorded heterosexual cases The consumption of contaminated remained relatively level, peaking food from food animals is the in 2006 and 2007 in females and primary cause of salmonellosis. males, respectively. The majority of The reduction of Salmonella in heterosexual men (78 %) were UK- various farm animals has been the born, and 55 % were thought to have target of public health interventions acquired their infection in Wales. The in Ireland and other countries. majority of heterosexual men (66 Source attribution is a useful tool in %) were diagnosed as primary or determining the relative contribution secondary syphilis, as was also the of particular food animals to human case for MSM (73 %). In heterosexual infections and evaluating efficiency women, however, 41 % of cases of targeted control measures. were not detected until the early latent stage and of these a third was From 2002-09 3529 non-enteric detected via antenatal screening, Salmonella isolates from humans highlighting the importance of this were referred to the National programme. Only 59 % of women Salmonella, Shigella & Listeria presenting during early latent Reference Laboratory (NSSLRL) for syphilis were born in the UK, whereas typing. In the same period 2426
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isolates from food animals (poultry Zoonotic Infections Department, = 1332, swine = 844, bovine = 250) Health Protection Agency Colindale , were typed in the Central Veterinary 2Toxoplasma Reference Unit, Public Research Laboratory (CVRL). Health Wales, Swansea, UK The microbial subtyping method A recent report by ACMSF on using the European Food Safety Toxoplasma gondii suggests that more Authority (EFSA) Source Attribution accurate figures on the burden of Modelling software was used. Data disease and the risk factors for infection was divided into 4-year blocks, in the UK population are needed i.e. 2002-05 and 2006-09 and the to inform future risk management subtype properties were serotype strategies. The HPA and the Public and phage type (Typhimurium and Health Wales Toxoplasma Reference Enteritidis only). Isolates from Unit (TRU) are currently undertaking patients with recent foreign travel a pilot study to investigate risk factors were removed and just 1 isolate per for toxoplasmosis in the UK. This point source outbreak was included. paper presents preliminary data from an enhanced surveillance scheme for Twenty-five percent of human toxoplasmosis established in 2008, isolates had a history of recent designed to better understand the foreign travel. S. Enteritidis (n burden of disease in England and = 1229) was the most common Wales. serotype and 36.8% of these were associated with foreign travel while Between 2008 and 2011, 1513 S. Typhimurium (n = 891) was cases of toxoplasmosis were more commonly associated with reported, with an average of 378 domestically acquired infection cases each year. The majority of (14% foreign travel). Poultry and cases were aged between 25 and pork accounted for the majority of 44 years (55.2%), and 53.3% were domestically acquired infections. female. Work is ongoing on dividing poultry There were 917 (60.6%) into broilers, layers, ducks and turkey immunocompetent (non-pregnant) and adding other food sources. cases, the majority presenting with lymphadenopathy; systemic Contact: [email protected] or ocular symptoms were also common. There were 311 (20.6%) immunosuppressed (non-pregnant) P-17 cases, with central nervous system ENHANCED SURVEILLANCE FOR and systemic symptoms most TOXOPLASMOSIS IN ENGLAND AND frequent. There were 158 pregnant WALES, 2008-2011 (10.4%) and 29 (1.9%) congenital cases. Of the pregnant cases, 121 Kate Halsby1, Bengu Said1, Janet 2 1 were asymptomatic (probably Francis , Catherine O’Connor , detected during screening), whilst Hilary Kirkbride1, Dilys Morgan1, 0 24 suffered a premature delivery or Edward Guy stillbirth. 1Gastrointestinal, Emerging and
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The enhanced surveillance system Results: has led to an improvement in the 1. The first system not only allowed detection of toxoplasma in England a secure and timely method of and Wales. However, numbers are transferring information but it still likely to be an under-estimate, also allowed the Unit to collect with a bias towards the more severe information relating to frequency infections. Defining the overall of calls which directly related to burden of infection in the UK will workload issues within the Unit. allow advice on minimising exposure Finally, through the collection of and other prevention measures to be direct notes from on-call staff this better targeted. has improved governance around Contact: [email protected] handover. 2. The second system produced a standard data collection method P-18 that has greatly enhanced our INNOVATIVE USES OF AN ONLINE knowledge of the care home SURVEY TOOL outbreaks. Alex Keenan1, Carl Rose2 Both systems have; 1Cheshire & Merseyside Health • improved timeliness of reporting, Protection Unit, Cheshire & • allowed for prompt feedback Merseyside, UK, 2Health Protection from the Unit to the partners, Agency NW, NW, UK • improved data completeness, • reduced workload both within the Introduction: Online survey tools Unit and for external partners. have the capacity for uses other than surveys. Through innovative use of Conclusions: These innovative uses these tools, Cheshire & Merseyside have greatly enhanced knowledge Health Protection Unit have created through standard collection of rich 2 systems that have enhanced datasets and reduced workload surveillance and reduced workload both within the Unit and for within the unit. external partners and stakeholders. It is envisaged that promotion of Methods: Two online systems were these systems will encourage other created. innovative uses of online survey 1. On-call staff submit returns for tools. their period on call through a secure Contact: [email protected] website. 2. Rather than the community nurses reporting daily updates for homes that they were managing without input to the Unit, they were encouraged to submit a simple but full report once the outbreak was over through a secure website.
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P-19 4 care areas agreed to participate. ESBL-E. coli were detected on one LONGITUDINAL STUDY OF ROLE occasion in 25/51 (49%) residents OF NURSING HOMES IN THE tested (20 at baseline and 5 after DISSEMINATION OF METICILLIN- 3 months). At 3 months, ESBL-K. RESISTANT STAPHYLOCOCCUS pneumoniae was detected in 2 AUREUS (MRSA), ESBL-PRODUCING patients one of whom also had ENTEROBACTERIACEAE (ESBL- ESBL-E. coli. MRSA was detected PE), VANCOMYCIN RESISTANT on one occasion in 12 (23.5%) of ENTEROCOCCI (VRE) AND the residents (8 at baseline and 4 CARBAPENEMASE PRODUCING after 3 months). Univariate analysis ENTEROBACTERIACEAE (CPE) showed a significant association Catherine Ludden1, Dearbháile between care area and MRSA/ESBL Morris1, Akke Vellinga1, Bernie colonisation at the start of the study, Austin3, Martin Cormican2 ,1 but only with ESBL at three months. 1National University of Ireland Higher dependency was associated Galway, Galway, Ireland, 2Department with ESBL colonisation. All ESBL-E. of Medical Microbiology, Galway coli isolates were E. coli O25b:ST131. University Hospitals, Galway, Ireland, The 2 ESBL-K. pneumoniae isolates 3St. Brendans Home, Community were indistinguishable by PFGE. Nursing Unit, Galway, Ireland VRE and CPE were not detected. Objectives:Antimicrobial resistance Conclusion:ESBL-E. coli is a major public health problem. O25b:ST131 and MRSA colonisation Nursing homes residence is were common at baseline and at 3 associated with colonisation with months. Data analysis suggests antimicrobial resistant organisms dependency is an important risk (AMRO) however the dynamics of factor. ESBL-K. pneumoniae was not AMRO colonisation over time are not detected at baseline but emerged in well described. 2 residents at 3 months. Method: Following ethical approval, Contact: [email protected] residents of a nursing home (NH) were recruited. Information on demographics, dependency level, P-20 hospitalisation and antimicrobial ONE IN TWO MYCOBACTERIUM BOVIS prescribing were obtained. Rectal CASES RESISTANT TO ISONIAZID: and nasal swabs were examined DRUG RESISTANCE IN HUMAN M. at 0 and 3 months for ESBL-PE, BOVIS TUBERCULOSIS INFECTION IN CPE, MRSA and VRE by culture THE SOUTH EAST OF IRELAND, 1999 on chromogenic agars with TO 2010 confirmation by conventional means. The E. coli O25b:ST131 clonal group Colette O’ Hare1, Carmel Mullaney1, was detected by PCR. PFGE was Maeve Doyle2, Sarah Jackson3, Joan performed using XbaI. O’ Donnell3, Patricia Prendiville1 1Public Health, HSE South (South Results: Fifty one of 88 residents in East), Kilkenny, Ireland, 2Microbiology
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Laboratory, Waterford Regional to the most appropriate treatment Hospital, Waterford, Ireland, 3Health and management of cases, in Protection Surveillance Centre, particular highlighting the need for Dublin, Ireland full information on drug sensitivities before step down of treatment. Aims: To describe the epidemiology of human Mycobacterium bovis cases Contact: [email protected] in the South East of Ireland from 1999 to 2010. Methods: Data from enhanced P-21 surveillance forms on each case PREVALENCE AND ASSOCIATED of Mycobacterium bovis TB was RISK FACTORS FOR SEXUALLY analysed in MS Excel. Timeline TRANSMITTED INFECTIONS AT data extracted from the Regional CHILDBIRTH, IRELAND, 2005-2010 laboratory systems were added to 1 2 the analysis. Jennifer Lutomski , Frances Shiely , Eleanor Molloy3 Results: In the South East of Ireland 1National Perinatal Epidemiology ten cases of human tuberculosis due Centre, Cork, Ireland, 2University to Mycobacterium bovis were notified College Cork, Cork, Ireland, 3Our over the twelve year period between Lady’s Children’s Hospital, Crumlin, 1999 and 2010. This represents Dublin, Ireland 3.5% of all culture confirmed Mycobacterium tuberculosis complex Background: Sexually transmitted cases in the South East for that infections (STI) have been increasing period. Over the twelve years, five across Europe and have resulted in (50%) of the Mycobacterium bovis increasing rates among women of cases had resistance to one or more childbearing age. first line anti-tuberculosis drugs, Methods: A retrospective cohort including two cases with multi- study was performed to derive drug resistance. The multi-drug population-based rates of STIs resistant cases had evidence that reported during hospitalisation for supported acquired resistance. The delivery between 2005 and 2010 three cases with monoresistance in Ireland. ICD-10-AM codes from to isoniazid were defined as having hospital discharge records were primary resistance. Eight patients used to identify STI cases. Due to with Mycobacterium bovis disease small numbers, unadjusted relative had a pulmonary component, and risks (RR) and corresponding 95% seven of these had acid fast bacilli confidence intervals (CI) stratified seen on microscopy (five on sputum by age were computed to assess and two on bronchial washings). the strength of association between Conclusions: Mycobacterium maternal risk factors and STI bovis continues to cause human diagnosis. disease and the high proportion Results: 415 of 403,642 childbirth of isolates with resistance to anti- hospitalisations included a diagnosis tuberculosis drugs raises issues as for a STI. Venereal warts were the
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commonest reported infection Candidaemia is associated with (62.4 per 100,000), followed by significant mortality and morbidity. syphilis (24.3 per 100,000) and Northern Ireland (NI), rates are anogenital herpesviral infection higher than those in England and (13.4 per 10,000). Women aged Wales. The aim of this study was <25 years were nearly four times as to improve our understanding of likely (RR 3.90; 95% CI 3.21-4.74) candidaemia in NI by describing to have a STI diagnosis at delivery the epidemiology of infections, than women aged >25 years. When analysing trends in antifungal stratified by age, relative to married resistance and investigating Candida women, single women <25 years of diagnostic methods. had a 2-fold risk of having a STI, Candida isolates from sterile sites, whereas single women >25 years of during 2002-2011, were extracted age had 3-fold risk. Over the six-year from a regional surveillance period, annual syphilis rates ranged database and validated against from 13.8 to 32.9 per 100,000 individual laboratory records. maternities. The stillbirth rate The dataset contained basic was substantially higher in women demographic information, including diagnosed with syphilis. patient location at the time of Conclusions: Demographic patterns testing. In addition, laboratories in STI risk observed from hospital supplied antifungal-susceptibility discharge charts were in line with data (2006-2011) and completed a international STI surveillance. questionnaire about their diagnostic The high annual rates of syphilis methods. observed within this well defined, There has been a general increase universally screened cohort suggest number of Candida (IRR1.04 95%CI that syphilis rates are underreported 1.004-1.070 P≤0.02). The most in the general population. prevalent species is C. albicans Contact: [email protected] (53.3% of 547 cases). Infection rates are higher in the older (75+), male population (40 per 100,000 P-22 population). Most were hospital inpatients (90.9%). Diagnostic THE EPIDEMIOLOGY OF CANDIDAEMIA methods were consistent across IN NORTHERN IRELAND DURING 2001 NI. Preliminary analysis indicated -2011 resistance was mainly in non-albicans Rachel Spiers1, Lynsey Patterson1, species, particularly to fluconazole Brian Smyth1, Tim Wyatt1, Lourda and voriconazole (up to 46 % and Geoghegan1, Gerard McIlvenny1, 33% respectively of C. glabrata Eileen Dorgan1, Paul Rooney1 species tested). No resistance was 1Health Protection, Public Health detected in C. albicans. Agency, Belfast, Northern Ireland, UK, 2 Whilst there has been an increase Belfast Health and Social Care Trust, in candidaemia the epidemiology of Belfast, Northern Ireland, UK infections reported in NI is similar
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to the rest of the UK1. A comparison for both members of the public and of diagnostic methods in England EHOs. is underway. In addition, a review The webpage address and a QR of candidaemia patients in NI is code will be included in letters for being undertaken to facilitate the individual cases to provide the generation of hypotheses regarding option of online completion. the higher NI candidaemia rate. EHOs will be given the option of 1 Health Protection Agency (HPA) paper based or online questionnaire 2011. Laboratory reports of completion. candidaemia, England, Wales and Northern Ireland. http://www. This will be piloted then rolled out hpa.org.uk/hpr/archives/2011/ across Greater Manchester. We will hpr3711.pdf describe the feasibility, acceptability and uptake of the web based option Contact: rachelspiers@googlemail. by individual cases and by EHOs. We com will report lessons learnt during this project. P-23 Contact: [email protected] BEYOND POST AND FAX: WEB BASED DATA COLLECTION FOR ROUTINE SURVEILLANCE P-24 MEASLES-RELATED William Welfare1 ,2, Greg Williams2, HOSPITALISATIONS DURING AN Kavitha Shankar1, Lorraine Lighton1 OUTBREAK IN THE NORTH EAST OF 1Health Protection Agency, ENGLAND Manchester, UK, 2University of Manchester, Manchester, UK Paul Bogowicz1 ,2, Craig Blundred1, Tricia Cresswell1 Greater Manchester Health 1Health Protection Agency, Newcastle Protection Unit currently uses upon Tyne, UK, 2Newcastle University, postal questionnaires for cases of Newcastle upon Tyne, UK Salmonella, Cryptosporidium and Giardia. Cases of VTEC, enteric fever, Introduction: This study aims Legionnaires’ disease and Shigella to describe the clinical features are followed up by environmental of severe measles requiring health officers (EHOs), completing hospitalisation during an outbreak paper questionnaires and faxing in the North East of England. these back. Methods: Patients were included if To aid rapid secure transmission they had been admitted to hospital of information, increase response between 1 September 2012 and rates, reduce postal costs and 28 February 2013 with measles. reduce paper , we are investigating Basic demographic information the feasibility of using HPA’s online was obtained retrospectively from survey tool, Select Survey, as a data a surveillance database. Lead collection option as an alternative clinicians were contacted via secure
Page 49 14th & 15th May 2013 email and/or telephone to obtain P-25 further clinical information. A pro forma was used to expedite the INTERNATIONAL EPIDEMIC data collection process. The data INTELLIGENCE: NEW AND EMERGING was entered and analysed using HAZARDS SURVEILLANCE IN Microsoft Excel. SCOTLAND Results: Forty-seven patients were Christopher Redman, Fiona Genasi, identified, with a median age of 14 Helen Sutton (interquartile range 1-20). The male Health Protection Scotland, Glasgow, to female ratio was 1.14. Measles UK was confirmed in 35/47 (74.5%). Background: With over 300 new Only 10/47 (21.3%) of patients had diseases emerging in the past 70 been vaccinated, and 6/10 (60.0%) years, and increased international vaccinations were post-exposure. travel and trade Health Protection Data on hospital admission, stay, Scotland began a programme and discharge was incomplete at the to identify and assess emerging time of submission of this abstract. hazards as risks to Scottish Public Preliminary findings suggest that Health. a number of patients experienced complications, including Objectives: To 1) survey sources convulsions, hepatitis, myocarditis, for potential hazards 2) identify and pneumonia. No patients died realistic threats to Scotland and 2) during the study period. The overall aid organisational resilience around case-hospitalisation rate was 19.2% such threats. (47/245). Method: Taking an all-hazard Conclusions: The results from this approach a range of experts from study will add to the literature, in niche areas of infectious disease and light of the changing epidemiology environmental health surveillance of measles infection in the United and response were asked to survey Kingdom. We hope to identify the media, surveillance and publications types of complications patients are and to report any potential risks. experiencing and whether there are Results: For a 1 month period any differences between age groups. (April 2012) 24 incidents were We also hope to describe the burden reported of which 7 were due to on health services resulting from single cases of H5N1 abroad. The the outbreak. This information will remaining incidents were related be taken into account when making to infectious diseases (N=14), recommendations for further chemical contaminants (N=1), measles vaccination campaigns. failure of testing kits (N=1), vaccine- Contact: [email protected] related outcomes (N=1) and one due to recovery from clinical rabies. Two incidents, Schmallenberg virus in livestock and sodium nitrate mislabelling, had realistic potential
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to affect the international public cases in Wales since 1990. The health through the food chain, while autumn peak (specimen weeks 32- malaria in the Bahamas had the 46) recorded the highest incidence potential to affect blood products. of lab-confirmed cryptosporidium A major weakness of the model was cases since 2002, with 294 cases that risk assessment was not being reported. This study investigated applied in the same way by each the epidemiological characteristics data supplier. of the 2012 autumn peak for specimen weeks 32-46, using data Conclusions: Risk assessment is a from the Enhanced Cryptosporidium term often used in clinical and health Surveillance questionnaires and protection practice but it is clear we CoSurv laboratory data. may understand if differently. As a result of this pilot guidance on risk The greatest number of cases were assessment is to be developed to recorded in September (n=122). encompass an all-hazard approach. The duration of the peak spanned longer than usual autumn peaks. Contact: christopher.redman@nhs. Of the 147 enhanced surveillance net questionnaires received, 100 cases were infected with C. hominis and the remaining cases infected with other P-26 or multiple strain types e.g. C. parvum EPIDEMIOLOGICAL CHARACTERISTICS and C. meleagridis. Outbreaks do OF THE 2012 AUTUMN PEAK OF not appear to account for the rise in CRYPTOSPORIDIUM cryptosporidium cases. Males and
1 1 females were equally infected. The Hannah Evans , Daniel Thomas , modal age group was 5-14 years. Kristin Elwin2, Rachel Chalmers2 1 Previously reported risk factors for Communicable Disease Surveillance infection such as animal contact Centre, Public Health Wales, Cardiff, 2 and eating out were reported in over UK, Cryptosporidium Reference Unit, 60% of cases. Public Health Wales Microbiology, Swansea, UK Investigating these case characteristics should provide a Cryptosporidium is the leading greater understanding about the protozoan cause of human epidemiology of cryptosporidiosis, gastrointestinal infection in monitor changes in genotypes, the UK. Cryptosporidium shows enable case-case comparisons and a marked seasonal trend with explore potential risk factors in peaks recorded in spring and late more detail for use in preventative summer/early autumn associated measures. with Cryptosporidium parvum and Cryptosporidium hominis, Contact: [email protected]. respectively. Preliminary analysis uk suggests that 492 cases were reported in Wales in 2012, the highest annual number of cryptosporidium
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P-27 travel associated hepatitis E cases which is currently limited. This HEPATITIS E VIRUS ENHANCED is particularly important given SURVEILLANCE IN WALES: that data on human cases may be IDENTIFYING RISK FACTORS FOR underestimated as a high proportion INDIGENOUS INFECTION of clinicians do not test for hepatitis Hannah Evans, Robert Smith E virus unless the patient reports Communicable Disease Surveillance a history of recent travel to a Centre, Public Health Wales, Cardiff, hepatitis E virus-endemic region. UK Contact: [email protected]. Hepatitis E is historically associated uk with travel to endemic areas and from consumption of contaminated food and water. However, the number of UK-acquired cases has been increasing over recent years although source of infection in these cases remains unknown. Public Health Wales is collaborating with the Health Protection Agency in providing limited enhanced surveillance using standard questionnaires to identify possible risk factors for UK-acquired hepatitis E infection. Preliminary analysis suggests that in Wales in 2012, 39 questionnaires were received on lab-confirmed hepatitis E cases of which 29 were UK-acquired cases and 10 were travel-related cases. Of the 29 UK-acquired cases, 72% were male, 90% of cases were aged 45 years and older and 45% of cases lived close to an estuary or coastal area. Findings from cases in Wales indicate that 72% of cases handled raw or uncooked meat, 41% of cases owned a pet and 35% of cases visited the countryside in the 9 weeks prior to illness. Investigating hepatitis E infection in Wales and possible risk factors may provide a greater knowledge on the epidemiology of non-
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Bloodborne Viruses and recorded ethnicity of infected Sexually Transmitted mothers was Chinese. HBIG was Infections: Home and indicated for 14/64 of the neonates and was delivered to 100% of these Away babies, 93% receiving it on the day of birth or the next day. All babies P-28 were immunised with the first, second and third dose of hepatitis TIMELINESS AND FOLLOW UP B vaccination. All babies received OF NEONATAL HEPATITIS B dose 1 on their day of birth or the IMMUNISATION IN WALES: 2011 next day, 50% (32/64) of babies Hannah Evans1, Simon Cottrell1, received dose 2 and 67% (43/64) Carol Roberts2, James Crocker2 babies received dose 3 in a timely 1Communicable Disease Surveillance way (25-36 day intervals). Centre, Public Health Wales, Cardiff, 2 This study provides useful UK, Health Protection Team, Public information to facilitate timeliness Health Wales, Preswylfa, UK and follow up of neonatal hepatitis B Hepatitis B virus is highly immunisation and provides baseline transmissible during the perinatal epidemiological data for monitoring period for babies born to hepatitis long term trends. B positive mothers. Timely Contact: [email protected]. prophylactic administration of uk hepatitis B vaccine and hepatitis B immunoglobulin (HBIG), where required, is more than 90% effective in preventing chronic infection in P-29 these babies, who would otherwise EXPANSION OF HIV SCREENING VIA be at high risk. AN ON-LINE ORDERING AND HOME SELF-SAMPLING SERVICE USING DRY To assist Public Health Wales Health BLOOD SPOT TESTING (RUClear? Protection Team in ensuring timely PILOTS 2011-2012) follow up of new-borns at risk of perinatal transmission, an all Wales Yasmin Ahmed-Little1, Vinay Neonatal Hepatitis B Database was Bothra1, Diane Cordwell3, David developed. This study summarises Freeman-Powell3, Dave Ellis4, uptake and timeliness of neonatal Samantha Scanlon3, Paul Klapper5, hepatitis B vaccination for children Stephen Higgins6, Roberto born during 2011 and resident in Vivancos2, Lorraine Lighton1 Wales. 1Greater Manchester Health Protection Unit, Manchester, UK, Seventy-one babies were born to 2Cheshire & Merseyside Health positive mothers in 2011, of which Protection Unit, Liverpool, UK, seven were lost to follow up (moved 3Central Manchester University away). Median maternal age was 30 Hospitals NHS Foundation Trust, years and did not vary significantly Manchester, UK, 4HPA Public Health by region. The most commonly Laboratory, Manchester, UK, 5The
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University of Manchester, Manchester, Population (positivity 1.43/1000 UK, 6North Manchester General tests) and high risk screening Hospital, Manchester, UK methods (positivity 4.16/1000 tests) were shown as cost-effective Background: The burden of disease against American guidelines (>1 relating to undiagnosed HIV infection new positive test/1000 tests). is significant UK-wide. Manchester and Salford have the second Conclusions: These results support and fourth highest prevalence the case for investment in HIV of HIV infection outside London population screening in high respectively. British HIV Association prevalence areas as a cost-effective (BHIVA) guidance recommends service and as recommended population screening in high by several national bodies. prevalence areas, expanding outside Commissioners should consider use of traditional antenatal/GUM of on-line ordering of self-sampling, settings. A single early diagnosed HIV DBS testing kits as a method of case of HIV could potentially save successfully increasing HIV screening £1.2m via prevention of onward and detection of early infection. transmission. Contact: yasmin.ahmed-little@nhs. Aims: To assess feasibility, net acceptability, sustainability, clinical and cost-effectiveness of introducing an on-line service allowing Greater Manchester residents to request HIV dry blood spot (DBS) self- sampling-at-home kits, facilitating early diagnosis of HIV infection in high prevalence areas with timely specialist referral. Methods: Use an existing, successful on-line chlamydia testing service (RUClear?) to provide an on-line HIV self-sampling testing kit requesting service for Greater Manchester residents. Key findings: The offer of HIV screening via home self-sampling using DBS test kits ordered on-line was demonstrated as feasible, acceptable, clinically and cost-effective and sustainable. Approximately 3000 tests were requested over an 18-month period. 7 new HIV infections detected, 4 at an early stage of infection.
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Vaccine Preventable members of staff, including a nurse Diseases: Injecting some and a doctor, received prophylactic vaccination and were temporarily common sense into disease excluded from their clinical duties. prevention The GP also worked two sessions in two different urgent care clinics while P-30 infectious. Management of staff and patient contacts in these clinics was KNOWING WHO IS INFECTIOUS AND handled by the acute trust. WHO IS PROTECTED: A CASE REPORT OF A HEALTHCARE WORKER WITH Conclusions: This case illustrates MEASLES some of the ramifications of a missed measles diagnosis. Infection Paul Bogowicz1 ,2, Julia Waller2, control measures are essential Deborah Wilson2, Kirsty Foster2 in preventing the exposure of 1Newcastle University, Newcastle, vulnerable individuals to measles, UK, 2North East Health Protection including healthcare workers. Unit, Newcastle, UK Further efforts are needed in Background: Since September educating healthcare workers and 2012, there has been an outbreak the public about measles and its of measles in the North East of infectivity. Employers should do England. There has been poor more to ensure that their staff are recognition of measles in a number immune. Initiatives are needed to of healthcare settings and this, improve vaccination coverage in the together with the lack of certainty wider community. about healthcare workers’ immune Contact: [email protected] status, has led to several instances of likely transmission in healthcare settings and considerable disruption P-31 to healthcare services. We describe a case involving a measles-infected IMMUNISING A CAPTIVE AUDIENCE IN healthcare worker. THE NORTH EAST OF ENGLAND - HOW ARE WE DOING? Case details: A 33 year old general 1 ,2 1 practitioner (GP) developed Mark McGivern , Julia Waller , Ken 2 symptoms of measles infection Ross 1 approximately nine days after visiting Health Protection Agency, North 2 a patient at home. He thought the East, UK, NHS, County Durham & patient, who was unvaccinated, had Darlington, UK scarlet fever. The GP worked four Prisoners are a diverse population half-day sessions over three days at and differ by age, gender, ethnicity, his regular practice while infectious. country of origin, and experience Twenty-two clinical contacts were of health and disease. Due to identified. Two immunosuppressed previous inequalities in access and individuals and a three-week old child opportunity many prisoners have received immunoglobulin. Three missed out on routine services
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including immunisations, reinforcing Ensure a tailored schedule is health inequalities in the offender planned for all prisoners, and that it populations. Primary prevention is is appropriately recorded. an important public health principle Develop a simple audit tool and immunisation is a cornerstone to review compliance with the of good preventative practice. recommendations above. An audit tool was developed by Contact: [email protected] a multiagency team involved in immunisations and prison health care in the North East Region. The P-32 audit aimed to measure current practice and provides a baseline. It INTRODUCTION OF A LIVE looked at policies/procedures and ATTENUATED INFLUENZA VACCINE IN facilities in each prison and reviewed NORTHERN IRELAND: A SURVEY OF a selection of prisoner records from PRACTICE STAFF each site looking at immunisation Sinéad McGuinness, Richard status and standard of record Smithson keeping. Public Health Agency, Northern The audit was undertaken in Ireland, UK nine prison/secure units during Introduction: Fluenz was used in September and October 2012. the Northern Ireland 2012-2013 It identified many areas of good flu vaccination programme as the practise, particularly around vaccine of choice for individuals in facilities and procedures. However, at-risk groups aged between 2 and measures to appropriately assess under 18 years. An online survey each individual’s immunisation was used to obtain feedback from history and provide a subsequent practice staff on Fluenz, to assess programme of planned vaccinations how staff found Fluenz and how they required significant improvement. perceived patients’ reactions to it. With the exception of hepatitis Methods: An online survey was B vaccinations, most prisoners developed using the SurveyMonkey had limited vaccination histories website, with 12 objective, non- and no record of vaccinations leading questions. A link to the offered. National and local policies survey was sent via email to all state that individuals with no 353 general practices in Northern vaccination history should be Ireland. The survey was open to all assumed to be unimmunised, and a staff involved in administering flu comprehensive, tailored programme vaccine, from 7th-30th January 2013. of vaccinations offered. There were 193 responses. The main recommendations were: Results: 71.9% of respondents Ensure improved screening and (n=138) preferred Fluenz to record keeping on or shortly after injected vaccine. 86.5% felt patients reception. preferred Fluenz. Some teenagers
Page 56 5 Nations Health Protection Conference preferred injected vaccine. There P-33 were parental concerns about Fluenz being ‘live,’ side effects and EXPLORING THE EPIDEMIOLOGY effectiveness. OF MEASLES IN YORKSHIRE AND THE HUMBER: IS SOCIO-ECONOMIC 68.6% of respondents experienced DEPRIVATION A RISK FACTOR? no difficulties and 53.8% found Fluenz easier to administer than Adrian Wensley injected vaccine. 72.1% felt they Health Protection Agency, had enough information. There were Yorkshire and the Humber Regional issues with supply, administration, Epidemiology Unit, Leeds, Yorkshire determining eligibility and and the Humber, UK communication. Introduction: Although extensive Greater proportions of those who immunisation literature has been attended training preferred Fluenz, published, none address how reported no difficulties and had factors affect the epidemiology of enough information compared to measles at a local level. This study those who did not attend. aims to explore the epidemiology of measles and MMR vaccination Conclusions: In the UK, annual Fluenz in Yorkshire and the Humber (Y&H). vaccination has been recommended This study also specifically examines for all children and adolescents aged deprivation and its association with from 2 to under 17 years. This survey measles incidence at a local and highlights issues associated with national level. Fluenz. Clear information is needed for professionals and the public. Methods: Data was collated from Training should include information Health Protection Agency case on administration, eligibility and management systems in Y&H contraindications. Practices should and combined with measures of be encouraged not to over-order deprivation and urbanisation. An supplies. ecological study design was used to test the association between Contact: sinead.mcguinness@hscni. deprivation and measles incidence. net A negative binomial multivariate model was constructed to adjust for the potential confounders of urbanisation and area vaccination uptake. Results: In univariate analysis a statistically significant association at a regional level is present between deprivation and measles incidence (RR 1.64 95%CI: 1.25 - 2.15, p<0.01). Indicating that those in the top two deprivation quintiles have a 64% increased risk of developing
Page 57 14th & 15th May 2013 measles in Y&H. When tested in a Environmental Change multivariate model with vaccination and the Four Furies: Fire, and urbanisation, any association Floor Freeze and … Wee between deprivation and measles incidence becomes non significant Beasties! (IRR 1.38 95%CI: 0.72 - 2.63, p=0.34). P-34 Discussion: Deprivation as a HEALTH EFFECTS OF FLOODING : risk factor for measles incidence ISSUES FOR HEALTH PROTECTION could not be established from this IN THE UK research. When examined at a PCT level nationally, any association Carla Stanke, Virginia Murray between measles incidence and Extreme Events and Health deprivation can be accounted for by Protection at Public Health the effects of urbanisation and area England vaccination uptake. This is the first Flooding is a regular occurrence research identified which compares in the UK and is associated with the effects of area vaccination a range of impacts on health and against other risk factors. wellbeing. In addition to deaths Contact: [email protected] from drowning, flooding may damage local infrastructure, affect access to water supplies and impact health systems, all of which have implications for human health and health protection. The health effects of flooding can be direct or indirect. Direct health effects are those caused by immediate contact with flood water, including drowning and physical trauma. Indirect health effects are those that result as a consequence of flooding and include the impacts from damage to infrastructure and water supplies, displacement, and disruption to people’s lives. Health effects can continue after flood waters recede and may persist for months or years. The HPA provides guidance on managing the health effects associated with flooding.
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Statistics from the Met Office Health, Health Protection Agency indicate that 2012 was the 2nd and UK Met Office and is a cross wettest year on record in the UK, government plan. and media reports documented 10 The CWP recommends a series of deaths associated with flooding. In steps to reduce the risk to health England, poorer communities are at from prolonged exposure to severe higher risk of coastal flooding while cold weather by raising public for river flooding, high flood risk awareness and triggering actions of areas tend to include higher income those in contact with people most at households. risk. UK climate change projections A Cold Weather Alert service provided indicate that winter rainfall levels by the UK Met Office underpins the are likely to increase significantly CWP. There are different alert levels while summer rainfall levels are depending on the severity of the likely to decrease significantly, cold event and a series of actions and coastal areas are likely to be based on these are recommended more vulnerable to climate change. for local health and social care Floods are complex problems that organisations and professionals require multi-agency responses, and community organisations. The with important implications for Plan has also been supported by the health protection. The health sector ‘Warm Homes Healthy People Fund’ must be aware of the potential risks over its first two years. This fund and be prepared to respond. aims to support Local Authorities Contact: [email protected] in reducing deaths and poor health due to cold housing. This poster will cover the development, P-35 publication and evaluation of the THE COLD WEATHER PLAN FOR Plan. It will highlight how the Plan ENGLAND aims to address EWD and cold related morbidity in England through Virginia Murray, Katie Carmichael1 1 engagement with public health, Extreme Events and Health health and social care professionals, Protection at Public Health England government, community actors, There were an estimated 24,000 voluntary partners and individuals. excess winter deaths (EWD) in Contact: [email protected] England and Wales in 2011/12. This equates to around 15 per cent more deaths in the winter period compared with the non-winter period. The Cold Weather Plan for England (CWP) is a public health plan and was first published in 2011 to help reduce EWDs. It is updated and published each winter by the Department of
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Hot Topics to designation as it allowed wide interpretation of DPsoE, from one to many international points of entry P-36 in each member state. Additional COMMON-SENSE INTERPRETATION problems were foreseen in utilising AND APPLICATION OF AN DPsoE during any Public Health INTERNATIONAL TREATY: APPLYING Emergency of International Concern THE INTERNATIONAL HEALTH (PHEIC) which might arise in turn REGULATIONS AT POINTS OF ENTRY from the all-hazard definition of potential PHEICs. What would be Christopher Redman1, Judy Hart2, expected from international hubs Anne Wilson3, Nicol Black4 which were not DPsoE was also 1Health Protection Scotland, unclear. Glasgow, UK, 2Public Health Wales, Mold, UK, 3Public Health Agency Conclusions: UK port health response Northern Ireland, Belfast, UK, 4Health at international ports operates at a Protection Agency, Newcastle, UK high standard. However, if DPsoE are not clearly defined and planned, Background: As a signatory to the confusion may result in early stages international Health Regulations of any PHEIC resulting in risk to (IHR) the UK undertook to enhance public health. surveillance and response. As part of this commitment and in line with Contact: [email protected] IHR the UK agreed to survey and designate appropriate sea and air ports under IHR. P-37 Objectives: To apply articles 19- MONITORING FOR LOW LEVEL 21 of the IHR in order to identify CONTAMINATION OF WATER WITH points of entry (sea and air ports) as VERO-TOXIGENIC E. COLI Designated Points of Entry (DPsoE). Siobhan Kavanagh1, Martin Method: Following a survey of key UK Cormican2, Dearbhaile Morris1 Ports against WHO criteria for DPsoE 1School of Medicine, Clinical Sciences by the four UK administrations the Institute, National University of Department of Health set up a DPoE Ireland, Galway, Galway, Ireland, Working Group to work through 2Centre for Health From Environment, issues arising and to present a list Ryan Institute, National University of of UK ports for designation. The Ireland, Galway, Galway, Ireland Working Group analysed barriers to Verotoxigenic E. coli (VTEC) in- designation, after consultation with cidence rates in Ireland have health protection, port operators, increased in recent years. Water and the Civil Aviation Authority. is a key transmission route for Results: After considering IHR VTEC. Bacteriological monitoring documentation and submissions of drinking water relies largely from key parties the wording of on culture-based examination IHR was found to be a major barrier of volumes of 100 ml to 1L; an
Page 60 5 Nations Health Protection Conference approach likely to miss low level, P-38 intermittent contamination of potential public health significance. PART 2A ORDERS: HOW HAVE THEY The objective was to develop a BEEN USED SINCE THEY WERE protocol for monitoring large water INTRODUCED? volumes for VTEC. We evaluated Nadir Patel1, Mike Gent1, Graham commercial filters for capturing Bickler2 Cryptosporidium, alone and in-series 1Health Protection Agency, West with a 0.45 μM filter (Millipore), Yorkshire, UK, 2Health Protection using sterile tap water spiked with E. Agency, South East, UK coli O157:H7. Filters were subjected to direct nucleic acid extraction and Introduction: New health protection extraction after broth enrichment at regulations came into force in 37°C and 42°C. Broths were cultured England in April 2010. These gave on CHROMagarTM VTEC plates. VTEC Local Authorities wider powers to was not captured to any significant deal with instances where infection degree by the Cryptosporidium filter or contamination may present a but was captured by the 0.45 μm risk to human health. One power filter. VTEC was detected in direct available to Local Authorities is a filter extracts and enrichments using Part 2A Order to impose restrictions real-time PCR targeting intimin (eae or requirements to protect human gene). The limit of detection of health. This study examined how the system was 10 colony-forming Part 2A Orders have been used by units (CFU)/L. Real-time PCR the Health Protection teams across targeting eae, verotoxin (vtx 1 & 2) England between 1st April 2010 and and O-antigen (O157 & O26) genes 1st December 2012. was applied to river water samples. Methods: A select survey Enrichments of filters at 42 ºC led questionnaire was sent to the CCDCs to earlier detection of VTEC by real- involved in each of the 18 Part 2A time PCR and improved isolation on Orders for this period. A 100% CHROMagarTM. Application of the response rate was achieved. method to large river water volumes (>10L) resulted in detection of Findings: Nearly all Part 2A vtx, eae, O157 and O26 genes and Orders were in relation to TB and isolation of a vtx 1/2 positive E. involved individuals with complex coli O26. We conclude that this is social issues. Most CCDCs (15/18) a promising approach to monitor reported the Part 2A Order achieved for VTEC contamination of water the outcomes they had hoped for sources. and most (14/18) felt the current system is working well or very well. Contact: siobhan.kavanagh@ Successfully enforcing a Part 2A nuigalway.ie Order proved more challenging than obtaining the Order chiefly due to issues relating to security and multiagency working. No individuals against whom a Part 2A Order was
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sought received any legal advice or During 2011-12 there were support. 1,276 cases of CDI in acute and community settings. Of these, 956 Discussion: In general the Part 2A were hospital-onset and 320 were Order system appears to be working community-onset. well. Issues which need further consideration include greater clarity Of the 320 community-onset cases, about the level of security that can 66% were females (210/320) and be used to detain an individual, 91% were aged 65 years and over raising awareness of Part 2A Orders, (291/320). Over half of the cases improving multiagency working and were living in their own home whether legal representation for (170/320; 53%). 49% (158/320) of those subject to Orders should be the cases had received antimicrobial reviewed. therapy in the previous 1 to 4 weeks prior to CDI onset. 43% (139/320) Contact: [email protected] had received GI therapy including proton pump inhibitors and H2 antagonists. 60% (192/320) had P-39 some form of healthcare contact A REGIONAL PROGRAMME prior to symptom onset. For both OF CLOSTRIDIUM DIFFICILE ‘community onset-community SURVEILLANCE IN PRIMARY AND/OR associated’ and ‘community onset- COMMUNITY SETTINGS: PREVALENCE, hospital associated’ cases the most RIBOTYPES AND RISK FACTORS prevalent ribotype was 078. Gillian Smyth, L Geoghegan, L Whilst the incidence of CDI in Patterson, H Crookshanks, A O’Hara acute healthcare settings in NI has Public Health Agency, Belfast, UK decreased since January 2009, the incidence of CDI with onset of To describe the epidemiology of symptoms in the community setting Clostridium difficile infection (CDI) has been increasing. This study in primary and community care confirms the presence of known risk settings in NI. factors; antimicrobials, GI therapy An enhanced surveillance and previous healthcare contacts, in programme for CDI in community this population of community-onset and primary care settings was CDI. Similar to the acute setting, introduced in April 2010. Enhanced ribotype 078 dominates amongst CDI proformas have been completed cases. for all CDI specimens taken in care Contact: [email protected] homes and requested from GP surgeries. Explanatory variables included patient demographics, residence of case, prior exposure to antimicrobials and gastrointestinal drugs, previous hospitalisation and CDI ribotype.
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Speakers and Chairs
Natalie Adams Anthony Breslin Natalie Adams joined Public Health Anthony Breslin qualified in England as an epidemiologist in Galway. He trained in Public Health 2012 after completing a degree in Scotland where he also worked in Geography and a Masters in as a Consultant in Communicable Public Health at the University of Disease and Environmental Health Nottingham. Natalie is currently prior to taking up his current post in based at the Centre for Infectious the North West of Ireland. Disease Surveillance and Control working on gastrointestinal Lisa Byrne infections, primarily norovirus. Lisa Byrne is currently an epidemiological scientist for Public Musarrat Afza Health England with responsibilities Musarrat Afza is a Consultant in for national surveillance of VTEC Communicable Disease Control in and HUS infections. Previously, Lisa Public Health England, West Midlands worked on surveillance of infections North Health Protection team. in blood donors for six years. Lisa Her special interest areas include has an MSc in Public Health from immunisation, environmental public the London School of Hygiene and health, travel health and public health Tropical Medicine. training. She has previously worked as a hospital physician with interest Catherine Coyle in diabetes and endocrinology Catherine Coyle is a Specialty Registrar in public health medicine Corinne Amar working and training in the Public Corinne Amar is currently the Health Agency in Northern Ireland, head of the Foodborne Pathogens across the areas of health protection, Reference Services, Public Health service development and screening England - London. Dr Amar trained and health improvement. as a molecular microbiologist and specialised in the study of James Crick gastrointestinal pathogens. James Crick is a Specialty Registrar in Public Health, currently on Nachi Arunachalam placement with the North Yorkshire Nachi Arunachalam is a Consultant and Humber Health Protection in Communicable Disease Control for Team. Prior to beginning Public the South Yorkshire Team of Public Health training he worked as a GP in Health England where he is the GI Yorkshire. lead. He trained in Public Health in both India and the United Kingdom.
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Louise Cullen Shaji Geevarghese Louise Cullen is a Surveillance Scientist Shaji Geevarghese is an Associate with the Department of Public Health Specialist in KSS PHEC . Lead Medicine in the HSE West. She is areas are Prisons, Local authority a member of the Department’s & Environmental health, TB, Port Management Team, and of the health etc. Has been working in Regional Immunisation Committee. Communicable disease control for She has recently completed a Masters the last 12 years. in Public Health, which involved a research study evaluating parent’s Noel Gill attitudes to a change in their child’s Noel Gill is Head of HIV & STI immunisation programme. Department, Nation Centre for Infectious Disease Surveillance and Meirion Evans Control (NICIDSC), Public Health Meirion Evans is a Consultant England, and Honorary Professor Epidemiologist at the Communicable at the London School of Hygiene Disease Surveillance Centre, Public Tropical Medicine. After house officer Health Wales and Reader at the posts in Cork and Dublin and a period Cochrane Institute of Primary Care working in Sierra Leone, he trained in and Public Health, Cardiff University. infectious disease epidemiology with He worked as a CCDC for 10 years the Public Health Laboratory Service before taking up his present post. in London.
Una Fallon Ian Grey Dr. Una Fallon trained in General Ian Gray is a Chartered Environmental Practice in Ireland and completed Health Practitioner and Principal her Public Health training in the UK. Policy Officer at the Chartered She is currently a consultant in Public Institute of Environmental Health. Health Medicine in the Midlands, He leads on public health and Ireland. Her interests include health protection. He led the project epidemiology, evidence-based Public Environmental Health 2012 – A key Health practice and health and the partner in delivering the public health environment. agenda which has shaped modern training and practice. Kirsty Foster Kirsty Foster is a Consultant in health Ruth Harrell Protection working in the North East Ruth Harrell is a Specialty Registrar of England. She is the regional lead in Public Health based in the West for sexual health and HIV. Midlands, currently working with the Field Epidemiology Service.
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Leena Inamdar Phillip Keel Leena Inamdar is a Consultant in Philip Keel is a hepatitis B research Health Protection at Public Health scientist in Epidemiology working England, based in Leeds. As Lead for Public Health England. He has Consultant for Bradford, a vibrant a jointly awarded MSc Veterinary multicultural city, there is always Epidemiology from London School of something exciting to work on, such Hygiene and Tropical Medicine/Royal as food poisoning outbreaks, TB Veterinary College. His interests incidents and flu outbreaks and she include engaging with school children really enjoys this aspect of her role. to encourage the pursuit of future careers in science. Jillian Johnston Jillian Johnston is a Specialty Alex Keenan Registrar in the Public Health Agency, Alex Keenan had a career as a Northern Ireland with an interest in Nuclear Physicist before a career health protection. in Public Health. He joined the HPA in 2006 and since then has been Smita Kapadia developing surveillance systems as Smita Kapadia is a Consultant in well as promoting innovative and Communicable Disease Control at novel approaches to Public Health the South Midlands and Hertfordshire issues and research activities. Public Health England Centre. Following her training in Public Health Ina Kelly in India and the UK, she worked as a Ina Kelly qualified in medicine in Locum Consultant at HPA Colindale 1986. She worked in Ireland, UK and Essex HPU. Smita is currently and Australia and completed GP the training and immunisation lead training in Western Australia. She and has an interest in control of now works as a Consultant in Public blood borne viruses. Health Medicine in Cork, in health protection and also with the National Cathriona Kearns Asthma Programme. Cathriona Kearms has been an epidemiological scientist with the Kenneth Lamden Public Health Agency (NI) for 5 Kenneth Lamden is a consultant years. She is the Northern Ireland with the Cumbria and Lancashire Enhanced Tuberculosis Surveillance Public Health England Centre. His coordinator. Cathriona worked interest in listeriosis stemmed from previously on agricultural research investigating several outbreaks in with the Agri-Food and Biosciences North West England. He Chaired the Institute (NI) and is currently in HPA Group that produced internal the final stage of a PhD on risks guidance on case management of associated with pesticides. Listeria monocytogenes. Dr Lamden’s other interests include giardiasis and vaccine preventable diseases.
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Dilys Morgan Scottish Environmental Public Health Dilys Morgan has had a long and Practice Network (SEPHPNet). Colin interesting career alternating between is also the Scottish representative mainly medical research in rural on a number of UK health Africa where she lived and worked for protection groups and maintains 13 years, and UK public health. Dilys close links with colleagues in PHE is currently Head of Gastrointestinal, (CRCE). Emerging and Zoonotic Infections at Public Health England, Colindale Michael Ryan London. Her particular interests are Michael Ryan is Irish and is currently the detection and assessment of new Adjunct Professor of International and emerging infections, particularly Health at University College at the human-animal interface. She Dublin and an International Health is also an honorary Professor at Consultant, having worked as Director the London School of Hygiene and of Global Alert and Response at the Tropical Medicine and has been World Health Organization in Geneva organising the 5 nations Conference for over 15 years since 2002 His background is in medicine, infectious disease and public Virginia Murray health. A graduate of University Virginia Murray is Head of Extreme College Galway, he undertook higher Events and Health Protection, specialist in Public Health at the Public Health England. In January Communicable Diseases Surveillance 2011, Virginia was appointed as Centre (PHLS/CDSC) in London. He Head of the new Extreme Events is an EPIET alumnus. and Health Protection and is taking Dr Ryan joined WHO in 1996 and led forward evidence based information numerous field response teams in and advice on flooding, heat, cold, managing outbreak tackling a wide volcanic ash, and other extreme range of serious tropical infections. weather and natural hazards events. From 2001 he worked as Coordinator The team leads on the Heatwave Plan of WHO’s Epidemic Response Team for England and the Cold Weather and the Global Outbreak Alert Plan for England and is working on and Response Network (GOARN) the health impacts of flooding plans. in responding to more than 150 international outbreaks. Colin Ramsay He was appointed Director of Alert Dr Colin Ramsay, is a Consultant and Response Operations in June Epidemiologist at Health Protection 2004 and shortly thereafter as Scotland where he has led on Director Global Alert and Response environmental issues since 1999. at WHO Headquarters. He leads a small team within HPS on environmental surveillance (Environmental Public health Tracking), incident response and guideline development and chairs the
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Corinna Sadlier Tara Shivaki Corinna Sadlier is a Specialist Tara Shivaji is a Specialist trainee registrar in Infectious Diseases. in Public Health in Scotland with She is currently working in St previous experience of communicable James’s Hospital, Dublin. She disease control in resource limited has a special interest in disease settings. Her research interests prevention particularly the utility of include translating evidence into vaccination. Her MD thesis which is policy and measures to address being undertaken with Trinity College health inequality. Dublin examines vaccine efficacy in HIV infected adults Lelia Thornton Lelia Thornton is a Specialist in Charles Saunders Public Health Medicine in the Health Charles Saunders is a Consultant Protection Surveillance Centre in in Public Health Medicine Dublin where she is head of the (Communicable Disease & hepatitis division. She is a senior Environmental Health) at Fife clinical lecturer in Trinity College NHS Board since 1995. Former Dublin. GP. Member of Health Protection Advisory Group, Health Protection John Watson Network. John Watson is Head of the Respiratory Diseases Department Martin Schweiger at Public Health England’s Centre Martin Schweiger is a Shoemaker’s for Infectious Disease Surveillance son attracted into medicine by the and Control in London. His main smell of antiseptics. UCCA found a interests include tuberculosis place at Leeds Medical School as term and acute respiratory infections started. Six years in Bangladesh led (particularly influenza, legionnaires to anger about preventable distress, and SARS). His work has focussed disease and death and the discovery on the surveillance, prevention and of the magic in public health. Risk control of these diseases at the local, identification and mitigation continue national and international levels as to excite my imagination. well as related research
Frances Shiely Frances Shiely is a Lecturer in Epidemiology and Public Health at University College Cork and a Senior Lecturer in Research Methodologies at the Clinical Research Facility, Cork. Her interests are in lifestyle epidemiology and sexually transmitted diseases.
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Notes
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Notes
Page 69 14th & 15th May 2013 Conference Organisers In Conference Ltd 4-6 Oak Lane Edinburgh EH12 6XH [email protected] www.in-conference.org.uk