Survey of tuberculosis incidents in hospital healthcare workers, England and Wales, 2005

BACKGROUND: Tuberculosis (TB) incidence has increased in England and Wales since 1987, with much of the increase in migrants from high TB incidence countries. The National Health Service increasingly depends on healthcare workers (HCWs) trained abroad, often from areas of high TB incidence. A retrospective survey of TB incidents in hospital-based HCWs was carried out to describe their frequency, distribution and characteristics. METHODS: Reports of HCWs with TB in hospitals were identified among routine surveillance of TB incidents. Additional data on these and reports of further incidents fitting the study definition were obtained by contacting local and regional Health Protection Units. RESULTS: At least 105 incidents of TB in hospital-based HCWs occurred in England and Wales in 2005. Most involved HCWs from high incidence countries, and most cases had pre-employment occupational health screening. We found no evidence of onward transmission within hospitals. CONCLUSIONS: Pre-employment screening for active disease may not be enough to prevent the occurrence of these incidents. A high index of suspicion among HCWs with TB symptoms is needed. Detection of latent infection with interferon gamma release assays, and the use of preventive treatment, should be evaluated.     

Uptake of pneumococcal polysaccharide vaccine in at-risk populations in England and Wales 1999-2005

The UK has had a pneumococcal polysaccharide vaccination (PPV) programme for groups at higher risk of invasive disease since 1992. This paper presents data from a sample of primary-care practices (Q-RESEARCH) of PPV uptake in patients according to their risk status. Of 2.9 million registered patients in 2005, 2.1% were vaccinated with PPV in the preceding 12 months and 6.5% in the preceding 5 years. Twenty-nine per cent of the registered population fell into one or more risk groups. The proportion of each risk group vaccinated in the previous 5 years ranged from 69% (cochlear implants), 53.4% (splenic dysfunction), 36.5% (chronic heart disease), 34.7% (diabetes), 22.9% (immunosuppressed), 28.7% (chronic renal disease), 15.9% (sickle cell disease) to 12.6% (chronic respiratory disease). Uptake was lower in areas where the non-white proportion of population was >10%. In conclusion, there remain large gaps in the uptake of PPV in several high-risk populations in the United Kingdom. Effective strategies need to be developed to address these deficiencies.     

Cryptosporidiosis decline after regulation, England and Wales, 1989-2005

Since new drinking water regulations were implemented in England and Wales in 2000, cryptosporidiosis has been significantly reduced in the first half of the year but not in the second. We estimate an annual reduction in disease of 905 reported cases and approximately 6,700 total cases.     

Mortality of asbestos workers in England and Wales 1971-81

A national study of British asbestos workers is briefly described and the mortality experience of 31 150 male asbestos workers in England and Wales who had been medically examined at least once as part of that survey is presented. The survey population is divided into workers with occupational exposure to asbestos before the inception of the 1969 Asbestos Regulations and those who worked with asbestos only after 1969. Of the 1128 who had died, 897 had worked before 1969; 34 of the death certificates received for these men mentioned mesothelioma and for another nine asbestosis was reported in the absence of mesothelioma or lung cancer. A statistically significant excess of lung cancer (SMR 136) was found. For the post-1969 workers, one case of asbestosis and one case of mesothelioma were reported, but further investigation of these cases showed probable occupational exposure to asbestos many years before 1969. The time from first exposure for this section of the population is too short to exclude an excess of asbestos related disease. The most noticeable excess of asbestos related disease was seen among the insulation workers who had more than twice (SMR 256) the expected number of deaths from lung cancer, and for whom almost 10% of all death certificates mentioned mesothelioma. No excess of any alimentary tract cancer was found and the population showed a significant deficit of large bowel cancer mortality (SMR 54).     

Mortality of asbestos workers in England and Wales 1971-81.

A national study of British asbestos workers is briefly described and the mortality experience of 31 150 male asbestos workers in England and Wales who had been medically examined at least once as part of that survey is presented. The survey population is divided into workers with occupational exposure to asbestos before the inception of the 1969 Asbestos Regulations and those who worked with asbestos only after 1969. Of the 1128 who had died, 897 had worked before 1969; 34 of the death certificates received for these men mentioned mesothelioma and for another nine asbestosis was reported in the absence of mesothelioma or lung cancer. A statistically significant excess of lung cancer (SMR 136) was found. For the post-1969 workers, one case of asbestosis and one case of mesothelioma were reported, but further investigation of these cases showed probable occupational exposure to asbestos many years before 1969. The time from first exposure for this section of the population is too short to exclude an excess of asbestos related disease. The most noticeable excess of asbestos related disease was seen among the insulation workers who had more than twice (SMR 256) the expected number of deaths from lung cancer, and for whom almost 10% of all death certificates mentioned mesothelioma. No excess of any alimentary tract cancer was found and the population showed a significant deficit of large bowel cancer mortality (SMR 54).     

蕲春县2004～2005年回乡农民工肺结核疫情登记分析

蕲春县是国家级贫困县,属经济欠发达地区,随着沿海和东部经济的发展,外出农民工队伍不断扩大,人口流动比例逐年增加,结核病控制工作难度也在不断加大,该文通过对全县2004～2005年回乡民工肺结核病登记情况进行分析,为制订这一特殊群体的结核病控制对策提供参考依据.     

Numbers of adults with diagnosed HIV infection 1996-2005--adjusted totals and extrapolations for England,Wales and Northern Ireland

Using data from the annual surveys of individuals receiving HIV related treatment or other care from 1996 to 2000, trends in prevalent numbers of diagnosed HIV infections have been extrapolated to the years 2001-05. Results show that the adjusted prevalent number for 1996 was 14,205 and that this has increased by 62% by the end of 2000, and will have increased by 139% by the end of 2005. The drivers for this increase have been the sustained rise in diagnoses in infections heterosexually acquired in sub-Saharan Africa and the continuing numbers of new diagnoses in men who have sex with men.     

Tuberculosis and ethnicity in England and Wales, 1950–70

This article seeks to contribute to recent debates about ethnicity and health by exploring the history of migration and tuberculosis in England and Wales between 1950 and 1970. It concludes that the story was more complex than recent writing, with its emphasis on 'port health' concerns, has implied. The fear that tuberculosis was being imported by migrants was certainly a central concern of both early researchers and the medical establishment. However, some researchers did show some interest in material explanations and in the roles of housing and work patterns in the transmission of the disease. A system of medical examinations at the ports of entry was not in fact implemented and it was at the local level that a system of surveillance was set up. Finally, despite much debate about the susceptibility of migrants, racial concerns were less evident than recent writers have suggested.     

Trends in fluoroquinolone (ciprofloxacin) resistance in enterobacteriaceae from bacteremias, England and Wales, 1990-1999

The Public Health Laboratory Service receives antibiotic susceptibility data for bacteria from bloodstream infections from most hospitals in England and Wales. These data were used to ascertain resistance trends to ciprofloxacin from 1990 through 1999 for the most prevalent gram-negative agents: Escherichia coli, Klebsiella spp., Enterobacter spp., and Proteus mirabilis. Significant increases in resistance were observed for all four species groups. For E. coli, ciprofloxacin resistance rose from 0.8% in 1990 to 3.7% in 1999 and became widely scattered among reporting hospitals. The prevalence of resistance in Klebsiella spp. rose from 3.5% in 1990, to 9.5% in 1996 and 7.1% in 1999, while that in Enterobacter spp. rose from 2.1% in 1990 to 10.5% in 1996 and 10.9% in 1999. For both Klebsiella and Enterobacter spp., most resistance was localized in a few centers. Resistance was infrequent and scattered in P. mirabilis, but reached a prevalence of 3.3% in 1999.     

Tetanus in England and Wales, 1984-2000

A review of national tetanus surveillance in England and Wales during 1984-2000 was undertaken to evaluate the surveillance system and national vaccination policy. Hospital Episode Statistics for tetanus in England for fiscal years 1989/90-1995/6 were also examined to estimate under-reporting. A total of 175 cases of tetanus were reported, giving an annual incidence of 0.20 per million, the lowest levels ever recorded. The highest incidence was in those aged over 64 years (0.66 per million) with no significant sex difference. Twenty (11%) cases were reported in people who were eligible for routine childhood vaccination. Outdoor injuries were the commonest reported exposure risk. Tetanus case under-reporting was estimated as 54-64%. We conclude that GPs should ensure that all their patients are fully vaccinated, targeting those born before 1961. High childhood tetanus vaccination coverage remains a priority. As the disease becomes rarer, enhanced tetanus case surveillance is essential for tetanus immunization policy evaluation.     

Tuberculosis in Havana City, 1995-1999

OBJECTIVE: Tuberculosis is a worldwide health problem getting a prioritized attention by the Cuban National Health System. To describe the main indicators of the Cuban Tuberculosis Control Program. METHODS: Based on surveillance data from the Provincial Center of Hygiene and Epidemiology, the health care network and strategies of the tuberculosis control program were reviewed; incidence rates, case finding indicators, diagnosis and case management were described. RESULTS: Eight subjects with respiratory symptoms were found per 1,000 attending general medical care services. The incidence rates of all tuberculosis types declined from 16.4 in 1995 to 12.0 x 10(5) people in 1999. Pulmonary tuberculosis incidence rate was reduced from 15.1 in1995 to 10.4 x 10(5) in 1999, whereas extrapulmonary tuberculosis had an increment from 1.3 to 1.6 x 10(5) in the same period. Of all new cases, 40-50 % were diagnosed at multispecialty clinics, 67.6% were diagnosed by positive smears, 15.2 % by positive cultures, 13.8 % by clinical and X-rays evidences only; and 0.9 % and 1.5 % were respectively diagnosed by biopsy and necropsy. There was an increase in the incidence rate in the age group 15-64 years in 1996 and 1997 but it declined again in 1998 and 1999. The age group 64 years and over showed a rate reduction from 1995 to 1999. In general, incidence rates diminished in the overall period. The average delay between onset of symptoms and diagnosis improved from 42 days in 1995 to 28.6 days in 1999. CONCLUSIONS: There seems to be a halt in reporting trends of new cases in 1996. Tuberculosis indicators reveal satisfactory changes in the study period.     

General outbreaks of infectious intestinal disease linked with red meat,England and Wales, 1992-1999

Between 1992 and 1999, 1,426 foodborne general outbreaks of infectious intestinal disease (IID) were reported to the Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC). Sixteen percent were linked with the consumption of red meat. Over 5,000 people were affected, with 186 hospital admissions and nine deaths. Beef (34%) and pig meat (32%) were the most frequently implicated meat types, with lamb implicated in 11% of outbreaks. The organisms most frequently reported were Clostridium perfringens (43.4%) and salmonellas (34.3%). During the summer, outbreaks were mainly of Salmonella spp. and attributed to the consumption of pig meat. In December, outbreaks of C. perfringens linked with beef predominated. Most outbreaks occurred as a result of food cooked on commercial catering premises (46%). The highlight of this surveillance period is a fall in the number of outbreaks linked with foods containing red meat. This corresponds with a steady decline in red meat consumption over the last two decades, as well as a transient though marked decline in the purchase and consumption of red meat in the UK during the BSE crisis in the early to mid 1990s. As cited in the Pennington Report, further reducing the morbidity and mortality from red meat outbreaks means targeting meat production at various points along the food chain from abattoir and butchering, to cooking and holding of cooked food, especially on commercial catering premises.     

General outbreaks of infectious intestinal disease associated with fish and shellfish, England and Wales, 1992-1999

Between 1992 and 1999 1425 foodborne general outbreaks of Infectious Intestinal Disease (IID) were reported to the PHLS Communicable Disease Surveillance Centre. Of these, 148 (10%) were associated with the consumption of fish and shellfish. Three main aetiologies were identified. Outbreaks associated with fish (47%) occurred more frequently in the summer months, and were linked with Scombrotoxic fish poisoning caused by the consumption of tuna that was improperly stored. Outbreaks associated with molluscs (36%) were associated with the consumption of oysters contaminated with viral pathogens, particularly in February. Outbreaks associated with the consumption of crustaceans (11%) often involved eating prawns that contained either salmonellas or viral pathogens. The maintenance of microbial quality from prior to capture/harvesting until the moment of consumption, based on a Hazard Analysis and Critical Control Point style approach, is essential if gastrointestinal illness associated with such produce is to be avoided.     

Poliomyelitis surveillance in England and Wales, 1969-1975

Poliomyelitis continued to be a rare disease in England and Wales in the period 1969-75. Only 31 paralytic and 44 cases of possible non-paralytic poliomyelitis were recorded during the 7 years. Of the 31 paralytic cases approximately one third were vaccine-associated; 3 were patients who had recently received oral poliovaccine and 7 had been in contact with a vaccinated person. Five of these 7 patients were parents of recently vaccinated children. The rate of vaccine-associated poliomyelitis was estimated in recipients to be 0.2 and in contacts 0.4 per million doses of vaccine given. Marker test results were reported on 555 strains of poliomyelitis virus isolated during 1969-75, using the reproductive capacity temperature test. Forty-eight (8.6%) resembled wild virus in this property, 15 strains being type 1, 8 type 2 and 25 type 3. Most of these isolations of apparently wild virus were from excreters with no symptoms of poliomyelitis, although 3 of the 15 type 1 strains were from patients with paralytic poliomyelitis and 3 from possible cases of non-paralytic poliomyelitis. None of the 8 apparently wild type 2 viruses was from a case of paralytic illness and only 1 of the 39 type 3 strains. Eleven of the 31 paralytic cases were in patients in whom the infection was likely to have been acquired abroad.