Communicable Disease Update: Vol. 17 (1), February 2018

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1 Communicable Disease Update: Vol. 17 (1), February 2018 Authors Health Service Executive (HSE) South (South East), Department of Public Health Publisher Health Service Executive (HSE) South (South East), Department of Public Health Download date 11/10/ :10:28 Link to Item Find this and similar works at -

2 Volume 17 Issue 1, Feb 2018 In this Issue The risk of spread of infection from animals to humans: farmers knowledge and their transmission prevention practices Page 1 2 It s not too late Get the flu vaccine Practical guidance for healthcare workers on HIV PrEP in Ireland Page 3 Immunisation uptake tables Page 4 Summary of infectious disease notifications Page 4 Editorial Team Dr. John Cuddihy Director of Public Health Dr. Marrita Mahon Ms. Bernadette O Connor Dr. Colette O Hare Administrator Ms. Catherine Moylan Catherine.Moylan@hse.ie Infectious disease notifications can be sent to: Public Health Department HSE South (SE) Lacken Dublin Road Kilkenny Tel.: Fax: Data were provided by University Hospital Waterford Laboratory, Senior Medical Officers, Communicable Disease Control Nurses, General Practitioners, Hospital Clinicians, Environmental Health Officers, and the STI Clinic. The risk of spread of infection from animals to humans: farmers knowledge, and their transmission prevention practices Of all human pathogens, 60% are zoonotic, i.e. infections that are naturally transmissible from vertebrate animals to humans. The One Health approach recognises that the health of people is connected to the health of animals, and the health of the environment. Zoonoses are transmitted by ingestion, bite, scratch, inhalation or skin contact. Indirect transmission of zoonotic gastrointestinal pathogens has been documented in outbreak settings, with illness being associated with contact with contaminated clothing or shoes, animal bedding, flooring, barriers, and other environmental surfaces. Farmers, because of their work with livestock, in an environment often contaminated with animal faeces or by-products, may be at higher risk for zoonotic disease. Other members of farming households, even if not working on the farm, may also be at higher risk through direct and indirect contact with animals. This is a summary of the findings from a study published in the Journal of Epidemiology and Infection last year [1]. It was a pen and paper survey to ascertain farmers knowledge of the risk of spread of infection from animals to humans, and their transmission prevention practices. It was a survey of 1,044 farmers who submitted material to Ireland's Regional Veterinary Laboratories in 2015, with an 84% response rate. The age of the respondents ranged from 12 to 91 years, with a mean age of 46 years. More than 90% were male. A variety of farming types were reported. Ninety percent of farmers did not know that healthy animals may be a source of infection for themselves or family members. Over half did not realise that disease can be contracted from sick poultry or pets. On the other hand, farmers knowledge of the risk to pregnant women of infection from birthing animals was high (88%). Younger farmers (<45 years) were more likely than older farmers (45+ years) to know what a zoonosis is, that one can catch an infection from healthy animals, from sick poultry, and from pets. Older farmers were more likely than younger farmers to identify aborting animals as a source of infection.

3 Ninety three percent of respondents reported washing their hands before eating or smoking while on the farm. Younger farmers were less likely than older farmers to wash their hands before eating or smoking on the farm, after handling sick animals and, in the morning and evening. One-third of respondents reported that they did not wear a boiler- suit/ wet-gear while working. Of those who did, almost onequarter did not remove it on entering the home. The Environmental Protection Agency recommends annual testing of private well water for bacterial contamination. In our survey, almost three-quarters of farmers reported sourcing their drinking water from a private well. Of these farmers, 62% tested their water less frequently than once a year. Approximately 40% of dairy farmers surveyed drank unpasteurised milk once a week or more frequently, indicating that dairy farmers continue to potentially expose themselves, and their families, unnecessarily, to pathogenic organisms in their milk. Most respondents accessed information on diseases on the farm from multiple sources. The most common information sources were the veterinary practitioner, newspapers, Teagasc (the Agriculture and Food Development Authority) and the Department of Agriculture, Food and the Marine. Consistent, thorough hand hygiene is the single most important measure that can be taken to reduce the risk of disease transmission, most particularly gastrointestinal infections but also respiratory tract and skin infections. The Food Safety Authority of Ireland recommends that farm work clothes or footwear are not worn in the home because they can spread E. coli. Consumption of unpasteurised milk or untreated water may also put farmers and their families at risk of contracting zoonotic infection. Unpasteurised (raw) milk can carry harmful bacteria such as Campylobacter, Listeria, Brucella, Mycobacterium bovis, Salmonella, Verotoxigenic E. coli (VTEC). The significant infection risks associated with the consumption of raw milk or raw milk derived products are well documented internationally. Half of Irish agricultural households get water from a private source. This contrasts with private well ownership in Ireland generally, which is about 10%. Well water can be vulnerable to contamination, particularly if the well is not properly constructed or protected. The Environmental Protection Agency (EPA) has reported that 25% of groundwater supplies in Ireland are contaminated with faecal coliforms. The results illustrate the need for further education, in plain language, to increase the awareness of potential biohazards on farms, and practical measures that can be taken to mitigate the risk of zoonotic infection. The fact that most farmers accessed information on diseases on the farm from multiple sources, suggests that a multi-faceted, One Health approach to infectious disease prevention in the farming community is merited. Evidence shows that building partnerships with agencies providing services in rural communities and trusted sources of information for the target population (e.g. farmer and country women s organisations, government departments, financial organisations etc.), to provide information and training are effective ways of engaging with health promotion activities in farming and rural communities. The Health Service Executive (HSE), with Department of Agriculture and Local Authority Veterinarians undertake health education and promotion activities directed at farmers throughout the year. The results of the survey have been published in Epidemiology and Infection [1] and presented at international public health and veterinary conferences. Posters and leaflets with advice about handwashing, protective clothing, pasteurising milk and private well water have been developed and will be distributed to Teagasc, the RVLs and farming Organisations. [1] Mahon M, Sheehan M, Kelleher P, Johnson A, Doyle S. Epidemiology and Infection 2017; 145: By Sarah Doyle, Consultant in Public Health Medicine & Marrita Mahon,

4 It s not too late -Get the flu vaccine In January, the number of cases of flu notified to the HSE South East Department of Public Health increased significantly. The number of people hospitalised, and the number consulting their GP, with flu also increased. Flu is expected to actively circulate in the community for the next four weeks at least. However, it is not too late for people in at risk groups to get the flu vaccine from their GP or pharmacist. The flu vaccine is the best way to protect yourself and those you care about from the flu. Flu is responsible for between 200 and 500 deaths each year in Ireland. Flu can cause serious complications such as pneumonia, and worsening of underlying illness especially in those in at risk groups including those aged 65 and older, those with long term medical conditions and pregnant women. The flu vaccine is a safe, effective way to prevent these flu related illnesses and deaths. For further information regarding the flu vaccine please see Practical guidance for healthcare workers on HIV pre-exposure prophylaxis (PrEP) in Ireland The HSE Sexual Health and Crisis Pregnancy Programme (SHCPP) and HIV PrEP Working Group, have developed practical guidance on HIV PrEP [1] to guide healthcare professionals who are seeing patients who may already be buying PrEP from the internet, are making enquiries about PrEP or are deemed suitable candidates for PrEP and who may wish to avail of PrEP on a private prescription. An information booklet [2] is also available for people who are accessing PrEP themselves or are considering accessing PrEP. [1] 20December% pdf [2] 20Ireland_English.pdf

5 Immunisation uptake for children at 12 and 24 months of age Local Health Office % vaccine uptake, Q BCG 1 * D 3 MenC 3 PCV 3 MMR 1 12 mths 12 mths 24 mths 24 mths 24 mths 24 mths Carlow-Kilkenny Tipperary South Waterford Wexford Ireland * BCG: At the time of writing, the HSE continues to experience delays with the supply of BCG vaccine. D 3 : Three doses of Diphtheria containing vaccine. In this table, uptake of D 3 is indicative of uptake of vaccines contained in the 5 in 1 or 6 in 1 combined vaccine. Summary of infectious diseases notified in 2017 (provisional data) Disease Cases 1 Disease 1 Cases 1 Bacterial Meningitis (not otherwise specified) 5 Listeriosis 1 Campylobacter infection 390 Malaria 4 Carbapenem-resistant Enterobacteriaceae (invasive) 2 Measles 0 Chlamydia trachomatis 634 Meningococcal Disease 8 Clostridium difficile 224 Mumps 36 Cryptosporidiosis 71 Noroviral infection 30 Giardiasis 57 Pertussis 60 Gonorrhoea 124 Rotavirus 271 Haemophilis influenza (invasive) 3 Rubella 0 Hepatitis A (acute) 4 Salmonellosis 49 Hepatitis B acute and chronic 31 Shigellosis 9 Hepatitis C 40 Streptococcus group A (invasive) 10 Hepatitis E 4 Streptococcus pneumoniae (invasive) 39 Herpes Simplex (genital) 131 Syphilis 14 HIV 16 Tuberculosis 29 Influenza 572 Verotoxigenic Escherichia coli infection 122 Legionellosis 0 Viral encephalitis 0 Leptospirosis 3 Viral Meningitis 26 Public Health Department, HSE (SE), Lacken, Dublin Road, Kilkenny. Tel: February 2018, Health Service Executive South Eastern Area Published by the Communications Department. Reference Number