HPS Weekly Report. Health Protection Scotland CURRENT NOTES. Contents. 1 August 2006 Volume 40 No. 2006/30 ISSN

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1 HPS Weekly Report Health Protection Scotland 1 August 2006 Volume 40 No. 2006/30 ISSN Contents CURRENT NOTES. Testing for syphilis and lymphogranuloma venereum infection. Salmonella Montevideo infections and Cadbury Schweppes. Scotland s Population Ozone Web air pollution monitoring system. Report on management of radioactive waste pages 157 & 168 SURVEILLANCE REPORT. HIV infection and AIDS: Quarterly report Cumulative totals HIV Reports: 4783 AIDS Cases: 1287 Deaths: 1506 AIDS Deaths: 882 pages Focus: HIV Prevalence among non-idu Heterosexuals, IDUs and Men who have Sex with Men who undergo attributable HIV testing in Scotland: 2005 update NOTIFIABLE TABLES to 21/07/2006 pages page 164 CURRENT NOTES Testing for syphilis and lymphogranuloma venereum infection 40/3001 The Scottish Neisseria gonorrhoeae Reference Laboratory (SNGRL) is now funded to provide a diagnostic PCR test for Treponema pallidum to improve the diagnosis of primary syphilis, and a confirmatory diagnostic PCR for lymphogranuloma venereum (LGV) associated serovars of Chlamydia trachomatis. These services will be available from 7 August Dr Andy Winter, chair of the British Association for Sexual Health and HIV Scotland, has notified all GUM consultants of these services and the criteria and requirements for submitting specimens. SNGRL has also circulated this information to all consultant microbiologists in Scotland. These data will feed into the national surveillance systems which include epidemiological information on infected persons. For syphilis, this is the National Enhanced Surveillance of Infectious Syphilis in Scotland (NESISS) hosted at HPS which relates to infection diagnosed in Scotland and, for LGV, this is the enhanced surveillance of LGV in the UK hosted by the Centre for Infections, HPA, London for all cases diagnosed in the UK. The information will be published periodically in the sexually transmitted infection surveillance reports. For further information please contact Dr Hugh Young at SNGRL (hugh.young@luht.scot.nhs.uk) or Dr Lesley Wallace at HPS (lesley.wallace@hps.scot.nhs.uk). Salmonella Montevideo infections and Cadbury Schweppes 40/3002 Further to Current note 40/2502 covering the recall of Cadbury Schweppes confectionery products, readers may already be aware that an outbreak control team (including representatives from the Health Protection Agency (HPA), the Food Standards Agency (FSA), DEFRA and selected local authorities) has given its view that the consumption of such products was the most credible explanation for an outbreak of Salmonella Montevideo in England and Wales earlier this year. The HPA and FSA comments are available at and news/newsarchive/2006/jul/cadbury (both accessed 1 August 2006). As reported in last week s Surveillance Report, Scotland also experienced an increase in S. Montevideo cases in the first half of 2006 (10 cases compared to two in the corresponding period of 2005). No cases involving this strain of S. Montevideo have, however, been reported since week 26. HPS was kept informed of developments during the period of the OCT s investigation. Scotland s Population /3003 On 28 July, the General Register Office for Scotland published Scotland s Population The Registrar General s Annual Review of Demographic Trends. This year, the report s focus is on causes of death. Scotland s death rate has been steadily falling for many years: it stood at 11 deaths per 1,000 population in 2005, compared to 11.9 only ten years ago. Chapter 2 of this Report looks back to 1855 (when the present system of death registration began) and analyses changes in the causes of death. It points to the dramatic decline in deaths from infectious diseases such as typhoid, smallpox, measles, whooping cough and tuberculosis - which killed thousands of people in the mid- 19th century but which are rare causes of death nowadays. It gives special attention to trends in the 3 main causes of death in Scotland today - cancer, heart disease and stroke - and shows that modern medical practice is continuing to reduce the death toll. But it also highlights causes of death which are increasing - such as cancer of the oesophagus, cirrhosis of the liver and other causes of death which are often linked to excessive alcohol consumption. The report is available from the General Register Office for Scotland (ISBN ) and the GROS website: Correspondence to: The Editor, HPS Weekly Report HPS, Clifton House, Clifton Place Glasgow, G3 7LN Scotland T F E wreditor@hps.scot.nhs.uk Printed in the UK HPS is a division of the NHS National Services Scotland Registered as a newspaper at the Post Office HPS 2006 Ozone Web air pollution monitoring system 40/3004 Further to Current note 40/2410, Ozone Web, a new internet tool, released in Copenhagen on 18 July by the European Environment Agency (EEA), offers users the opportunity to monitor and track ground level ozone incidents on a pan-european scale, for the first time. Ground level ozone presents one of the most prominent air pollution problems in Europe. Data from more than 500 air quality monitoring stations is sent to the EEA in Copenhagen every hour and displayed in (near) real time on the new web site. Current notes continue on page 164

2 Surveillance Report HPS WEEKLY REPORT Volume 40 No.2006/30 1 August In the quarter 1 April, NHS Scotland laboratories reported positive HIV-antibody test results for 87 individuals not previously recorded as HIV-positive. The cumulative total of known HIV-positive individuals in Scotland is now 4783, of whom 3499 (73%) are male and 1284 (27%) are female (Table 1). At least 1506 (31%) are known to have died. Of the 87 recently reported HIV-positive individuals, 57 (66%) are male, and 68 (78%) are aged between 25 and 44 years (Table 3). The probable route of transmission was men who have sex with men (MSM) in 30 cases, heterosexual intercourse in 37 cases and injecting drug use in one case. Of the heterosexual cases, 28 probably acquired their infection abroad. For 19 cases, the transmission category is, as yet, undetermined. Twenty-nine of the cases were from Greater Glasgow*, 24 from Lothian, six from Tayside and five from Lanarkshire. (Table 4). Of the 87 cases reported during the second quarter of 2006, 45 (52%) (and 1509 (32%) of the 4783 total reports) are presumed to have acquired their infection outwith Scotland (Table 6). During the same quarter, three cases of AIDS were reported by clinicians (Table 7). The cumulative number of AIDS cases is now 1287, of whom 1011 (79%) are male, while 882 (69%) are known to have died. Of the newly reported AIDS cases, two were from Greater Glasgow & Clyde and one from Lothian; two cases were male. During the period 1 April 2005 to 31 March 2006, 2188 persons had at least one CD4 count performed: 286 (13%) had a count <200 cells/ mm 3, 1094 (50%) a count of between 201 and 500, and 808 (37%) a count of > 500 (Table 12). The majority of cases were from the Lothian (848, 39%) and Greater Glasgow* (562, 26%) areas (Table 12). Across Scotland, 67% of cases attending for CD4 monitoring are receiving triple therapy or higher. Of the 75 cases who entered monitoring for the first time between 1 January and 31 March 2006, 22 (29%) had a count <200, 32 (43%) a count between 201 and 500, and 21 (28%) a count of > 500 (Tables 13 & 14). (AIDS News Supplement to the Weekly Report) HIV infection and AIDS: Quarterly report HIV reports:4783 AIDS cases:1287 deaths:1506 AIDS deaths:882 Table 1 HIV-1 infected persons, Scotland by exposure category and date reported; ANSWER In the 12 months prior to 31 March 2006, 2032 persons had at least one viral load test performed, 1221 (60%) having undetectable viral load (<50 copies/ ml). Of the 290 cases that entered monitoring for the first time in the same period, 105 (36%) had a viral load <50. Across Scotland, 1428 (70%) cases attending for viral load monitoring are receiving antiretroviral therapy. Of the 1385 persons on triple therapy or more, 1140 (82%) had a viral load <50 cells/ml (Table 15). The current treatment profiles for cases on triple therapy or more are presented in Table 16. Over half of all cases on therapy (713, 51%) are prescribed two nucleoside or nucleotide reverse transcriptase inhibitors (NRTI) plus a nonnucleoside RTI (NNRTI) or a protease inhibitor (PI); 85% (606) of cases receiving this combination of drugs had undetectable viral load. To reduce the effects of reporting delay, the data presented in Tables 11 to 16 are three months in arrears. For the UK as a whole, cases of HIV infection and AIDS cases had been reported by 30 June 2006 (Tables 17-18). This issue of ANSWER features data which were created after the dissolution of Argyll & Clyde NHS Board on 1 April Data in Tables 4, 8, 12 & 14 are presented on the basis of the old NHS boards (excluding Argyll & Clyde) plus the constituent components of Argyll & Clyde which have been inherited by Greater Glasgow and Highland. More detailed information and cumulative information is included in the following tables. Figures 1-3 illustrate the extent of quarterly variation over the past two years. A longer time period must be considered before valid conclusions may be drawn regarding trends. The HIV-positive and AIDS databases are under continual review and modification as additional information becomes available. This may result in apparent discrepancies when current and previously published tables are compared. *Excludes the inherited component of Argyll & Clyde NHS Board. How person probably April 2006 to June 2006 Cumulative acquired the virus Male Female Male Female % of Men who have sex with men (MSM) Sexual intercourse between men and women high risk partner exposure in Africa exposure abroad (excl. Africa) exposure UK under investigation no further information available Heterosexual sub-total Injecting drug use (IDU) IDU and MSM Blood factor (e.g. Haemophiliac) Blood/Tissue transfer (e.g. Transfusion) Mother to Child Other/Undetermined Men and women who had sex with injecting drug users, or with those infected through blood factor treatment or blood transfusion, or women who had sex with bisexual men. 2. Persons without other identified risks but who have had sexual intercourse in Africa. 3. Persons without other identified risks but who have had sexual intercourse abroad excluding African countries. 4. Includes persons infected in the UK prior to 1985 and persons who acquired their infection abroad.

3 Figure 1 HIV-1 infected persons, Scotland by exposure category and quarter reported; Table 3 HIV-1 infected persons, Scotland by age group and date reported; Figure 2 Heterosexual HIV-1 transmissions, Scotland by specific exposure category and quarter reported; Table 2 HIV-1 infected persons, Scotland heterosexual transmissions by exposure category and date reported; How person probably April 2006 to June 2006 Cumulative acquired the virus Male Female Male Female Exposure to high risk partner(s) i.e. to partner(s) presumed infected through: Men who have sex with men (MSM) Injecting drug use Blood factor treatment (e.g. for haemophilia) Blood/Tissue transfer (e.g. transfusion) Exposure to presumed heterosexually infected partner(s): Exposure abroad 1 in Africa in Latin America/Caribbean in Asia in North America in Europe in Australasia in country(ies) not known Exposure in the UK to partner(s) presumed infected: outside Europe within Europe Partner(s) exposure category undetermined: investigation continuing investigation closed Individuals from abroad, and individuals from the UK who have lived or visited abroad, for whom there is no evidence of high risk partners. Where there has been exposure to infection in more than one region, allocation is in the hierarchy shown. 2. All reports have been followed up and no evidence of partner(s) with risks other than hetrosexual exposure has been found. 3. No further information available. April 2006 to June 2006 Cumulative Age (Years) Male Female Male Female Not stated HPS WEEKLY REPORT Volume 40 No.2006/30 1 August 2006

4 HPS WEEKLY REPORT Volume 40 No.2006/30 1 August Table 4 HIV-1 infected persons, Scotland by NHS board and date reported; April 2006 to June 2006 Cumulative men (Male) (Female) Injecting drug use Other/ Undetermined men (Male) (Female) Injecting drug use Other/ Undetermined Ayrshire & Arran Borders Dumfries & Galloway Fife Forth Valley Grampian Greater Glasgow Highland Lanarkshire Lothian Shetland Tayside Western Isles Argyll & Clyde (Inherited by Greater Glasgow & Clyde) Argyll & Clyde (Inherited by Highland) Table 5 HIV-1 infected children (aged 14 years or under at time of HIV test), Scotland by exposure category; cumulative How children probably acquired the virus Male Female Mother to child Blood factor (e.g. Haemophiliac) Blood/Tissue transfer (e.g. Transfusion) Other/Undetermined Includes persons infected in the UK prior to 1985 and persons who acquired their infection abroad. Includes all children with AIDS, or with virus detected, or with HIV-1 antibody at age 18 months or over. [Source: Institute of Child Health, London and SCIEH] Table 6 HIV-1 infected persons presumed to have been infected outwith Scotland by presumed geographical area of exposure, exposure category, and date reported; Geographic Area men April 2006 to June 2006 Cumulative (Male) (Female) Injecting drug use Other/ Undetermined Figure 3 HIV-1 infected persons, Scotland by NHS board and quarter reported; men (Male) (Female) Injecting drug use Other/ Undetermined Africa Other UK/Ireland Europe Americas/Caribbean Asia Australasia Middle East Not Known

5 Table 7 AIDS cases (and known deaths), Scotland by exposure category and date reported; How person probably April 2006 to June 2006 Cumulative acquired the virus Male (Deaths) Female (Deaths) Male (Deaths) Female (Deaths) (Deaths) Men who have sex with men (MSM) 1 (4) 0 (0) 473 (323) 0 (0) 473 (323) Sexual intercourse between men and women high risk partner 1 0 (0) 0 (2) 14 (11) 49 (26) 63 (37) exposure in africa 2 0 (0) 0 (0) 64 (24) 40 (4) 104 (28) exposure abroad (excl. Africa) 3 0 (1) 0 (0) 24 (12) 14 (3) 38 (15) exposure UK 0 (0) 1 (0) 32 (23) 22 (14) 54 (37) under investigation 0 (0) 0 (0) 8 (2) 3 (0) 11 (2) no further information available 0 (0) 0 (0) 5 (3) 10 (6) 15 (9) Heterosexual sub total 0 (1) 1 (2) 147 (75) 138 (53) 285 (128) Injecting drug use (IDU) 1 (3) 0 (3) 301 (256) 119 (98) 420 (354) IDU and MSM 0 (0) 0 (0) 17 (11) 0 (0) 17 (11) Blood factor (e.g. Haemophiliac) 4 0 (0) 0 (0) 40 (33) 0 (0) 40 (33) Blood/Tissue transfer (e.g. Transfusion) 4 0 (0) 0 (0) 11 (8) 8 (6) 19 (14) Mother to Child 0 (0) 0 (1) 10 (6) 9 (6) 19 (12) Other/Undetermined 0 (1) 0 (0) 12 (7) 2 (0) 14 (7) 2 (9) 1 (6) 1011 (719) 276 (163) 1287 (882) 1. Men and women who had sex with injecting drug users, or with those infected through blood factor treatment or blood transfusion, or women who had sex with bisexual men. 2. Persons without other identified risks but who have had sexual intercourse in Africa. 3. Persons without other identified risks but who have had sexual intercourse abroad excluding African countries. 4. Includes persons infected in the UK prior to 1985 and persons who acquired their infection abroad. Table 8 AIDS Cases, Scotland by NHS board of registration and date reported; NHS Board MSM April 2006 to June 2006 Cumulative (Male) (Female) Injecting drug user Other/ Undetermined MSM (Male) (Female) Injecting drug user Other/ Undetermined Ayrshire & Arran Borders Dumfries & Galloway Fife Forth Valley Grampian Greater Glasgow Highland Lanarkshire Lothian Tayside Argyll & Clyde (Inherited by Greater Glasgow & Clyde) Argyll & Clyde (Inherited by Highland) Table 9 HIV infected persons, Scotland by selected risk factor, year of report 1, and subtype 2 ; Cases presumed infected Cases presumed infected Cases under investigation within UK outwith UK (Location of exposure not known) Risk Factor Subtype B Subtype No Info Subtype B Subtype No Info Subtype B Subtype No Info Year non-b non-b non-b Hetrosexual Other Excludes cases under investigation 2 Subject to reporting delay. 3 Subtyping of HIV specimens began on 1 April Subtype data provided by Drs Sheila Burns (Regional Virus Laboratory, Edinburgh), Sheila Cameron (Regional Virus Laboratory, Glasgow) and David Yirrell (Centre for HIV research, University of Edinburgh). 157 HPS WEEKLY REPORT Volume 40 No.2006/30 1 August 2006

6 HPS WEEKLY REPORT Volume 40 No.2006/30 1 August 2006 (A) (B) (C) (D) 158 Table 10 Trends in HIV and AIDS, Scotland 1 by year of report / death and selected category; HIV REPORTING by risk and presumed geographical area of exposure MONITORING AND DEATHS 2 PROGRESSION Year ALL RISKS 4 Men who have sex with men (MSM) Sexual intercourse between IDU Age Group 5 of report/ men and women monitoring/ Presumed area of exposure 3 Presumed area of exposure 3 Presumed area of exposure 3 death Individuals AIDS All undergoing Cases HIV AIDS within outwith outwith within outwith outwith within outwith outwith CD4 count Registered Infected only 8 Scotland Scotland UK Scotland Scotland UK 8 Scotland Scotland UK monitoring 6 Cases HIV REPORTING by NHS board and risk Lothian Greater Glasgow & Clyde 10 Tayside Grampian Year of report HIV MSM Hetero IDU HIV MSM Hetero IDU HIV MSM Hetero IDU HIV MSM Hetero IDU Reports 4 Reports 4 Reports 4 Reports HIV Reporting of sexual contact transmissions by NHS board and presumed geographical area of exposure Lothian Greater Glasgow & Clyde 10 Tayside Grampian MSM Hetero 9 MSM Hetero 9 MSM Hetero 9 MSM Hetero 9 Year Within Outwith Within Outwith Within Outwith Within Outwith Within Outwith Within Outwith Within Outwith Within Outwith of report UK UK UK UK UK UK UK UK UK UK UK UK UK UK UK UK HIV Reporting by selected presumed geographical region of exposure Year AFRICA EUROPE (ex UK) AMERICAS/CARIBBEAN ASIA of report MSM Hetero IDU Other 7 MSM Hetero IDU Other 7 MSM Hetero IDU Other 7 MSM Hetero IDU Other Due to active follow-up, data on the Scottish AIDS/HIV Register is constantly changing. Figures presented in this table may differ slightly from those previously published. Active follow-up is currently taking place on 225 cases on the Register. 2. Death figures are for those persons known to be HIV infected, or who have been diagnosed with AIDS. In some cases the actual cause of death may have been unrelated to the person's infection status. Death data is subject to reporting delay. 3. Presumed Location Exposure is based on information provided by the patient at the time of test or during subsequent follow-up. A case is presumed to have been infected in Scotland if, after investigation, no evidence exists to the contrary. Outwith UK is a subset of outwith Scotland. Cases under investigation are excluded from all categories except the total. 4. Includes persons outwith three main risks groups 5. Age at time of first positive specimen. 6. Subject to reporting delay. 7. Pediatric, blood/blood product recipients, and persons whose risk is unknown/undetermined. 8. Includes cases currently under investigation. 9. Excludes cases currently under investigation. 10. Includes both the former Greater Glasgow and the inherited component of Argyll & Clyde NHS Board

7 Table 11 CD4 Monitoring, Scotland HIV infected persons alive at 31 March 2006 who have undergone CD4 count monitoring within the previous 12 months by exposure category and most recent CD4 count How person probably Most recent CD4 count acquired the virus < >500 Men who have sex with men (MSM) Sexual intercourse between men and women Injecting drug use Other/Undetermined Table 12 CD4 Monitoring, Scotland HIV infected persons alive as at 31 March 2006 who have undergone CD4 count monitoring: numbers by most recent CD4 count and percentage on ART 1 (in this analysis triple therapy level or higher) within the previous 12 months, by NHS board 1 Most recent CD4 count NHS board 1 < >500 Cases (% ART) Cases (% ART) Cases (% ART) Cases (% ART) Cases (% ART) Cases (% ART) Ayrshire & Arran Borders Dumfries & Galloway Fife Forth Valley Grampian 8 (75%) 21 (81%) 30 (73%) 42 (59%) 47 (72%) 148 (70%) Greater Glasgow 3 (33%) 53 (73%) 136 (64%) 171 (59%) 199 (67%) 562 (64%) Highland Lanarkshire Lothian 20 (40%) 98 (68%) 213 (68%) 216 (68%) 301 (71%) 848 (68%) Shetland Tayside 5 (40%) 21 (57%) 28 (68%) 47 (53%) 80 (68%) 181 (62%) Western Isles Argyll & Clyde (Inherited by Greater Glasgow & Clyde) Argyll & Clyde (Inherited by Highland) NHS boards excl. GG, LO, GR and TY 2 9 (44%) 42 (58%) 74 (63%) 71 (65%) 125 (85%) 321 (78%) 45 (47%) 241 (68%) 507 (67%) 587 (63%) 808 (70%) 2188 (67%) 1 NHS board of residence or, where this is not known, NHS board of source of specimen. Treatment data is presented only for those NHS boards with 100+ cases currently undergoing monitoring. 2 Greater Glasgow, Lothian, Grampian and Tayside Notes (Tables 11 & 12 ): It is estimated that this surveillance covers greater than 95% of HIV infected persons in Scotland undergoing immunological monitoring. Due to reporting delay, tables are produced 3 months in arrears. Table 13 CD4 Monitoring, Scotland Cases being monitored for the first time between 1 January 2006 to 31 March 2006 by exposure category and initial CD4 Count How person probably Initial CD4 count acquired the virus < >500 Men who have sex with men (MSM) Sexual intercourse between men and women Injecting drug use Other/Undetermined HPS WEEKLY REPORT Volume 40 No.2006/30 1 August 2006

8 HPS WEEKLY REPORT Volume 40 No.2006/30 1 August Table 14 CD4 Monitoring, Scotland Cases being monitored for the first time between 1 January 2006 to 31 March 2006 by NHS board* and initial CD4 Count Initial CD4 count NHS board* < >500 Ayrshire & Arran Borders Dumfries & Galloway Fife Forth Valley Grampian Greater Glasgow Highland Lanarkshire Lothian Shetland Tayside Western Isles Argyl & Clyde (Inherited by Greater Glasgow & Clyde) Argyl & Clyde (Inherited by Highland) *NHS board of residence or, where this is not known, NHS board of source of specimen. Note: Due to reporting delay, Tables 13 and 14 are produced 3 months in arrears Table 15 HIV infected persons alive at 31 March 2006 who had undergone viral load monitoring by most recent viral load and level of antiretroviral treatment (number of cases being monitored and % of total within treatment group) All cases attending in previous 12 months Cases attending for the first time in the previous 12 months Most recent Triple Mono/ Naïve Stopped Triple Mono/ Naïve Stopped VL group or more Dual or more Dual < (82%) 29 (67%) 16 (4%) 36 (18%) (78%) 1 (20%) 7 (5%) 3 (30%) (12%) 7 (16%) 35 (9%) 25 (12%) (17%) 2 (40%) 9 (6%) 1 (10%) 33 1k-10k 34 (2%) 2 (5%) 86 (21%) 29 (14%) (3%) 1 (20%) 26 (17%) 3 (30%) 34 > 10k 43 (3%) 5 (12%) 266 (66%) 111 (55%) (2%) 1 (20%) 112 (73%) 3 (30%) (68%) 43 (2%) 403 (20%) 201 (10%) (42%) 5 (2%) 154 (53%) 10 (3%) Number & row pct. Table 16 HIV positive cases being monitored between 1 April 2005 to 31 March 2006: numbers by treatment profile and undetectable viral load status Treated VL <50 Treatment profile N % N % of total in class 2 NRTI + NNRTI % % 2NRTI + PI % % NRTI/NtRTI + NNRTI % % NRTI/NtRTI + PI % % Triple NRTI 77 6% 66 86% Other % % % % Key to treatments: NRTI - Nucleoside reverse transcriptase inhibitor; NNRTI - non-nucleoside reverse transcriptase inhibitor; NtRTI - Nucleotide reverse transcriptase inhibitor; PI - Protease inhibitor

9 Table 17 HIV-1 infected persons, United Kingdom by exposure category and date reported; How person probably July 04 to June 05 July 05 to June 06 Cumulative to June 2006 acquired the virus Male Female Male Female Male Female 1 Men who have sex with men (MSM) Sexual intercourse between men and women exposure to high risk partner exposure abroad exposure UK investigation continuing/closed Heterosexual sub-total Injecting drug use (IDU) Blood factor treatment Blood/Tissue transfer Mother to Infant Other or Investigation continuing/closed Includes 46 cases whose sex was not stated. 2. Includes 778 men who had also injected drugs. [Sources: HPA, London and HPS] Table 18 AIDS cases, United Kingdom by exposure category and date reported; How person probably July 04 to June 05 July 05 to June 06 Cumulative to June 2006 acquired the virus Male Female Male Female Male (Deaths) Female (Deaths) Men who have sex with men (MSM) Sexual intercourse between men and women exposure to high risk partner exposure abroad exposure UK investigation continuing/closed Heterosexual sub-total Injecting drug use (IDU) Blood factor treatment Blood/Tissue transfer Mother to Infant Other or Investigation continuing/closed Includes 336 men who had also injected drugs [Sources: HPA, London and HPS] The last HIV & AIDS Surveillance Report was in Issue 06/15 The next HIV & AIDS Surveillance Report will be in Issue 06/ HPS WEEKLY REPORT Volume 40 No.2006/30 1 August 2006

10 HPS WEEKLY REPORT Volume 40 No.2006/30 1 August Focus: HIV prevalence among non-idu heterosexuals, IDUs and men who have sex with men who undergo attributable HIV testing in Scotland: 2005 update Since 1989, HPS, in association with HIV testing laboratories throughout Scotland, has collected data on persons who have undergone attributable HIV testing. Data for 2005 and recent previous annual data are presented in this report. In 2005, persons from Grampian, Greater Glasgow, Lothian and Tayside had at least one named HIV test (Table 1); 295 (1.0%) of these being antibody positive. It should be noted that the figure excludes repeat tests within a calendar year and tests undertaken in the context of screening programmes; tests on blood donors, those attending for a travel screen and antenatal clinic attendees being excluded. The figure compares with those of 24303, and for 2004, 2003 and 2002, respectively of the (81%) were tested in the GUM clinic setting. The corresponding numbers of persons tested in GUM clinics for 2004, 2003 and 2002, are 18421, and 8815, respectively. Thus, between 2002 and 2005, a 162% increase in the numbers of persons undergoing an HIV test in GUM clinics was observed (Figure 1). This dramatic trend reflects Scottish Executive Health Department policy which promoted the introduction of routine HIV testing for all persons attending GUM clincs with a new sexually transmitted infection problem. Non-IDU heterosexual men and women In 2005, persons from Grampian, Greater Glasgow, Lothian and Tayside, identified as non-idu heterosexuals, underwent attributable HIV testing;110 (0.5%) of these being antibody positive (Table 2). The corresponding figures for 2004 and 2003 were (0.7%) and (0.8%), respectively. Thus, principally for the reason indicated above, a near 100% increase in testing between 2003 and 2005 was observed. TABLE 1: HIV prevalence among adults (age 15yrs+) by selected NHS Board*, 2005 NHS board Tested Positive % Positive GRAMPIAN % GREATER GLASGOW % LOTHIAN % TAYSIDE % *NHS Board of source of specimen TABLE 2: Prevalence of HIV among adults (age 15+) having a named HIV-antibody test, Scotland* ; Non-IDU Heterosexuals by geographical region of exposure and gender Males Females Geographical region Year Tests Positive % Positive Tests Positive % Positive of exposure UK % % % % % % Sub-saharan Africa % % % % % % North Africa/Middle East % % % % % % Indian Sub-continent % % % % % % Far East/Other Asia % % % % % % North America % % % % % % Central/South America % % % % % % Caribbean % % % % % % Western Europe % % % % % % Eastern Europe % % % % % % Australasia % % % % % % Not Known % % % % % % % % % % % % * Grampian, Greater Glasgow, Lothian and Tayside only. The decline in prevalence among non-idu heterosexuals from 0.8% to 0.5% between 2003 and 2005 is mainly due to increased testing among those, attending GUM clinics, whose sexual behaviour was confined to the UK. The expansion of testing in this relatively low risk population resulted in prevalence declining from 0.3% (27/8278) in 2003 to 0.1% (22/16217) in Among those who declared sexual behaviour in sub-saharan African countries, prevalence remained high 6.5% and 10% among men and women, respectively. As in 2004, the prevalence of HIV among women indicating sexual behaviour in the Far East was high at 3% (3/90). Injecting drug users (IDUs) In 2005, 2261 IDUs throughout Scotland had an attributable HIV test and, of these, 21 (0.9%) were antibody positive; the corresponding rates for TABLE 3: Prevalence of HIV among adults (age 15+) having a named HIV test, Scotland by NHS board, selected exposure category, and year of test Injecting drug users Homo/bisexual males NHS board Year Tested Positive %Positive Tested Positive %Positive ARGYLL & CLYDE % % % % % % % % AYRSHIRE & ARRAN % % % % % % % % BORDERS % % % % % % % % DUMFRIES & GALLOWAY % % % % % % % % FIFE % % % % % % % % FORTH VALLEY % % % % % % % % GRAMPIAN % % % % % % % % GREATER GLASGOW % % % % % % % % HIGHLAND % % % % % % % % LANARKSHIRE % % % % % % % % LOTHIAN % % % % % % % % ORKNEY % % % % % % % % SHETLAND % % % % % % % % TAYSIDE % % % % % % % % WESTERN ISLES % % % % % % % % SCOTLAND % % % % % % % %

11 2004, 2003 and 2002 being 0.5%, 0.6% and 0.5%, respectively (Table 3). Eight of the 21 diagnoses were made in Lothian and four in Dumfries & Galloway (D & G). While the resulting HIV prevalence among Lothian IDUs having an attributable test was 1.2%, that among D & G IDUs was 3.3%. Of the 21 antibody positive IDUs, only three (all male, two from D & G) were under the age of 25. Such individuals are likely to have acquired their HIV recently, probably through injecting drug use but possibly through sexual intercourse. Fourteen of the remaining 18 IDUs were aged Nine of the 21 probably acquired their infection outside Scotland. FIGURE 1: Named HIV-antibody testing, Scotland* Individuals tested (excl. screens, repeat tests, and known positives) Individuals tested 30,000 25,000 20,000 15,000 10,000 5,000 All persons tested Persons tested in GUM Clinics Year * Grampian, Greater Glasgow, Lothian and Tayside only. While HIV transmission among IDUs in Scotland is relatively rare, behavioural data indicate that there is considerable potential for it. In 2004/2005, 31% of IDUs reporting to the Information and Statistics Division s Scottish Drug Misuse Database indicated that they had shared a needle and syringe in the previous month. The corresponding sharing rates for the previous 4 years since 2000/2001 were 34%, 35%, 33% Enquiries Any enquiries about these data should be made to Mr Glenn Codere, tel: bbvsti@hps.scot.nhs.uk Acknowledgements - HIV Surveillance Coordinators and Collaborators SCOTLAND: Aberdeen and North East Scotland Blood Transfusion Service, Aberdeen: Ms I Gray, Dr S Urbaniak, Mr D Wilson Ayrshire & Arran NHS Board, Ayr: Dr M Smellie Borders General Hospital, Melrose: Ms E Anderson, Dr D Clutterbuck, Mr P Machell Borders NHS Board, Melrose: Dr Tim Patterson Crosshouse Hospital, Kilmarnock: Ms L Bruce, Dr G Downie, Dr R Hardie, Ms A Lundie, Dr G Williams, Mr B Wilson Dumfries & Galloway NHS Board: Dr D Breen Dumfries & Galloway Royal Infirmary: Mr M Gray, Dr G Jones, Dr P Rafferty, Dr F Toolis East of Scotland Blood Transfusion Service, Ninewells Hospital, Dundee: Dr G Galea Falkirk & District Royal Infirmary: Dr J Harvey, Ms A Paterson, Ms J Ure Fife Health Board, Cupar: Dr C Saunders Forth Valley Health Board, Stirling: Dr H Prempeh Gartnavel General Hospital, Glasgow: Dr S Cameron, Dr W Carman, Ms R Raajaravi, Dr R Fox, Dr D Kennedy, Ms L McDonald, Ms R McHugh, Dr R Wong Glasgow Royal Infirmary: Ms R Connor, Sis E Little, Prof G Lowe, Ms N Brodie Glasgow & West of Scotland Blood Transfusion Service, Glasgow: Dr B Dow, Dr D Frame, Dr R Green Grampian NHS Board, Aberdeen: Dr M Rossi Grampian University Hospitals NHS Trusts: Dr S Armstrong, Mr I Collacott, Dr G Douglas, Ms J Findlay, Dr R Herriot, Ms K Hughes, Dr R Laing, Dr G McKenna, Dr P Molyneaux, Dr T Reid, Dr D Richards Greater Glasgow and Clyde NHS Board, Glasgow: Dr S Ahmed, Dr C Chiang Hairmyres Hospital, East Kilbride: Dr D Baird, Mr F Christison, Mr M Stewart Health Protection Scotland: Ms B Bednarek, Mr F Boero, Mrs E Carragher, Ms P Cassels, Miss M McNicol, Ms R Porteous, Ms J Reilly, Mr W Smyth, Ms B Wayne Highland NHS Board, Inverness: Mr K Hepburn, Dr K Oates, Dr J Wrench Inverclyde Royal Hospital, Greenock: Dr E Biggs, Ms M McDougall, Dr P Semple Lanarkshire NHS Board, Hamilton: Dr J Logan Lothian NHS Board, Edinburgh: Dr J Stevenson, Dr C Evans Monklands Hospital, Airdrie: Ms I Glen, Dr N Kennedy, Ms L McCann, Dr J Roberts, Ms H Robertson, Ms M Roche, Ms R Thomson, Dr A Todd, Mr J Westwater, Ms I Winning Muirhouse Practice, Edinburgh: Dr R Robertson and 34%. In 2004/2005, 47% of injectors reported having shared spoons/ water/filters/solutions in the previous month; this proportion comparing with 49% for 2003/2004. It is also worth noting that HCV remains highly incident among IDUs in Scotland. Men who have sex with men (MSM) In 2005, 2912 MSM had an attributable HIV test and, of these, 115 (4.0%) were antibody positive (Table 3). The corresponding rates for 2004, 2003 and 2002 were 4.2%, 3.7% and 3.6%, respectively. The only NHS board area in which a notable increase in prevalence among MSM having an attributable HIV test occurred was Argyll & Clyde (6.5% (5/77) in 2005). This rate compares with 3.8%, 3.6% and 2.9% in 2004, 2003 and 2002, respectively. The prevalence of HIV among MSM undergoing HIV testing, generally, is similar across all mainland NHS board areas. Although HIV prevalence among this population is static at around 4.0%, preliminary investigations of the incidence of infection among MSM undergoing repeat attributable HIV testing, indicate that incidence was stable at around 1% during and then increased to approximately 4% in This finding is consistent with the increase in the incidence of syphilis among MSM in recent years. It is also worth noting that the number of MSM undergoing HIV testing in 2005 was This figure compares with those of 2574, 2113 and 1780 in 2004, 2003 and 2002, respectively. Definitions of presented data HPS use the following criteria in order to extract data for presentation. Numbers tested: Individuals tested. Excludes repeat tests carried out on individuals within the indicated calendar year, screening tests, and known positives who had previously presented in Scotland. Positives: Includes persons newly diagnosed HIV-positive (regardless of origin of infection), and persons known to be positive who are presenting in Scotland for the first time. Excludes known positives who had previously presented in Scotland. NHS board: NHS board of residence or, where this is not known, NHS board of source of specimen Ninewells Hospital, Dundee: Mr K Appleyard, Dr P Davey, Mr N Docherty, Dr A France, Mr J Gibbs, Ms W Lees, Sis A Lovelady (Perth), Dr W McGuire, Dr P McIntyre, Dr N Murdoch, Sis W Mutch, Dr D Nathwani, Mr R Potts, Ms M Reid, Ms D Ross, Dr R Smith, Ms M Taylor, Mr J Wallace, Mr E Wooldridge, Dr D Yirrell North of Scotland Blood Transfusion Service, Raigmore Hospital, Inverness: Dr T Ferguson, Dr P Forsyth, Dr S Lumley Orkney NHS Board, Kirkwall: Dr K Black Raigmore Hospital, Inverness: Mr T Bell, Ms J Ferguson, Dr D Ho-Yen Royal Alexandra Hospital, Paisley: Ms A Cairns, Mr I Connell, Mr J Mallon, Dr B Weinhardt Royal Hospital for Sick Children, Edinburgh: Dr J Mok Royal Infirmary, Edinburgh: Dr S Burns, Sis L Docking, Dr S Lawson, Ms G Leadbetter, Dr W A Liston, Prof A Ludlum, Dr A McMillan, Ms F McNeilage, Ms P Munro, Dr G Scott, Dr K Templeton, Dr C Thompson Sandyford Initiative, Glasgow: Dr R Nandwani, Dr G Sharp, Dr A Winter, Ms A Mir Scottish National Blood Transfusion Service, Edinburgh: Dr J Gillon, Mr A Jordan, Mr A MacMillian, Dr B McClelland, Dr R Perry, Dr C Prowse, Dr P L Yap Scottish Executive Department of Health: Dr E Stewart, Mr J. Froggatt, Ms K Chalmers, Mr M McCormack Shetland NHS Board, Lerwick: Dr S Taylor Southern General Hospital, Glasgow: Mr J Guthrie, Ms E Scott, Mr J Winning Stirling Royal Infirmary: Mr G Inglis, Tayside NHS Board, Dundee: Dr C. McGuigan Victoria Hospital, Kirkcaldy: Dr D Bhattacharyya, Ms B Cowper, Dr C Lafong, Dr I Laurenson Western General Hospital, Edinburgh: Dr R P Brettle, Dr C L S Leen, Dr P Welsby, Dr D Wilks, Mr A Wilson Western Infirmary, Glasgow: Dr J Farrell, Mr E Galloway, Dr E McCruden, Dr A Peacock, Ms C Ross Western Isles NHS Board, Stornoway, Isle of Lewis: Dr A George Wishaw General Hospital, Wishaw, Lanarkshire: Mrs A Hughes, Dr K Liddell, Mr I McCormick Yorkhill Hospital, Glasgow: Dr D Aitken, Ms L Bain, Ms A Brown, Dr R Hague, Dr M Hepburn, Ms M King, Ms J McKenzie, Ms L McNairney, Dr D Tappin ENGLAND: HPA Communicable Disease Surveillance Centre, London: Ms S Cliffe, Dr B Evans, Mr J Forde, Dr O N Gill, Mr J Mithal, Ms M. Hill, Ms K. Sinka Institute of Child Health, University of London: Ms J Masters, Prof C Peckham, Dr P Tookey, Ms C Townsend 163 HPS WEEKLY REPORT Volume 40 No.2006/30 1 August 2006

12 HPS WEEKLY REPORT Volume 40 No.2006/30 1 August 2006 Statutory Notification of Infectious Diseases Week ended 21July 2006 An ISD Scotland National Statistics release 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 Bacillary dysentery Chickenpox Cholera Erysipelas Food poisoning Legionellosis Lyme Disease Malaria Measles Meningococcal infection Mumps Rubella Scarlet fever Tuberculosis: resp Tuberculosis: non-resp Viral hepatitis Whooping cough TOTAL Infectious Disease NHS BOARD AREA Current Previous Current from1st week week week week of year AC AA BR DG FF FV GR GG HG LN LO OR SH TY WI last year 2005** 2006* Bacillary dysentery Chickenpox Cholera Erysipelas Food poisoning Legionellosis Lyme Disease Malaria Measles Meningococcal infection Mumps Rubella Scarlet fever Tuberculosis: resp Tuberculosis: non-resp Viral hepatitis Whooping cough TOTAL Amendments : none Source: Information and Statistics Division, National Services Scotland * This includes 1 Diphtheria (FF wk 29), 1 Toxoplasmosis (HG wk 02) 2 Typhoid Fever (AA wk 24, AC wk 27). **This inlcudes 2 Leptospirosis, 2 Puerperal Fever 164 Either by entering a place name or by clicking on a map of Europe, users will be able to follow air quality locally and on a European scale. The web site will also include information on the health implications of the ozone values users are experiencing. [EEA News Release, 18 July newsreleases/ozone2006-en] Report on management of radioactive waste 40/3005 The Committee on Radioactive Waste Management (CORWM) is an independent committee appointed jointly in 2003 by the UK Government and devolved administrations in Scotland, Wales and Northern Ireland. Its task has been to review the options for the estimated 470,000 cubic metres of radioactive wastes. The Scottish Executive, with UK government and the administrations of Wales and Northern Ireland, this week welcomed the report by the Committee making recommendations for the longterm management of the UK s higher level radioactive waste. The UK Government and the devolved administrations will continue to work together and develop policy in light of the Committee s recommendations, and a full response will be made to respective Parliaments and the National Assembly for Wales when they are in session later in the autumn. The Report can be accessed on the CORWM website at [Source: Scottish Executive News release, 31 July /07/ NHS BOARD ABBREVIATIONS AC Argyll &Clyde DG Dumfries & Galloway GG Greater Glasgow LN Lanarkshire SH Shetland AA Ayrshire & Arran FF Fife GR Grampian LO Lothian TY Tayside BR Borders FV Forth Valley HG Highland OR Orkney WI Western Isles