Common animal-associated infections (England and Wales): first quarter 2022
Updated 14 February 2023
Applies to England and Wales
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Background
This quarterly report is produced by the Emerging Infections and Zoonoses team in the Clinical and Emerging Infections Directorate, UK Health Security Agency (UKHSA).
The report summarises confirmed (and probable for leptospirosis) cases of selected zoonoses reported in England and Wales between January and March 2022 (first quarter) and includes additional information on the quarterly trends for hepatitis E, leptospirosis, and Lyme disease. The impacts of the public health measures implemented in England and Wales due to the coronavirus (COVID-19) pandemic during quarter one of 2021 should be considered when making comparisons with this time period.
Data reported as provisional is subject to change due to late notifications and de-duplication.
The data presented in this report supersedes data in previous reports due to late notifications and de-duplication.
Hepatitis E data is not presented in this quarterly report. As part of an internal review, the data is being reviewed and validated and will be published in the next report.
Overview
Table 1. Animal-associated infections in England and Wales: quarterly confirmed laboratory reports by specimen date Q1 2020 to Q1 2022
| Disease (organism) | Q1 2020 | Q2 2020 | Q3 2020 | Q4 2020 | Total (2020) | Q1 2021 | Q2 2021 | Q3 2021 | Q4 2021 | Total (2021) | Q1 2022* | Total (2022*) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Anthrax (Bacillus anthracis) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Brucellosis (Brucella spp.) ** | 1 | 1 | 6 | 1 | 9 | 1 | 3 | 3 | 1 | 8 | 0 | 0 |
| Leptospirosis (Leptospira spp.) | 15 | 7 | 22 | 7 | 51 | 8 | 5 | 16 | 26 | 55 | 4 | 4 |
| Lyme disease (Borrelia burgdorferi) | ||||||||||||
| All cases | 173 | 188 | 625 | 276 | 1,262 | 119 | 225 | 573 | 239 | 1,156 | 142 | 142 |
| Acute infections | 53 | 132 | 468 | 155 | 808 | 59 | 146 | 477 | 180 | 862 | 92 | 92 |
| Pasteurellosis (Pasteurella spp.) | 175 | 153 | 214 | 190 | 732 | 196 | 258 | 243 | 188 | 885 | 203 | 203 |
| Q-fever (Coxiella burnetii) | ||||||||||||
| All cases | 7 | 5 | 3 | 2 | 17 | 3 | 2 | 5 | 2 | 12 | 6 | 6 |
| Acute infections | 6 | 3 | 3 | 1 | 13 | 2 | 2 | 5 | 2 | 11 | 4 | 4 |
| Toxoplasmosis (Toxoplasma gondii)† | n/a | n/a | n/a | n/a | n/a | n/a | n/a | 45 | 53 | 98 | 55 | 55 |
*Provisional data.
** Serology results, in addition to culture results, were introduced in Q1 2019.
† Based on date specimen received.
n/a = not available due to issues in the reference laboratory related to coronavirus (COVID-19).
Leptospirosis
Data for leptospirosis was obtained from the Rare and Imported Pathogens Laboratory (RIPL, UKHSA Porton). As of 1 August 2020, a laboratory confirmed case of leptospirosis is defined by a positive 16S rRNA PCR result only. An Immunoglobulin M (IgM) enzyme-linked immunoabsorbent assay (EIA) continues to be performed on all samples of suspected leptospirosis cases. A case with a positive leptospirosis IgM result will usually be treated clinically on the basis of this result, even in the absence of a positive PCR result. A case with a positive IgM but without a confirmatory PCR result is therefore reported as a probable case for surveillance purposes.
There were 4 confirmed cases of leptospirosis reported in the first quarter of 2022, compared to 8 cases reported in the same quarter of 2021. There were 23 probable cases reported in the first quarter of 2022, compared to 28 in the same quarter of 2021. Figure 1 shows the number of confirmed cases reported by quarter over the past 5 years (2018 to 2022).
Figure 1. Laboratory confirmed and probable cases of leptospirosis by quarter, Q1 2018 to Q1 2022
In the first quarter of 2022, all confirmed cases (4; 100%) were male (aged 28 to 69 years). Cases were reported in the South West (2), London (1) and the East of England (1). No cases were reported in Wales.
No cases reported recent travel abroad. Of the 4 confirmed cases, 3 reported potential exposures:
- one case had an exposure linked to a water source, specifically to canal water
- 2 cases had an exposure linked to animals – both reported an exposure to rats, one of which also reported exposure to farm animals
Lyme disease
Data for Lyme disease was obtained from the Rare and Imported Pathogens Laboratory (RIPL, UKHSA Porton). The total number of confirmed Lyme disease cases reported in the first quarter of 2022 (n=142) was higher than in the same time period in 2021 (n=119). The total number of acute cases was higher in quarter 1 2021 (59), compared to quarter 1 2022 (92).
Figure 2 shows how the number of cases continue to peak during the summer months (third quarter), which corresponds to the peak times of exposures to ticks in the UK in the spring and summer months.
Figure 2. Laboratory confirmed cases of Lyme disease by quarter, Q1 2018 to Q1 2022
Of the total cases, 92 (65%) were acute (including 8 with neurological Lyme disease) and 50 (35%) were longstanding. Of the acute cases, 48 were male (aged 4 to 78, median 47) and 44 were female (aged 4 to 86, median 51). Table 2 shows the age group and sex distribution.
Table 2. Laboratory confirmed acute cases of Lyme disease by age group and sex, Q1 2022
| Age group | Male | Female | Total |
|---|---|---|---|
| 0 to 14 | 4 | 1 | 5 |
| 15 to 24 | 3 | 6 | 9 |
| 25 to 34 | 8 | 5 | 13 |
| 35 to 44 | 8 | 6 | 14 |
| 45 to 54 | 10 | 8 | 18 |
| 55 to 64 | 7 | 9 | 16 |
| 65 to 74 | 6 | 4 | 10 |
| Over 75 | 2 | 5 | 7 |
| Total | 48 | 44 | 92 |
The regions that reported the most acute cases in the first quarter of 2022 were London (n=22), South East (n=18), South West (n=16) (Table 3). Only one of the acute cases in the first quarter of 2022 reported foreign travel, specifically to eastern Europe.
Table 3. Laboratory confirmed acute cases of Lyme disease by region, Q1 2020 to Q4 2021
| UKHSA Centre | 2021 Q1 | 2021 Q2 | 2021 Q3 | 2021 Q4 | 2021 Total | 2022 Q1 | 2022 Total |
|---|---|---|---|---|---|---|---|
| East Midlands | 2 | 2 | 5 | 1 | 10 | 4 | 4 |
| East of England | 7 | 11 | 24 | 14 | 56 | 4 | 4 |
| London | 21 | 27 | 83 | 45 | 176 | 22 | 22 |
| North East | 3 | 6 | 15 | 5 | 29 | 2 | 2 |
| North West | 4 | 24 | 52 | 19 | 99 | 12 | 12 |
| South East | 11 | 30 | 150 | 36 | 227 | 18 | 18 |
| South West | 6 | 31 | 115 | 36 | 188 | 16 | 16 |
| West Midlands | 3 | 3 | 7 | 6 | 19 | 6 | 6 |
| Yorkshire and Humber | 1 | 8 | 20 | 11 | 40 | 5 | 5 |
| Wales | 1 | 4 | 6 | 7 | 18 | 3 | 3 |
| Total | 59 | 146 | 477 | 180 | 862 | 92 | 92 |
Note: specimens sent for Lyme disease referral testing should be accompanied by a completed referral form.
Toxoplasmosis
Data for toxoplasmosis was obtained from the Toxoplasma Reference Unit (TRU, Swansea). Toxoplasmosis surveillance data between the first quarter of 2020 and the second quarter of 2021 is currently unavailable – this is due to the impact of pressures on the laboratory as a result of the COVID-19 pandemic and, therefore, reporting on recent trends is not possible at this stage. The data will be published retrospectively, as soon as it is available.
There were a total of 55 confirmed toxoplasmosis cases reported in the first quarter of 2022. Of the total confirmed cases, 16 were male (aged 0 to 66, median 33) and 39 were female (aged 15 to 75, median 32). Table 4 shows the age group and sex distribution. It is likely that reported numbers are an underestimate, biasing towards severe infections as individuals with severe or symptomatic disease are more likely to be tested.
Table 4. Laboratory confirmed cases of toxoplasmosis by age group and sex, Q1 2022
| Age group | Male | Female | Total |
|---|---|---|---|
| Under 15 | 2 | 0 | 2 |
| 15 to 24 | 2 | 6 | 8 |
| 25 to 44 | 8 | 25 | 33 |
| 45 to 64 | 3 | 7 | 10 |
| Over 64 | 1 | 1 | 2 |
| Total | 16 | 39 | 55 |
Other zoonotic organisms (provisional data)
There were 4 reports of Capnocytophaga spp. Infection in the first quarter of 2022. No reports were further speciated. Capnocytophaga spp. are frequently carried in the mouths of companion animals (cats and dogs) or humans and may be associated with an animal or human, bite or opportunistic infections in those with impaired immune systems. Unfortunately, limited information is available in these cases to determine the likely route of exposure.
There were 5 reports of Mycobacterium marinum in the first quarter of 2022. Of these, all cases were male aged over 45 years. All cases were reported in England. Potential exposure information was unavailable for all 5 cases.
There were 3 reports of Erysipelothrix rhusiopathiae in the first quarter of 2022. Of these, 1 case was female and 2 cases were male. All cases were reported in England. E. rhusiopathiae is the cause of swine erysipelas and can cause erysipeloid in humans. Infection is often linked to exposure to infected animals or animal products. No additional information on potential exposures was available for these cases.
Three toxigenic Corynebacterium ulcerans infections were reported in the first quarter of 2022. All cases were reported in England and were male and aged over 60 years. All cases reported contact with companion animals. Three companion animals linked to 2 of the cases were swabbed and toxigenic C. ulcerans was identified in 2 of the animals, both linked to the same human case. In England, contact with companion animals remains the most frequently reported exposure for individuals with confirmed toxigenic C. ulcerans infections, however, the animals may not show evidence of infection and it is not always possible to confirm the carriage of C. ulcerans.
There were 5 reports of Taeniasis in the first quarter of 2022, 2 of which were speciated to T. saginata.
There were 2 reports of Toxocariasis in the first quarter of 2022, neither of which were further speciated.