March 2015: Issue 6. I would like to highlight some of the topics in this edition of Transmit where we have focused on Vaccine Preventable Diseases

Transcription

1 March 2015: Issue 6 Foreword I would like to highlight some of the topics in this edition of Transmit where we have focused on Vaccine Preventable Diseases The Duty Room Update has information about the new Shingles vaccine programme for people aged 70, 78 and 79 years. The article on the childhood vaccination and vaccine preventable diseases shows the success and importance of childhood vaccination. Meningococcal infection remains an important public health problem. There were 49 cases of invasive meningococcal disease in N. Ireland in 2014; Group B infection accounted for 79% of confirmed cases in 2014 (23/29). The article on influenza vaccine highlights the uptake of flu vaccine in each of the groups, noting the high uptake among school children (79.6%). Contents Page 1 Introduction 2-6 Duty Room Updates 7-13 Immunisations and Vaccine Preventable Diseases Meningococcal disease in Northern Ireland, Update on Influenza vaccination 2014/ Scarlet Fever and igas 23 PHA Web Links to Surveillance Data 24 DHSSPS Web Links We have highlighted the incidence of Scarlet Fever and Invasive Group A Streptococcal Infection (igas). All cases of Scarlet Fever should be reported to the PHA Duty Room as a notifiable disease. Assistant Director of Public Health (Health Protection)

2 Duty Room Updates This section of Transmit aims to bring current Public Health issues and events to the attention of our professional colleagues. The Duty Room provides specialist health protection advice, guidance and operational support on all health protection matters. The Duty Team will respond to all enquiries from health professionals and others, including nursing and residential homes, local councils, community health services (including schools and social services). The new contact details for the Duty Room are: Health Protection Duty Room Tel: Fax: The new Shingles vaccine programme for people aged 70, 78 and 79 Shingles is caused by the same virus that causes chickenpox. After you recover from chickenpox, some of the virus remains inactive in the body and nervous system. It can then reactivate later in life when your immune system is weakened. About a quarter of adults will get shingles at some point in their life. For most people shingles can be a mild infection with good recovery, but it can be very painful and uncomfortable and tends to affect people more commonly as they get older. The older people are, the worse it can be, with some people left with pain lasting for years after the initial rash has healed, which is called post-herpetic neuralgia. In 2010, the UK s Joint Committee on Vaccination and Immunisation (JCVI) recommended that a herpes zoster (shingles) vaccination programme should be introduced for adults aged 70 years with a catch up programme for those aged 70 to 79 years. The UK is one of the first countries in the world to introduce a shingles vaccine programme for older adults. In the first year of the programme (2013/14), the vaccine was routinely offered to adults aged 70 years and to adults aged 79 as part of the catch up campaign. In the current year (14/15) the vaccine is being offered to those aged 70 years on 1 st September 2014, with a catch-up cohort in those aged 78 or 79 on 1 st September Those aged 71 who were eligible in the first year of the programme, but did not receive the vaccine can also be given it as part of the campaign. People aged 80 and over will not get the shingles vaccination because the vaccine effectiveness diminishes with age and is not recommended for people aged 80 years or older. Those currently aged will be offered the vaccine over the next few years. As the vaccine is a live vaccine, it cannot be given to people with a lowered immunity either due to disease or to medications. The clinicians factsheet referenced below gives more details on this or in cases of uncertainty about eligibility; the patient s specialist should be contacted for advice. It is estimated that the vaccination programme will prevent nearly 40% of the hundreds of cases of shingles seen every year in Northern Ireland in people over 70 and will reduce the severity of the symptoms for those who do develop the condition. For those vaccinated but who later developed shingles, studies show that the vaccine significantly reduces the burden of illness by 55% and significantly reduces the incidence of post herpetic neuralgia by 67%. 2

3 As shingles is not a notifiable disease and is primarily based on a clinical diagnosis, there has not been any routine surveillance data previously collected in the UK. In order to monitor the impact and effectiveness of the shingles vaccination programme, Public Health England has set up new surveillance systems to assess the impact of the vaccination programme on the incidence of shingles and post herpetic neuralgia, and these results will be available over the next few years. Although some GP s offered the shingles vaccine with the influenza vaccine during October and November of 2014, unlike the influenza vaccine, the shingles vaccine can be given throughout the year. Practices are therefore encouraged to continue to call in eligible people who have not received the vaccine already and to offer it opportunistically if eligible patients attend the practice for other reasons. A factsheet with more details about the programme and which answers many of the common questions about the programme can be found at: Dr L Jessop Consultant in Health Protection 3

4 Prevention of hepatitis B transmission in babies born to mothers with hepatitis B Hepatitis B is a virus that mainly affects the liver and is transmitted by blood and bodily fluids. People with chronic hepatitis B infection are at risk of the disease progressing to liver cirrhosis and hepatocellular cancer. Babies born to hepatitis B positive mothers are at particular risk of acquiring infection in the perinatal and postnatal period and those who become infected with hepatitis B tend to go on to be chronic carriers rather than clearing the infection. Chronic infection occurs in 90% of those infected perinatally but is less frequent if acquired in childhood (e.g. 20 to 50% in children between one and five years of age). All women are offered a screening test for hepatitis B infection as part of routine antenatal care. Those found to be infected are appropriately counselled and advised that their babies should be vaccinated against hepatitis B. Appropriate vaccination can prevent over 90% of cases developing chronic infection after perinatal transmission. She is also urgently referred to hepatology and household contacts, including other children, are offered screening and vaccination. The following graph shows the annual number of live births to mothers with hepatitis B in Northern Ireland. The annual numbers are small (45 in 2014), with a slight upward trend since It is vital that babies born to hepatitis B positive mothers receive the recommended schedule of immunisations at the appropriate time. The vaccine is given at birth, 1, 2 and 12 months of age. A blood test to look for hepatitis B infection is carried out at 12 months to see if the child has become infected despite immunisation, if so, they are referred for appropriate follow-up. A booster dose of hepatitis B vaccine is recommended with the pre-school boosters at around 3 years and 4 months of age. Babies born to highly infectious (HBeAg +ve) mothers also receive HBIG at birth to further reduce the risk of transmission. 4

5 The Public Health Agency (PHA) collects information quarterly to monitor the uptake of the vaccine programme, known as Cover of Vaccination Evaluated Rapidly (COVER) data. Data is collected on: 3 doses given at 12 months of age; 4 doses at 24 months of age and 4 doses ever given. The graph below shows hepatitis B vaccine uptake for births cohorts 2008 to There has been consistently high uptake, with 100% of babies receiving 3 doses of hepatitis B vaccine before the 1 st birthday for the last 3 years. The number of babies that received 4 doses before their 2 nd birthday has also improved with the highest being recorded at 91% in Some of the lower uptake is attributed to children moving out of Northern Ireland. The GP and health visitor plays an important role in checking the vaccine uptake of babies born to hepatitis B positive mothers. Infants identified as having missed the 1, 2, or 12 month hepatitis B dose should be referred to the relevant paediatrician for rescheduling. The PHA also sends the GP practice a reminder letter about the pre-school booster at 3 years of age. This can be given in surgery along with the other pre-school vaccine. A blood test to look for hepatitis B infection should also be carried out. A new leaflet has been developed to give information to pregnant women who have hepatitis B and it has been translated into 11 different languages. The leaflet can be found here: translations Mr M Lavelle Health Protection Nurse Dr J Johnston Consultant in Health Protection 5

6 Ensure the correct vaccine is given There are currently a number of vaccines with similar names in use and it is vitally important to ensure that the correct vaccine is given in the appropriate circumstances. 1. Infanrix-IPV +Hib is a Diphtheria, Tetanus, Pertussis, Polio and Hib combined vaccine used for primary immunisation of infants at 8, 12 and 16 weeks old. The Hib component of the vaccine is supplied as a freeze dried preparation in a separate glass vial, which must be reconstituted with the contents of the pre-filled syringe containing the other antigens in order that all components are given and adequate protection initiated. There have been reports of immunisers failing to reconstitute the Hib part of the vaccine. 2. Infanrix-IPV+Hib must not be mistaken with the pre-school booster Infanrix-IPV, this is the vaccine which replaced Repevax for pre-school boosting last year, it does not contain a Hib component. 3. Public Health England have reported that they are aware of a number of cases where pregnant women have inadvertently received the shingles vaccine (Zostavax ) instead of Boostrix-IPV the pertussis containing vaccine for pregnant women. We are not aware of any reports of this occurring in Northern Ireland but it is useful to remind colleagues that Boostrix-IPV is the only currently available recommended vaccine for boosting pertussis immunity in pregnant women. Boostix-IPV should be given to pregnant women at each pregnancy from 28 weeks gestation. NB: Shingles (and chickenpox) vaccines contain live varicella zoster virus (VZV) that has been weakened, and whilst most women of childbearing age in the UK will be immune to VZV, it would be vital to check the immune status of the woman in case she is susceptible to varicella in which case treatment with immunoglobulin may be indicated. Any vaccine administration error should be reported to the PHA Duty Room so that appropriate advice may be sought. Mrs M Loughrey Health Protection Nurse 6

7 Immunisations and Vaccine Preventable Diseases Immunisation uptake figures for Northern Ireland at 12 and 24 months of age remain above the UK average and we have the highest uptake levels in the UK. In particular uptake rates for MMR at 24 months reached 96.4% in quarter end September 2014, the highest reported in the UK for this period (table 1 and figure 3). Table 1: Completed primary immunisations by 12 and 24 months of age, quarter end September 2014, Northern Ireland and UK Area % Coverage at 12 months % Coverage at 24 months DTaP/IPV/Hib3 MenC PCV2 Rota2 DTaP/IPV/Hib3 PCV Booster Hib/MenC MMR1 Belfast 95.9% 97.7% 96.0% 93.0% 97.2% 95.2% 93.9% 94.0% South Eastern 97.9% 99.0% 97.7% 93.1% 98.6% 96.3% 96.4% 96.2% Northern 97.7% 98.8% 97.6% 95.7% 99.0% 97.4% 97.1% 97.1% Southern 98.4% 98.7% 98.4% 95.6% 99.0% 97.3% 97.4% 97.5% Western 98.3% 98.7% 98.3% 93.6% 99.6% 97.5% 97.3% 97.0% NI Total 97.6% 98.6% 97.6% 94.3% 98.7% 96.8% 96.5% 96.4% England 93.9% N/A 93.5% N/A 95.9% 92.3% 92.2% 92.2% Scotland 97.5% 98.0% 97.5% 92.7% 98.3% 96.0% 96.0% 95.7% Wales 94.6% 96.1% 94.0% 89.2% 97.1% 94.9% 94.3% 95.2% UK 94.3% N/A 94.0% N/A 96.1% 92.7% 92.7% 92.6% N/A accurate data not available 7

8 Figure 1: Vaccination uptake rates of DTaP/IPV/Hib3* at 12 months, NI and UK, by quarter (*3 doses of Diphtheria, Tetanus, Pertussis, Polio and Haemophilus Influenzae type b) From 1 July 2013 the routine childhood immunisation schedule included the rotavirus vaccine to protect babies against rotavirus. As at December 2014 there is 6 months data for children who reached the age of 12 months (between July-December) and who should have received the vaccine (2 doses). Based on the 6 months data, uptake for Northern Ireland is 94.6%. All district council areas achieved over 90% uptake ranging from 91.2% in Fermanagh to 98.8% in Strabane, with 50% of the council areas reaching 95% or higher. 8

9 Figure 2: Rotavirus vaccination uptake rates at one year of age in Northern Ireland by LGD for July-December 2014 MMR vaccination uptake at 24 months in Northern Ireland has been consistently higher than the UK. Uptake reached over 95% in quarter ended June 2012 (95.3%) exceeding the WHO target of 95%. This increasing trend has continued with uptake reaching the highest level recorded in Northern Ireland at 96.4% in quarter end June 2014 and has remained at this level for quarter end September 2014 (figure 3). 9

10 Figure 3: MMR vaccination uptake rates at 24 months, NI and UK, by quarter Figure 4: Uptake of the MMR1 vaccination at two years of age in Northern Ireland by LGD for

11 All council areas except Belfast achieved the WHO target of 95% uptake for 1 dose of MMR at two years of age based on data for the calendar year 2014 (figure 4). Further analysis shows the percentage uptake rates in Belfast were: East 97.2%, North 92.4%, South 94.3% and West 92.1%. Immunisation uptake figures for Northern Ireland at 5 years of age remain above the UK average for each of the vaccine schedules. Table 2: Completed primary immunisations and boosters by 5 years of age, quarter end September 2014, Northern Ireland and UK Area % Coverage at 5 years DTaP/IPV/Hib3 MMR1 MMR2 DTaP/IPV Belfast 96.2% 95.4% 86.9% 88.3% South Eastern 98.6% 97.5% 94.4% 95.7% Northern 98.5% 97.0% 94.6% 95.9% Southern 97.6% 97.6% 92.8% 93.3% Western 97.5% 98.4% 95.2% 96.2% NI Total 97.7% 97.2% 92.9% 93.9% England 95.7% 94.5% 88.5% 88.6% Scotland 98.4% 97.7% 93.9% 94.6% Wales 96.4% 96.3% 92.6% 92.9% UK 96.0% 94.9% 89.3% 89.4% Figure 5: MMR vaccination uptake rates at 5 years, NI and UK, by quarter 11

12 Figure 6: Uptake of two doses of MMR vaccine at five years of age in Northern Ireland by LGD for 2014 All council areas except Belfast achieved over 90% uptake for 2 doses of MMR at five years of age based on data for the calendar year 2014 (figure 6). Further analysis shows the percentage uptake rates in Belfast were: East 89.4%, North 87.8%, South 86.1% and West 86.8%. Vaccine preventable diseases During 2014 laboratory confirmed cases of measles in Northern Ireland decreased significantly with only one case reported compared to ten cases in 2013 and nine cases in 2012 (table 3). However, it is important to note that sixteen out of the nineteen confirmed measles cases reported in Northern Ireland during were associated with a single outbreak which began in late An increase in laboratory confirmed cases of mumps was seen during 2012 and 2013 but during 2014 a decrease was noted. The majority of cases reported since 2012 were in the year age group (73%; 490/669). Of the 490 cases in the year age group 84% (414/490) had received two doses of the MMR vaccine. 12

13 Table 3: Laboratory reports of vaccine preventable infectious diseases, Northern Ireland, * Disease 2014* Diphtheria Measles Mumps Polio Rubella Tetanus Whooping Cough *Data is provisional A temporary vaccination programme for pregnant women was introduced in the UK in 2012, in response to a national whooping cough outbreak. The programme vaccinates women in pregnancy (between 28 and 38 weeks) meaning that the mother passes immunity on to her unborn child, protecting the baby until they receive their first whooping cough vaccination at 2 months old. The Joint Committee on Vaccination and Immunisation (JCVI) advised in July 2014 that the pertussis vaccination programme for pregnant women should continue for a further five years. Uptake of pertussis vaccination in pregnancy is approximately 60% in Northern Ireland. However, during 2014 seven laboratory confirmed cases of whooping cough were reported in babies aged under 3 months old. The mother had not been immunised in six of the seven cases which highlights the importance of the immunisation programme for pregnant women. References Mrs J Murphy Mr L Shilliday Dr R Smithson Surveillance Officer Surveillance Manager Consultant in Health Protection 13

14 Meningococcal disease in Northern Ireland, 2014 Following the introduction of Men.C vaccine, the majority of disease in Northern Ireland is now caused by Neisseria meningitides serogroup B. Worldwide, serogroups A, C, Y and W135 also cause significant levels of disease. Enhanced Surveillance of Meningococcal Disease (ESMD) was first implemented in Northern Ireland in 1999, to monitor cases of meningitis and septicaemia known or suspected to be caused by N. meningitidis. The data is used to monitor both the impact of the disease and the efficacy of the meningococcal serogroup C vaccination programme which began in Surveillance is based on notifications from clinicians, laboratory confirmed reports from local laboratories and the PHE Meningococcal Reference Unit (MRU) in Manchester. Meningococcal disease summary 2014 There were 49 cases of invasive meningococcal disease (IMD) notified in 2014, giving a Northern Ireland rate of 2.7/100,000 population Of the 49 notifications 29 (59%) were laboratory confirmed 45% (13/29) of the laboratory confirmed cases were tested by PCR, 7 (24%) by culture and 9 (31%) had both PCR and culture tests Serogroup B accounted for 79% (23/29) of confirmed cases in There were two cases of serogroup C, 3 serogroup W135 and one case was non-groupable for IMD Of the 29 confirmed cases the average length of stay in hospital was 9 days (range 2-78 days) One IMD associated death occurred in 2014, giving a case fatality ratio of 2.0% compared with 1.7% in 2013 The incidence rate of IMD in Northern Ireland during 2014 was lower than in 2013 (3.2/100,000) at 2.7 cases per 100,000 population. Of the 49 notified cases in 2014, 59% (29/49) were laboratory confirmed (Figure 1). N. meningitidis serogroup B was the predominant pathogen accounting for 79% (23/29) of all cases confirmed in Since 2002, serogroup B has accounted for greater than 80% of all laboratory confirmed cases (Figure 2). In 2014, there were two cases of serogroup C, 3 serogroup W135 and 1 case was non-groupable. Of the two cases of serogroup C one was in the 5-14 years age group and one was in the years age group. One case had received 3 doses of Meningococcal C vaccine while the other case had no record of receiving any doses. Consistent with previous years, age-specific incidence during 2014 was highest in infants and young children (Figure 3). Ages ranged from 26 days to 89 years with a median of 2 years. There was one IMD associated death during 2014, giving a case fatality rate (CFR) of 2.0% (1/49), compared with a CFR of 1.7% (1/58) in The case was not laboratory confirmed. 14

15 Figure 1: Number of notified and confirmed cases of IMD and overall rates per 100,000 population, Northern Ireland, Figure 2: Laboratory confirmed cases of IMD by serogroup, Northern Ireland,

16 Figure 3: Age-specific incidence rates of IMD, Northern Ireland, Dr R Smithson Consultant in Health Protection Mrs J Murphy Surveillance Officer 16

17 Update on Influenza vaccination 2014/15 Although rates of flu have started to decrease, flu virus is still in circulation and as you will have seen from the recent PHA communication to all GPs and Practice Managers (issued: 25/03/2015) Influenza vaccine should continue to be offered until the end of April. It is particularly important that all pregnant women are offered flu vaccine, which can be given at any stage during pregnancy, so those who have newly discovered they are pregnant or those women in the later stages of pregnancy who have not yet received the Flu vaccine should be encouraged to get it. The PHA continues to monitor flu activity with partners in health and social care; comprehensive surveillance information can be found at ( It is important to acknowledge the hard work of all in Trusts, Primary and Social Care sectors in terms of control of Influenza. Provisional Influenza vaccine uptake data to the end of January 2015 shows good vaccine uptake as set out in the table below. Rates may improve closer to DHSSPSNI Flu vaccine uptake targets when all data is collated and verified at the end of the season. Influenza vaccine Uptake N Ireland as at 31/1/15 Category % Uptake rate as at 31/1/15 Aged 65 years and over 71.7% Aged <65 years in an at risk group 69.0% Pre-school children 2-4 years 53.8% School children P1-P7 79.6% Since the Flu vaccination campaign commenced it has become apparent that a proportion of the A (H3N2) virus circulating is not well matched to this year s vaccine. Whilst good protection can be expected against circulating A (H1N1) strains the vaccine this year appears to be less effective against circulating A (H3N2) strains. However Flu vaccination still remains the best protection against Flu, especially for those in the designated risk groups, such as pregnant women mentioned above. The influenza vaccine generally offers very good protection against influenza and changes to the virus are considered each year before production of the vaccine. We would therefore encourage people to continue to be vaccinated each year if they fall into a category eligible for the vaccine. It is of particular note that the programme to vaccinate all school children P1-P7 children has been an overwhelming success with almost 80% uptake achieved, based on the data available. This uptake rate is above the DHSSPSNI target for this group of 75%, so sincere thanks and congratulations to the School (Public Health) Nursing teams who vaccinated intensively over an 8-10 week period and to those GPs who were responsible for vaccinating those children who required second doses and who missed out on the day the school nurses visited the schools. It would appear that the rationale for vaccinating school children against the flu is being borne out by initial data from last year s campaign in England which demonstrates that in areas where primary school age children were offered vaccine (pilot areas); the cumulative GP consultation rate for influenza like illness was lower in all age groups than in non-pilot areas (i.e. areas where school children not offered vaccine) the cumulative influenza positivity rate in all ages, in primary care, in areas that were not offering vaccine to school children was higher than in the pilot areas 17

18 the cumulative proportion of emergency department respiratory attendances was 8.7% in non-pilot areas compared with 8.5% in pilot areas. It is important to note that the data relates to all age groups and not just to primary school children who were offered the vaccine; this supports the strategic aim of the extended influenza vaccination programme, in that its benefits are evident across the whole population. Mrs M Loughrey Health Protection Nurse Scarlet Fever and IGAS There were 158 scarlet fever cases reported in the first quarter of 2015 which is lower than the number reported in the corresponding period last year (191). However, overall there is an increasing trend which is similar to 2014, when the peak incidence was in April. Scarlet Fever Reports to Duty Room (by month) Number of Reports through HP Zone Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

19 Scarlet Fever Reports to the Duty Room (by epi-week) igas Notifications to the Duty Room (by month) Where specimen date was unavailable, notification date was used. Ms R Spiers Epidemiological Scientist Dr C McLoughlin Senior Epidemiological Scientist 19

20 Scarlet fever: Frequently Asked Questions What is Scarlet fever? Scarlet fever (sometimes called scarlatina) is an infectious disease caused by bacteria called Streptococcus pyogenes, or Group A streptococcus (GAS). The same bacteria can also cause impetigo. These bacteria can be found on the skin or in the throat, where they can live without causing problems. However, under some circumstances, they can also cause disease like scarlet fever. Scarlet fever is characterised by a rash, which usually accompanies a sore throat, and is sometimes confused with the measles rash. The bacteria that cause the infection produce toxins (poisons), which cause a rash, a red and swollen tongue and flushed cheeks. Scarlet fever is mainly a childhood disease and is mostly common between the ages of two and eight years. It was once dangerous, but antibiotic treatment means it is now much less common and much less serious. There were 190 cases reported in N. Ireland in 2012, 155 cases in 2013 and 631 cases in It is highly contagious and bacteria are carried in saliva and mucous in the nose. The disease is spread by sneezing, coughing, or breathing out. It can also be caught by direct contact with the mucous or saliva of an infected person. It takes around two to five days to develop symptoms after being infected. If you think your child has scarlet fever, you should consult your GP. The disease tends to be most common in the winter and spring and the treatment consists of a 10-day course of antibiotics. How do I protect myself from scarlet fever? Scarlet fever is spread via the mucous and saliva of infected people. It can also be cough from any drinking glasses, plates or utensils they have used. To protect yourself from getting the illness you should: Wash your hands often Not share eating utensils with an infected person Wash, or dispose of, handkerchiefs and tissues contaminated by an infected person Be aware that you can catch scarlet fever by inhaling airborne droplets if someone with the illness coughs or sneezes in the air near you. If you think you, or your child, have scarlet fever: Get advice from your GP. Make sure that you/your child takes the full course of any antibiotics prescribed. Although you or your child will feel better very quickly after starting the course of antibiotics, you must complete the course of treatment to ensure that you do not carry the germs in your throat after you have recovered. Stay at home, away from nursery, school or work for at least 24 hours after starting the antibiotic treatment, to avoid spreading the infection You can help stop the spread of infection through frequent hand washing and by not sharing eating utensils, clothes, bedding and towels. All contaminated tissues or handkerchiefs should be washed, or disposed of immediately. 20

21 What are the symptoms? The symptoms are: The first symptoms of scarlet fever often include a sore throat, headache, fever, nausea and vomiting. After 12 to 48 hours the characteristic fine red rash develops (if you touch it, it feels like sandpaper). Typically, it first appears on the chest and stomach, rapidly spreading to other parts of the body. On more darkly-pigmented skin, the scarlet rash may be harder to spot, although the sandpaper feel should be present Fever over 38.3 C (101 F) or higher is common White coating on the tongue, which peels a few days later, leaving the tongue looking red and swollen (known as strawberry tongue ) Swollen glands in the neck Feeling tired and unwell Flushed red face, but pale around the mouth. The flushed face may appear more sunburnt on darker skin Peeling skin on the fingertips, toes and groin area, as the rash fades It usually takes two to five days from infection before the first symptoms appear. However, the incubation period may be as short as one day and as long as seven days. Scarlet fever usually clears up after a week, but it is advisable to consult with your GP to get advice and treatment if required. How do you get it? Scarlet fever is highly contagious. The bacteria are present in the mouth, throat and nose of the infected person and are spread by contact with that person s mucus or saliva. These might ever be on cups, plates or surfaces, such as tables that might have been used or touched by someone carrying the bacteria. You can also catch the disease by breathing infected airborne droplets produced through an infected person s coughing or sneezing. Who is most at risk? Scarlet fever is mainly a childhood disease, with around 90% of cases occurring in children under 10 years old. It is most common between the ages of two and eight years, with four-year olds most likely to develop the illness. Occasionally outbreaks of scarlet fever occur in nurseries and schools. Adults of all ages can also catch scarlet fever, but the disease is much less common in adults. How is it diagnosed and what is the treatment? Most mild cases of scarlet fever will clear up on their own, but it is still best to see your GP if you, or your child are showing symptoms. Having treatment for the illness speeds recovery and reduces the risk of complications. You will also become non-contagious more quickly. In most cases, doctors can diagnose scarlet fever from the symptoms alone. The diagnosis can be confirmed by taking a throat swab, which is then sent to a laboratory to identify the bacteria causing the infection. In some cases, a throat swab is not enough and a blood test may be needed. The usual treatment for scarlet fever is a 10-day course of antibiotics. The fever will usually subside within 24 hours of starting this, but it is important to take the whole course to completely clear the germs from your throat. 21

22 If scarlet fever is not treated with antibiotics, it can be infectious for two to three weeks after the symptoms appear. Provided all prescribed antibiotics are taken as directed, most cases will not infect other people after 24 hours of treatment. Current guidance advises that children should not return to nursery or school and adults to work until a minimum of 24 hours after starting treatment. If you have a high temperature you should drink plenty of fluids. You can also take paracetamol or ibuprofen to bring down your temperature and relieve discomfort. Once you have had scarlet fever you are unlikely to get it again. What are the potential complications? Most cases of scarlet fever have no complications at all. However, in the early stages, there is a small risk that you might get one of the following: Ear infection Throat abscess Pneumonia Inflammation of the sinuses (sinusitis) Meningitis On rare occasions, at a later sage the disease could lead to: Bone or joint problems Liver damage Kidney damage Acute rheumatic fever (which can damage the heart) Patients, or their parents, should keep an eye out for any symptoms that might suggest these complications in the first few weeks after the main infection has cleared up and, if concerned, seek medical help immediately. Where can I get more information? If you would like more information about scarlet fever, please visit the NHS Choices website: Adapted from: Scarlet Fever: Frequently Asked Questions. Public Health England (March 2014) Scarlet fever: Frequently Asked Questions 22

23 PHA Web Links to Surveillance Data Surveillance data on the main topics of Public Health interest are available through the following web links: Notifications of Infectious Diseases: Group B Streptococcus: Vaccination coverage: Avian Influenza: Brucellosis: Gastrointestinal infections: Hepatitis: Healthcare Associated Infections: Meningococcal disease: health /health-protection/meningococcal-disease Respiratory infections: Sexually transmitted infections: Tuberculosis: 23

24 DHSSPS Web Links CMO Letters and Urgent Communications relevant to Health Protection, and issued in the three months preceding publication of this edition of Transmit, are accessible through the following web links: Co-Poisoning HSS (MD) 36/ October 2014 (PDF 516KB) CBRN HSS (MD) 4/ March 2015 (PDF 178 KB) Ebola HSS (MD) 41/ December 2014 (PDF 266 KB) Meningococcal C HSS (MD) 39/ December 2014 (PDF 231 KB) Seasonal Flu HSS (MD) 30/ September 2014 (PDF 152KB) HSS (MD) 40/ December 2014 (PDF 147 KB) We welcome your feedback on the content of Transmit. Please feel free to contact emma.walker@hscni.net with your suggestions or articles that you would like to see included. 24