The latest English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report from Public Health England (PHE) shows that there were an estimated 61,000 antibiotic resistant infections in England during 2018, which represents a 9% rise from 2017.

Antibiotics are essential in treating serious bacterial infections, and are also used to help ward off infections during chemotherapy, caesarean sections and other surgeries. However, they are still being used to treat less serious illnesses such as coughs, earache and sore throats that often get better by themselves. Taking antibiotics encourages harmful bacteria to become resistant, meaning antibiotics may not work when they are really needed.

The threat of antibiotic resistance is growing and the ESPAUR report shows that antibiotic-resistant bloodstream infections rose by 32% between 2014 and 2018.

In response to this, PHE has re-launched its Keep Antibiotics Working campaign, which aims  to alert the public to the risks of antibiotic resistance. The campaign also provides effective self-care advice to help people and their families if they are not prescribed antibiotics. The campaign also includes TV, radio and digital advertising.

Source: PHE, 31 October 2019

On 1 November 2019, the UK Health Minister announced that a new trial, named the Group B Streptococcus (Group B Strep) trial, has been given ethical approval by the Health Research Authority in England and Health and Care Research in Wales.

Group B Strep is the most common cause of life-threatening infection in newborn babies, causing a range of serious infections including pneumonia, meningitis and sepsis.

The trial will involve 80 hospitals in England, Wales and Scotland and at least 320,000 women will take part, with recruitment starting in spring 2020. The results of the trial will be used to inform the future of pregnancy care across the UK and aims to help save babies’ lives.

The trial, funded by the National Institute for Health Research (NIHR), will look at the effectiveness of two different tests compared with standard care:

• a lab-based test, the Enriched Culture Medium (ECM) test at 35-37 weeks of pregnancy 
• a ‘bedside test’ at the start of labour

The ECM test is currently recommended for use on high-risk groups in late pregnancy by the Royal College of Obstetricians and Gynaecologists’ clinical guidelines.

Group B Strep infections in newborn babies can usually be prevented by giving antibiotics through a vein to women during labour, which reduces the risk by up to 90%.

The UK currently does not routinely test pregnant women for Group B Strep, and instead identifies pregnant women with risk factors for their newborn developing the infection.

Research has shown: 

• A 31% rise in the prevalence of Group B Strep infections in babies under three months old since 2000 in the UK and Ireland with 65% of the mothers of affected babies showing no risk factors. 
• The bacteria are present in approximately one-in-five pregnant women, usually causing no harm to the carrier, but may be passed unknowingly from a mother to her baby around birth. 
• One in 1,750 newborn babies will develop a Group B Strep infection. Of these, one in 19 of these babies will die and one in 14 survivors will be left with a long-term disability.

Source: Department of Health and Social Care (SHSC), 1 November 2019

Tick-borne encephalitis virus (TBEV) has been detected in ticks, for the first time, in the UK. These findings form part of ongoing research by Public Health England (PHE) and the Emerging and Zoonotic Infections National Institute for Health Research (NIHR) Health Protection Research Unit at the University of Liverpool.

Tick-borne encephalitis (TBE) is an infection spread by tick bites and is endemic in mainland Europe and Scandinavia, as well as Asia.

Most people who catch TBE will not develop any symptoms, but it can cause flu-like conditions, and in a small number of cases, may lead to more serious disease involving the central nervous system.

The virus has been detected in a small number of ticks in Thetford Forest and an area on the border between Hampshire and Dorset. Further work is under way to identify the distribution of TBEV infected tick populations.

Earlier in 2019, a European visitor became ill after being bitten by a tick in the New Forest. This is considered to be a highly probable case of tick borne encephalitis (TBE). The patient was reported to PHE through the European Early Warning and Response System (EWRS), and has since made a full recovery.

No other cases of TBE acquired in the UK have been identified and there have been no cases of TBEV in ticks or mammals in Scotland. The risk from TBEV is currently assessed as very low for the general population. 

Further information on TBE can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Source: PHE, 29 October 2019

The UK Government has recently committed to spending £3.5 million to help develop new treatments for gonorrhoea and to make them available in low and middle-income countries.

This investment is part of a continued partnership with the Global Antimicrobial Resistance Innovation Fund (GAMRIF) and the Global Antibiotic Research and Development Partnership (GARDP).

The investment aims to enable global access to gonorrhoea treatment, especially in low- and middle-income countries where the burden of antimicrobial resistance (AMR) is greatest, and to fund GARDP’s development of a new oral antibiotic, zoliflodacin, which is now in the last stage of clinical trials.

Zoliflodacin is one of the few antibiotics in development which specifically treats gonorrhoea, which is significant as treatments for gonorrhoea are becoming less effective. There have been cases of gonorrhoea developing resistance to recommended treatments, including in the UK.

Gonorrhoea is among the most common sexually-transmitted infections (STIs), with an estimated 87 million new cases globally every year. The STI can have severe consequences on public health and, when left untreated, serious consequences for reproductive health as well as increased risk of transmission of HIV and other STIs.

Source: Department of Health and Social Care (DHSC), 31 October 2019

The World Health Organization (WHO) (European Region) has released an expert opinion on managing drug-resistant tuberculosis (DR-TB) in children and adolescents.

DR-TB is particularly dangerous, with many young people suffering through non-diagnosis. It is estimated that, in the WHO European Region, two thousand children under the age of 15 with TB remain undiagnosed each year, while this figure is believed to be higher in 15–19 year olds.

Of those infected, 14% have dangerous and hard-to-treat forms of TB. This raises the risk that those who are undiagnosed with DR-TB will unknowingly spread the disease to large numbers of people.

The new guidance is evidence-based and provides updates on recent scientific evidence, as well as region-specific clinical and public health recommendations on tackling DR-TB in children and adolescents.

The guidance also recommends using the TB drug bedaquiline, if necessary, to help patients with DR-TB, including children aged six years and older. It is recommended that children of three years and older be given delamanid, another recently developed TB drug.

The expert opinion is supported by a commentary in the Lancet.

Source: WHO Europe, 31 October 2019

The European Centre for Disease Prevention and Control (ECDC) has reported an outbreak of carbapenemase-producing (NDM-1 and OXA-48) and colistin-resistant Klebsiella pneumoniae sequence type (ST) 307 in North-East Germany.

As of 21 October 2019, 17 patients in three hospitals and one rehabilitation clinic in Mecklenburg-West Pomerania had been affected. Six of the 17 cases presented with clinical symptoms of infection, while 11 were identified as carriers.

This is the first reported outbreak in Germany of K. pneumoniae that produce both NDM-1 and OXA-48 while also involving the emerging clone ST307. The outbreak strain is closely related to a K. pneumoniae ST307 isolate producing the same carbapenemases detected earlier in Finland from a patient previously hospitalised in Russia, yet there is no epidemiological link between the Finnish case and the outbreak in Germany.

K. pneumoniae ST307 is a high-risk clone which is expanding globally, including in the EU/EEA. The specific German outbreak strain carries virulence markers associated with increased ability to cause disease. Genetic characteristics related to a potential survival advantage in the environment have also been described for K. pneumoniae ST307. 

The combination of extensive antimicrobial resistance, increased virulence and capacity to persist in the environment result in a high risk for dissemination and future healthcare-associated outbreaks of this K. pneumoniae ST307 outbreak strain in hospitals and other healthcare settings. 

However, the risk of transmission for individuals outside healthcare settings is low. Enhanced control measures have been implemented in the involved German hospitals, and no further cases have been detected since the end of September 2019.

Source: ECDC, 28 October 2019

Established in 2009, World Pneumonia Day is marked every year on 12 November. It aims to: 

• raise awareness about pneumonia 
• promote interventions to protect against, prevent and treat pneumonia 
• highlight proven approaches and solutions in need of additional resources and attention 
• generate action, including continued donor investment, to combat pneumonia and other common, yet sometimes deadly, childhood diseases

Pneumonia is one of the leading causes of deaths in children under the age of five, despite being preventable and treatable. Although vaccines and other preventative efforts are decreasing the burden of the disease, more work is still required.

Further information and resources on World Pneumonia Day are available on the Stop Pneumonia website.

On 30 October 2019, the eighth annual Scottish greenhouse gas emissions annual target report for the year 2017 was published. 

The Scottish greenhouse gas emissions annual target is required under section 33 of the Climate Change (Scotland) Act 2009. It also fulfils the requirement under section 38 of the Act to report on the impact on emissions resulting from the exercise of electricity generation related functions.

Under section 33 of the Act, the annual report is split into four parts, which are annual and domestic effort targets, net Scottish emissions, the net Scottish Emissions account (NSEA) and Scottish electricity consumption and generation.

The new Climate Change (Emissions Reduction Targets) (Scotland) Bill will amend the above sections of the Act, as well as Scotland's emissions reduction targets, when it becomes law. Reporting on target years from 2018 onwards will occur under the requirements of the amended Climate Change (Scotland) Act.

Source: Scottish Government, 30 October 2019