Camden. Camden. Barnet. Barnet. Barking/Dag. Barking/Dag. Chart 2: PCT rates per 100,000 population population

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1 NORTH EAST & NORTH CENTRAL LONDON HEALTH PROTECTION UNIT APRIL 2011 MONTHLY SUMMARY CASES 415 cases were to NENCL HPU during April In addition, the unit managed 24 incidents, 98 enquiries and 149 contacts. Table 1 shows the number of cases per PCT/LA. had the highest number of cases (65) and Barking & Dagenham the lowest (16). Table 2 shows the rates per 100,000 population. Enfield PCT had the highest rate, (20) and Waltham Forest, Barking & Dagenham and the lowest (9 each). The overall rate for NENCL HPU sector was 14. Table 3 shows rates by age band and gender. Males accounted for 54% of cases, females 46%. The rate per 100,000 population was highest in females under 1 year. Table 1: of cases by PCT Chart 1: of cases by PCT PCT Barking/Dag 16 Reported cases by PCT 65 Barking/Dag City/Hackney Enfield City/Hackney 41 Haringey 36 Enfield Haringey Islington Newham 28 0 Islington 29 Other/NK 16 Newham 28 Redbridge 24 Other/NK 16 T/Hamlets 23 Redbridge 24 W/Forest 22 T/Hamlets W/Forest 22 Barking/Dag City/Hackney Enfield Haringey Islington Newham Other/NK Redbridge T/Hamlets W/Forest Table 2: PCT rates per 100,000 population Rate/100k Chart 2: PCT rates per 100,000 population PCT population Barking/Dag 9 Rate/100k PCT population rates/100k population 19 Barking/ City/Hackney NENCL Enfield City/Hac Haringey 16 Enfield Haringey 16 Islington Newham 12 Islington 15 Redbridge 9 Newham 12 T/Hamlets 10 Redbridg 9 W/Forest 10 T/Hamle 10 NENCL 14 W/Fores 10 Barking/Dag City/Hackney Enfield Haringey Islington Newham Redbridge T/Hamlets W/Forest Table 3: Rates/100,000 population Chart 3: Rate per 100,000 population by age band and gender by age band and gender All Ages F M Rates/100k population by age band and gender Under 1 year Female Male 1-4 years Under years years 5-14 years years year years years yea years yearsye years 6 5 Under year ye yea Female Male

2 Table 4 lists all infections by status ( or ). Of the 415 cases in April, 262 (63%) were laboratory. The organism with the highest number of cases was campylobacter with 75 cases, equating to 18% of the total cases. Table 4: Cases by diagnosis/infection and status Campylobacteriosis Mumps Measles Scarlet Fever 31 8 Tuberculosis Rotaviral gastroenteritis Salmonellosis Meningococcal infection 17 6 igas (Invasive Grp A Strep) Shigellosis B (flexneri) 9 9 Shigellosis D (sonnei) 9 8 Hepatitis B, acute 8 7 PVL-associated staphylococcal 6 5 Whooping cough 4 2 Giardiasis 3 3 Hepatitis B, chronic 3 2 Rubella 3 1 Shigellosis 3 2 Typhoid fever 3 2 Amoebic dysentery 2 1 E.coli infection, VTEC O Food poisoning 2 Haemophilus influenzae, unspec 2 2 Legionnaires Disease 2 2 Listeriosis 2 2 Malaria 2 2 Pneumococcal meningitis 2 1 Scombroid fish poisoning 2 Streptococcal infection, unspec 2 2 Varicella (chickenpox) 2 Table 5 shows the 10 infections with the highest number of cases in April 2011 and compares these with the number of cases in April of the preceding 2 years. Measles 60 cases of measles were in April 2011, compared with 18 cases in the same month in Just under half (28) were laboratory. Of the 12 cases of measles in, 5 were (age range 7 months to 32 years), 4 of these 5 were unvaccinated and one adult being up to date with vaccines in Sweden. Most cases remain sporadic across the sector but spread within educational establishments is expected over the coming weeks. NENCL HPU has undertaken a sector-wide communications exercise. Letters have been circulated to GPs, Walk-In-Centres and hospitals (including GUM clinics) as well as all state and private schools. All cases associated with an educational establishment are being thoroughly investigated and Directors of Public Health will be kept informed if clusters emerge. Meningococcal Disease There was a 3-fold increase in the number of meningococcal cases in April when compared with April 2010, from 5 cases to 17, however, the number of cases has remained unchanged. Scarlet Fever There was also an increase in the number of scarlet fever cases during April, 31 cases were and 8 were laboratory. Scarlet fever is currently more prevalent in the community and this increase is reflected across the London sector. Acute Hepatitis A 1 1 Table 5: Diagnoses/infections with the highest Acute hepatitis E 1 1 number of cases in April 2011, compared with Brucellosis 1 1 the same month in the previous 2 years Cryptosporidiosis 1 1 Diagnosis/Infection E.coli infection, other/unspec 1 1 Campylobacteriosis Hand, foot & mouth disease 1 Mumps Hepatitis C, acute 1 1 Measles Herpes Zoster, other 1 Scarlet Fever Melioidosis 1 1 Tuberculosis Meningitis, other viral 1 Rotaviral gastroenteritis Paratyphoid fever 2 2 Salmonellosis Pneumococcal septicaemia 1 1 Meningococcal infection Prion disease 1 igas (Invasive Grp A Strep) Scabies 1 Shigellosis B (flexneri) Shigellosis A (dysenteriae) 1 Shigellosis D (sonnei) Streptococcus Grp B haemolytic 1 Viral haemorrhagic fever, unspec

3 INCIDENTS 24 incidents were during April They are divided into 2 categories Outbreaks and TB incidents (where screening of contacts outside the household needs to be carried out). There were 19 outbreaks across 7 PCTs. 47% of the outbreaks were due to norovirus and 52% occurred in care homes. Table 6: Outbreaks Food Poisoning Gastroenteritis Hand, foot & mouth Norovirus Varicellazoster virus PCT Principal Context Barking/Dagenham Care Home School 1 1 Care Home 1 1 School 1 1 City/Hackney Hospital 1 1 Enfield Care Home 1 1 Food Outlet 1 1 Nursery 1 1 Care Home Nursery 1 1 Redbridge Care Home 1 1 Hospital 2 2 Nursery 1 1 Waltham Forest Care Home Table 7: TB Incidents PCT Principal Context Detail School A school student with smear positive pulmonary TB. The family and close contact tracing has not identified any potential source of infection, or any evidence of ongoing transmission. 180 students in the year group as well as the case's teachers are to be offered screening as the case attended school for 2-3 months whilst symptomatic. W/Forest College/University Hospital School College/University A case of smear positive pulmonary TB who attends a college in Walthamstow. 17 students and 8 staff members will be offered screening once culture is. Up to 250 immunocompromised patients who attend a sexual health service may have been exposed to smear positive case of TB. The index case attended the clinic a number of times whilst symptomatic. Screening clinics are underway. A case of smear positive TB in a student who is now on treatment. Awaiting culture results, but seems likely to be pulmonary TB. Screening of students and staff who have been in close contact with the case will be undertaken at the school in early June. A case of smear and culture positive pulmonary TB has been identified in a student who attends a college in. Both staff and students at the college who have had significant and close contact with the case will be screened.

4 PCT CASE TOTALS Barking & Dagenham Campylobacteriosis 1 1 Campylobacteriosis Mumps 3 1 Mumps 9 4 Measles 3 Measles 12 5 Scarlet Fever 1 Scarlet Fever 3 Tuberculosis 2 Rotaviral gastroenteritis 9 9 Meningococcal infection 1 Salmonellosis 4 4 Hepatitis B, chronic 1 Meningococcal infection 2 2 Malaria 1 1 igas (Invasive Grp A Strep) 2 2 Streptococcal infection, unspec 1 1 Shigellosis B (flexneri) 2 2 Paratyphoid fever 1 1 Shigellosis D (sonnei) 1 1 Prion disease 1 Hepatitis B, acute PVL-associated staphylococcal 1 1 Hepatitis B, chronic 1 1 Listeriosis 1 1 Malaria 1 1 Paratyphoid fever City & Hackney Campylobacteriosis 6 6 Campylobacteriosis 8 7 Mumps 7 Mumps 9 3 Measles 5 3 Measles 7 3 Tuberculosis 1 Scarlet Fever 2 1 Salmonellosis 1 1 Salmonellosis 1 1 Meningococcal infection 1 Meningococcal infection 2 Shigellosis B (flexneri) 5 5 igas (Invasive Grp A Strep) 1 1 Shigellosis D (sonnei) 1 1 Shigellosis B (flexneri) 1 1 PVL-associated staphylococcal 1 1 Shigellosis D (sonnei) 2 2 Giardiasis 2 2 Hepatitis B, acute 2 2 Shigellosis 1 Whooping cough 1 Legionnaires Disease 1 1 Rubella 1 Pneumococcal meningitis 1 Shigellosis 1 1 Scombroid fish poisoning 2 Amoebic dysentery 1 Brucellosis 1 1 Streptococcal infection, unspec 1 1 Cryptosporidiosis 1 1 Streptococcus Grp B haemolytic

5 Enfield Haringey Campylobacteriosis Campylobacteriosis 5 4 Mumps 4 1 Mumps 8 3 Measles 7 4 Measles 4 1 Scarlet Fever 5 2 Scarlet Fever 2 Tuberculosis 2 Tuberculosis 6 4 Rotaviral gastroenteritis Salmonellosis 5 5 Salmonellosis 4 4 Meningococcal infection 2 1 igas (Invasive Grp A Strep) 2 2 Shigellosis D (sonnei) 1 1 Whooping cough 1 1 PVL-associated staphylococcal 2 2 Shigellosis 1 1 Legionnaires Disease 1 1 Haemophilus influenzae, unspec Varicella (chickenpox) 1 Pneumococcal septicaemia 1 1 Shigellosis A (dysenteriae) Islington To otal rep eported Nu umber co onfirmed Campylobacteriosis 4 3 Campylobacteriosis 4 3 Mumps 5 2 Mumps 4 Measles 2 1 Measles 4 1 Scarlet Fever 1 Scarlet Fever 5 1 Meningococcal infection 2 Tuberculosis 2 1 igas (Invasive Grp A Strep) 1 1 Salmonellosis 2 2 PVL-associated staphylococcal 1 Meningococcal infection 1 Food poisoning 1 Shigellosis D (sonnei) 2 1 Pneumococcal meningitis 1 1 Whooping cough 2 1 Acute Hepatitis A 1 1 Food poisoning 1 Meningitis, other viral 1 Hepatitis C, acute Herpes Zoster, other To otal rep eported Nu umber co onfirmed

6 Newham Redbridge Campylobacteriosis 6 6 Mumps 5 3 Mumps 1 Measles 6 5 Measles 1 Scarlet Fever 2 2 Scarlet Fever 3 Tuberculosis 2 2 Tuberculosis 5 4 igas (Invasive Grp A Strep) 2 2 Salmonellosis 1 1 Shigellosis B (flexneri) 1 1 Meningococcal infection 2 1 PVL-associated staphylococcal 1 1 igas (Invasive Grp A Strep) 1 1 Rubella 2 1 Shigellosis D (sonnei) 1 1 Haemophilus influenzae, unspec 1 1 Hepatitis B, acute 2 1 E.coli infection, other/unspec 1 1 Hepatitis B, chronic 1 1 Hand, foot & mouth disease 1 Typhoid fever Amoebic dysentery 1 1 E.coli infection, VTEC O Acute hepatitis E Tower Hamlets Waltham Forest reporte ted Numbe ber confirm rmed Campylobacteriosis 9 9 Campylobacteriosis 1 1 Mumps 2 Mumps 6 2 Scarlet Fever 5 2 Measles 5 4 Salmonellosis 2 1 Scarlet Fever 2 Meningococcal infection 2 1 Tuberculosis 3 1 igas (Invasive Grp A Strep) 1 1 Meningococcal infection 1 1 Hepatitis B, acute 2 2 igas (Invasive Grp A Strep) Giardiasis 1 1 Typhoid fever 1 1 Listeriosis reporte ted Numbe ber confirm rmed

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