395 cases were reported to NENCL HPU during March In addition, the unit managed 39 incidents, 81 enquiries and 110 contacts.

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1 NORTH EAST & NORTH CENTRAL LONDON HEALTH PROTECTION UNIT MARCH 2011 MONTHLY SUMMARY CASES 395 cases were to NENCL HPU during March In addition, the unit managed 39 incidents, 81 enquiries and 110 contacts. Table 1 shows the number of cases per PCT/LA. Barnet had the highest number of cases (68) and Waltham Forest the lowest (10). Table 2 shows the rates per 100,000 population. Enfield and Barnet PCTs had the highest rates, (20 each) and Waltham Forest the lowest (4). The overall rate for NENCL HPU sector was 13. Table 3 shows rates per 100,000 population by age band and gender. Males accounted for 55% of cases, females 45%. The highest rate was in males under 1 year Table 1: of cases by PCT PCT No. of cases Chart 1: of cases by PCT Barking & Dagenham 19 Barnet 68 number of cases by PCT Camden 34 Barking City & Hackney 24 Barnet Enfield Camden 34 Haringey 37 City/Ha Havering 14 Enfield Islington Haringe Newham 41 Haverin 14 0 Other/NK 14 Islington 24 Redbridge 22 Newham 41 Tower Hamlets 29 Other/N 14 Waltham Forest 10 Redbrid T/Hamle 29 W/Fore 10 Barking/Dag Barnet Camden City/Hackney Enfield Haringey Havering Islington Newham 14 Other/NK 22 Redbridge 29 T/Hamlets 10 W/Forest Table 2: PCT rates per 100k population PCT Rate Chart 2: PCT rates per 100k population Barking & Dagenham 11 Barnet 20 PCT Rate PCT Rate/100k population Camden 15 Barking NENCL Rate City & Hackney 11 Barnet Enfield 20 Camden Haringey 16 City/Ha Havering 6 Enfield 20 0 Islington 13 Haringe 16 Newham 17 Haverin 6 Redbridge 8 Islington 13 Tower Hamlets 12 Newham 17 Waltham Forest 4 Redbrid 8 NENCL 13 T/Hamle 12 PCT Rate NENCL Rate W/Fore 4 Barking/Dag Barnet Camden City/Hackney Enfield Haringey Havering Islington Newham 8 Redbridge 12 T/Hamlets 4 W/Forest 13 Table 3: Rate per 100k population by gender and age band Chart 3: Rate per 100k population by gender and age band Age Band F M 0 yrs Female Rate/100k Male population by gender and age band 1-4 yrs yrs yrs yrs yrs yrs yrs yrs yrs y yrs 65+ yrs y yrs 65+ yrs yrs Female Male

2 Of the 395 cases to the unit, 271 (69%) were laboratory. The organism with the highest number of cases was campylobacter with 89 cases, equating to 23% of the total cases. Table 5 shows the 10 infections with the highest number of cases in March 2011 and compares these with the number of cases in March of the preceding 2 years. The number of mumps cases has fallen from 110 cases in March 2010 to 35 cases in March Paratyphoid cases have increased from 1 case in March 2010 to 9 cases in March All paratyphoid cases were linked to travel abroad. Chart 4 shows the number of cases by month and year from January 2008 to date. Table 4: Cases by diagnosis/infection Diagnosis Campylobacteriosis Scarlet Fever Rotavirus Mumps 35 7 Table 5: Diagnoses/infections with the highest Tuberculosis number of cases in March 2011, compared with Measles the same month in the previous 2 years Salmonellosis March March March Paratyphoid fever Shigellosis (flexneri) 6 6 Campylobacteriosis Shigellosis (sonnei) 6 6 Scarlet Fever Gastroenteritis 6 0 Rotavirus Food poisoning 5 0 Mumps Giardiasis 5 5 Tuberculosis Meningococcal infection 5 2 Measles PVL-assoc staph infection 5 5 Salmonellosis Typhoid fever 5 2 Paratyphoid fever Whooping cough 5 4 Shigellosis (flexneri) Acute Hepatitis A 4 3 Shigellosis (sonnei) Hepatitis B, acute 4 4 Strep Grp A, non-invasive/unspec 4 4 Haemophilus influenzae 3 3 Hepatitis B, chronic 3 3 Hepatitis B, unspecified 3 0 Malaria 3 3 Chart 4: of cases per month from Rubella 3 0 January 2008 to March 2011 Bacterial meningitis, unspec 2 0 Cryptosporidiosis Monthly case totals from January 2008 to March E.coli VTEC O January Hepatitis E 2 1 Februar igas (Invasive Grp A Strep) 2 2 March Meningitis, other viral April Meningococcaemia May Meningococcal meningitis June Acute hepatitis B 1 1 July Amoebic dysentery 1 0 August Bacterial pneumonia, other Septem Enteroviral meningitis October Erythema infectiosum (fifth disease) Novemb Hepatitis C, chronic 1 1 Decemb Hepatitis C, unspecified 1 1 Klebsiella 1 0 Listeriosis 1 1 Noroviral gastroenteritis 1 1 Parvovirus infection Pneumococcal pneumonia 1 0 Shigellosis 1 1 Shigellosis C (boydii) 1 1 Tetanus 1 0 Varicella (chickenpox) January February March April May June July August September October November December

3 SITUATIONS 39 incidents were during March They are divided into 2 categories Oubreaks and TB incidents (where screening of contacts outside the household needs to be carried out). There were 31 outbreaks across 11 PCTs. 48% of the outbreaks were due to norovirus and 35% occurred in hospital wards. Table 6: Outbreaks Bacillus cereus Food Poisoning PCT Principal Context Barking/Dag Nursery 1 1 Barnet Hospital 1 1 Camden Hospital 1 1 Enfield Care Home Community 1 1 Food Outlet/Restaurant 1 1 Hospital 1 1 Nursery Haringey Hospital 1 1 Havering Care Home Food Outlet/Restaurant 1 1 Hospital Islington Nursery 1 1 Newham School 2 2 Redbridge Hospital 1 1 T/Hamlets Food Outlet/Restaurant 1 1 W/Forest Care Home Gastroenteritis Impetigo Norovirus Parvovirus B19 Staph aureus, MRSA Varicellazoster virus Table 7: TB Incidents PCT Principal Details Context Barnet School Smear and culture negative case of TB in a school. Cavitating lesions in the RUL were found on the CXR and TB treatment was commenced. The case is a member of the kitchen staff in a Jewish primary school. An incident meeting at the school was held and six members of kitchen staff were identified as having close and prolonged contact with the case and have been invited for screening. Camden University A student attending the School of Oriental and African Studies was diagnosed in March with smear positive, culture positive MDRTB. A risk assessment was carried out with the tutuor and the TB team from UCLH. Awaiting contact list from school, anticipate screening appointments will be in May. City & Hackney School A case of pulmonary TB in a school, smear and culture positive, fully sensitive. The case has been symptomatic since January with a productive cough. Risk assessment in the school is currently being undertaken. Haringey Workplace Risk assessment is in progress. Two to four staff will require screening this month. Islington College Screening for 24 students and 7 staff is in progress. Newham College A pupil who attends a further education college has been diagnosed with sputum smear positive TB. Screening of pupils and staff is being arranged. Newham School Screening of pupils and staff has taken place at a school with a case of smear positive TB. Full results are pending. Newham Congregation A case of sputum smear and culture positive pulmonary TB who attends a mosque. Screening results are pending.

4 PCT CASE TOTALS Barking & Dagenham Campylobacteriosis 1 1 Scarlet Fever 6 2 Mumps 1 Measles 1 Salmonellosis 2 2 Meningococcal infection 2 PVL-assoc staph infection 1 1 Acute Hepatitis A 1 1 Bacterial meningitis, unspec 1 E.coli infection, VTEC O157 1 igas (Invasive Grp A Strep) infection 1 1 Hepatitis C, unspecified Barnet Campylobacteriosis Scarlet Fever 3 Rotavirus Infection Mumps 5 Tuberculosis 4 2 Measles 6 5 Salmonellosis 4 4 Paratyphoid fever 2 2 Giardiasis 1 1 Whooping cough 1 Hepatitis B, chronic 1 1 Rubella 1 E.coli infection, VTEC O Meningococcal meningitis 1 1 Acute hepatitis B Camden Campylobacteriosis Scarlet Fever 1 Mumps 4 1 Tuberculosis 3 1 Measles 2 Salmonellosis 3 2 Shigellosis B (flexneri) 2 2 Food poisoning 1 Meningococcal infection 1 1 Cryptosporidiosis 1 1 Amoebic dysentery 1 Erythema infectiosum (fifth disease) 1 Hepatitis C, chronic 1 1 Noroviral gastroenteritis

5 City & Hackney Campylobacteriosis 4 4 Scarlet Fever 8 4 Mumps 2 Tuberculosis 1 1 Measles 3 1 Paratyphoid fever 1 1 Rubella 1 Meningitis, other viral 2 Pneumococcal pneumonia Enfield Campylobacteriosis Scarlet Fever 4 Rotavirus Infection Mumps 2 Tuberculosis 2 1 Measles 2 Salmonellosis 1 1 Shigellosis B (flexneri) 1 1 Food poisoning 2 Whooping cough 1 1 Acute Hepatitis A 1 1 Hepatitis B, acute 2 2 Hepatitis B, chronic 1 1 Meningococcaemia 2 1 Meningococcal meningitis Haringey Campylobacteriosis 7 7 Scarlet Fever 3 2 Rotavirus Infection 1 1 Mumps 4 2 Tuberculosis 3 2 Measles 2 Salmonellosis 2 2 Paratyphoid fever 2 2 Gastroenteritis 1 Giardiasis 3 3 PVL-assoc staph infection 1 1 Hepatitis B, chronic 1 1 Malaria 2 2 Rubella 1 igas (Invasive Grp A Strep) infection 1 1 Bacterial pneumonia, other

6 Havering Campylobacteriosis 2 2 Scarlet Fever 2 1 Mumps 2 Measles 1 Salmonellosis 2 2 Food poisoning 2 Whooping cough 1 1 Haemophilus influenzae infection Islington Campylobacteriosis 1 1 Scarlet Fever 7 4 Mumps 1 1 Tuberculosis 4 3 Measles 3 2 Shigellosis B (flexneri) 1 1 Shigellosis D (sonnei) 2 2 PVL-assoc staph infection 2 2 Hepatitis E 1 1 Listeriosis 1 1 Shigellosis C (boydii) Newham Campylobacteriosis 8 8 Scarlet Fever 1 Mumps 3 Tuberculosis 5 4 Salmonellosis 7 4 Paratyphoid fever 3 3 Typhoid fever 4 1 Acute Hepatitis A 1 1 Hepatitis B, acute 1 1 Haemophilus influenzae infection 1 1 Hepatitis B, unspecified 2 Malaria 1 1 Bacterial meningitis, unspec 1 Klebsiella 1 Varicella (chickenpox)

7 Redbridge Campylobacteriosis 5 5 Scarlet Fever 3 Rotavirus Infection 1 1 Mumps 1 Measles 1 1 Salmonellosis 1 1 Gastroenteritis 5 Giardiasis 1 1 PVL-assoc staph infection 1 1 Typhoid fever 1 1 Hepatitis B, acute 1 1 Enteroviral meningitis Tower Hamlets Campylobacteriosis Scarlet Fever 2 Mumps 5 1 Tuberculosis 3 2 Measles 2 1 Salmonellosis 1 Paratyphoid fever 1 1 Acute Hepatitis A 1 Hepatitis E 1 Shigellosis Waltham Forest Mumps 3 Tuberculosis 2 1 Measles 1 Meningococcal infection 1 Cryptosporidiosis 1 1 Parvovirus infection