This snapshot, taken on
02/11/2012
, shows web content acquired for preservation by The National Archives. External links, forms and search may not work in archived websites and contact details are likely to be out of date.
 
 
The UK Government Web Archive does not use cookies but some may be left in your browser from archived websites.

CDR Weekly
  Search CDR




Adobe AcrobatCurrent Issue in PDF format

This site uses Adobe Acrobat

Download here >

 

Final Issue: Volume 16 Number 51

Published on: 21 December 2006

Final Issue in PDF Current Issue in PDF format
PDF format (283 Kb)

News Archives

Last updated: Volume 14, No.12 (PDF file,173 KB)

Archives | News Archives 2004: Page 1| News 18 March 2006

News Archives: | 2006 | 2005 | 2004 | 2003

LACORS/HPA collaborative study of raw shell eggs and their use in catering premises

 

The Department of Health has announced that people who have received a blood transfusion in the UK since 1 January 1980 will no longer be able to donate blood (1,2). This additional donor selection criterion will be implemented by all four of the United Kingdom Blood Sevices (UKBS) including the National Blood Service, on 5 April 2004.

This additional precautionary measure to safeguard the blood supply is being taken in the light of the first possible transmission of variant Creutzfeldt-Jakob Disease (vCJD) by blood transfusion which was reported in December 2003 (3). The transfusion occurred in 1996; the blood donor was well at the time but developed symptoms of vCJD in 1999 and died the following year. The recipient was diagnosed with vCJD in 2003.

Since 1997, in view of the uncertainty as to whether vCJD could be transmitted by blood or blood products, the UKBS have  put in place a number of other measures to reduce the risk of a potential onward cycle of transmission.  These include:

This is a highly precautionary approach and the benefit of receiving a blood transfusion when needed far outweighs any possible risk of contracting vCJD. To date, there has been only one possible case of vCJD being transmitted by blood, although the NBS issues over 2.5 million units of blood components every year.

As of 1 March 2004 there have been 146 definite and probable cases of vCJD in the UK, six cases in France, and one in each of Canada, Hong Kong, the Irish Republic, Italy, and the United States.  The eventual number of individuals within the UK population likely to develop vCJD remains uncertain; current estimates range from current numbers up to 540.  It is not known what number of current or past blood, or tissue donors, may develop vCJD in the future.

UK Blood Services can offer further information and advice to blood donors on 0845 7711 711.

NHS Direct can offer advice and information to members of the public who are concerned about the risk of contracting vCJD from a blood transfusion on 0845 4647.

Table 1 Comparison of Salmonella contamination rates in UK Produced eggs in 1995/6 and 2003

Salmonella detail
Year of study and number of
salmonella positive pooled samples
1995/6(3) (%)*
n=13,970
2003 (%)†
n=4987
All salmonellas
138
(1)
16
(0.3)
S. Enteritidis
119
(0.9)
14
(0.3)
S. Enteritidis PT4
82
(0.6)
4
(0.1)
Other S. Enteritidis
37
(0.3)
10
(0.2)

References

1.Elson R, Little CL, Mitchell RT. LACORS/ Health Protection Agency Co-ordinated Food Liaison Group Studies: Microbiological examination of raw shell eggs and their use in catering premises. London: LACORS, 2004. Available to subscribers online at <http://www.lacors.com>.

2.PHLS.  Salmonella Enteritidis outbreaks in England and Wales, September to November 2002. Commun Dis Rep CDR Weekly [serial online] 2002 [cited 17 March 2004]; 12(49): News. Available at <http://wwww.hpa.org.uk/cdr/archives/2002/cdr4902.pdf>.

3.Advisory Committee on the Microbiological Safety of Food. Second report on Salmonella in eggs. London: The Stationery Office, 2001.

4.PHLS.  Public health investigation of Salmonella Enteritidis in raw shell eggs. Commun Dis Rep CDR Weekly [serial online] 2002 [cited 17 March 2004]; 12(50): News. Available at<http://wwww.hpa.org.uk/cdr/archives/2002/5002.pdf> .

5.HPA. Salmonella Enteritidis outbreak in central London linked to Spanish eggs. Commun Dis Rep CDR Weekly [serial online] 2004 [cited 17 March 2004]; 12(50): News. Available at <http://www.hpa.org.uk/cdr/archives/archive04/news/news0304.htm#s_ent>.

6.Food Standards Agency. Agency re-emphasises advice on use and handling of all eggs and issues guidance on use of Spanish eggs. In: Food Standards Agency website [online]. London: FSA, 29 October 2002. Available at: <http://www.food.gov.uk/news/pressreleases/reemphasiseeggadvice>.

7.Food Standards Agency. Eggs – what caterers need to know.  In: Food Standards Agency website [online]. London: FSA News archive, 14 January 2003. Available at <http://www.food.gov.uk/news/newsarchive/105589>.

 

Psittacosis associated with a pet shop in Huddersfield

 

A number of birds infected with Chlamydophila (previously known as Chlamydia) psittaci, which can cause psittacosis in humans, has recently been found in Huddersfield, West Yorkshire, in a branch of a national chain of pet supermarkets.  They were diagnosed on 17 December 2003 and came from a single supplier in York. The higher value birds were treated and the remainder destroyed the following day. The pet shop was decontaminated.   The company's guidance advises stores to keep records of those who purchase birds so that, in the event of psittacosis being detected, they can be advised to look out for symptoms and seek treatment – this is not necessarily the practice in other pet shops.  As a result, one customer was serologically confirmed as having a C.psittaci infection and two members of the store's staff presented to their general practitioner.

Psittacosis is an acute generalised chlamydial disease with an incubation period of between one and four weeks. Clinical presentations can be variable, with fever, headache, myalgia, and respiratory symptoms, which are often disproportionately mild compared with the extensive pneumonia seen on chest x-ray. Although usually mild or moderate, disease can be severe especially if left untreated, particularly in the elderly or those with intercurrent illness.  Seemingly healthy birds shed organisms in respiratory secretions or faeces, which may remain viable for several months. Transmission of disease is mainly through inhalation of aerosols, respiratory secretions, or dried faecal or feather dust, although oral infection and through handling of infected birds' plumage and tissues have been reported.  It does not spread person-to-person.

Since 1998, a number of similar incidents associated with pet supermarkets have occurred, and in smaller retail pet shops, garden centres, and bird fairs. This has taken place against a drop in reported laboratory confirmed cases from 482 in 1994 to about 100 in more recent years.  As sero-surveys suggest that both under-diagnosis and under-reporting are common, we would be interested to hear of any current cases connected with pet retailers.  Please contact Robert Smith, Zoonoses Surveillance Unit, National Public Health Service for Wales, Communicable Disease Surveillance Centre; tel: 029 20 521997, fax: 029 20 521987, email: <robert.smith@nphs.wales.nhs.uk>.

 

 

World TB Day, 24 March 2004, ‘Every breath counts – stop TB now!'

 

World TB Day is held each year on 24 March, in recognition of Robert Koch's presentation on this day in 1882 that the tubercle bacillus could be found in the sputum of tuberculosis patients. The aim is to promote awareness and knowledge for action against tuberculosis. World Health Organization (WHO) projections suggest that there will be approximately 150 million cases and 36 million deaths from tuberculosis between 2002 and 2020 <http://www.who.int/gtb>. One third of the worlds human inhabitants are currently infected with tuberculosis and each year there are eight million new cases, and two million people die, even though tuberculosis is a curable disease. The breakdown in health services, the spread of HIV/AIDS, and the emergence of multidrug-resistant tuberculosis are exacerbating the impact of this disease. The Stop TB Partnership, a global association that has focused on direct advocacy for resource mobilisation and strengthening political and governmental commitment, is now aiming to intensify its efforts, which are specifically directed at engendering greater public commitment and participation in tuberculosis control/elimination <http://www.stoptb.org>.

In England, Wales, and Northern Ireland the number of cases and tuberculosis rate continued to increase in 2002 (enhanced TB surveillance preliminary results). Six thousand nine hundred and seventy-four cases were reported in 2002, which represents an overall rate of 12.8 per 100,000 population. Although the United Kingdom (UK) is considered to be a low incidence country, there is considerable regional and local variation across the country and within subgroups of the population. In 2001, the tuberculosis rate was below 20/100,000 in 89% of the 376 local authorities of England and Wales, but was between 20 and 40 in 8%, and reached over 40/100,000 in 3% of local authorities, mainly in London and Leicester. High tuberculosis rates in London, as in some other cities, may be due to the concentration of population subgroups at higher risk of tuberculosis such as migrants from high-prevalence countries and the homeless. In England, Wales, and Northern Ireland, people born outside the UK represented 63% of the tuberculosis cases in 2001, and were 19 times more likely to have tuberculosis than those born in the UK.

The level of multi-drug resistance is relatively stable in the UK (0.8% in 2001), while the proportion of isoniazid resistance slightly increased in 2001 (6.7%). This increase was mainly due to an outbreak in London that was first recognised in early 2000, with the first case identified retrospectively as being in 1995 (1).

The final report on tuberculosis cases reported in the UK in 2001 and a summary preliminary report on 2002 cases will be available in the tuberculosis section of the HPA website at <http://www.hpa.org.uk/infections/topics_az/tb/menu.htm>, with an update of the detailed epidemiological data from the surveillance systems co-ordinated from the Health Protection Agency's Communicable Disease Surveillance Centre.

References

1.HPA. Isoniazid mono-resistant tuberculosis in north London – update. Commun Dis Rep CDR Wkly [serial online] 2004 [cited 17 March 2004]; 14(12): News. Available at <http://www.hpa.org.uk/cdr/archives/2004/cdr1204.pdf>.

 

Isoniazid mono-resistant tuberculosis in north London – update

 

 

An outbreak of Isoniazid mono-resistant tuberculosis (TB) in north London was first recognised in 1999-2000, when most cases started to appear.  The earliest case was in 1995 (diagnosed retrospectively) (1-4). Molecular typing has shown that all cases are caused by the same strain of TB.  One hundred and sixty-four cases have so far been reported in this outbreak, which is mainly focussed in north London.  One hundred and thirty-seven cases were diagnosed in London, and 27 outside London.  Many of the cases have complex needs, and there are strong associations with drug use and prison detention.  These and other factors, such as homelessness, present substantial challenges to treatment. 

Outcomes
At least half of the cases have shown poor adherence to treatment.  Forty-eight per cent have so far completed treatment.  In London, 19 of the 137 cases (14%) have been lost to follow-up.  Of the 33 still on treatment, 18 (55%) have poor adherence.

There are five cases of multi-drug resistant TB (MDR-TB).  Four are the result of poor adherence to treatment.  The fifth case in a schoolgirl aged 15 years is of most concern, as there is evidence of likely transmission of MDR-TB in the community from another case (S) who had acquired rifampicin resistance.  There are no known direct links between them, but contact tracing is ongoing.  Molecular typing, however, shows the same mechanism of rifampicin resistance in both cases. This profile is shared by only five per cent of rifampicin-resistant strains.  Case S has been infectious for long periods.  She has also infected her young child, who has a clinical diagnosis of tuberculous infection and is being treated as MDR-TB.

Since the start of the incident, there have been two TB-related deaths, and an additional three deaths from other causes.

Ongoing investigation and management

Ensuring treatment completion remains a challenge in this incident.  The Incident Control Committee (ICC) is working with north London TB networks to identify additional measures and to allocate the resources necessary to achieve treatment completion in this complex patient group.  An update report is available from HPA-London Regional Epidemiology Services.

Following the community-acquired MDR-TB, the microbiological investigation in London will be extended.  The Health Protection Agency's Mycobacterium Reference Unit (MRU) in Dulwich will continue to type isoniazid mono-resistant isolates from London tuberculosis cases.  In addition, the MRU will type MDR-TB isolates from north London.

New cases continue to be identified in prisons both inside and outside London.  The ICC is working with prisons, Primary Care Trusts, and Health Protection Units to identify and manage these cases.

 

References

 

1.CDSC.Drug resistant tuberculosis in north London: update. Commun Dis Rep CDR Wkly [serial online] 2000 [cited 17 March 2004]; 10(32): News. Available at <http://www.hpa.org.uk/cdr/archives/CDR00/cdr3200.pdf>.

 

2.CDSC. Drug resistant tuberculosis in north London: update. Commun Dis Rep CDR Wkly [serial online] 2001 [cited 17 March 2004]; 11(3): News. Available at <http://wwww.hpa.org.uk/cdr/archives/2001/cdr0301.pdf>.

 

3.CDSC. Drug resistant tuberculosis in north London: update. Commun Dis Rep CDR Wkly [serial online] 2001 [cited 17 March 2004]; 11(32): News. Available at <http://wwww.hpa.org.uk/cdr/archives/2001/cdr3201.pdf>.

 

4.PHLS. Drug resistant tuberculosis in north London: update. Commun Dis Rep CDR Wkly [serial online] 2002 [cited 17 March 2004]; 12(31): News. Available at <http://wwww.hpa.org.uk/cdr/archives/2002/cdr3102.pdf>.

 

Protecting the blood supply from variant CJD: deferral of donors who have received a blood transfusion

 

The Department of Health has announced that people who have received a blood transfusion in the UK since 1 January 1980 will no longer be able to donate blood (1,2). This additional donor selection criterion will be implemented by all four of the United Kingdom Blood Sevices (UKBS) including the National Blood Service (NBS), on 5 April 2004.

This additional precautionary measure to safeguard the blood supply is being taken in the light of the first possible transmission of variant Creutzfeldt-Jakob Disease (vCJD) by blood transfusion which was reported in December 2003 (3). The transfusion occurred in 1996; the blood donor was well at the time but developed symptoms of vCJD in 1999 and died the following year. The recipient was diagnosed with vCJD in 2003.

Since 1997, in view of the uncertainty as to whether vCJD could be transmitted by blood or blood products, the UKBS have  put in place a number of other measures to reduce the risk of a potential onward cycle of transmission.  These include:

This is a highly precautionary approach and the benefit of receiving a blood transfusion when needed far outweighs any possible risk of contracting vCJD. To date, there has been only one possible case of vCJD being transmitted by blood, although the NBS issues over 2.5 million units of blood every year.

As of 1 March 2004 there have been 146 definite and probable cases of vCJD
in the UK, six cases in France, and one in each of Canada, Hong Kong, the Irish Republic, Italy, and the United States.  The eventual number of individuals within the UK population likely to develop vCJD remains uncertain; current estimates range from current numbers up to 540.  It is not known what number of current or past blood, or tissue donors, may develop vCJD in the future.

UK Blood Services can offer further information and advice to blood donors on 0845 7711 711.

NHS Direct can offer advice and information to members of the public who are concerned about the risk of contracting vCJD from a blood transfusion on 0845 4647.

 

References

1.Department of Health. Further precautions to protect blood supply. Press Release 2004/0104.
London: Department of Health, 16 March 2004. Available at<http://www.dh.gov.uk/Publications
AndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4076608&chk=
MTwE%2Bl>.

 

2.Devlopments in vCJD. Hansard [online] 16 March 2004 [cited 18 March 2004]. Available at  
<http://www.parliament.the-stationery office.co.uk/pa/cm200304/cmhansrd/cm040316/debtext/40316-05.htm#40316-05_head0>.

 

3.Llewelyn, CA Hewitt PE, Knight RSG, Cousins S, McKenzie J, Will RG, et al. Possible transmission of variant Creutzfeldt-Jakob disease by blood transfusion. Lancet 2004; 363: 417-21.