Research and analysis

HPR volume 10 issue 28: news (26 August)

Updated 16 December 2016

1. HAI and antimicrobial use point prevalence survey for England, 2016

More than four million people in Europe, each year, acquire a healthcare-associated infection (HAI), of whom approximately 37,000 die as a direct result of the infection [1]. The death toll from HAI is therefore comparable to the number dying each year in road traffic accidents.

Surveillance of both HAI and of antimicrobial use (AMU) – one of the drivers of antimicrobial resistance – are essential components of infection prevention and control, and of antimicrobial stewardship.

The latest point prevalence survey (PPS) for England to collect both HAI and AMU data is being conducted by PHE between 5 September and 14 December 2016. It is the fifth PPS to collect HAI data, and the second to also collect data on AMU (ie prescribing levels, doses used and the extent of adherence to guidelines).

In preparation for the 2016 survey, PHE has trained over 400 participants from NHS and independent sector organisations via a series of face-to-face and online training sessions.

Supporting documentation for participants has been published on the PHE website [2].

1.1 References

1. ECDC (2008). Annual epidemiological report on communicable diseases in Europe, 2008.
2. PHE website. Healthcare associated infections (HAI): point prevalence survey, England.

2. ECDC expert opinion on whole genome sequencing in Europe

The European Centre for Disease Prevention and Control has published an expert opinion on whole genome sequencing for public health surveillance developed through a collaboration between member state experts who considered the potential and the challenges associated with integrating the technology into EU level surveillance and cross-border outbreak assessment over the next five years [1,2].

Whole genome sequencing is transforming public health surveillance and outbreak investigation by providing more accurate pathogen identification, antimicrobial resistance profiling, transmission tracking and biological risk assessment. However, the ECDC expert group considered the obstacles needing to be overcome before WGS can be applied at the European level. These range from differences in the sequencing platforms, inter-laboratory comparability, lack of standard bioinformatics pipelines, definition of WGS-derived strain nomenclature, comparability with older typing techniques, and translation of epidemiological and genomic sequence data into meaningful information for public health decision-making.

To support member states in the transition to WGS from earlier technologies, and to ensure that WGS is adopted without compromising continuity of national and EU-level surveillance, ECDC is proposing to:

• map other WGS-based public health initiatives and engage partnerships
• lead on the integrated analysis of microbiological data and epidemiological data
• provide guidance on and validation of WGS-based methods for surveillance, and
• develop, run and evaluate selected pilot implementation studies.

Also published by ECDC is an updated “roadmap” for integration of molecular/genomic typing into EU surveillance and epidemic preparedness. This includes recommendations for priority diseases, and WGS-based surveillance implementation processes, developed by ranking the options according to public health added-value and taking account of resources available to member states and the ECDC [2].

2.1 References

1. ECDC (15 August 2016). Expert opinion on whole genome sequencing for public health surveillance.
2. “Whole genome sequencing empowers disease surveillance and outbreak investigation”, ECDC website news story, 15 August.

3. Consultation on proposed clinical commissioning policy on PrEP for HIV

On 10 August, NHS England launched a 45-day public consultation on a proposed clinical commissioning policy proposition on pre-exposure prophylaxis (PrEP) for HIV [1,2]. The aim of the public consultation is to test the policy proposal with a wider group of stakeholders.

The public consultation is being run without prejudice to the outcome of legal proceedings that are ongoing relating to commissioning of HIV-PrEP services [3].

In the meantime, NHS England has said it remains committed to working in partnership with Public Health England to run a number of early-implementer test sites, over the next two years, to research how HIV-PrEP could be commissioned in the most clinically and cost effective way.

3.1 References

1. PHE (10 August, 2016). Consultation on Specialised Services clinical commissioning policies and service specifications.
2. “Clinical commissioning policy proposition on Pre-Exposure Prophylaxis”, NHS England website news story, 10 August.
3. NHS England (2 August 2016). August update on the commissioning and provision of Pre Exposure Prophylaxis (PREP) for HIV prevention).

4. Infection and vaccine coverage reports in this issue of HPR

The following reports are published in this issue of HPR. The links below are to the relevant webpage collections or publications.

4.1 Infection reports

• Laboratory reports of hepatitis A and C (E&W): January to March 2016
• Hepatitis B (England): annual report 2015

4.2 Vaccine coverage reports

• Cumulative estimates of MenACWY coverage to end-July 2016