HPS Weekly Report
28 Aug 2018
Volume 52 No. 34
Listeria surveillance: new EU-wide study reveals that most outbreaks remain undetected
A large-scale study coordinated by the European Centre for Disease Prevention and Control (ECDC) found that more than half of the severe listeriosis cases in the EU belong to clusters, many of which are not being picked up fast enough by the current surveillance system. Listeriosis is a relatively rare but potentially severe food-borne disease that has been reported in increasing numbers in EU/EEA countries since 2008. In 2016, 2,536 cases were reported, including 247 deaths.
The study examined listeriosis epidemiology through whole genome sequencing and found that this method, when implemented at EU-level, could lead to faster detection of multi-country outbreaks. A more timely detection of clusters would potentially limit the occurrence of further cases from the same, common food source.
The study analysed 2,726 human Listeria monocytogenes isolates from 27 countries between 2010 and 2015. It found that slightly fewer than 50% of the cases were isolated, whereas the remaining cases were clustered together. Around one-third of the cases that were identified as part of a cluster affected more than one country, often lasting for several years. However, only two listeriosis outbreaks were reported in the EU in 2016 and five in 2015, suggesting that many of them have gone undetected.
Source: ECDC, 20 August 2018
Public health response to tick-borne diseases
A report has been published by the European Centre for Disease Prevention and Control (ECDC) investigating the public health response to two emergencies involving tick-borne diseases, specifically looking at the involvement of communities.
The report found that the affected and at-risk communities can be a key resource for the public health sector when preparing for and responding to public health emergencies related to infectious diseases.
The case studies were:
- two cases of autochthonous infection with Crimean-Congo haemorrhagic fever (CCHF) in the autonomous community of Castilla y León in Spain in 2016 (technical report)
- the first two endemic cases of tick-borne encephalitis (TBE) in the Netherlands, which appeared in 2016 in the Utrecht and Twente regions (technical report)
The technical reports describe the engagement and role of communities during the pre-incident, incident and post-incident phases of the two outbreaks. They identify a number of good practices, which other EU member states could apply.
Source: ECDC, 23 August 2018
MERS case confirmed in England
Public Health England (PHE) confirmed on 23 August 2018 that an individual has been diagnosed with Middle East Respiratory Syndrome (MERS) in England.
The patient was initially admitted to a hospital in Leeds before being transferred to the Royal Liverpool Hospital, an expert respiratory infectious disease centre, where they are stable and receiving appropriate treatment.
The patient is a resident of the Middle East, where they are believed to have contracted the infection, before travelling to the UK.
While this is a serious infection for the individual, the risk of transmission to the general population from this case is very low. This is the fifth case of MERS diagnosed in England, with previous cases diagnosed in 2012 and 2013.
Source: PHE, 23 August 2018
Information and guidance on MERS is available to view on our website.
Samoa rolls out triple drug therapy to accelerate elimination of lymphatic filariasis
Samoa has become the first country to implement the new triple drug regime recommended by the World Health Organisation (WHO) for the treatment of lymphatic filariasis (LF), a neglected tropical disease.
Commonly known as elephantiasis, LF infection occurs when filarial parasites are transmitted to humans through mosquitoes. Infection is usually acquired in childhood and can cause hidden damage to the lymphatic system. In 1997, the Fiftieth World Health Assembly resolved to eliminate LF as a public health problem. In 2000, WHO launched the Global Programme to Eliminate Lymphatic Filariasis (GPELF), which has the goal of eliminating LF as a public health problem by 2020.
WHO published guidelines in 2017 on alternative mass drug administration (MDA) regimens to eliminate filariasis, in which IDA (a combination of ivermectin, diethylcarbamazine and albendazole) is recommended for annual treatment in settings where its use is expected to have the greatest impact. Annual mass treatment of the entire eligible population of Samoa began on 14 August 2018 and is expected to be completed by 26 August 2018.
The Ministry of Health of Samoa has prepared for this MDA campaign by implementing a renewed national lymphatic filariasis elimination action plan. More than 1,500 community health workers and youth groups have been trained in basic epidemiology and transmission of the disease, the elimination strategy and prevention and management of any adverse events which, although rare, are more likely to occur after infected people ingest the tablets. A comprehensive social mobilisation and advocacy campaign has also been implemented.
The Pacific Island nations that have eliminated lymphatic filariasis as a public health problem to date include the Cook Islands, Marshall Islands, Niue, Tonga and Vanuatu.
Source: WHO, 24 August 2018
Health inequalities in Scotland report published
A new report entitled ‘The Scottish Burden of Disease Study, 2016’ has recently been published.
The report found that people living in the poorest areas of Scotland have double the rate of illness or early death than people in the wealthiest areas. Nearly a third (32.9%) of early deaths and ill health could be avoided if the whole population had the same life circumstances as the people who live in the wealthiest areas.
The report shows that early death and illnesses associated with the things that can harm health the most, such as drugs, tobacco, poor diet and alcohol, are more common in the poorest areas than in wealthiest areas.
COMEAP report on the health impacts associated with air pollutants – NO2 and PM2.5
The UK independent expert committee, the Committee on the Medical Effects of Air Pollutants (COMEAP), released a report on quantifying the health impacts associated with exposure to NO2 and PM2.5 air pollutants, the two pollutants most relevant to human health. Combustion engine emissions are a significant source of both these pollutants and their impacts on health are very closely related and difficult to separate.
The evidence for the effects of PM2.5 is clearer than that for NO2. Earlier COMEAP reports assessed the health effects of PM2.5 (alone) in terms of excess or attributable mortality. The evidence for the effects of NO2 alone on human health is less clear than that for particulate pollution, so interpreting the scientific evidence on NO2 has proved to be a challenging task for COMEAP. This new report therefore addresses public health impacts in terms of attributable mortality linked to NO2 exposure alone as an air pollutant and NO2 in combination with PM2.5. COMEAP was not however able to come to a unanimous view regarding the conclusions drawn from the scientific evidence. As a result, the report presents a majority committee view and the views of a dissenting group who did not support the majority conclusions. The report explains the reasons for the differences of expert opinion.
COMEAP concluded that, overall, the impact of NO2 with PM2.5 was equivalent to an increase in deaths of 28,000 to 36,000 in the UK. These numbers are not figures for the actual deaths recorded as being due to air pollution in the UK. They are estimates only of the number of deaths that air pollution could cause, if air pollution was the sole cause of death in those people. Air pollution is rarely if ever the sole cause of death so these figures are potentially misleading especially when reported in the press as deaths actually caused by air pollution.
COMEAP also quote a lower range of an excess of 16,000 to 19,000 equivalent deaths associated with NO2 exposure. The difference in the two sets of estimates relates to variation in scientific expert confidence in the use of the published research data, which was one of the areas where the expert committee was most divided.
COMEAP provide an alternative explanation for the scale of the health impacts, i.e. for a sustained reduction in NO2 of 1 μg/m3 and for all other traffic related pollutants over the next 106 years, the average life expectancy in the UK would increase by around eight days. For a reduction in NO2 of 1 μg/m3 alone, then the increase in average life expectancy in the UK would be around two to five days. This may be an easier metric to understand for some.
It is not possible within the constraints of this short item to give a full briefing on the COMEAP report and its conclusions; this will be provided on the Health Protection Scotland (HPS) website in due course.