Research and analysis

HPR volume 10 issue 22: news (8 July)

Updated 16 December 2016

1. CMO advice for travellers to the Rio Olympics

The Chief Medical Officer for England has issued advice for UK residents travelling to Brazil for the Rio 2016 Olympics (5 to 12 August) and Paralympics (7 to 18 September), including official advice about the mosquito-borne Zika virus infection [1].

The World Health Organization’s Emergency Committee on Zika advised in June that, given the low risk, there should be no general restrictions on travel to the Games but emphasised the importance of ensuring that all those attending should be fully informed of the risks of Zika virus infection and the personal protective measures necessary to reduce those risks [2]; also of the action they should take if they suspect they have been infected.

Professor Dame Sally Davies has issued ‘Five Top Tips’ [1], in particular that those attending the Games should make sure they protect themselves by using a good insect repellent – high in the ingredients DEET or Picardin – use it according to instructions day and night and, in general, wear loose-fitting long-sleeved tops and trousers.

Those who are pregnant should postpone travel if possible, the CMO advises. If there is an obligation to travel, a doctor should be consulted beforehand so the necessary precautions can be explained. Regarding the risk of sexual transmission of the virus, travellers are advised that they should use condoms during sex while at the Olympics and for 8 weeks after their return. Those with pregnant partners or hoping to become pregnant in the near future should consult the PHE website for further, specific advice [3].

1.1 References

1. DH and FCO (5 July). ‘Health advice for people travelling to a Zika affected area’, GOV.UK news story.

2. PHE website. Zika Health Protection Guidance: Preventing infection by mosquito bites

3. PHE website. Zika Health Protection Guidance: preventing infection by sexual transmission.

2. PHE publishes full annual STIs data for 2015

PHE has released its annual data on sexually transmitted infections (STIs) in England [1-6] which are covered in depth in this issue of Health Protection Report.

The main review report, Sexually transmitted infections and Chlamydia screening in England, 2015 [1], provides an overview of trends for the STIs of most concern in England:

• gonorrhoea
• syphilis
• genital herpes
• chlamydia
• genital warts

The latest data show that were 434,456 STIs reported in England in 2015; 54,275 of which were among gay, bisexual or other men who have sex with men, a 10% increase since 2014. Chlamydia was the most commonly diagnosed STI, accounting for 46% of diagnoses (200,288 cases), followed by genital warts (68,310 cases) [2].

The impact of STIs remains greatest in young people under the age of 25 years, and among gay, bisexual and other men who have sex with men. The large fall in genital warts seen this year in young women is an expected positive effect of the national Human papillomavirus (HPV) vaccination programme.

Individual reports are also presented on: chlamydia retesting [3]; Lymphogranuloma Venereum [4]; shigella [5]; genital warts [6]

2.1 References

1. PHE (5 July 2016). Sexually transmitted infections and chlamydia screening in England, 2015. HPR 10(22) Advance Access report.
2. ‘New STI figures show continued increases among gay men’, PHE press release, 5 July 2016.
3. PHE (5 July 2016). Monitoring rates of chlamydia re-testing within the English National Screening Programme (January 2013 to June 2015). HPR 10(22) Advance Access report.
4. PHE (5 July 2016). Lymphogranuloma venereum infections in England 2004 to 2016. HPR 10(22) Advance Access report.
5. PHE (5 July 2016). Shigella infections in England with a focus on sexual transmission between men who have sex with men: laboratory reports 2004 to 2016. HPR 10(22) Advance Access report.
6. PHE (8 July 2016). Continuing trend of declining genital warts diagnoses in young women in England: update to end 2015. HPR 10(22): news (see below).

3. Continuing trend of declining genital warts diagnoses in young women in England: update to end 2015

Rates of first-episode genital warts (GW) diagnoses in specialist sexual health clinics, collected in the Genitourinary Medicine Clinic Activity Dataset (GUMCADv2), among 15 to 19 year old females have declined by 38.9% between 2009 and 2015. Reductions were greatest among 15 year old females (83.2%), an age cohort largely offered the quadrivalent vaccine. A smaller reduction of 30.2% has also been seen in 15 to 19 year old males.

The UK was the first country in the world to introduce a national HPV vaccination programme in September 2008 using the bivalent HPV 16/18 vaccine. In September 2012, the programme changed to using the quadrivalent vaccine, which also includes HPV types 6 and 11, providing protection against GW [1]. The target group for the routine vaccination programme is 12 to 13 year old females and uptake has been high. Previously reported data up to the end of 2014 has shown modest declines in GW diagnoses, suggesting a potentially cross-protective effect of the bivalent vaccine against GW [2-4]. This report presents the first evidence of declines in GW diagnoses in young females offered the quadrivalent vaccine in England .

Data for 2009 to 2015 collected in GUMCADv2, submitted by specialist sexual health clinics in England, were reviewed. The greatest declines were observed in 15 and 16 year-old females, a proportion of whom would have received the quadrivalent vaccine [5]. In 2015, 28.9% and 57.4% of 15 year-old females received the bivalent and quadrivalent vaccine, respectively, while 71.5% and 14.4% of 16 year old females received the bivalent and quadrivalent vaccine, respectively. All vaccinated females over the age of 17 in 2015 would have been offered the bivalent vaccine. A decrease of 83.2% and 58.0% between 2009 and 2015 in the rate of GW diagnoses was seen for 15 and 16 year-old females, respectively (see figure below; and in PDF version for greater clarity).

Overall, there has been a marked decrease of 38.9% (from 685.8 to 419.2 per 100,000 population) in the rate of GW diagnoses for females aged 15 to 19 years and of 17.5% (from 698.9 to 576.8 per 100,000 population) for females aged 20 to 24 years. A decrease of 30.2% (from 274 to 191.2 per 100,000 population) was seen for 15 to 19 year old males and 15.5% (from 849.6 to 718.2 per 100,000 population) for 20 to 24 year old males over the same time period. The percentage declines lessen with increasing age, as does the estimated vaccine coverage. In females above the age eligible for HPV vaccination (born before 1 September 1990), and same aged males, diagnosis rates showed no similar declines. Additionally, other STI diagnoses, specifically genital herpes, chlamydia, and gonorrhoea, did not show similar patterns of declines.

In summary, there have been very large reductions in the rate of GW diagnoses in young females offered the quadrivalent vaccine. Declines in rates of GW diagnoses are already higher than expected in this age group. Modest declines in rates of GW diagnoses were also seen in females only offered the bivalent vaccine, which strengthens evidence of a potential cross-protective effect as previously explored [3,4].

Rates of genital warts diagnoses and HPV vaccination coverage in England, by age and year

3.1 References

1. PHE (2009). Human papillomavirus (HPV) immunisation programme - first year safety review 2009.

2. PHE (2015). Continuing trend of declining genital warts diagnoses in young women in England associated with HPV 16/18 vaccination: update to end-2014. HPR 9(22)

3. Howell-Jones R, Soldan K, Wetten S, Mesher D, Williams T, Gill ON, et al (2013). Declining genital warts in young women in England associated with HPV 16/18 vaccination: an ecological study. J Infect Dis. 208(9): 1397-403.

4. Canvin M, Sinka K, Hughes G, Mesher D (in press). Decline in genital warts diagnoses among young women and young men since the introduction of the bivalent HPV (16/18) vaccination programme in England: an ecological analysis. Sex Transm Infect.

5. PHE (2015). Human Papillomavirus (HPV) Vaccine Coverage in England, 2008/009 to 2013/14: a review of the full six years of the three-dose schedule.