HPS Weekly Report CURRENT NOTES 22 October 2014 Volume 48 No. 2014/22 ISSN 1753-4224 (Online) ESVAC reports drop in sales of veterinary antibiotics CONTENTS CURRENT NOTES • ESVAC reports drop in sales of veterinary antibiotics 552 • Meningococcal meningitis – university students 553 • Guidelines on syndromic surveillance in human and animal health 553 • FSA Food and You survey findings published 554 • Ebola - update 555 The data are collected annually as part of the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) project, which involves co-operation between the national authorities throughout the European Union (EU) and is co-ordinated by EMA. Public health authorities worldwide are confronted with increasing levels of resistance to antibiotics in humans and animals and are engaged in actions at various levels to fight this issue. The responsible use of antibiotics is a key factor in minimising the risk of development of resistance. According to member states, different factors may have contributed to the decline: NOTIFIABLE TABLE Notifiable diseases 48/4201 Sales of antibiotics for use in animals fell overall by 15% between 2010 and 2012 in Europe, according to a report published last week by the European Medicines Agency (EMA). Of the 20 European countries that provided data over this time-span, 18 observed decreases ranging from 0.4% to 49%. 556 Statutory Notification of Infectious Diseases Week ended 10 October 2014 558 • national programmes and campaigns on the responsible use of antimicrobials; • restrictions on the use of certain antimicrobials; • increased awareness of the threat of antimicrobial resistance; • reduction targets for the use of antimicrobials in animal production in certain member states; • fluctuations in size and types of animal populations. While additional analysis is needed to confirm the main reasons for this decline, the reduction in the use of antibiotics is a positive sign. However, the report (available at http://www.ema.europa. eu/ema/index.jsp?curl=pages/news_and_events/news/2014/10/ news_detail_002189.jsp&mid=WC0b01ac058004d5c1#) also shows that there is scope for further decrease. Measures to promote the rational use of antibiotics in animals need to continue as part of the European Commission’s action plan against antimicrobial resistance. At national level, policies exist to define and promote the most appropriate use of antibiotics in animals. Collecting accurate data on the sale and use of these medicines in food-producing animals is an essential first step to inform the development and monitoring of such policies. The ESVAC project was launched in April 2010 by EMA following a request from the European Commission to develop a harmonised approach to the collection and reporting of data from EU Member States on the use of antimicrobials in animals. Since the start of the project, the number of countries providing data has continuously increased. For the 2012 report, 26 countries from the European Economic Area (EEA) submitted data on sales of antibiotics authorised in their territory. These countries account for approximately 95% of the food-producing animal population in the region. The ESVAC report is issued every year and is used by risk assessors and risk managers in member states to inform antimicrobial policy and the responsible use of antimicrobials. [Source: EMA News Release, 16 October 2014. http://www.ema.europa.eu/ema/index.jsp?curl=pages/ news_and_events/news/2014/10/news_detail_002189.jsp&mid=WC0b01ac058004d5c1] Meningococcal meningitis – university students 48/4202 The Public Health Protection Unit, NHS Greater Glasgow and Clyde, was notified last week of two confirmed cases of meningococcal infection in Strathclyde University students. There was no identifiable link between the two cases. Both cases were recovering in hospital. Close contacts of both cases had been given public health advice and, where appropriate, treated with antibiotics. As a precautionary measure, information was also provided to students at the university raising awareness of the symptoms of meningococcal infection. [Source: NHSGGC News Release, 17 October 2014. http://www.nhsggc.org.uk/content/default.asp?page=s1192_3&newsid=18628&bac k=s1192] A vaccination programme against meningitis C (Men C) for first-time university entrants under the age of 25 was introduced from 1 August 2014. This is a time-limited catch-up programme that will run until the first cohort of S3 pupils, who received the adolescent booster dose of Men C in 2013, reach university age (2017). From 2017 onwards university entrants will have received a dose of Men C vaccine routinely as part of their adolescent booster vaccines. The provision was that, where students were not vaccinated before leaving for university, they could register with a new GP practice once they arrived and arrange to get the vaccine there as soon as possible, ideally in freshers week and no later than 31 October 2014. If an individual seeks vaccination later than 31 October 2014, GP practices should apply clinical judgement to assess the needs of the patient. More details on the catch-up programme were outlined in Current notes 48/2503 and 48/3501 (at http://www.hps.scot.nhs.uk/ewr/redirect.aspx?id=58861 and http://www.hps.scot.nhs.uk/ewr/ redirect.aspx?id=60274 respectively). Guidelines on syndromic surveillance in human and animal health 48/4203 The first European guidelines on syndromic surveillance in human and animal health, the ‘Triple-S guidelines for designing and implementing a syndromic surveillance system’, were published on 11 October. The guidelines are one of the main outcomes of the European Unionfunded project ‘Triple-S’, the main aim of which has been to increase the European capacity for near-real-time surveillance and monitoring of health-related events in the animal and the human health sectors. The Triple-S guidelines provide evidence-based recommendations and suggestions for each step of the set-up, use and assessment of a syndromic surveillance system. They aim to encourage a common understanding of the structure and utility of systems, and improve communication among European countries on critical public health threats. The guidelines are designed to be useful in HPS WEEKLY REPORT Volume 48 No.2014/42 22 October 2014 553 the context of the wide range of health systems and data sources found in European countries, and their main principles can be applied globally. The guidelines are intended for public health professionals and epidemiologists working in human or animal health surveillance who would like to use syndromic surveillance to support existing surveillance systems and public health monitoring. Triple-S was a project co-financed by the EU through the Executive Agency for Health and Consumers. It started in September 2010 and formally ended in December 2013, and was coordinated by the French Institute for Public Health Surveillance (InVS) in Paris. It involved 24 organisations from 13 European countries (including both HPS and the Health Protection Agency – now PHE). As an outcome of the first meeting, held in November 2010, an updated definition of ‘syndromic surveillance’ was published in 2011. All publications originating from the Triple-S project, including the guidelines and reports on conducted inventories and site visits, can be found on the Triple-S web site - http://www. syndromicsurveillance.eu/. [Source: Eurosurveillance News, 16 October 2014. http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=20927] FSA Food and You survey findings published 48/4204 The Food Standards Agency (FSA) publishes its ‘Food and You survey’ once every two years. The report provides information on reported behaviours, attitudes and knowledge relating to food issues. This year’s survey, published on 21 October, found that 51% of adults surveyed stored meat in line with FSA guidelines suggesting that up to half may store raw meat in a way that could lead to cross-contamination. FSA advice is to always keep raw meat on the bottom shelf of the fridge away from cooked meats and other fresh and ready-to-eat food so juices do not drip onto other food products. Wrapping raw meats in cling film or storing away in sealed containers will help to guard against cross-contamination. The survey showed an increase in awareness of the FSA’s Food Hygiene Rating Scheme, and the Food Hygiene Information Scheme in Scotland (at http://ratings.food.gov.uk/). Recognition of the schemes was found to be highest in Northern Ireland at 88%. Lowest awareness was in Scotland at 70%. Recognition of the schemes across the UK had however increased significantly with latest figures showing that 76% of respondents were aware of the scheme, up from 55% in previous years. The survey also gives an insight into the number of people with a food allergy. In total, 4% reported having an allergy. Of that 4%, nearly two thirds (66%) said they had seen a doctor about their allergy with 40% saying that it had been clinically diagnosed. Overall, 11% of respondents reported living in a household in which someone had a food allergy (not necessarily clinically diagnosed). The Food and You survey is used to collect information about reported behaviours, attitudes and knowledge relating to food safety issues. It provides data on people’s reports of their food purchasing, storage, preparation, consumption and factors that may affect these such as eating habits, influences on where respondents choose to eat out and experiences of food poisoning. This is the third round of the survey which consisted of 3,453 interviews with a representative sample of adults aged 16 and over across the UK. Food and You is carried out on behalf on the FSA by TNS BMRB. Reports of findings individual to each UK country will be will be published in four separate country reports on Tuesday 16 December. These will include findings related to healthy eating in Scotland and Northern Ireland. [Source: FSA News Release, 21 October 2014. http://www.food.gov.uk/ news-updates/news/2014/13159/new-food-and-you-survey-findings-published] HPS WEEKLY REPORT Volume 48 No.2014/42 22 October 2014 554 Ebola - update 48/4205 Having declared Senegal officially free of Ebola virus disease transmission on 17 October 2015, the World Health Organisation (WHO) has announced that Nigeria was also officially free of Ebola virus transmission on 20 October. Both Senegal and Nigeria maintained high levels of active ‘case finding’ for 42 days, this is twice the maximum incubation period of the disease and should therefore detect possible unreported cases. The WHO has commended both Senegal’s and Nigeria’s diligence to end the transmission of Ebola virus disease, advising that the most important lesson learned is that an immediate and well coordinated response can stop imported Ebola virus disease in its tracks. Response plans included contact tracing and monitoring of those potentially exposed to the disease, rapid testing of all suspected cases, increased surveillance at the country’s entry points and national public awareness campaigns. [Sources: WHO News Releases, 17 & 20 October 2014. http://www.who.int/entity/mediacentre/news/ebola/17-october-2014/en/index.html; http:// www.who.int/entity/mediacentre/news/ebola/20-october-2014/en/index.html] The Scottish Government Resilience Committee (SGoRR) met on 15 October to discuss the latest developments in Scotland’s response to the Ebola outbreak in West Africa. The meeting was attended by the First Minister and the Health Secretary along with experts in infectious diseases from Health Protection Scotland and senior officials from the Scottish Government. Ministers were updated on the latest situation in the three affected countries of Sierra Leone, Guinea and Liberia. They were also given updates on how Scotland’s health service is preparing for any possible case, and steps being taken by the oil industry to protect workers who are returning from West Africa. [Source: Scottish Government News Release, 16 October 2014. http:// news.scotland.gov.uk/News/Ebola-preparedness-1164.aspx] Further guidance, information and advice is available on the HPS website at http://www.hps.scot. nhs.uk/travel/viralhaemorrhagicfever.aspx and is under continuous review. Enquiries concerning this from the NHS in Scotland should be directed to [email protected]. Travel guidance on Ebola is also available on TRAVAX (for health professionals - http://www. travax.nhs.uk/) and fitfortravel (for the general public - http://www.fitfortravel.nhs.uk/home.aspx). HPS WEEKLY REPORT Volume 48 No.2014/42 22 October 2014 555 Notifiable diseases Part 2 (Notifiable Diseases, Organisms and Health Risk States) of the Public Health etc. (Scotland) Act came into effect on 1 January 2010 and sets out new duties for registered medical practitioners, NHS boards and directors of diagnostic laboratories. GP practices should familiarise themselves with the Scottish Government guidance on the new notification requirements at: http:// www.scotland.gov.uk/Topics/Health/Policy/Public-Health-Act. Registered medical practitioners report notifiable diseases based on ‘clinical suspicion’. As such, notifications may not be subject to laboratory report confirmation. The published figures will record therefore how many diseases have been clinically suspected. Patient notifications can, however, be reclassified. When, for example, a suspected (and notified) tuberculosis case is subsequently reported as negative by a laboratory (and found not to be a health protection risk) it would subsequently be removed from the disease totals. Diseases to be notified by registered medical practitioners with effect from 1 January 2010: Notifiable Diseases which come into effect on 1 January 2010 *Anthrax *Meningococcal disease *Botulism Brucellosis *Cholera Mumps *Necrotising fasciitis *Paratyphoid *Clinical syndrome due to E. coli O157 infection (see note 1) *Diphtheria *Haemolytic Uraemic Syndrome (HUS) *Haemophilus influenzae Type b (Hib) *Measles *Pertussis (Whooping Cough) *Severe Acute Respiratory Syndrome (SARS) *Smallpox Tetanus Tuberculosis (respiratory or non-respiratory) (see Note 2) *Tularemia *Plague *Poliomyelitis *Typhoid *Viral haemorrhagic fevers *Rabies *West Nile fever Rubella Yellow Fever It is recommended that those diseases above marked with an * require urgent notification, i.e. within the same working day. Note 1: Escherichia coli O157 Clinical suspicion should be aroused by (i) likely infectious bloody diarrhoea or (ii) acute onset non-bloody diarrhoea with a biologically plausible exposure and no alternative explanation. Examples of biologically plausible exposures include: • contact with farm animals, their faeces or environment; • drinking privately supplied or raw water; • eating foods such as undercooked burgers or unpasteurised dairy products; • contact with a confirmed or suspected case of VTEC infection. Further guidance is available at: http://www.hps.scot.nhs.uk/giz/e.coli0157.aspx. Where a case is notified as HUS (Haemolytic Uraemic Syndrome) it should NOT also be notified as ‘Clinical syndrome due to E. coli O157 infection’. HPS WEEKLY REPORT Volume 48 No.2014/42 22 October 2014 556 Note 2: Tuberculosis For the purposes of notification, respiratory TB or non-respiratory TB should be taken to have the same meanings as the World Health Organisation definitions of pulmonary TB and nonpulmonary TB respectively: Pulmonary TB is tuberculosis of the lung parenchyma and/or the tracheobronchial tree. Non-pulmonary TB is tuberculosis of any other site. Where tuberculosis is clinically diagnosed in both pulmonary and non-pulmonary sites, this should be treated as pulmonary TB. Registered medical practitioners have been advised to contact their local NHS Board Health Protection Team for advice should they have any doubts about the diagnosis of suspected cases. Non-notifiable diseases Registered medical practitioners are no longer required to notify the diseases listed below. • Bacillary dysentery • Chickenpox • Food poisoning • Scarlet fever • Viral hepatitis These diseases are now covered by a list of notifiable organisms details of which will be reported by laboratories to health protection teams. HPS WEEKLY REPORT Volume 48 No.2014/42 22 October 2014 557 Statutory Notification of Infectious Diseases Week ended 10 October 2014 A National Statistics release Infectious Disease Anthrax Botulism Brucellosis Cholera Clinical Syndrome E. coli O157 Diphtheria Haemolytic Uraemic Syndrome (HUS) Haemophilus Influenzae Type B (Hib) Measles Meningococcal Infection Mumps Necrotizing Fasciitis Paratyphoid Fever Pertussis Plague Poliomyelitis Rabies Rubella Severe Acute Respiratory Syndrome (SARS) Smallpox Tetanus Tuberculosis: Respiratory Tuberculosis: Non-respiratory Tularemia Typhoid Fever Viral Haemorrhagic Fevers West Nile Fever Yellow Fever TOTAL Total from Current Current Previous first week week week week of year: last year 2013 1 1 1 1 5 1 3 165 2 3 1 64 5 4 453 7 2 10 22 1012 3 20 5 4 18 3 2 23 Amendments: Add 1 Tuberculosis: respiratory (1 x wk 38) AA Ayrshire & Arran FF Fife LO Lothian TY Tayside BR FV LN WI NHS BOARD ABBREVIATIONS Borders DG Dumfries & Galloway Forth Valley GR Grampian Lanarkshire OR Orkney Western Isles 5 5 39 181 131 7 2049 Total from first week of year: 2014 2 1 5 8 1 4 2 50 53 242 9 6 326 21 1 194 102 4 2 1033 Source: Health Protection Scotland, NHS National Services Scotland GGC Greater Glasgow & Clyde HG Highland SH Shetland Correspondence to: The Editor, HPS Weekly Report, Health Protection Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland T 0141-300 1100 F 0141-300 1172 E [email protected] W http://www.ewr.hps.scot.nhs.uk/ Printed in the UK. HPS is a division of the NHS National Services Scotland. Registered as a newspaper © Health Scotland 2014 558 HPS WEEKLY REPORTatthe Post Office. Volume 48Protection No.2014/42 22 October 2014
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