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Final Issue: Volume 16 Number 51

Published on: 21 December 2006

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Published: 5 October 2006 Volume 16, No.40 (PDF file, 243 KB)

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Enhanced influenza surveillance: winter 2006/2007

Annually, the beginning of October marks the start of the enhanced surveillance for seasonal influenza and other respiratory viruses in the United Kingdom (UK). In previous years the peak of influenza activity has occurred between October and March in the UK and the impact of the disease on the population has been dependent on the strain of influenza circulating that year. All indices used to monitor influenza activity in the UK are currently well below base line levels.

The data collected by the enhanced influenza surveillance carried out by the Health Protection Agency (HPA) Centre for Infections is summarised in regular influenza reports

<>, which provide comprehensive information on the clinical and virological indicators of influenza activity throughout the influenza season, up to week 20 2007. Reports will initially be published fortnightly on a Wednesday.

Vaccine supply
The Department of Health has informed all GPs that while the requested amount of influenza vaccine will be produced this winter, it will be supplied between October and December as a result of initial delays in production [1]. 15 million doses will be available in the UK to cover vaccination of all people at high risk but some persons may not receive their vaccine until late in the year. As in previous years, the HPA will be monitoring the uptake of vaccine in England, on behalf of the Department of Health. Last winter over 75% of people aged 65 or more were vaccinated, the highest rate since monitoring was introduced in 2000. Further information can be obtained at <>.


1. Government issues advice to GPs on Flu jab supply. Government News Network [online] 2 October 2006 [accessed 4 October 2006]. Available at <


Food-borne botulism associated with home prepared meat products from Poland


A case of food-borne botulism occurred in the Republic of Ireland in September 2006. Since the beginning of 2003, there have been a further four cases of food-borne botulism in the United Kingdom (UK) and the Republic of Ireland [1]. Three of these five incidents involved Polish nationals, and were associated with the consumption of home prepared meat products originating from Poland.

In 2003, a male Polish national living in England developed botulism and subsequently died, having eaten a home prepared meat product (‘bigosh’) brought from Poland. Botulinum neurotoxin serotype B [BoNTB] was detected in serum samples collected prior to death. The second incident occurred in a male Polish national living in England in 2005 who developed botulism within 24 hours of consuming home preserved pork originally prepared in Poland. Clostridium botulinum type B and BoNTB were recovered from the patient’s faeces and from the jar of home preserved pork. The patient was treated with antitoxin and made a complete recovery. The preserved pork had been home slaughtered, bottled, stored at room temperature for several months in Poland prior to bringing to England for consumption. The most recent incident affected a Polish national living in the Republic of Ireland who developed symptoms of botulism after consuming home prepared pork which again originated in Poland. C. botulinum type A/B was isolated from the patient faeces and from a sample of home preserved pork. The patient received antitoxin and is making steady progress.

Of the remaining two cases of food-borne botulism reported in the UK, one was associated with UK commercially prepared hummus, and the final case with recent travel to Georgia. Readers should be aware of the increase in incidence of food botulism associated with the consumption of home prepared meat products from eastern European countries, which have much higher rates of food-borne botulism than either the UK or the Republic of Ireland [2,3]. The main vehicles for botulism transmission are meat dishes, and in particular home preserved pork in bottling jars. Clinicians should be aware of the possible increased risk of botulism among migrant workers from eastern Europe.



1. McLauchlin J, Grant KA, Little CL. Foodborne botulism in the UK. J Public Health 2006; in press, available ahead of print from <>.
2. Galazka A, Przbylska A. Surveillance of botulism in Poland: 1960-1998. Eurosurveillance 1999; 4:69-72.
3. Varma JK, Katsitadze G, Moiscrafishvili M, et al. Foodborne botulism in the Republic of Georgia. Emerg Infect Dis 2004;10:1601-5.



Cryptosporidiosis in England and Wales


In the autumn of 2005 there was an increase in cases of human cryptosporidiosis together with two outbreaks putatively linked to public water supplies in South England and North Wales. These outbreaks led the Drinking Water Inspectorate (DWI) to instruct water companies to review their cryptosporidium risk assessments for surface water-derived treatment works by 30 April 2006. DWI also provided guidance on risk assessment criteria, monitoring and communications. DWI undertook to review the relevant regulations in light of any lessons learnt from companies’ revised risk assessments and from the reports of the outbreak control teams. In the interim, the Health Protection Agency (HPA) was commissioned by DWI to produce a report updating knowledge on cryptosporidiosis (epidemiology and health surveillance data) since the publication of the Bouchier Report in 1998 [1]. The DWI has now published this report on the epidemiology of cryptosporidiosis produced by the Health Protection Agency, the National Public Health Service for Wales, and the University of East Anglia [2].

Cryptosporidium causes diarrhoea in people of all ages, but is most common in young children. Disease can be severe in people with an immune deficiency, particularly involving severe depletion of T-cell count and function [3]. Seasonal increases in the spring and autumn have been observed each year between 1989 to 2000, but since then, the spring peak of cases of cryptosporidiosis has declined, whereas no similar reduction has been observed in the autumn peak. Although the foot and mouth disease outbreak contributed to the decline in cases in the spring of 2001 [4,5] the reduction continues to be apparent. There is now good evidence to support the view that this is due to investment in new or improved water treatment, including first time filtration, particularly in the North West of England [6].

Regulatory monitoring data since 1999 have shown that water supplies may occasionally contain very low numbers of Cryptosporidium oocysts. The significance of these is unclear because the oocysts may be non-viable or may be of a species that are not very infectious for humans. It also remains possible, however, that low oocyst counts of highly infectious isolates represent a risk to public health.
The routes by which people in the second half of the year become infected require further investigation, but swimming pools and foreign travel both appear to be important. The reference genotyping of isolates of Cryptosporidium to species level has proved important to understanding the distribution of the two main species (C. parvum and C. hominis) within the human population and in identifying species-specific risk factors [7].

In 2006 Cryptosporidium cases have increased in August and September (Figure 1) and so far show similar numbers at this time of year to those in four out of five years between 2001 and 2005. As in previous years, this rise in cases is mainly caused by C. hominis.

Figure 1 Cases of cryptosporidiosis reported in England and Wales: 1998 to 2006

Figure 1 Cases of cryptosporidiosis reported in England and Wales: 1998 to 2006



1. Expert Group chaired by Bouchier I. Cryptosporidium in water supplies; Third report of the group of experts. London: Department of the Environment, Transport and the Regions, Department of Health), 1988. pp. 1-171. Available at <>.
2. Nichols G, Chalmers R, Lake I, Sopwith W, Regan M, Hunter P, et al. Cryptosporidiosis: A report on the surveillance and epidemiology of Cryptosporidium infection in England and Wales. Drinking Water Directorate Contract Number DWI 70/2/201. London: Drinking Water Inspectorate, 2006. Available at
3. Hunter PR, Nichols,G (2002). Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients. Clin Microbiol Rev 2002; 15: 145-54.
4. Hunter PR, Chalmers RM, Syed Q, Hughes LS, Woodhouse S, Swift L. Foot and mouth disease and cryptosporidiosis: possible interaction between two emerging infectious diseases. Emerg Infect Dis 2003; 9: 109-12.
5. Smerdon W J, Nichols T , Chalmers R M, Heine H, Reacher MH. Foot and mouth disease in livestock and reduced cryptosporidiosis in humans, England and Wales. Emerg Infect Dis 2003; 9: 22-8.
6. Sopwith W , Osborn K, Chalmers R, and Regan M. The changing epidemiology of cryptosporidiosis in North West England. Epidemiol Infect 2005; 133: 785-93.
7. Hunter PR, Hughes LS, Woodhouse S, Syed Q, Verlander N, Chalmers RM and members of the project steering committee. Case-control study of sporadic cryptosporidiosis with genotyping. Emerg Infect Dis 2004; 10: 1241-9

Code of practice for the prevention and control of health care associated infection

The Department of Health in England has published the Code of practice for the prevention and control of healthcare associated infection as part of the implementation of The Health Act 2006 [1]. An earlier draft of the code was published in July, and the Code has subsequently been restructured and shortened.

The purpose of the Code is to help NHS bodies plan and implement how they can prevent and control healthcare associated infections (HCAI). It sets out criteria by which managers of NHS organisations and other health care providers should ensure that patients are cared for in a clean environment, where the risk of HCAI is kept as low as possible. The Healthcare Commission will be using this code to assess NHS performance, and similar requirements will be introduced for the private and voluntary healthcare sector and care homes.


1. Department of Health. The Health Act 2006 - code of practice for the prevention and control of health care associated infection. London: DH, 1 October 2006. Available at