Cheshire & Merseyside Health Protection Unit

Transcription

1 Cheshire & Merseyside Health Protection Unit HEALTH PROTECTION Epidemiology Report 2009 Health Protection Agency

2 Acknowledgements We would like to acknowledge the contributions and support from the staff at the Cheshire & Merseyside Health Protection Unit (HPU). Particular mention goes to Alex Keenan who as our epidemiology and surveillance analyst has produced all tables and graphs. This is also an opportunity to express our appreciation of our professional and clinical colleagues and also our partner agencies who work with us in investigating and controlling communicable diseases, and in responding to chemical and other environmental hazards. These agencies include: Local Authorities Primary Care Trusts Hospital or Specialist NHS Trusts and the Strategic Health Authority Ambulance Service Environment Agency United Utilities Fire & Rescue Services CHaMPs (Cheshire & Merseyside Public Health Network) Health & Safety Executive The HPU has particularly close working arrangements with Directors of Public Health and staff in Primary Care Trusts (PCTs) and we are very grateful for their collaboration. HPU team members work day-to-day with environmental health officers, infection control and TB nurses, microbiologists and scientists to investigate and control infectious diseases. We are also delighted to work closely with the Police, Fire & Rescue services, Ambulance services and local authorities in developing the emergency planning and response systems. We have established good links with those assessing chronic environmental problems, particularly with local authority officers involved in pollution, and also with colleagues in the Environment Agency. We receive highly specialised expert advice and support from our Health Protection Agency colleagues in regional epidemiology units and in local microbiology laboratories, as well as in our regional and national HPA Centres for infection, radiation, chemical and environmental hazards, and emergency preparedness and response. We would like to acknowledge the high level of commitment and valued contributions and support from our own administrative and professional staff in the Cheshire & Merseyside Health Protection Unit. Maintaining our databases of cases and incidents requires strong commitment and attention to detail. 2

3 Executive Summary The Cheshire & Merseyside Health Protection Unit receives notifications and reports from doctors and laboratories, and a range of requests for assistance from many other sources. The main priority is to handle public health risk from notifiable infections and to investigate and ensure control of communicable disease outbreaks. We investigate each case thoroughly in partnership with local professionals in each PCT or local authority and we are very appreciative of the teamwork with microbiologists, environmental health officers, infection control nurses, community TB nurses and many others. A variety of other health protection problems were also reported and investigated with other agencies, such as chemical incidents, drinking water and other environmental hazards. A short commentary is made below on some of the key challenges in Meningococcal Infection There were 99 Meningococcal infections reported (both official and unofficial notifications) in 2009, compared with 109 in Of those that were Laboratory confirmed, 94% were Group B infections (compared to 98% in 2008). Due to the introduction of the successful Men C immunisation programme in 1999, the number of Meningococcal Group C infections are now extremely low (1 in 2009 and 0 in 2008) not only in those vaccinated, but also in older age groups (due to herd immunity). Respiratory Illnesses The number of reports (both official and unofficial notifications) of TB infection in 2009 (excluding atypical mycobacteria) was 115, of these 45 (39%) were reported from the Liverpool area. TB is still an important public health challenge and remains high in urban areas. All cases and their close contacts are investigated and tested to assess if any other household members or others have been infected or may be a source of infection. Although most of the TB cases in the Cheshire and Merseyside area are reported in people of UK origin, there is also a need for increased awareness of both primary and secondary care clinicians of those who are born outside the UK or have social links with high prevalence countries ( 40 per ). Legionella infection remains uncommon and numbers vary from year to year, with 9 reports (both official and unofficial notifications) in 2009 and 10 in Travel abroad is a common risk factor for Legionnaires disease, and the number of cases with no travel history are fully investigated and a risk assessment undertaken by the HPU. 3

4 Gastrointestinal Illness Campylobacter remains the most common cause of food poisoning with 2348 laboratory confirmed reports received during Salmonella infections are common (392 confirmed laboratory reports during 2009). Salmonella outbreaks are investigated in line with the agreed outbreak control plan, i.e. in collaboration with local authorities and PCTs. In 2009, the HPU investigated and managed a large Salmonella outbreak (PT 5c) associated with a large community gathering. E. coli O157, although uncommon (29 laboratory confirmed reports received during 2009), is a very serious infection which commonly leads to Haemolytic Uraemic Syndrome (HUS) in children under the age of 10 years. All cases are thoroughly investigated by the HPU using a standard national questionnaire and every effort is made to ensure protection of high risk groups and facilities. Vaccine Preventable Diseases: Mumps is one of the most common vaccine preventable diseases that affects children and young adults. In 2009 there were 1274 reports (both official and unofficial notifications) compared to 6073 in Mumps is an important public health problem and continued effort is needed to protect children and young people as it can lead to serious complications in a small number of children. The impact of mumps on primary and secondary care staff in relation to consultation time, undertaking investigation (including laboratory diagnosis) and providing advice should not be underestimated. The key to population protection is to ensure children are fully immunised with 2 doses of the MMR vaccine. Measles There were 282 reports (both official and unofficial notifications) received in 2009 compared to 336 in 2008 (which was largely due to an outbreak in Cheshire). Of the 282 reports, salivary tests were performed on 180, and 25 were positive for measles. There is a national concern with regard to the re-emergence of measles which is due to low MMR uptake rates. Whooping Cough The HPU maintains strong vigilance and seeks to prevent its transmission to vulnerable close contacts. The HPU received 66 reports (both official and unofficial notifications) during 2009 compared to 81 in Healthcare Associated Infections MRSA the number of patients with MRSA (bacteraemia) has significantly reduced from a high of 361 in 2004/05 to 157 in 2008/09 (57% reduction) across Cheshire and Merseyside hospitals. Although the figures vary between trusts, and there is still a lot to be done, overall all trusts have implemented comprehensive infection control measures to achieve these figures. 4

5 Clostridium Difficile The figures for C. difficile has also shown a significant drop from 3592 in 2007/08 to 2256 in 2008/09 (37% reduction). However there are still continuing concerns about persistent high levels of diarrhoeal disease associated with C difficile infections in both community and hospital settings. The HPU continues to support both PCTs and acute trusts in the investigation and management of C. difficile outbreaks. Sexually Transmitted Infections and HIV HIV The numbers of new cases of HIV in Cheshire and Merseyside has increased from 199 in 2008 to 209 in This is mainly due to an increase in the number of cases attributed to heterosexual transmission. Syphilis data from GUM clinics shows a decrease from 76 cases in 2008 to 53 in 2009 across Cheshire and Merseyside. Gonorrhoea data from GUM clinics shows a decrease from 707 cases in 2008 to 456 in 2009 across Cheshire and Merseyside. However these figures are still high, indicating the need for strengthening public health interventions. Chlamydia data from GUM clinics shows a decrease from 4736 cases in 2008 to 3560 in 2009 across Cheshire and Merseyside. However the national trend is on the increase and the local data is difficult to interpret as testing for chlamydia varies between clinics. Hepatitis B Hepatitis B The number of laboratory confirmed acute hepatitis B infections decreased from 38 in 2008 to 24 in 2009 (27% reduction). The figures indicate that most cases occur in the age groups, accounting for more than 40% in All cases are investigated by the HPU in collaboration with partner organisations, and advice given on prevention of onward transmission to their close contacts. Vaccination with hepatitis B vaccine to those at risk is an important public health measure in the UK. Travel Related Infections Dysentry (includes Shigella, E. Histolitica) More than 45% of cases reported (both official and unofficial notifications) in 2009 had a history of travel outside the UK during the incubation period. Food Poisoning (includes E. Coli, Salmonella, Campylobacter etc.) In 2009, 318 (11%) reported cases (both official and unofficial notifications) had a history of travel outside the UK during the relevant incubation period. Cryptosporidium & Giardia Lamblia In 2009, 14% and 15% of all reported cases (both official and unofficial notifications) respectively had a history of travel outside the UK during the incubation period. 5

6 Legionella Of the 8 laboratory confirmed cases reported in 2009, 3 (38%) had a history of travel outside the UK during the incubation period. Malaria All 3 cases reported in 2009 were travel related as would be expected. Environment Related Incidents & Situations Chronic Environmental Issues The HPU, in collaboration with partner agencies, investigated and managed 77 chronic environmental issues in 2009, with work on many of these ongoing. Of these, 30 (39%) relate to contaminated land queries. Investigations around these will include assessing risk to human health, in partnership with HPA toxicology specialists. Acute Environmental Issues Public health assessments of acute chemical and other environmental incidents, such as discoloured water, are again undertaken with full collaboration with partner agencies. On occasions some large fires may give rise to community concern and are also assessed to rule out significant health hazards. Emergency Planning Emergency Planning We regularly review our preparedness for dealing with health protection incidents and exercise our emergency plans in collaboration with our NHS and other Civil Contingency partners. This also involves a debrief meeting and identification of lessons learned from actual incidents to inform our plans. COMAH Sites There are a large number of top-tier COMAH sites in Cheshire and Merseyside, i.e. in addition to other lower-tier sites for chemical industries, which pose particular challenges for C&M HPU. Exercises In 2009, we took part in a wide range of emergency planning exercises (15) with partner agencies to test our major incident plans, and specific scenarios or contingencies, in order to fulfil our statutory duties under the Civil Contingencies Act 2004 and other relevant legislations. Dr. Sam Ghebrehewet CCDC and Interim HPU Director Cheshire & Merseyside Health Protection Unit December

7 List of Figures Figure 1 Meningococcal Reports by Age, Cheshire & Merseyside, 2005 to 2009 Figure 2 Figure 3 Figure 4 Rate of Meningococcal Reports per Population by PCT 2009 Meningococcal Reports by Group, Cheshire & Merseyside, 2005 to 2009 Meningococcal Reports per Population by PCT, Cheshire & Merseyside 2005 to 2009 Figure 5 All TB Reports by Age, Cheshire & Merseyside 2005 to 2009 Figure 6 Reports of TB (Non Atypical) by Age, Cheshire & Merseyside 2005 to 2009 Figure 7 All Reports of TB by PCT, Cheshire & Merseyside 2005 to 2009 Figure 8 Reports of TB (Non Atypical) by PCT, Cheshire & Merseyside 2005 to 2009 Figure 9 All Reports of TB by Ethnic Group, Cheshire & Merseyside 2005 to 2009 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Reports of TB (Non Atypical) by Ethnic Group, Cheshire & Merseyside 2005 to 2009 Reports of Onset Date of Legionella by Month, Cheshire & Merseyside 2005 to 2009 Reports of Legionella by Age, Cheshire & Merseyside 2005 to 2009 Reports of Legionella by PCT, Cheshire & Merseyside 2005 to 2009 Reports of Legionella by Travel Association (where travel noted), Cheshire & Merseyside 2005 to 2009 Figure 15 Campylobacter Reports by Week, Cheshire & Merseyside 2005 to

8 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21 Figure 22 Figure 23 Figure 24 Campylobacter Reports per Population by PCT, Cheshire & Merseyside 2005 to 2009 Rate of Campylobacter Reports by PCT, Cheshire & Merseyside 2009 Salmonella Reports by PCT, Cheshire & Merseyside 2005 to 2009 Salmonella Serogroup Reports by Year, Cheshire & Merseyside 2005 to 2009 Salmonella Enteritidis Reports by Phage Type and Year, Cheshire & Merseyside 2005 to 2009 Salmonella Reports by Week, Cheshire & Merseyside 2005 to 2009 E. Coli O157 Reports by PCT and Year, Cheshire & Merseyside 2005 to 2009 E. Coli O157 Reports by Week, Cheshire & Merseyside 2005 to 2009 E. Coli O157 Reports by Age Group, Cheshire & Merseyside 2005 to 2009 Figure 25 Gastroenteritis Outbreaks by PCT, Cheshire & Merseyside 2005 to 2009 Figure 26 Gastroenteritis Outbreaks by Month, Cheshire & Merseyside 2009 Figure 27 Mumps Reports by PCT, Cheshire & Merseyside 2005 to 2009 Figure 28 Figure 29 Figure 30 Figure 31 Influenza Vaccination Uptake Rate Age 65 and Over by PCT, Cheshire & Merseyside 2008 / 2009 MRSA Reports of Bacteraemias, Cheshire & Merseyside Acute Trusts, April to March 2002 to 2009 Number of C. difficile Reports for Patients Aged 65 Years and over, Cheshire & Merseyside Acute Trusts April 2004 to 2009 New Cases of HIV Infections, Cheshire & Merseyside 1996 to

9 Figure 32 Figure 33 Figure 34 Figure 35 Figure 36 Figure 37 Figure 38 New Cases of HIV by Transmission Route, Cheshire & Merseyside 1996 to 2009 New Diagnoses of Syphilis, Cheshire & Merseyside 1995 to 2009 New Diagnoses of Gonorrhoea, Cheshire & Merseyside 1995 to 2009 New Diagnoses of Chlamydia, Cheshire & Merseyside 1995 to 2009 Reports of Hepatitis B per Population by PCT, Cheshire & Merseyside 2005 to 2009 Reports of Hepatitis B per Population by Age Band, Cheshire & Merseyside 2005 to 2009 Hepatitis B Reports by Week of Notification, Cheshire & Merseyside 2005 to 2009 Figure 39 Acute Incidents by Incident Type, Cheshire & Merseyside 2009 Figure 40 Acute Incidents by PCT and Incident Location, Cheshire & Merseyside

10 List of Tables Table 1 Table 2 Table 3 Table 4 Table 5 Table 6 Table 7 Table 8 Table 9 Table 10 Table 11 Number of Meningococcal Reports by PCT for Cheshire & Merseyside Number of All TB Reports by PCT for Cheshire & Merseyside 2005 to 2009 Number of TB Reports excluding Atypical TB Reports by PCT for Cheshire & Merseyside 2005 to 2009 Number of Legionella Reports by PCT, Cheshire & Merseyside 2005 to 2009 Number of Campylobacter Reports by PCT, Cheshire & Merseyside 2005 to 2009 Number of Salmonella Reports by PCT, Cheshire & Merseyside 2005 to 2009 Number of E. Coli O157 Reports by PCT, Cheshire & Merseyside 2005 to 2009 Number of Mumps Reports by PCT, Cheshire & Merseyside 2005 to 2009 Influenza Percentage of Vaccine Uptake Age 65 and over by PCT, Cheshire & Merseyside 2008 / 2009 Number of Hepatitis B Reports by PCT, Cheshire & Merseyside 2005 to 2009 Number and Percentage of Infectious Diseases Reporting Travel Outside the UK as a Risk Factor, Cheshire & Merseyside 2009 Table 12 Reported Chronic Environmental Hazards, Cheshire & Merseyside 2009 by Incident Type Table 13 Reported Chronic Environmental Hazards, Cheshire & Merseyside 2009 by PCT Table 14 Acute Chemical Incidents by Incident Type, Cheshire & Merseyside

11 Table 15 Acute Chemical Incidents by PCT, Cheshire & Merseyside 2009 Table 16 Emergency Planning Exercises in Cheshire 2009 Table 17 Emergency Planning Exercises in Merseyside

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13 Figure 2 : Rate of Meningococcal Reports per Population by PCT

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15 Table 1 : Number of Meningococcal Reports by PCT for Cheshire & Merseyside PCT Sefton Wirral Liverpool Knowsley Halton & St. Helens Warrington Western Cheshire Central & Eastern Cheshire Total

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17 Table 2 : Number of All TB Reports by PCT for Cheshire & Merseyside 2005 to 2009 PCT Sefton Wirral Liverpool Knowsley Halton & St. Helens Warrington Western Cheshire Central & Eastern Cheshire Total Table 3 : Number of TB Reports excluding Atypical TB Reports by PCT for Cheshire & Merseyside 2005 to 2009 PCT Sefton Wirral Liverpool Knowsley Halton & St. Helens Warrington Western Cheshire Central & Eastern Cheshire Total

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28 Table 4 : Number of Legionella Reports by PCT Cheshire & Merseyside 2005 to 2009 PCT Sefton Wirral Liverpool Knowsley Halton & St. Helens Warrington Western Cheshire Central & Eastern Cheshire Total

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30 30

31 Figure 17 : Rate of Campylobacter Reports by PCT, Cheshire & Merseyside,

32 Table 5 : Number of Campylobacter Reports by PCT, Cheshire & Merseyside 2005 to 2009 PCT Sefton Wirral Liverpool Knowsley Halton & St. Helens Warrington Western Cheshire Central & Eastern Cheshire Total

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36 Table 6 : Number of Salmonella Reports by PCT, Cheshire & Merseyside 2005 to 2009 PCT Sefton Wirral Liverpool Knowsley Halton & St. Helens Warrington Western Cheshire Central & Eastern Cheshire Total

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41 Table 7 : Number of E. Coli O157 Reports by PCT, Cheshire & Merseyside 2005 to 2009 PCT Sefton Wirral Liverpool Knowsley Halton & St. Helens Warrington Western Cheshire Central & Eastern Cheshire Total

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45 Table 8 : Number of Mumps Reports by PCT, Cheshire & Merseyside 2005 to 2009 PCT Sefton Wirral Liverpool Knowsley Halton & St. Helens Warrington Western Cheshire Central & Eastern Cheshire Total

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47 Table 9 : Influenza - Percentage Vaccine Uptake Age 65 and over by PCT, Cheshire & Merseyside 2008 / 2009 PCT 2008 / 2009 Sefton 76 Wirral 76 Liverpool 73 Knowsley 76 Halton & St. Helens 75 Warrington 75 Western Cheshire 75 Central & Eastern Cheshire 78 47

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57 Table 10 : Number of Hepatitis B Reports by PCT, Cheshire & Merseyside 2005 to 2009 PCT Sefton Wirral Liverpool Knowsley Halton & St. Helens Warrington Western Cheshire Central & Eastern Cheshire Total

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59 Table 11 : Number and Percentage of Infectious Diseases Reporting Travel Outside the UK as a Risk Factor, Cheshire & Merseyside 2009 Total Reports Outside UK % Outside UK Travel Travel Cryptosporidium Dysentery Food Poisoning Giardia Lamblia Legionella Malaria Viral Hepatitis

60 Table 12 : Reported Chronic Environmental Hazards, Cheshire and Merseyside 2009 by Incident Type Incident Type 2009 Airborne Release 25 Contaminated Land 30 Discoloured Water 0 Explosion 0 Fire 0 Food & Drink 1 Land Release 0 Leak 0 Malicious Act 0 Water Incident 4 Spill 0 Unknown 0 Other 17 Total 77 Table 13 : Reported Chronic Environmental Hazards, Cheshire and Merseyside 2009 by PCT PCT 2009 Sefton 5 Wirral 2 Liverpool 4 Knowsley 8 Halton & St Helens 18 Warrington 21 Western Cheshire 6 Central & Eastern Cheshire 13 Total 77 60

61 Table 14 : Acute Chemical Incidents by Incident Type, Cheshire & Merseyside, 2009 Incident Type 2009 Airborne Release 0 Contaminated Land 1 Discoloured Water 10 Explosion 0 Fire 2 Food & Drink 1 Land Release 0 Leak 3 Malicious Act 1 Water Incident 1 Spill 3 Unknown 0 Other 1 Total 23 Table 15 : Acute Chemical Incidents by PCT Cheshire & Merseyside 2009 PCT 2009 Sefton 3 Wirral 2 Liverpool 3 Knowsley 0 Halton & St Helens 1 Warrington 2 Western Cheshire 6 Central & Eastern Cheshire 6 Total 23 61

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64 C&M HPU Support to Emergency Planning Exercises, Cheshire & Merseyside, 2009 Table 16: Emergency Planning Exercises in Cheshire 2009 DATE EXERCISE TYPE February 09 LRF Black Start Table Top February 09 Crypto Outbreak Regional Workshop October 09 LRF Trinity 2 Table Top October 09 LRF Checkmate 1 Table Top November 09 LRF Checkmate 1 Table Top 64

65 Table 17 : Emergency Planning Exercises in Merseyside 2009 DATE EXERCISES TYPE February 09 University Hosp Aintree Table Top February 09 COMAH Exercise Live FLOGAS March 09 Merseyside Police Table Top Disaster Victim ID March 09 COMAH Exercise Table Top PENTAGON April 09 St Helens MBC Table Top Ex Argonaut June 09 COMAH Exercise Live BAKER PETROLITE August 09 NHS Flu Pandemic Table Top Exercise Napoleon September 09 Liverpool City Council Workshop Cruise Liner Exercise October 09 COMAH Exercise Live SHELL TRANMERE December 09 LRF Exercise Athena Regional Workshop 65