HPS Weekly Report CURRENT NOTES CONTENTS. World Hepatitis Day 28 July Candida auris emerging fungal pathogen
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1 HPS Weekly Report 26 July 2016 Volume 50 No. 2016/30 ISSN (Online) CONTENTS CURRENT NOTES World Hepatitis Day 28 July Candida auris emerging fungal pathogen 235 Public health risks of the Bacillus cereus group 236 Environmental incidents - SEISS reports (Falkirk industrial unit major fire) 237 SURVEILLANCE REPORT Surveillance of known hepatitis C antibody positive cases in Scotland: results to 31 December CURRENT NOTES World Hepatitis Day 28 July /3001 This Thursday (28 July) marks World Hepatitis Day ( worldhepatitisday.org/), which aims to raise awareness of the disease and encourage better access to treatment. The disease is one of the top 10 causes of global death, costing 1.4 million lives every year. There are more than 400 million people chronically infected with hepatitis B and C worldwide. The theme for this year s global campaign is ELIMINATION. This year sees the first ever World Health Organization s Global Strategy for Viral Hepatitis, which sets a goal of eliminating viral hepatitis as a public health threat by The draft text of the strategy is available at global_health_sector_strategy_viral_hepatitis_13nov.pdf. To the end of 2015, it is estimated that 36,000 people were living with chronic hepatitis C infection in Scotland; of these 60% had been diagnosed. In financial year 2015/2016, 1,735 hepatitis C infected individuals were initiated onto antiviral therapy. In this issue, the number of newly diagnosed hepatitis C antibody positive people are presented. Candida auris emerging fungal pathogen 50/3002 Since April 2015 a critical care unit in England has been managing an outbreak of Candida auris with over 40 patients either colonised or infected. 1 Around 20% of these patients have had candidaemia. The hospital outbreak has been difficult to control, despite enhanced infection control interventions, including regular patient screening, environmental decontamination and ward closure. Candida auris is an emerging fungal pathogen - a yeast species first isolated from the external ear of a patient in Japan in Since then C. auris has been associated with bloodstream infections, wound infections and otitis. It has also been cultured from urine and the respiratory tract, although it is not known if positive cultures from these sites represent infections or colonisations. One of the most important features of C. auris is that it is commonly resistant to the first-line antifungal drug fluconazole, and may also be resistant to other classes of antifungal drugs (including amphotericin B and the echinocandins). The strains currently circulating in England appear to be susceptible to the echinocandin group but it should be noted that this species can evolve rapidly to develop further resistance.
2 Microbiologists need to be aware that any Candida spp isolates associated with invasive infections and isolates from superficial sites in patients transferred from an affected hospital (UK or abroad) should be analysed to species level. Most routinely used identification systems may misidentify C. auris. If Candida haemulonii,candida famata, Candida sake, Saccharomyces cerevisiae or Rhodotorula glutinis (the latter species is pink on Sabouraud s agar and is easily distinguished) are identified, further work should be undertaken to ensure that they are not C. auris. This would involve either (a) MALDI-TOF Biotyper analysis (NB: microbiologists with access to MALDI-TOF Biotyper must ensure that C. auris is either already present or added to their local database) or (b) molecular sequencing of the D1/D2 domain which can be offered at the PHE Mycology Reference Laboratory. The PHE Mycology Reference Laboratory in Bristol is keen to review any suspicious isolates. Please send pure isolates on Sabouraud s slopes accompanied by the appropriate form (accessible from Further Guidance for the Laboratory Investigation, Screening, Management and Infection Prevention and Control of cases of C. auris is available at publications/candida-auris-laboratory-investigation-management-and-infection-prevention-andcontrol. References 1. Public Health England News story, 1 July PHE responds to cases of Candida auris in England. Available from: (accessed 22 July 2016). 2. Satoh K, Makimura K, Hasumi Y, et al. Candida auris sp.nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiology and immunology. 2009;53(1):41-4. Available from: (accessed 22 July 2016). Public health risks of the Bacillus cereus group 50/3003 A panel of scientific experts set up by the European Food Safety Authority (EFSA) has updated a 2005 scientific opinion on the risks to public health related to Bacillus cereus and other Bacillus species in food. The Bacillus cereus group comprises eight species. One of these, Bacillus thuringiensis, is used as a biopesticide for insect control. These naturally occurring, soil-borne bacteria can cause foodborne illnesses which usually result in vomiting and diarrhoea. The panel have stated that the only way to identify strains of Bacillus cereus group unambiguously is to determine their complete genome sequence. They recommend the use of whole genome sequencing techniques to collect relevant information as a pre-requisite for further risk assessment. The experts also recommend control options to manage risks caused by these bacteria. One of the most important options is to keep food refrigerated at a maximum temperature of 7 C. From 2007 to 2014, EU member states reported 413 strong-evidence foodborne outbreaks associated with Bacillus cereus, which affected 6,657 people and caused 352 hospitalisations. Risks for public health related to the presence of Bacillus cereus and other Bacillus spp. including Bacillus thuringiensis in foodstuffs can be accessed at pub/4524. [Source: EFSA News Release, 20 July news/160720] HPS WEEKLY REPORT Volume 50 No.2016/30 26 July
3 Environmental incidents - SEISS reports (Falkirk industrial unit major fire) 50/3004 The Scottish Environmental Incident Surveillance System (SEISS) recorded the following incident in the past week: A fire broke out at an industrial unit storing tanks of highly flammable acetylene gas in Falkirk. More than 30 firefighters were called to the unit at Bankside Industrial Estate shortly after midnight on 18 July. Additional crews from across central Scotland had to be called in due to the protracted nature of the blaze. The Scottish Fire and Rescue Service said the fire was extinguished and made safe by about 05:00. Two crews were initially sent to the site of the fire before further crews were dispatched due to the severity of the incident. A total of 35 firefighters were involved in the operation ( For more detailed information on SEISS, go to aspx?id=107 or contact either Ian Henton or Colin Ramsay at HPS on HPS WEEKLY REPORT Volume 50 No.2016/30 26 July
4 Surveillance Report Surveillance of known hepatitis C antibody positive cases in Scotland: results to 31 December 2015 Prepared by: Glenn Codere, Amanda Weir, Andrew McAuley, Allan McLeod, Cameron Watt, Sharon Hutchinson, David Goldberg In Scotland During January to December 2015, 1821 new cases of hepatitis C antibody-positivity were diagnosed. This figure compares to 1857, 1941, and 2024 for 2012, 2013 and 2014 respectively. An average of 1866 cases were diagnosed per annum in the years , compared with 1911 from The number newly diagnosed in previous years has been revised following improvements in de-duplication methodologies and quality checks of the data. FIGURE 1: Persons in Scotland reported to be hepatitis C antibody positive by year and quarter of earliest positive specimen, to 31 December Annual number of diagnoses Year of earliest positive specimen Quarter 1 Quarter 2 Quarter 3 Quarter 4 Of new (2015) cases, 33% (593) resided in Greater Glasgow & Clyde NHS Board area, 17% (307) in Lothian, 11% (192) in Tayside, 7% (135) in Grampian, and < 7% each in the other NHS board areas. 69% (1255) were male and 31% (560) female. Gender was not reported in fewer than 1% (6) of cases. At the time of diagnosis, 16% (295) were aged years, 36% (652) were aged years, 28% (509) were aged years, 12% (219) were aged years, and 6% (108) were aged 60+ years. Source of referral was known in 77% (1397) of cases, 30% (425) being diagnosed in the hospital setting (including infectious disease and gastroenterology units) and 28% (391) were diagnosed by general practitioners. 19% (261) were known to have been diagnosed in specialist drug services, where dry blood spot testing for hepatitis C was introduced in 2009 (diagnoses made on dry blood spot samples were confirmed at NHS testing laboratories). HPS WEEKLY REPORT Volume 50 No.2016/30 26 July
5 A cumulative total of cases of hepatitis C antibody-positivity had been diagnosed as at 31 December % (14718) resided in Greater Glasgow & Clyde NHS Board area, 14% (5371) in Lothian, 10% (4016) in Grampian, 8% (3236) in Tayside, and < 8% each in the other NHS board areas. 67% (25852) were male and 32% (12337) female, gender was not known in 1% (388) of cases. At the time of diagnosis, 31% (12010) were aged years, 36% (13857) were aged years, 19% (7167) were aged years, 7% (2581) were aged years, and 4% (1421) were aged 60+ years. Age was not known in 1% (448) of cases. 66% (20987) of diagnosed individuals not known to be dead are currently aged between 30 and 49 years, 20% (6306) between 50 and 59 years, 8% (2537) are aged 60+, and 6% (1742) aged under 30 years. 17% (6559) are known to have died. Risk group was known in 56% (21657) of cases. Of those where risk group was known, 91% (19607) of infections were among persons who inject drugs (PWID). Source of referral was known in 78% (30198) of cases: 34% (10263) were diagnosed in the hospital setting (including infectious disease and gastroenterology units), 29% (8746) by general practitioners, 8% (2348) in genito-urinary medicine clinics, 8% (2309) in prison, and 7% (2222) in specialist drug services. Methods For details of methods see SCIEH Weekly Report vol.33 no.99/29 (at ewr/redirect.aspx?id=14870). In collaboration with the Scottish National Blood Transfusion Service (SNBTS), records of hepatitis C antibody positive cases diagnosed through their screening programme have been added to the national surveillance database. Acknowledgements HPS thanks collaborators and contributors to national HCV surveillance throughout Scotland for their assistance in the compilation and production of these data. HPS WEEKLY REPORT Volume 50 No.2016/30 26 July
6 TABLE 1: Persons in Scotland reported to be hepatitis C antibody positive; Number and rate/ population 1 by NHS board and year of earliest positive specimen, to 31 December NHS board Total 2 AA Number Rate/ BR Number Rate/ DG Number Rate/ FF Number Rate/ FV Number Rate/ GR Number Rate/ GGC Number Rate/ HG Number Rate/ LN Number Rate/ LO Number Rate/ TY Number Rate/ Scotland 3 Number Rate/ Based on population at 30 June of indicated year. 2. Includes persons diagnosed prior to Includes persons diagnosed in island boards (NHS Orkney, NHS Shetland and NHS Western Isles). NHS board refers to the persons NHS board of residence, or where this is not known, the NHS board of source of referral. HPS WEEKLY REPORT Volume 50 No.2016/30 26 July
7 TABLE 2: Persons in Scotland reported to be hepatitis C antibody positive by NHS board and risk group, to 31 December NHS board PWID Blood Factor Other Not known Total Ayrshire & Arran Borders Dumfries & Galloway Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lanarkshire Lothian Tayside All Islands Scotland Notes: Other includes sexual contact, tattoo/body piercing, needlestick, bite, blood spillage, blood transfusion, or perinatal risk. Persons who acquired their hepatitis C infection In Scotland through blood factor will have become infected prior to the time, in the mid 1980 s, when heat treatment was introduced to prevent blood borne infection. NHS board refers to the persons NHS board of residence, or where this is not known, the NHS board of source of referral. All Islands refers to NHS Orkney, NHS Shetland and NHS Western Isles. HPS WEEKLY REPORT Volume 50 No.2016/30 26 July
8 TABLE 3: Persons in Scotland reported to be hepatitis C positive and not known to be dead by NHS board, gender, and current age group, to 31 December Age range Gender < Total AA Male Female Total BR Male Female Total DG Male Female Total FF Male Female Total FV Male Female Total GR Male Female Total GGC Male Female Total HG Male Female Total LN Male Female Total LO Male Female Total TY Male Female Total Scotland Male Female Total Notes: Excludes 446 cases with age not known. NHS board totals include cases with gender not known. Scotland totals include 92 cases from Orkney, Shetland, and Western Isles NHS Boards. Data for these boards cannot be featured separately due to confidentiality issues. HPS WEEKLY REPORT Volume 50 No.2016/30 26 July
9 TABLE 4: Persons in Scotland reported to be hepatitis C antibody positive by gender, age group at diagnosis and year of earliest positive specimen, to 31 December Sex Age Total 1 Male < NK Total % 68% 66% 68% 69% 65% 63% 65% 64% 69% 67% Female < NK Total % 31% 33% 31% 31% 34% 35% 34% 33% 31% 32% Total 2 < NK Total Includes persons diagnosed prior to Includes 388 persons with gender not known. HPS WEEKLY REPORT Volume 50 No.2016/30 26 July
10 TABLE 5: Persons in Scotland reported to be hepatitis C antibody positive by source of referral and year of earliest positive specimen, to 31 December Source of referal Total 1 GP Hospital patients GUM Clinic Prison Drug Service Other Not Known Total Includes persons diagnosed prior to Other includes those diagnosed in counselling clinics, renal units, haemophilia clinics, occupational health and Scottish National Blood Transfusion Service donor screening. The last hepatitis C Surveillance Report was in Issue 15/28 The next hepatitis C Surveillance Report will be in Issue 17/TBC NHS BOARD ABBREVIATIONS AA Ayrshire & Arran BR Borders DG Dumfries & Galloway GGC Greater Glasgow & Clyde FF Fife FV Forth Valley GR Grampian HG Highland LO Lothian LN Lanarkshire OR Orkney SH Shetland TY Tayside WI Western Isles Correspondence to: The Editor, HPS Weekly Report, Health Protection Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland T F E NSS.HPSWReditor@nhs.net W Printed in the UK. HPS is a division of the NHS National Services Scotland. HPS Registered WEEKLY as a newspaper REPORT at the Post Office. Volume Health 50 Protection No.2016/30 Scotland July
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