Foreword. Health protection service bulletin February Contents. Influenza. 2011: Issue 1

Transcription

1 11: Issue 1 Health protection service bulletin February 11 Foreword Welcome to issue 1 of Transmit in 11. As you will be acutely aware, influenza infection has challenged us all again early in 11, with high consultation rates in primary and secondary care, and high ICU admissions. Adults under the age of 65 years were particularly affected by flu this year. We also had flu B circulating at the same time and a seasonal peak in RSV infections. All of these led to increased pressure on the service. At the peak, approximately % of the normal total of adult-intensive care beds were occupied by patients with flu. At the same time, there was an increase in people seeking influenza vaccination as this is, of course, the most effective way to prevent flu. However, this does place additional demands on general practice at a time when consultation rates are high and, similarly, colleagues across the health and social care system have worked especially hard to manage delivery of service and service pressures and I would like to extend my personal thanks to them for this. We continue to see cases of invasive meningococcal disease in Northern Ireland 69 cases in, of which group B counted for 92%. There is a continued need to maintain public and professional awareness of the symptoms, signs, diagnosis and treatment of meningococcal infection. This edition of Transmit includes an update from the healthcare associated infections (HCAI) team and outlines updates to our surveillance programmes and the HCAI surveillance data. There has also been a change to the childhood immunisation schedules, with the MMR, PCV13 and Hib/MenC vaccines now given at the same visit between 12 and 13 months of age, preferably just after the first birthday. The health protection service faced many acute response challenges during and no doubt we will see more of the same in 11. You can follow health protection issues on the Public Health Agency (PHA) website: and specific issues in relation to flu on the Flu Aware NI website: Dr Lorraine Doherty Assistant Director of Public Health (Health Protection) Contents Page 1: Influenza and vaccination programme update to December Page 3: Healthcare associated infections team update Page 5: Quarterly reporting of MRSA and CDI episodes Page 6: Meningococcal disease in Northern Ireland Page 8: News Influenza At the time of writing, flu activity appears to have peaked for the /11 season. Consultation rates began to climb in week 49 and two weeks later, exceeded the baseline threshold of 7/, population. Subsequently, consultation rates reached a peak in week 1 of 11, which was almost as high as the peak reached during the pandemic in the previous season. Similar trends are noted from the out-of-hours (OOH) centres. In contrast to last year, the highest age-specific consultation rates for flu/flu-like illness were in adults under 65 years. Continued on page 2

2 Figure 1: Sentinel GP consultation rate for combined flu and flu-like illness, 9/ /11 Combined consultation rate per, population / season Summer period /11 season Week Flu A Flu B Flu A (H1N1) 9 Combined Consultation Rate Number of detections The main circulating respiratory viruses have been influenza A (H1N1) 9, influenza B and respiratory syncytial virus (RSV). The majority of laboratory flu detections have been influenza A (H1N1) 9 and were mainly in the under 65 years age group. In 9, the pandemic had substantially subsided before RSV detections rose, whereas this winter, both circulated concurrently. All the influenza viruses characterised to date at the HPA Respiratory Virus Laboratory are similar to the influenza viruses contained within this year s seasonal influenza vaccination. In the post-pandemic period, surveillance of deaths associated with flu infection was no longer required, and monitoring of deaths reverted to the pre-pandemic arrangement, where deaths registered with certain keywords that may be related to respiratory illness are monitored. This method gives a fuller overall picture of the mortality that may be attributable to respiratory viruses. However, reporting of deaths of people with confirmed influenza was re-introduced in early January 11. To date, the PHA have received reports of the deaths of 29 people who had confirmed influenza A (H1N1) 9. Twenty seven of these people were adults. All but two had underlying conditions, the vast majority of which would place them in at-risk categories. This season, adults in at-risk categories, and therefore included in the routine programme, have been at much greater risk of severe outcomes from flu than the general population. There were also a substantial number of patients with influenza A (H1N1) 9 who required admission to intensive care. This put pressure on ICU capacity, meaning that escalation measures were required. This, however, was successful in managing demand. Pregnant women also remain particularly susceptible to developing complications from influenza A (H1N1) 9 infection. Flu vaccination is of course the most effective measure we have to control flu. Circulating strains of flu this year have been well matched to the vaccine strains, with little change to H1N1 9 detected. The vaccination rates reported in this issue reflect the hard work of GP practices and Health and Social Care Trusts (HSCTs), and are very welcome. It remains a challenge to increase the acceptability of flu vaccination, further improve uptake rates and complete vaccination before the onset of the flu season. The PHA consistently urged those in the relevant at-risk groups to seek vaccination: The Chief Medical Officer also wrote to clinicians regarding the management of patients presenting with severe or complicated influenza or flu-like illness during the winter: Page 2

3 The PHA seasonal influenza bulletin is currently being issued on a weekly basis and can be accessed from the PHA website: The bulletin can also be accessed through the Flu Aware website developed by the PHA at: A full summary of this year s flu season will be included in a future issue. Seasonal influenza vaccination programme: December update The seasonal influenza vaccination programme commenced in October. Interim reports on provisional vaccine uptake figures are collected monthly during the winter programme period. As at the end of December, the proportion of people in Northern Ireland aged 65 years and over who had received the /11 seasonal influenza vaccine was 69.8%, while uptake in the under 65 at-risk group was 62.7% (provisional data). This compares with 77% uptake in those aged 65 years and over, and 81.8% in the under 65 at-risk group, for the same period last year. The PHA is aware that there was further vaccine delivery in January 11, which will be reflected in future reports. Healthcare associated infections (HCAI) team update In April 8, the Modernisation and Improvement Programme Board (MIPB) of the DHSSPS set out the roles and responsibilities of each new organisation formed under phase two of the Review of Public Administration (RPA). The PHA has responsibility for service improvement in the areas of health protection (HP), health improvement and screening. The Health and Social Care Board (HSCB) has responsibility for performance monitoring of progress towards standards and targets, working closely with the PHA in the areas for which the PHA has lead responsibility. Within this context, the HCAI team within the PHA s health protection service works in partnership with organisations across health and social care. The central themes of the HCAI team s work are that: infection prevention and control (IPC) is an integral part of safe healthcare; infection prevention and control is everyone s business. The responsibilities of the HCAI team include: implementation of DHSSPS policy on HCAIs (Changing the Culture ); progressing work on other/additional interventions to reduce and prevent HCAIs, including work on environmental cleanliness; providing support to HSCTs as required to embed processes and achieve required outcomes in respect of HCAI reduction; providing support to the HSCB for performance management of HSCTs in achieving ministerial targets relating to HCAIs; providing HP/IPC service and support to primary and community settings, including nursing and residential homes; provision of advice and expert knowledge to the DHSSPS on policy relating to HCAI reduction and prevention; reporting progress and being accountable to the DHSSPS for implementation of HCAI policy and achievement of HCAI reduction targets. Team members Dr Lourda Geoghegan, Consultant in Health Protection, Team Lead. Ms Caroline McGeary, Senior HP/IPC Nurse, Nursing Lead. Ms Annette O Hara, HP/IPC Nurse, Southern LCG area. Ms Alison Quinn, HP/IPC Nurse, Western LCG area. Ms Hilda Crookshanks, HP/IPC Nurse, Belfast LCG area. Ms Geraldine Reid, HP/IPC Nurse, South Eastern LCG area; HP/IPC nursing service in partnership with Northern HSCT, Northern LCG area. Dr Lynsey Patterson, Epidemiological Scientist, CDI and SA (HCAI) and AMR. Mr Gerry McIlvenny, Information Manager, SSI and ICU Surveillance. Ms Gillian Smyth, Surveillance Information Officer, CDI and SA (HCAI). Ms Eileen Morelli, Surveillance Information Officer, SSI and ICU Surveillance. Ms Alison McCusker, Surveillance Information Assistant, SSI and ICU Surveillance. Page 3

4 While individual HCAI team members have different roles and responsibilities within the HCAI team, and also within the health protection service, the HCAI team works on a regional basis and provides cross-cover for all incidents/outbreaks/service areas as required. Contact details for the HCAI team are listed below contact is made through the health protection duty room. Individual team members may also be contacted directly regarding continuing and/or non-urgent HP/IPC matters ( firstname.surname@hscni.net). Health protection duty room: Mon Fri (9am to 5pm) Tel: or Fax: pha.dutyroom@hscni.net Areas of focus 11/12 The HCAI team is currently working in partnership with the HSCB to draft and agree a HCAI action plan for primary and community care settings. This plan will address the nursing and residential home sector, general medical and dental practices/service providers, and community pharmacies. It is envisaged the action plan will be finalised and available by the end of March 11. The HP/IPC nursing service within the HCAI team has been enhanced during /11. The team provides HP/IPC service support to the nursing and residential home sector, providing facility visits, supported risk assessment and management for HCAI incidents/outbreaks, and site specific training and education. The nursing team is also in the midst of rolling out regional training sessions relating to the cleanyourhands hygiene campaign and best practice for CDI management. During 11/12, the HCAI team plans to establish and develop systems to support best HP/IPC practice in primary care settings. This work will form part of the roll-out of the HCAI action plan for primary and community care settings. The team will continue to support HSCTs, with HCAI improvement work ongoing. In particular, the team will provide advice and support through partnership working with HSCTs who are not on, or are moving away, from their expected trajectory for HCAI reduction as set out in ministerial performance targets. The HCAI team also provides support to the HSCB for performance management of HCAI reduction targets. This is achieved through provision of comprehensive surveillance information/data used to underpin HCAI improvement across health and social care. The team also provides intelligence to support assessment of progress towards achievement of HCAI reduction targets. During 11/12, the HCAI team will continue to lead (as appropriate) HCAI incidents/outbreaks arising in primary and community care settings. Team members will also continue to contribute (as appropriate) to the risk assessment and management of HCAI incidents/ outbreaks arising in acute care environments. The HCAI team (in conjunction with the health protection surveillance team) delivers all regional HCAI surveillance programmes. This includes programmes for C. difficile, S. aureus, surgical site (orthopaedic, C-section, cardiac and neurosurgery) and intensive care surveillance. During 11/12, our ICU surveillance programme will be transitioned from paper-based to electronic systems through partnership working with the Critical Care Network (CCaNNI) and ICU clinical staff. Our programme of enhanced surveillance of CDI cases resident in community settings through the health protection duty room will be maintained. Regular feedback from this programme will now be included in quarterly CDI surveillance reports. Page 4

5 Quarterly reporting of MRSA and CDI episodes The following tables are taken from the PHA quarterly S. aureus and C. difficile reports for October December. The full reports can be found at: These reports are based on data extracted from the Northern Ireland HCAI web-based system, which is validated by the HSCTs on a quarterly basis. MRSA in quarter four MRSA rates in quarter four decreased by approximately 16% compared to quarter three (Table 1). MRSA rates decreased below the lower action limit for Northern Ireland, supporting a statistically significant reduction in MRSA rates during quarter four. Table 1: Quarterly number and rate of MRSA patient episodes, July December Jul Sep Oct Dec Episodes Rate Episodes Rate Belfast HSCT Northern HSCT South Eastern HSCT Southern HSCT Western HSCT Northern Ireland total CDI in quarter four CDI reports for hospital inpatients aged 65 years and over decreased by 16% (17 episodes) compared to quarter three. CDI rates decreased by 21%. CDI reports for community patients aged 65 years and over increased by % (nine episodes) compared to quarter three. Total CDI reports, for hospital inpatients and community patients combined aged two years and over, decreased by 4% (Table 2). Table 2: Quarterly number and rate of C. difficile episodes in patients aged two years and over, July December Jul Sep Oct Dec Episodes Rate Episodes Rate Belfast HSCT Northern HSCT South Eastern HSCT Southern HSCT Western HSCT Northern Ireland total Northern Ireland community total Page 5

6 Meningococcal disease in Northern Ireland Following the introduction of the MenC vaccine, the majority of meningococcal disease in Northern Ireland is now caused by Neisseria meningitidis 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 are 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 HPA Meningococcal Reference Unit (MRU) in Manchester, and mortality data based on death certificates from the Northern Ireland Statistics and Research Agency (NISRA). Meningococcal disease summary There were 69 cases of invasive meningococcal disease (IMD) notified in, giving a Northern Ireland rate of 3.9/, population. Of the 69 notifications, 37 (54%) were laboratory confirmed (Figure 2). Serogroup B accounted for 92% (34/37) of confirmed cases in. There was one case of serogroup Y and an additional two cases were confirmed but were non-groupable for IMD. Three IMD deaths occurred in, giving a case fatality ratio of 4.3% compared with 5.4% in 9. The incidence rate of IMD in Northern Ireland during was lower than in 9 (4.1/,) at 3.9 cases per, population. Figure 2: Number of notified and confirmed cases of IMD, and overall rates per, population in Northern Ireland, by year 2 All notifications Confirmed cases All cases rate/, Number of notified cases Rate per, population Year N. meningitidis serogroup B was the predominant pathogen, accounting for 92% (34/37) of all cases confirmed in. Since 2, serogroup B has accounted for more than 8% of all laboratory confirmed cases (Figure 3). In, there were no cases of serogroup C. Of the remaining three confirmed cases, one was serogroup Y and two were non-groupable. Page 6

7 Figure 3: Laboratory confirmed cases of IMD in Northern Ireland, by serogroup and year 16 Others Group C Group B 1 1 Number of cases Year Source: CDSC, October Consistent with previous years, age-specific incidence during 9 was highest in infants and young children (Figure 4). Ages ranged from one month to 8 years, with a median of two years. There were three IMD-associated deaths during, giving a case fatality rate (CFR) of 4.3% (3/69), compared with a CFR of 5.4% (4/74) in 9. All three cases were confirmed as serogroup B. Two of the cases were in the 4 years age group and one case was in the 5 14 years age group. Figure 4: Age-specific incidence rates of IMD in Northern Ireland, 8 Age-specific incidence rate per, population Age-groups Page 7

8 Change to the childhood immunisation schedule vaccinations at 12 and 13 months of age (MMR, PCV 13 and Hib/MenC) HSS(MD)4/11, available at: From 1 April 11, vaccines currently given at 12 and 13 months of age in Northern Ireland (MMR, PCV 13 and Hib/MenC) should be given at the same visit, between 12 and 13 months of age. The aim should be to give it just after the first birthday. Carbon monoxide poisoning: ongoing vigilance to ensure recognition and prevention HSS MD 45/, available at: This letter contains useful information about the risks of carbon monoxide poisoning, how to avoid them, and how to recognise those affected. It includes information on: the web-based resource for the public, prepared by the DHSSPS, entitled Carbon monoxide: are you at risk?, which you can share with patients and is available at: the main sources in the home that can pose a risk of carbon monoxide exposure; the signs and symptoms that might suggest exposure in your patients, and the recently circulated PHA algorithm, which is available at: the Health and Safety Executive for Northern Ireland s carbon monoxide campaign website, available at: watchout.hseni.gov.uk/index how cases should be managed. Further information for health professionals and other agencies: Health protection duty room Public Health Agency 4 th Floor Linenhall Street Belfast BT2 8BS Tel: or pha.dutyroom@hscni.net Published by the Public Health Agency, Ormeau Avenue Unit, 18 Ormeau Avenue, Belfast BT2 8HS. Tel: Textphone/Text Relay: Page 8