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HPS Weekly Report
CURRENT NOTES
22 October 2014
Volume 48 No. 2014/22
ISSN 1753-4224 (Online)
ESVAC reports drop in sales of veterinary antibiotics
CONTENTS
CURRENT NOTES
• ESVAC reports drop in sales of
veterinary antibiotics
552
• Meningococcal meningitis –
university students
553
• Guidelines on syndromic
surveillance in human and
animal health
553
• FSA Food and You survey
findings published
554
• Ebola - update
555
The data are collected annually as part of the European
Surveillance of Veterinary Antimicrobial Consumption (ESVAC)
project, which involves co-operation between the national authorities
throughout the European Union (EU) and is co-ordinated by EMA.
Public health authorities worldwide are confronted with increasing
levels of resistance to antibiotics in humans and animals and
are engaged in actions at various levels to fight this issue. The
responsible use of antibiotics is a key factor in minimising the risk of
development of resistance.
According to member states, different factors may have contributed
to the decline:
NOTIFIABLE TABLE
Notifiable diseases 48/4201 Sales of antibiotics for use in animals fell overall by 15%
between 2010 and 2012 in Europe, according to a report published
last week by the European Medicines Agency (EMA). Of the 20
European countries that provided data over this time-span, 18
observed decreases ranging from 0.4% to 49%.
556
Statutory Notification of
Infectious Diseases
Week ended 10 October 2014
558
• national programmes and campaigns on the responsible use of
antimicrobials;
• restrictions on the use of certain antimicrobials;
• increased awareness of the threat of antimicrobial resistance;
• reduction targets for the use of antimicrobials in animal
production in certain member states;
• fluctuations in size and types of animal populations.
While additional analysis is needed to confirm the main reasons
for this decline, the reduction in the use of antibiotics is a positive
sign. However, the report (available at http://www.ema.europa.
eu/ema/index.jsp?curl=pages/news_and_events/news/2014/10/
news_detail_002189.jsp&mid=WC0b01ac058004d5c1#) also shows
that there is scope for further decrease. Measures to promote
the rational use of antibiotics in animals need to continue as part
of the European Commission’s action plan against antimicrobial
resistance.
At national level, policies exist to define and promote the most
appropriate use of antibiotics in animals. Collecting accurate data on
the sale and use of these medicines in food-producing animals is an
essential first step to inform the development and monitoring of such
policies.
The ESVAC project was launched in April 2010 by EMA following a request from the European
Commission to develop a harmonised approach to the collection and reporting of data from EU
Member States on the use of antimicrobials in animals. Since the start of the project, the number
of countries providing data has continuously increased.
For the 2012 report, 26 countries from the European Economic Area (EEA) submitted data on
sales of antibiotics authorised in their territory. These countries account for approximately 95% of
the food-producing animal population in the region.
The ESVAC report is issued every year and is used by risk assessors and risk managers in
member states to inform antimicrobial policy and the responsible use of antimicrobials. [Source:
EMA News Release, 16 October 2014. http://www.ema.europa.eu/ema/index.jsp?curl=pages/
news_and_events/news/2014/10/news_detail_002189.jsp&mid=WC0b01ac058004d5c1]
Meningococcal meningitis – university students
48/4202 The Public Health Protection Unit, NHS Greater Glasgow and Clyde, was notified last
week of two confirmed cases of meningococcal infection in Strathclyde University students. There
was no identifiable link between the two cases. Both cases were recovering in hospital. Close
contacts of both cases had been given public health advice and, where appropriate, treated with
antibiotics.
As a precautionary measure, information was also provided to students at the university raising
awareness of the symptoms of meningococcal infection. [Source: NHSGGC News Release, 17
October 2014. http://www.nhsggc.org.uk/content/default.asp?page=s1192_3&newsid=18628&bac
k=s1192]
A vaccination programme against meningitis C (Men C) for first-time university entrants under the
age of 25 was introduced from 1 August 2014. This is a time-limited catch-up programme that will
run until the first cohort of S3 pupils, who received the adolescent booster dose of Men C in 2013,
reach university age (2017). From 2017 onwards university entrants will have received a dose of
Men C vaccine routinely as part of their adolescent booster vaccines.
The provision was that, where students were not vaccinated before leaving for university, they
could register with a new GP practice once they arrived and arrange to get the vaccine there as
soon as possible, ideally in freshers week and no later than 31 October 2014. If an individual
seeks vaccination later than 31 October 2014, GP practices should apply clinical judgement to
assess the needs of the patient.
More details on the catch-up programme were outlined in Current notes 48/2503 and 48/3501
(at http://www.hps.scot.nhs.uk/ewr/redirect.aspx?id=58861 and http://www.hps.scot.nhs.uk/ewr/
redirect.aspx?id=60274 respectively).
Guidelines on syndromic surveillance in human and animal health
48/4203 The first European guidelines on syndromic surveillance in human and animal health,
the ‘Triple-S guidelines for designing and implementing a syndromic surveillance system’, were
published on 11 October. The guidelines are one of the main outcomes of the European Unionfunded project ‘Triple-S’, the main aim of which has been to increase the European capacity for
near-real-time surveillance and monitoring of health-related events in the animal and the human
health sectors.
The Triple-S guidelines provide evidence-based recommendations and suggestions for each step
of the set-up, use and assessment of a syndromic surveillance system. They aim to encourage a
common understanding of the structure and utility of systems, and improve communication among
European countries on critical public health threats. The guidelines are designed to be useful in
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the context of the wide range of health systems and data sources found in European countries,
and their main principles can be applied globally. The guidelines are intended for public health
professionals and epidemiologists working in human or animal health surveillance who would
like to use syndromic surveillance to support existing surveillance systems and public health
monitoring.
Triple-S was a project co-financed by the EU through the Executive Agency for Health and
Consumers. It started in September 2010 and formally ended in December 2013, and was
coordinated by the French Institute for Public Health Surveillance (InVS) in Paris. It involved 24
organisations from 13 European countries (including both HPS and the Health Protection Agency
– now PHE). As an outcome of the first meeting, held in November 2010, an updated definition of
‘syndromic surveillance’ was published in 2011.
All publications originating from the Triple-S project, including the guidelines and reports on
conducted inventories and site visits, can be found on the Triple-S web site - http://www.
syndromicsurveillance.eu/. [Source: Eurosurveillance News, 16 October 2014. http://www.
eurosurveillance.org/ViewArticle.aspx?ArticleId=20927]
FSA Food and You survey findings published
48/4204 The Food Standards Agency (FSA) publishes its ‘Food and You survey’ once every two
years. The report provides information on reported behaviours, attitudes and knowledge relating to
food issues.
This year’s survey, published on 21 October, found that 51% of adults surveyed stored meat in
line with FSA guidelines suggesting that up to half may store raw meat in a way that could lead
to cross-contamination. FSA advice is to always keep raw meat on the bottom shelf of the fridge
away from cooked meats and other fresh and ready-to-eat food so juices do not drip onto other
food products. Wrapping raw meats in cling film or storing away in sealed containers will help to
guard against cross-contamination.
The survey showed an increase in awareness of the FSA’s Food Hygiene Rating Scheme, and the
Food Hygiene Information Scheme in Scotland (at http://ratings.food.gov.uk/). Recognition of the
schemes was found to be highest in Northern Ireland at 88%. Lowest awareness was in Scotland
at 70%. Recognition of the schemes across the UK had however increased significantly with latest
figures showing that 76% of respondents were aware of the scheme, up from 55% in previous years.
The survey also gives an insight into the number of people with a food allergy. In total, 4%
reported having an allergy. Of that 4%, nearly two thirds (66%) said they had seen a doctor about
their allergy with 40% saying that it had been clinically diagnosed. Overall, 11% of respondents
reported living in a household in which someone had a food allergy (not necessarily clinically
diagnosed).
The Food and You survey is used to collect information about reported behaviours, attitudes
and knowledge relating to food safety issues. It provides data on people’s reports of their food
purchasing, storage, preparation, consumption and factors that may affect these such as eating
habits, influences on where respondents choose to eat out and experiences of food poisoning.
This is the third round of the survey which consisted of 3,453 interviews with a representative
sample of adults aged 16 and over across the UK. Food and You is carried out on behalf on the
FSA by TNS BMRB.
Reports of findings individual to each UK country will be will be published in four separate country
reports on Tuesday 16 December. These will include findings related to healthy eating in Scotland
and Northern Ireland. [Source: FSA News Release, 21 October 2014. http://www.food.gov.uk/
news-updates/news/2014/13159/new-food-and-you-survey-findings-published]
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Ebola - update
48/4205 Having declared Senegal officially free of Ebola virus disease transmission on 17
October 2015, the World Health Organisation (WHO) has announced that Nigeria was also
officially free of Ebola virus transmission on 20 October.
Both Senegal and Nigeria maintained high levels of active ‘case finding’ for 42 days, this is twice
the maximum incubation period of the disease and should therefore detect possible unreported
cases.
The WHO has commended both Senegal’s and Nigeria’s diligence to end the transmission of
Ebola virus disease, advising that the most important lesson learned is that an immediate and well
coordinated response can stop imported Ebola virus disease in its tracks.
Response plans included contact tracing and monitoring of those potentially exposed to the
disease, rapid testing of all suspected cases, increased surveillance at the country’s entry points
and national public awareness campaigns. [Sources: WHO News Releases, 17 & 20 October
2014. http://www.who.int/entity/mediacentre/news/ebola/17-october-2014/en/index.html; http://
www.who.int/entity/mediacentre/news/ebola/20-october-2014/en/index.html]
The Scottish Government Resilience Committee (SGoRR) met on 15 October to discuss the latest
developments in Scotland’s response to the Ebola outbreak in West Africa. The meeting was
attended by the First Minister and the Health Secretary along with experts in infectious diseases
from Health Protection Scotland and senior officials from the Scottish Government.
Ministers were updated on the latest situation in the three affected countries of Sierra Leone,
Guinea and Liberia. They were also given updates on how Scotland’s health service is preparing
for any possible case, and steps being taken by the oil industry to protect workers who are
returning from West Africa. [Source: Scottish Government News Release, 16 October 2014. http://
news.scotland.gov.uk/News/Ebola-preparedness-1164.aspx]
Further guidance, information and advice is available on the HPS website at http://www.hps.scot.
nhs.uk/travel/viralhaemorrhagicfever.aspx and is under continuous review. Enquiries concerning
this from the NHS in Scotland should be directed to NSS.HPSEbolaenquiries@nhs.net.
Travel guidance on Ebola is also available on TRAVAX (for health professionals - http://www.
travax.nhs.uk/) and fitfortravel (for the general public - http://www.fitfortravel.nhs.uk/home.aspx).
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Notifiable diseases
Part 2 (Notifiable Diseases, Organisms and Health Risk States) of the Public Health etc.
(Scotland) Act came into effect on 1 January 2010 and sets out new duties for registered medical
practitioners, NHS boards and directors of diagnostic laboratories. GP practices should familiarise
themselves with the Scottish Government guidance on the new notification requirements at: http://
www.scotland.gov.uk/Topics/Health/Policy/Public-Health-Act.
Registered medical practitioners report notifiable diseases based on ‘clinical suspicion’. As such,
notifications may not be subject to laboratory report confirmation. The published figures will record
therefore how many diseases have been clinically suspected.
Patient notifications can, however, be reclassified. When, for example, a suspected (and notified)
tuberculosis case is subsequently reported as negative by a laboratory (and found not to be a
health protection risk) it would subsequently be removed from the disease totals.
Diseases to be notified by registered medical practitioners with effect from 1 January 2010:
Notifiable Diseases which come into effect on 1 January 2010
*Anthrax
*Meningococcal disease
*Botulism
Brucellosis
*Cholera
Mumps
*Necrotising fasciitis
*Paratyphoid
*Clinical syndrome due to E. coli
O157 infection (see note 1)
*Diphtheria
*Haemolytic Uraemic
Syndrome (HUS)
*Haemophilus influenzae
Type b (Hib)
*Measles
*Pertussis (Whooping Cough)
*Severe Acute Respiratory
Syndrome (SARS)
*Smallpox
Tetanus
Tuberculosis (respiratory or
non-respiratory) (see Note 2)
*Tularemia
*Plague
*Poliomyelitis
*Typhoid
*Viral haemorrhagic fevers
*Rabies
*West Nile fever
Rubella
Yellow Fever
It is recommended that those diseases above marked with an * require urgent notification, i.e.
within the same working day.
Note 1: Escherichia coli O157
Clinical suspicion should be aroused by (i) likely infectious bloody diarrhoea or (ii) acute onset non-bloody
diarrhoea with a biologically plausible exposure and no alternative explanation. Examples of biologically
plausible exposures include:
• contact with farm animals, their faeces or environment;
• drinking privately supplied or raw water;
• eating foods such as undercooked burgers or unpasteurised dairy products;
• contact with a confirmed or suspected case of VTEC infection.
Further guidance is available at: http://www.hps.scot.nhs.uk/giz/e.coli0157.aspx.
Where a case is notified as HUS (Haemolytic Uraemic Syndrome) it should NOT also be notified
as ‘Clinical syndrome due to E. coli O157 infection’.
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Note 2: Tuberculosis
For the purposes of notification, respiratory TB or non-respiratory TB should be taken to have
the same meanings as the World Health Organisation definitions of pulmonary TB and nonpulmonary TB respectively:
Pulmonary TB is tuberculosis of the lung parenchyma and/or the tracheobronchial tree.
Non-pulmonary TB is tuberculosis of any other site.
Where tuberculosis is clinically diagnosed in both pulmonary and non-pulmonary sites, this should
be treated as pulmonary TB.
Registered medical practitioners have been advised to contact their local NHS Board Health
Protection Team for advice should they have any doubts about the diagnosis of suspected cases.
Non-notifiable diseases
Registered medical practitioners are no longer required to notify the diseases listed below.
• Bacillary dysentery
• Chickenpox
• Food poisoning
• Scarlet fever
• Viral hepatitis
These diseases are now covered by a list of notifiable organisms details of which will be reported
by laboratories to health protection teams.
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Statutory Notification of Infectious Diseases
Week ended 10 October 2014
A National Statistics release
Infectious Disease
Anthrax
Botulism
Brucellosis
Cholera
Clinical Syndrome E. coli O157
Diphtheria
Haemolytic Uraemic Syndrome (HUS)
Haemophilus Influenzae Type B (Hib)
Measles
Meningococcal Infection
Mumps
Necrotizing Fasciitis
Paratyphoid Fever
Pertussis
Plague
Poliomyelitis
Rabies
Rubella
Severe Acute Respiratory Syndrome
(SARS)
Smallpox
Tetanus
Tuberculosis: Respiratory
Tuberculosis: Non-respiratory
Tularemia
Typhoid Fever
Viral Haemorrhagic Fevers
West Nile Fever
Yellow Fever
TOTAL
Total from
Current
Current Previous
first week
week
week
week
of year:
last year
2013
1
1
1
1
5
1
3
165
2
3
1
64
5
4
453
7
2
10
22
1012
3
20
5
4
18
3
2
23
Amendments: Add 1 Tuberculosis: respiratory (1 x wk 38)
AA Ayrshire & Arran
FF Fife LO Lothian
TY Tayside
BR
FV
LN
WI
NHS BOARD ABBREVIATIONS
Borders
DG Dumfries & Galloway
Forth Valley
GR Grampian Lanarkshire
OR Orkney Western Isles
5
5
39
181
131
7
2049
Total from
first week
of year:
2014
2
1
5
8
1
4
2
50
53
242
9
6
326
21
1
194
102
4
2
1033
Source: Health Protection Scotland,
NHS National Services Scotland
GGC Greater Glasgow & Clyde
HG Highland
SH Shetland
Correspondence to: The Editor, HPS Weekly Report, Health Protection Scotland, Meridian Court,
5 Cadogan Street, Glasgow, G2 6QE, Scotland
T 0141-300 1100
F 0141-300 1172
E NSS.HPSWReditor@nhs.net
W http://www.ewr.hps.scot.nhs.uk/
Printed in the UK. HPS is a division of the NHS National Services Scotland.
Registered
as a newspaper
© Health
Scotland 2014
558
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