HPS Weekly Report. Contents CURRENT NOTES. 1 October 2009 Volume 43 No. 2009/39 ISSN (Online)

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1 HPS Weekly Report 1 October 2009 Volume 43 No. 2009/39 ISSN (Online) Contents CURRENT NOTES. HPV vaccine batch recall. Clostridium difficile infection in healthcare settings - Prevention and Control. Scottish Health Survey Mortality amongst asbestos workers SURVEILLANCE REPORT pages Vaccine uptake, measles, mumps, rubella, whooping cough, chickenpox NOTIFIABLE TABLES to 18/09/2009 pages pages CURRENT NOTES HPV vaccine batch recall 43/3901 On 29 September, the Medicines and Healthcare products Regulatory Agency (MHRA) issued a drug alert to the healthcare community advising them of the recall of the human papillomavirus (HPV) vaccination batch quarantined following the death of a 14-year-old girl. The recall is being voluntarily carried out by GlaxoSmithKline (GSK), the manufacturer of the HPV vaccine Cervarix, as a precautionary measure. Healthcare professionals administering the vaccine are being asked to return any unused stock of this batch to GSK. The MHRA considers that the risk/benefit profile for Cervarix remains positive and that the safety and efficacy of the vaccine had been extensively researched in clinical trials before licensing. The national HPV vaccination programme will continue as there are no supply issues associated with Cervarix. New stock is readily available. [Source: MHRA Press Release, 29 September All vaccine stocks in Scotland from the same batch as was used in the affected English school are likewise being quarantined. Scotland s Chief Pharmaceutical Officer has instructed all s to take this batch out of circulation. At this stage there is no proven link between the death and the HPV vaccine and this step is being taken in Scotland and elsewhere in the UK as a precautionary measure. [Scottish Government News Release, 29 September Preliminary autopsy results on the young girl who sadly died have suggested that she had a rare and grave underlying medical condition likely to have caused her death and that it was most unlikely that the HPV vaccination was the cause of death. An update on HPV vaccine uptake in Scotland is included in this week s surveillance report (pp ). Clostridium difficile infection in healthcare settings - Prevention and Control 43/3902 On 25 September, HPS issued a revised edition of Guidance on Prevention and Control of Clostridium difficile Infection (CDI) in Healthcare Settings in Scotland (at nhs.uk/pubs/redirect.aspx?id=42640) which provides easily accessible advice covering key aspects of prevention and control of CDI. The guidance provides a standardised evidence-based approach to diagnosis, prevention and control, and treatment of CDI to enable staff to deliver safe healthcare and support the reduction of CDI in their organisation. In areas where no solid evidence exists, advice is based on expert consensus. The guidance was developed using the Health Protection Network (HPN) methodology for development of guidelines. The guidance was revised and expanded in some areas following wider consultation. This guidance is intended for use in all healthcare settings in Scotland including acute and nonacute hospitals. Correspondence to: The Editor, HPS Weekly Report HPS, Clifton House, Clifton Place Glasgow, G3 7LN Scotland T F E NSS.HPSWReditor@nhs.net Printed in the UK HPS is a division of the NHS National Services Scotland Registered as a newspaper at the Post Office HPS 2009 A new section on CDI in the community has been added. Advice in this section is directed primarily at health protection teams and infection control teams to enable them to deal with incidents in the community. Adult care homes and other facilities (outside of the NHS) need only adhere to the recommendations given in section on CDI in the community (section ), however this should not be considered as a comprehensive guidance for these settings. A short guide to managing CDI both in healthcare settings and in the community can be found in Appendix B.

2 Key recommendations have not changed in comparison with the first version of the guidance but some areas have been expanded with more detailed advice. Of special importance is the section on Surveillance (section 2.2.2), which now contains specific advice on local surveillance, investigation of severe cases and escalation of reporting. The section on roles and responsibilities now includes more comprehensive advice on how to implement the recommendations of this guidance. A new section on specific measures in CDI Outbreaks has been added to the revised version of the guidance. Scottish Health Survey /3903 A report published on 29 September presents the findings of the fourth Scottish Health Survey - the first to be published following the redesign of the survey after a major review in 2005/2006. It was commissioned by the Scottish Government and the product of a collaboration between the Scottish Centre for Social Research, the MRC Social and Public Health Sciences Unit based in Glasgow and the Department of Epidemiology and Public Health at University College London. The survey - based on interviews with over 8,000 adults and children each year - provides an extremely valuable collection of data on health and health behaviours in Scotland not available from other sources. The redesigned survey is intended to improve the usefulness of this resource by providing results more frequently and increasing the opportunities for level analysis in future years. The amalgamation of NHS Health Scotland s Health Education Population Survey (HEPS) with the Scottish Health Survey from 2008 also provided an opportunity to increase the breadth of potential analysis from this new data source whilst reducing the overall cost to Government and reducing the burden on interview respondents. The Scottish Health Survey is the main data source for two of the national indicators and provides a wealth of data for monitoring and evaluating a wide range of policies to improve Scotland s health and to reduce health inequalities. The principal focus of the Scottish Health Survey 2008 is cardiovascular disease and the related risk factors, including smoking, alcohol, diet, physical activity, obesity. Information on general health, mental health and dental health are also included. The report is available at Mortality amongst asbestos workers /3904 The Asbestos Survey was established to monitor the long-term health of workers covered by regulations to control occupational exposure to asbestos. The aim of this report was to provide an updated analysis of mortality among asbestos workers, to investigate which causes of death were associated with exposure to asbestos, and to undertake a more detailed analysis of the stripping/removal workers. From 1971, workers were recruited during initially voluntary and later statutory medical examinations. During the medical, a brief questionnaire was completed, and participants were then flagged for cancer and death registrations with the National Health Service Central Register (NHSCR) via the Office for National Statistics (England and Wales) (ONS) or the General Register Office for Scotland (GROS). There were 15,496 deaths among the 98,912 workers included in the analysis. All cause mortality was significantly higher than in the general population. Known associations between asbestos exposure and mortality from lung, peritoneal and pleural cancers, mesothelioma and asbestosis were confirmed, and some evidence of associations with stroke and stomach cancer mortality was observed. Limited evidence suggested that asbestos-related disease risk might be lower among those first exposed in more recent times. Among the removal workers, deaths were elevated for all causes, all cancers including lung cancer, mesothelioma, and circulatory disease. Spending more than 40 hours per week in a stripping enclosure increased the risk of all cause, circulatory disease, and ischaemic heart disease mortality. However the different dust suppression techniques and respirator types did not affect mortality rates. Longer follow-up will allow the impact of recent regulations on the health of asbestos workers to be assessed. Research report RR 730 The Asbestos survey: mortality among asbestos workers and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy. It can be accessed at htm. 364

3 Surveillance Report Vaccine uptake, measles, mumps, rubella, whooping cough, chickenpox Prepared by: Sheriff Adewunmi, Katy Sinka, Patricia Cassels and John Love This quarterly report, presents the notifications and confirmed cases of vaccine preventable diseases for the period ending week 36, 2009 and vaccine uptake figures for the quarter ending 30 June Measles, mumps and rubella There have been 133 measles notifications in Scotland since the start of Of these, only 16 cases were laboratory confirmed. There has been only one new confirmed case of measles since the last surveillance report. 1 For the same week period (week 36) last year, there were 172 notifications and 53 confirmed cases. One measles case reported in the last surveillance report 1 has been discounted, following further laboratory testing which ruled it out as a confirmed case. A quarter of the confirmed cases so far this year were travel related. None were immunised, although two were children too young to be routinely offered immunisation. Mumps cases continue to be reported. Following an overall steady decline since 2005 there has been a recent upturn in cases. For the first 36 weeks of 2009, there were 803 notifications and 386 laboratory confirmed cases of mumps. For the same week period last year, the figures were 582 and 142 respectively. As seen in the earlier outbreaks, over 60% of the confirmed mumps cases are adolescents and young adults (aged years). The increase in the number of cases and the age group affected is similar to trends observed elsewhere in the UK. 2 The median age of confirmed cases was 22 years. Cases continue to be mainly among the young adult age group, who are often under immunised against mumps, not having been routinely offered two s of MMR vaccine. Figure 1 shows the trend in mumps notifications over time. FIGURE 1: Mumps notifications by age in Scotland (Week 36) of Notifications * *2009 reports to week 36 Year There have been 68 notifications of rubella in the first 36 weeks of However, none of these was confirmed as a case. Four confirmed cases of rubella were reported last year. Whooping cough (pertussis) < There have been 70 notifications and 32 confirmed cases of whooping cough in the first 36 weeks of 2009 compared to 85 notifications and 63 confirmed cases in the same week period of Of the 32 laboratory confirmed cases so far in 2009, 12 were under one year of age, five of whom were less than one month old and would have been too young to be immunised. Chickenpox There have been 13,621 notifications of chickenpox in the first 36 weeks of 2009 compared to 9,172 notified cases for the same week period last year. s of chickenpox cases fluctuate from year to year. There is often a peak in the early part of the year. The current apparent rise in cases is in line with trends seen over the last 5-10 years in Scotland. (see Figure 2). FIGURE 2: Trend showing chickenpox notifications in Scotland (Week 36) of Notifications Vaccine uptake Year Chickenpox * *2009 reports to week 36 Vaccine uptake remains generally high in Scotland. Quarterly uptake figures 3 for children reaching ages 12 months, 24 months and five years by 30 June 2009 are shown in Tables 3, 4 and 5 respectively. FIGURE 3: Vaccine uptake at 24 months in Scotland (Second Quarter) Percentage uptake * Calendar quarter D3 T3 P3 Pol3 Hib3 MMR PCV Men C Hib/Men C boost PCV boost *2009 vaccine uptake to second quarter Uptake rates by 24 months of age for completing primary courses of diphtheria, tetanus, pertussis, polio, Hib, MenC and PCV remain high and stable between 96% and 98%. Uptake of one of MMR by 24 months increased to 93.3% (from 92.6% in the previous quarter). For those reaching five years of age, uptake also increased to 96.2% (from 95.6% previously), remaining above the target of 95%. Uptake rates for the two booster vaccines (Hib/MenC and PCV) given at 12 and 13 months of age continue to rise steadily. These vaccines were newly introduced in Quarterly uptake rates for children reaching 24 months of age was 94.1% for the Hib/MenC booster (from 93.7% previously), the PCV booster remained constant at 93.8%. 365

4 TABLE 1: Vaccine preventable diseases: notifications to week 36/2009 Weeks of notifications received Cumulative totals to week weeks 21-24/09 weeks 25-28/09 weeks 29-32/09 weeks 33-36/09 week 36/09 week 36/08 Measles Mumps Rubella Whooping cough Chickenpox TABLE 2: Vaccine preventable diseases: laboratory reports to week 36/2009 Weeks of laboratory confirmation Cumulative totals to week weeks 21-24/09 weeks 25-28/09 weeks 29-32/09 weeks 33-36/09 week 36/09 week 36/08 Measles Mumps Rubella Whooping cough TABLE 3: Primary immunisation uptake rates at 12 months old: Evaluation Quarter: 1 April to 30 June 2009 in Cohort 1 % completed primary course by 12 months D T P Pol Hib MenC 4 PCV 5 Ayrshire & Arran Borders Dumfries & Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles NHS Board unknown Scotland Children reaching 12 months of age during the evaluation quarter 1 April to 30 June 2009 (i.e. born 1 April to 30 June 2008) 2. For records from the former NHS Argyll & Clyde (which was dissolved on 31 March 2006), is derived from GP practice code. There are a small number of records which do not have a practice code recorded and therefore the is unknown. 3. The 5 in 1 vaccine (comprising DTP/Pol/Hib) was introduced in September These vaccinations can be recorded separately on the SIRS system and therefore rates may differ slightly. This may be due to children who have received a single vaccine outwith Scotland or due to local recording practices. 4. Changes to the routine childhood immunisation schedule were introduced on 4 September Prior to September 2006, children required three s of MenC conjugate vaccine as part of their course of primary immunisations. Under the new schedule, children require two s of MenC before the age of 12 months, followed by the Hib/MenC booster after the age of 12 months. Therefore, from quarter ending 30 September 2006, the calculation of uptake rates for MenC has been amended to reflect the change in the number of s required for a complete course of MenC (two s under 12 months). 5. PCV was introduced in September NHS Orkney have identified data recording issues which may be affecting their reported uptake rates. These issues are currently being reviewed by NHS Orkney... Not Applicable. Key: D= Diphtheria vaccine (3 s). T= Tetanus vaccine (3 s). P= Pertussis vaccine (3 s). Pol= Polio vaccine (3 s). Hib= Haemophilus Influenzae type b vaccine (3 s). MenC= Meningococcal serogroup C conjugate vaccine (2 s). PCV= Pneumococcal conjugate vaccine (2 s). 366

5 TABLE 4: Primary and booster immunisation uptake rates at 24 months old. Evaluation quarter: 1 April to 30 June in Cohort 1 % completed primary course by 24 months % completed booster course by 24 months D T P Pol Hib MenC 4 PCV 6 MMR 1 Hib/MenC 5 PCVB 6 Ayrshire & Arran Borders Dumfries & Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles NHS Board unknown Scotland Children reaching 24 months of age during the evaluation quarter 1 April to 30 June 2009 (i.e. born 1 April to 30 June 2007) Scotland: ISD Scotland 2. For records from the former NHS Argyll & Clyde (which was dissolved on 31 March 2006), is derived from GP practice code. There are a small number of records which do not have a practice code recorded and therefore the is unknown. 3. The 5 in 1 vaccine (comprising DTP/Pol/Hib) was introduced in September These vaccinations can be recorded separately on the SIRS system and therefore rates may differ slightly. This may be due to children who have received a single vaccine outwith Scotland or due to local recording practices. 4. Changes to the routine childhood immunisation schedule were introduced on 4 September Prior to September 2006, children required three s of MenC conjugate vaccine as part of their course of primary immunisations. Under the new schedule, children require two s of MenC before the age of 12 months, followed by the Hib/MenC booster after the age of 12 months. Therefore, from quarter ending 30 September 2006, the calculation of uptake rates for MenC has been amended to reflect the change in the number of s required for a complete course of MenC (two s under 12 months). 5. The Hib/MenC Booster was introduced in September 2006; children in this cohort would have been offered one of Hib/MenC at around 12 months. 6. PCV was introduced in September 2006; children in this cohort would have been offered two s at two and four months, and a booster of PCVB at around 13 months. 7. NHS Orkney have identified data recording issues which may be affecting their reported uptake rates. These issues are currently being reviewed by NHS Orkney... Not Applicable. Key: D= Diphtheria vaccine (3 s). T= Tetanus vaccine (3 s). P= Pertussis vaccine (3 s). Pol= Polio vaccine (3 s). Hib= Haemophilus Influenzae type b vaccine (3 s). MenC= Meningococcal serogroup C conjugate vaccine (2 s). MMR1= Measles, mumps and rubella vaccine (1 ). PCV= Pneumococcal conjugate vaccine (2 s). Hib/MenC= Hib/MenC booster (1 over 11 months). PCVB= Pneumococcal conjugate vaccine (1 over 12 months). 367

6 TABLE 5: Primary and booster immunisation uptake rates at 5 years old. Evaluation quarter: 1 April to 30 June in Cohort 1 % completed primary course by 5 years % completed booster course by 5 years D T P Pol Hib MenC 4 MMR 1 D T P Pol MMR 2 Ayrshire & Arran Borders Dumfries & Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles NHS Board unknown Scotland Children reaching 5 years of age during the evaluation quarter 1 April to 30 June 2009 (i.e. born 1 April to 30 June 2004) 2. For records from the former NHS Argyll & Clyde (which was dissolved on 31 March 2006), is derived from GP practice code. There are a small number of records which do not have a practice code recorded and therefore the is unknown. 3. The 5 in 1 vaccine (comprising DTP/Pol/Hib) was introduced in September These vaccinations can be recorded separately on the SIRS system and therefore rates may differ slightly. This may be due to children who have received a single vaccine outwith Scotland or due to local recording practices. 4. Changes to the routine childhood immunisation schedule were introduced on 4 September Prior to September 2006, children required three s of MenC conjugate vaccine as part of their course of primary immunisations. Under the new schedule, children require two s of MenC before the age of 12 months, followed by the Hib/MenC booster after the age of 12 months. Therefore, from quarter ending 30 September 2006, the calculation of uptake rates for MenC has been amended to reflect the change in the number of s required for a complete course of MenC (two s under 12 months). 5. NHS Orkney have identified data recording issues which may be affecting their reported uptake rates. These issues are currently being reviewed by NHS Orkney... Not Applicable. Key for primary courses: Key for booster courses D= Diphtheria vaccine (3 s). D= Diphtheria vaccine (4th ) T= Tetanus vaccine (3 s). T= Tetanus vaccine (4th ). P= Pertussis vaccine (3 s). P= Pertussis vaccine (4th ) Pol= Polio vaccine (3 s). Pol= Polio vaccine (4th ). Hib= Haemophilus Influenzae type b vaccine (3 s). MMR 2= Measles, mumps and rubella vaccine (2nd ). MenC= Meningococcal serogroup C conjugate vaccine (2 s). 368

7 Human papillomavirus (HPV) immunisation uptake rates 2008/09 HPV immunisation was introduced in Scotland in 2008, as part of the routine childhood schedule, to help protect girls against developing cervical cancer later in life. The HPV vaccine protects against the two types of HPV that cause 70% of cervical cancers. The immunisation involves a three course of vaccine delivered over a six month period. The HPV vaccine uptake rates for 2008/09 4 are presented in Tables These include the final uptake figures for the secondary-school based immunisation programme for routine second year girls (S2), and older girls within the catch up programme in fifth and sixth years (S5 and S6). In addition, interim uptake figures are also shown for girls who were eligible for the catch up programme but who had left school. This part of the programme began later than the school based immunisations and girls in this group are still being invited for their immunisations. Uptake of all three s of HPV vaccine in the routine age group (girls in S2) was 89.4%. In the school-based catch up programme for fifth and sixth years over 84% of eligible girls completed the full course. Although no uptake target was set for the campaign, these figures are above the lower TABLE 6: HPV immunisation uptake rates for girls in second year of secondary school (S2) in school year 2008/09 1 of girls in cohort 2 1st 1st 2nd 2nd 3rd 3rd Ayrshire and Arran Borders Dumfries and Fife Forth Valley Grampian Greater Glasgow & Clyde 3 Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles Scotland Uptake rates are based on immunisations recorded on the CHSP School system and SIRS as at 10 August Girls recorded on CHSP-School as being in class year S2 as at 11 May These girls are in the second year of secondary school and are around 12 to 13 years of age. 3. NHS Lanarkshire is delivering the HPV programme to schools in Cambuslang and Rutherglen (Camglen), however HPV data for Camglen are recorded/shown under NHS Greater Glasgow & Clyde on CHSP School. 4. All s except NHS Orkney use CHSP School/SIRS to record HPV immunisations. NHS Orkney have provided their own figures. levels used in the mathematical models to estimate the best protective impact of the HPV immunisation programme and its cost effectiveness. 5 Among school leavers the interim uptake is relatively low by contrast with first and second uptake at 43.1% and 35.0% respectively. There are a number of contributory factors to take into account when interpreting these figures. This part of the programme began later than the school based programme with most NHS Boards inviting girls for the first of their three s early in Some girls may not yet have been invited for their third and delays in data recording will mean that some vaccines that have been given will not show in the uptake figures. As a consequence, these figures are expected to rise when the final figures are published at the end of the year. References 1. Adewunmi S, Sinka K, Johnston F et al. Surveillance report: Vaccine uptake, measles, mumps, rubella, whooping cough, chickenpox. HPS Weekly Report 2009: 43(2009/26): Health protection Agency. Laboratory confirmed number of mumps cases in England and Wales- update to end of April Health Protection Report 2009;3(25). Available URL: (Accessed 10 September 2009). 3. ISD Scotland website. Childhood Immunisations uptake rates, quarter ending 30 June Available URL: (Accessed on 24 September 2009). 4. ISD Scotland website. Childhood Immunisations: Human Papilloma Virus (HPV) Immunisation Uptake rates: 2008/09. Available URL: html (Accessed on 24 September 2009). 5. Jit M, Choi Y.H and Edmunds W.J. Economic evaluation of human papillomavirus vaccination in the United Kingdom. BMJ 2008:337:a NHS Argyll & Clyde ceased to exist on 31 March 2006 and the administration was split between two sub-areas that now fall under the administration of NHS Greater Glasgow and Clyde and NHS Highland respectively. For the calculation of uptake rates, HPV immunisation data recorded on CHSP School under the former NHS Argyll & Clyde are allocated to their current area using GP practice code. There are a small number of records which do not have a practice code recorded and therefore for statistical purposes, is unknown. These records are included in the Scotland cohort and uptake rates and therefore the sum of the cohorts for all s does not equate to the total cohort for Scotland. 369

8 TABLE 7: HPV immunisation uptake rates for girls in fifth year of secondary school (S5) in school year 2008/09 1 of girls in cohort 2 1st 1st 2nd 2nd 3rd 3rd Ayrshire and Arran Borders Dumfries and Fife Forth Valley Grampian Greater Glasgow & Clyde 3 Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles Scotland Uptake rates are based on immunisations recorded on the CHSP School system and SIRS as at 10 August Girls recorded on CHSP School as being in class year S5 as at 11 May These girls are in the fifth year of secondary school and are around 15 to 16 years of age. 3. NHS Lanarkshire is delivering the HPV programme to schools in Camglen, however HPV data for Camglen are recorded/shown under NHS Greater Glasgow & Clyde on CHSP School. 4. All s except NHS Orkney use CHSP School/SIRS to record HPV immunisations. NHS Orkney have provided their own figures. 5. NHS Argyll & Clyde ceased to exist on 31 March 2006 and the administration was split between two sub-areas that now fall under the administration of NHS Greater Glasgow and Clyde and NHS Highland respectively. For the calculation of uptake rates, HPV immunisation data recorded on CHSP School under the former NHS Argyll & Clyde are allocated to their current area using GP practice code. There are a small number of records which do not have a practice code recorded and therefore for statistical purposes, is unknown. These records are included in the Scotland cohort and uptake rates and therefore the sum of the cohorts for all s does not equate to the total cohort for Scotland. TABLE 8: HPV immunisation uptake rates for girls in sixth year of secondary school (S6) in school year 2008/09 1 of girls in cohort 2 1st 1st 2nd 2nd 3rd 3rd Ayrshire and Arran Borders Dumfries and Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles Scotland Uptake rates are based on immunisations recorded on the CHSP School system and SIRS as at 10 August Girls recorded on CHSP-School as being in class year S6 as at 11 May These girls are in the sixth year of secondary school and are around 16 to 17 years of age. 3. NHS Lanarkshire is delivering the HPV programme to schools in Camglen, however HPV data for Camglen are recorded/shown under NHS Greater Glasgow & Clyde on CHSP School. 4. All s except NHS Orkney use CHSP School/SIRS to record HPV immunisations. NHS Orkney have provided their own figures. 5. NHS Argyll & Clyde ceased to exist on 31 March 2006 and the administration was split between two sub-areas that now fall under the administration of NHS Greater Glasgow and Clyde and NHS Highland respectively. For the calculation of uptake rates, HPV immunisation data recorded on CHSP School under the former NHS Argyll & Clyde are allocated to their current area using GP practice code. There are a small number of records which do not have a practice code recorded and therefore for statistical purposes, is unknown. These records are included in the Scotland cohort and uptake rates and therefore the sum of the cohorts for all s does not equate to the total cohort for Scotland. 370

9 Table 9: HPV immunisation uptake rates for girls in secondary school in second, fifth and sixth years (S2, S5 and S6) in school year 2008/09 1 of girls in cohort 2 1st 1st 2nd 2nd 3rd 3rd Ayrshire and Arran Borders Dumfries and Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles Scotland Uptake rates are based on immunisations recorded on the CHSP School system and SIRS as at 10 August Girls recorded on CHSP-School as being in class year S2, S5 or S6 as at 11 May NHS Lanarkshire is delivering the HPV programme to schools in Camglen, however HPV data for Camglen are recorded/shown under NHS Greater Glasgow & Clyde on CHSP School. 4. All s except NHS Orkney use CHSP School/SIRS to record HPV immunisations. NHS Orkney have provided their own figures. 5. NHS Argyll & Clyde ceased to exist on 31 March 2006 and the administration was split between two sub-areas that now fall under the administration of NHS Greater Glasgow and Clyde and NHS Highland respectively. For the calculation of uptake rates, HPV immunisation data recorded on CHSP School under the former NHS Argyll & Clyde are allocated to their current area using GP practice code. There are a small number of records which do not have a practice code recorded and therefore for statistical purposes, is unknown. These records are included in the Scotland cohort and uptake rates and therefore the sum of the cohorts for all s does not equate to the total cohort for Scotland. TABLE 10: Provisional HPV immunisation uptake rates for girls in the catch up cohort who have left school (born 2 September 1990 to 1 September 1992) 1 2 of girls in cohort 3 1st 1st 2nd 2nd 3rd 3rd Ayrshire and Arran Borders Dumfries and Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles Scotland 2, Interim statistics based on data recorded on the CHI system as at 30 June 2009/SIRS system as at 10 August. Some vaccinations may have been given but have not yet been recorded on CHSP. In addition, data quality assurance checks are ongoing and data are provisional subject to these checks. 2. of residence. There are a small number of records which do not have a postcode recorded and therefore for statistical purposes, of residence is unknown. These records are included in the Scotland cohort and uptake rates and therefore the sum of the cohorts for all s does not equate to the total cohort for Scotland. 3. Girls born between 02/09/1990 and 01/09/1992, who have left school. 4. Data for NHS Fife and NHS Orkney are not currently available. 5. NHS Lanarkshire is delivering the HPV programme to girls in Camglen, however HPV data for Camglen are recorded/shown under NHS Greater Glasgow & Clyde on CHSP School/ SIRS... Not available. Uptake rates for the third of HPV immunisation will be published in December 2009 if data recording is sufficiently complete. 371

10 TABLE 11: Provisional HPV uptake rates for girls in S5 and S6 in school year 2008/09 and girls who have left school who were born 2 September 1990 to 1 September of girls in cohort 3 1st 1st 2nd 2nd 3rd 3rd Ayrshire and Arran Borders Dumfries and Fife Forth Valley Grampian Greater Glasgow & Clyde 5 Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles Scotland 2, Interim statistics based on data recorded on the CHI system as at 30th June 2009/SIRS system as at 10 August. Some vaccinations may have been given but have not yet been recorded on CHSP. In addition, data quality assurance checks are ongoing and data are provisional subject to these checks. 2. of residence. There are a small number of records which do not have a postcode recorded and therefore for statistical purposes, of residence is unknown. These records are included in the Scotland cohort and uptake rates, and therefore the sum of the cohorts for all s does not equate to the total cohort for Scotland. 3. Girls recorded on CHSP School as being in class year S5 or S6 as at 11 May 2009, and girls who have left school and were born between 2 September 1990 and 1 September Data for NHS Fife and NHS Orkney are not currently available. 5. NHS Lanarkshire is delivering the HPV programme to girls in Camglen, however HPV data for Camglen are recorded/shown under NHS Greater Glasgow & Clyde on CHSP School/ SIRS... Not available. Uptake rates for the third of HPV immunisation will be published in December 2009 if data recording is sufficiently complete. The last Vaccine preventable and childhood disease Surveillance Report was in Issue 09/26 The next Vaccine uptake and related diseases Surveillance Report will be in Issue 09/51 372

11 A National Statistics release Statutory Notification of Infectious Diseases (by age) Week ended 18 September 2009 Age Group Infectious Disease All ages Under & over Not known M F M F M F M F M F M F M F M F M F M F Anthrax Bacillary dysentery Chickenpox Cholera Diphtheria Erysipelas Food poisoning Legionellosis Leptospirosis Lyme Disease Malaria Measles Meningococcal infection Mumps Paratyphoid fever Plague Poliomyelitis Puerperal fever Rabies Relapsing fever Rubella Scarlet fever Smallpox Tetanus Toxoplasmosis Tuberculosis: respiratory Tuberculosis: non-respiratory Typhoid fever Typhus fever Viral haemorrhagic fevers Viral hepatitis Whooping cough TOTAL

12 Infectious Disease Statutory Notification of Infectious Diseases (by ) Week ended 18 September 2009 NHS BOARD AREA Amendments: add 10 Chickenpox (LO 10 x wk 37); 1 Erysipelas (LO 1 x wk 37); 1 Food poisoning (DG 1 x wk 35); 3 Mumps (LO 3 x wk 37); 13 Tuberculosis : respiratory (GG 2 x wk 12, FV 1 x wk 15, GG 3 x wk 17, GG 1 x wk 18, GG 1 x wk 26, GG 2 x wk 27, GG 1 x wk 28, GG 2 x wk 29); 7 Tuberculosis : non-respiratory (GG 1 x wk 10, GG 1 x wk 11, GG 1 x wk 14, GG 1 x wk 17, GG 1 x wk 20, LO 1 x wk 36, GG 1 x wk 37); 1 Whooping cough (LO 1 x wk 37) delete 1 Anthrax (FF 1 x wk 37); 1 Chickenpox (GR 1 x wk 16); 4 Food poisoning (GR 3 x wk 18, 1 x wk 36); 1 Tuberculosis : respiratory (GG 1 x wk 11) NHS BOARD ABBREVIATIONS Current week Previous week Current week last year Source: Health Protection Scotland, NHS National Services Scotland AA Ayrshire & Arran GG Greater Glasgow & Clyde LN Lanarkshire SH Shetland TY Tayside BR Borders FF Fife GR Grampian LO Lothian WI Western Isles DG Dumfries & FV Forth Valley HG Highland OR Orkney Total from1st week of year AA BR DG FF FV GR GG HG LN LO OR SH TY WI Anthrax Bacillary dysentery Chickenpox Cholera Continued fever Diphtheria Erysipelas Food poisoning Legionellosis Leptospirosis Lyme Disease Malaria Measles Meningococcal infection Mumps Paratyphoid fever Plague Poliomyelitis Puerperal fever Rabies Relapsing fever Rubella Scarlet fever Smallpox Tetanus Toxoplasmosis Tuberculosis : resp Tuberculosis : non-resp Typhoid fever Typhus fever Viral haemorrhagic fevers Viral hepatitis Whooping cough TOTAL