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Final Issue: Volume 16 Number 51
Published on: 21 December 2006
Final Issue in PDF
Last updated: Volume 15, No.21 (PDF file, 402 KB)
A 13-month study of bacteraemia in children, caused by methicillin-resistant Staphylococcus aureus (MRSA) will start on 1 June 2005. The study is being undertaken across the United Kingdom and the Republic of Ireland by the Health Protection Agency in collaboration with the British Paediatric Surveillance Unit, St George’s Hospital, London, Health Protection Scotland, and the National Disease Surveillance Centre, Dublin.
Analysis of reports routinely submitted to LabBase* has indicated that although the numbers of cases of MRSA bacteraemia in children remain low, there has been, nonetheless, an upward trend, rising from 4 in 1990 to 76 in 2004, although the latter figure is still provisional (1). The number of reports has remained constant in the last few years with around 70 to 75 cases reported each year.
As the above data were derived from voluntary reporting of cases they probably under-estimate the true incidence of infection. The main aim of the study is to obtain a robust estimate of the incidence of MRSA bacteraemia in children. In addition, the study aims to define the demographic and descriptive epidemiological features of the patient population, in particular the proportion of cases that are either healthcare-associated or community-acquired. Infections due to MRSA have historically been primarily acquired in hospitals, however, in the last few years, there have been reports from other countries, particularly the United States, of infections in children that have been acquired in the community and which have no demonstrable links to the hospital environment (2-4). The consolidation of microbiological, epidemiological, and clinical information will allow us to determine if community-acquired MRSA bacteraemia has also emerged in the United Kingdom. These findings will have implication for the management of severe paediatric infections due to S. aureus in the community.
Healthcare workers are encouraged to report cases of MRSA bacteraemia in children aged under 16 years and to ensure that isolates are sent to the Staphylococcus Reference Laboratory, HPA Centre for Infections, 61 Colindale Avenue, London NW9 5HT.
For further information, or to provide details of cases please contact Alan Johnson (firstname.lastname@example.org) or Catherine Goodall (email@example.com) at the Department of Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency Centre for Infections, London.
1.Khairulddin N, Bishop L, Lamagni TL, Sharland M, Duckworth G. Emergence of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia among children in England and Wales, 1990-2001. Arch Dis Child 2004 ; 89(4):378-9.
2.Groom, AV, Wolsey DH, Naimi TS, Smith K, Johnson S, Boxrud D. Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 2001; 286: 1201-1205.
3.Fey PD, Said-Salim B, Rupp ME, Hinrichs SH, Boxrud DJ, Davis CC. Comparative molecular analysis of community- or hospital-acquired methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2003; 47: 196-203.
4.Dietrich DW, Auld DB, Mermel LA. Community-acquired methicillin-resistant Staphylococcus aureus in Southern New England Children. Pediatrics 2004; 113: 347-52.
On 25 May 2005 a new set of International Health Regulations (IHR) was approved by the World Health Assembly (1,2). The IHR are a legally binding code of practices and procedures designed to prevent the international spread of infectious diseases, while minimising interference with world travel and trade (3). The current regulations were agreed by the member states of the World Health Organization (WHO) in 1969 and currently include procedures for notification of certain diseases, health related rules for international travel and trade, procedures and practices at ports and borders, and documentation requirements (4). For some time however the regulations have been recognised to be inadequate for the challenges posed by the 21st Century global village, and for example have contributed little in the face of newly emerging infections such as SARS and avian influenza (5). They set out roles and responsibilities for the WHO and its member states, but only in relation to three diseases: infectious cholera, plague, and yellow fever.
The revision of the Regulations has been underway for several years with participation by all 192 Member States of the WHO. During this process, the Health Protection Agency (HPA), in consultation with counterparts in the devolved administrations, has advised the Department of Health and others in preparing a position on the proposals for the United Kingdom (6). Over the last year this work culminated in several sessions of an Intergovernmental Working Group before final approval at the World Health Assembly.
The new regulations are based largely on the experience gained and lessons learnt by the WHO and the global community over the past 30 years. To a large extent, they reflect internationally accepted good practice, and set out rules and operational mechanisms for a more coordinated international response to the spread of disease. The new rules extend beyond infectious diseases to rare instances of chemicals or even radiation posing an international threat. Countries will have much broader obligations to build national capacity for surveillance and response, as well as routine preventative measures (such as public health actions at ports and for means of transport). A particular emphasis is on developing the ability as to detect and respond to public health emergencies of international concern and share information about them, with a code of conduct for notification and response. Specific attention is placed on detecting the emergence of new diseases or novel variants of new diseases. There is also provision for detecting deliberately released agents, although terms like bioterrorism are avoided. The regulations include a list of diseases such as smallpox, polio, and SARS, whose occurrence must be notified to WHO, but also include a matrix to help national authorities to decide whether other incidents constitute public health events of international concern. Consideration is made of whether an outbreak is serious, unusual or unexpected, whether there is a significant risk of international spread and whether there is a significant risk of international travel or trade restrictions.
After being adopted by the World Health Assembly, the regulations will formally come into force in two years time. WHO member states will now have to assess their capacities to identify and verify events, as well as to control them. The regulations identify specific capacity requirements that must be in place in each country within a fixed timeframe.
The World Health Assembly resolution containing the revised IHR is available at
1.World Health Assembly concludes: adopts key resolutions affecting global public health (press release). Geneva: World Health Organization, 25 May 2005. Available at <http://www.who.int/mediacentre/news/releases/2005/pr_wha06/en/index.html>.
2.Revision of the International Health Regulations. Agenda item 13.1. Resolution WHA58.3, Fifty-eighth World Health Assembly. Geneva: World Health Organization; 23 May 2005.
3.WHO, CSR [online]. International Health Regulations (IHR) (1969). Third annotated edition. Geneva: World Health Organisation, 1995. Available at <http://www.who.int/csr/ihr/current/en/>.
4.Nicoll N, Jones J, Aavitsland P, Giesecke G. Proposed new International Health Regulations. BMJ 2005; 330:321-2.
5.Nicoll A, Jones J. Modernisation of the International Health Regulations – WHO European Region consultation. Eurosurveillance Weekly [serial online] 2004 cited [23 May 2005]; 8(22). Available at <http://www.eurosurveillance.org/ew/2004/040527.asp#3>.
6.Health Protection Agency. Modernisation of the International health regulations – round two inter-governmental working group, Geneva, 1-12 November 2004. Commun Dis Rep CDR Wkly [serial online] 2004:14(44): News. Available at <http://wwww.hpa.org.uk/cdr/archives/2004/cdr4404.pdf>.
The National Study of HIV in Pregnancy and Childhood (NSHPC) contributes paediatric data to the national quarterly surveillance tables for the United Kingdom (UK). More detailed information on paediatric infections and HIV in pregnancy is now available online as a set of slides <http://www.hpa.org.uk/infections\topics_az\hiv_and_sti\hiv\epidemiology\introduction.htm>.
The NSHPC is the surveillance system for obstetric and paediatric HIV in the UK and Ireland. Data on pregnancies in HIV infected women booking for maternity care in the British Isles are collected through a voluntary confidential reporting scheme run under the auspices of the Royal College of Obstetricians and Gynaecologists. Data on infants born to diagnosed HIV infected women, and HIV infected children, are collected through the Royal College of Paediatrics and Child Health's British Paediatric Surveillance Unit.
Additional paediatric data are available from laboratory reports to the HPA. Data from all sources are combined at the Institute of Child Health where the NSHPC is based. In addition to demographic data, information is collected on timing of maternal diagnosis and the management and outcome of pregnancy. Obstetric and paediatric reports are linked and follow-up information is sought for infants born to infected women in order to establish infection status. Summary data on clinical status and treatment is collected annually for all infected children.
Almost all HIV infected children living in the UK today were infected through mother-to-child transmission. Since the late 1990s there has been a year-on-year increase in the number of infants born in the UK/Ireland to HIV infected women, with over 1000 such births in 2003. Since 2002, however, over 80% of HIV infected pregnant women have been diagnosed prior to delivery and the majority of these have taken advantage of interventions to reduce the risk of mother-to-child transmission of the virus. Consequently the proportion of infants who are themselves infected has been significantly reduced.