Congenital anomaly surveillance in England and Wales

The National Congenital Anomaly System (NCAS) was set up in 1964, following the thalidomide epidemic, as a monitoring system designed to detect changes in the frequency of reporting of malformations. Its original aim was to detect anomalies reported within 7 days of birth. The NCAS is voluntary at all stages and covers all live- and stillbirths. It has two tiers; a 'passive system' receiving congenital anomaly notifications through a standard paper notification form, known as the SD56, and the congenital anomaly registers that send notifications electronically. Congenital anomalies are classified using the International Classification of Diseases codes and 10 monitoring groups. The Office for National Statistics performs a statistical analysis on a monthly, quarterly and annual basis, using the cumulative sum technique, which is the basis upon which surveillance alerts are raised within the system. The NCAS is now an open database where congenital anomalies can be notified whenever they are detected. The aim of this paper is to describe the current operation and uses of the NCAS based on guidelines for the evaluation of public health surveillance systems published by the Centers for Disease Control and Prevention.     

Acute pesticide poisoning in England and Wales.

Between 1979 and 1983 less than 1% of admissions from acute poisoning in the UK were due to pesticides and fewer than 4% of admissions in those under 5 years were from this cause. Organochlorine, organophosphorus and carbamate insecticides account for only 10% of the total in both children and adults. Suspected pesticide poisoning was the cause of fewer than 0.3% of home accidents in those under 10 years of age and less than 4% of suspected poisonings documented by the Home Accident Surveillance System. Rodenticides were thought to be involved in 62% of these cases. Of children who presented to hospital 42% were admitted and 93% of these were discharged home within 2 days. In the UK, the morbidity from acute pesticide poisoning in children is low and the mortality is nil and there is therefore no evidence to support the view that paediatric pesticide intoxication is a significant clinical problem. Though no fatalities were recorded in children, pesticides were responsible for 1.3% of all deaths due to poisoning in the UK between 1979 and 1983. In adults admitted to hospital, the mortality from pesticide poisoning is approximately 12% and three quarters of these deaths are due to the deliberate ingestion of paraquat. The general term pesticide refers to a group of products that are used as insecticides, acaricides, fungicides, herbicides, rodenticides, and plant growth agents. Chemically, the group includes bipyridilium compounds, carbamates, chloralose, chlorates, coumarins, dinitro compounds, dithiocarbamates, fluoroacetates, organochlorine organophosphorus and organotin compounds, pentachlorophenol, phenoxyacetates, phosphine (as magnesium and aluminium phosphides), pyrethrins, pyrethroids and triazines.(ABSTRACT TRUNCATED AT 250 WORDS)     

Congenital malformations in the Fylde region of Lancashire, England 1957-1973

This paper uses data collected by a consultant paediatrician to examine variations in the prevalence of neural tube and cardiovascular malformations within the Fylde region of North West England. Results at the district scale indicate contrasts in the geographical distributions of the two classes of malformation and these are then further assessed via a case-control study which standardises for factors such as date of conception, age of mother and parity. The results of this study suggest that there were wards in Blackpool and Fleetwood with unusually high prevalences of neural tube defects. Further research is being undertaken to identify the causes of these concentrations.     

Trends in induced abortion in England and Wales.

Analysis of routinely published abortion and fertility data for England and Wales between 1968 and 1980 shows that the age-specific abortion rates increased from 1968 until about 1973 when the rates peaked for all ages; rates then declined until 1977 but have subsequently returned to higher levels. Two factors are implicated: (1) the recent changes are related to parallel changes in the fertility rate; but (2) there is also a tendency for recent cohorts of women to resort to abortion more readily. These relationships are derived from analyses of fertility rates and abortion ratios, the proportion of conceptions that result in abortions. The results are discussed in terms of attitudes and practices related to birth control.     

The value of England and Wales congenital malformation notification scheme data for epidemiology: male genital tract malformations.

Data from the England and Wales national congenital malformation notification scheme were examined for associations of male genital tract malformations. For some of the malformations comparison of notification rates with the literature suggested gross undernotification. There was also evidence suggesting bias: examination of the relationships of the malformations to birth weight, maternal parity, and maternal age at delivery showed some highly significant trends in risk, most of which were at variance with findings in the literature, and several potential mechanisms for bias could be adduced. Direct investigation is needed, for this and other similar data sets, of the extent and mechanisms of biased undernotification.     

Hepatitis E in England and Wales

In 2005, 329 cases of hepatitis E virus infection were confirmed in England and Wales; 33 were confirmed indigenous infections, and a further 67 were estimated to be indigenous infections. Hepatitis E should be considered in the investigation of patients with hepatitis even if they have no history of travel.     

Trends in pelvic inflammatory disease in England and Wales.

Hospital admissions for pelvic inflammatory disease increased by 8.7% a year among women aged 15-44 in England and Wales between 1966 and 1976. Acute disease was three times as frequent as chronic disease, although admissions for the chronic condition are increasing more rapidly than for the acute. Peak incidence of acute disease is at ages 20-24 and of chronic disease at ages 25-29. Divorced women had the highest rates of both forms. Single women had higher rates of acute disease than married women but the latter had higher admission rates for chronic disease. In general, the pattern of acute disease follows that of sexually transmitted disease. The pattern of chronic disease in turn reflects the long-term effects of acute disease. The increase in chronic disease is of concern because hospital discharge rates are increasing more rapidly than for acute disease, and in 1976 one in every eight cases mentioned infertility in association with the disease.