Research and analysis

HPR volume 10 issue 12: news (24 March)

Updated 16 December 2016

1. Progress reported on national TB strategy implementation

Significant progress in implementation of PHE and NHS England’s national strategy on the prevention and control of tuberculosis in England is described in the latest PHE strategy update report, published to coincide with World TB Day [1,2,3].

Progress reported includes:

• establishment of: a national TB programme office (at PHE Colindale); and 7 TB Control Boards that cover all PHE regions and bring together PHE/NHSE with local authorities, the NHS, local service commissioners and other stakeholders to oversee local implementation of the strategy
• arrangements having been made for new entrant LTBI screening to operate in areas with the highest prevalence/incidence rates (ie above 20 cases per 100,000 population and/or where case numbers total more than 0.5% of total notifications in England). For example, 27 of the total 32 CCGs in the London region fall into this priority category
• agreeing funding from NHS England for on-going new entrant LTBI testing and treatment programmes to the end of the 2016 to 2017 financial year
• harmonising quality standards for diagnostic procedures and expanding the Birmingham Public Health Laboratory’s whole-genome-sequencing capacity – currently operating on a pilot basis – so as to offer a national service for TB in the foreseeable future
• improving services for socially vulnerable and at-risk groups, such as the homeless and the prison population. Lessons learned from 2 large prison outbreaks that occurred in the West Midlands during 2015 are noted

The update provides links to guidance published by NHSE to support CCGs in implementation of the strategy, including on identification of lead CCGs, development of local incentives for GPs to identify and test patients at risk of LTBI, the development of secondary care treatment services to operate in cases where LTBI is detected, etc.

One stakeholder charity’s role in supporting TB Control Boards in assessing regional and local priorities is noted in the update. This relates to the roll-out of new entrant LTBI testing and treatment programmes, which is likely to be a priority for most control boards. The national strategy [3] had noted significant variation in the organisation and quality of LTBI screening arrangements, and in the level of participation of different population groups targetted. The charity TB Alert has been contracted by NHSE/PHE to examine the factors influencing participation and how the levels of participation might be improved, which organisations (statutory or voluntary) are best placed to reach target populations and which settings (primary care, community, educational) are most appropriate.

1.1 References

1. WHO (24 March, 2016). World TB Day 2016: Focus on the most vulnerable populations.

2. PHE website. See: Tuberculosis (TB): annual update.

3. PHE website. See: Tuberculosis (TB): collaborative strategy for England.

2. Updated ECDC guidance on chlamydia prevention and control

Recently updated ECDC guidance on chlamydia control in Europe [1] makes the case for national chlamydia control strategies in EU/EEA member states and shows ways to develop, implement or improve national or local control activities.

As set out in the guidance, ECDC recommends that EU/EEA member states have a national strategy or plan for the control of STIs including chlamydia, which should include the provision of primary prevention interventions as well as evidence-based case management guidelines relating to treatment and partner notification. Widespread opportunistic testing or a screening programme should be considered once effective primary prevention activities and case management strategies are in place [2]. The guidance also emphasises the importance of having sufficient resources available for monitoring and evaluation before implementation of any programme.

In 2014, there were nearly 400,000 cases of chlamydia infections officially reported in 26 EU/EEA countries, with more than three million cases being recorded by ECDC between 2005 and 2014, mainly among young females, making chlamydia the most commonly reported sexually transmitted infection (STI) across the EU/EEA [3]. Untreated infection can lead to serious reproductive complications, including pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility [4].

In England, the National Chlamydia Screening Programme recommends that sexually-active 15 to 24 year-old women and men are tested for chlamydia annually and on change of sexual partner. The programme aims to prevent and control chlamydia through early detection and treatment of asymptomatic infection and to raise awareness of chlamydia among health professionals and young adults.

2.1 References

1. ECDC (2015). Chlamydia control in Europe.
2. “How to control chlamydia – an ECDC guidance for Europe”. ECDC press release, 7 March 2016.
3. ECDC (2016). Surveillance atlas of infectious diseases.
4. Kalwij et al (2010). Screening and treatment of Chlamydia Trachomatis infections. BMJ, April 21, 340.

3. UK child vaccination coverage data, October to December 2015, in this issue of HPR

Latest quarterly coverage data for children in the UK who reached their first, second, or fifth birthday between October and December 2015 are published in this issue of HPR [1].

The report discusses participation and data quality aspects of the vaccine coverage assessment process. In this evaluation period, data were received from all Health Boards in Northern Ireland, Scotland and Wales. In England, all but 2 former PCTs submitted data; a further 8 former PCTs reported data quality issues.

Children who reached their first birthday in the quarter are the fifth quarterly cohort to be offered rotavirus vaccine routinely at 2 and 3 months of age.

3.1 Reference

1. Quarterly vaccination coverage statistics for children aged up to five years in the UK (COVER programme): October to December 2015.