Research and analysis

HPR volume 10 issue 38: news (4 November)

Updated 16 December 2016

1. Multi-country outbreak of Salmonella Enteritidis linked to eggs

On 28 October the European Centre for Disease Prevention and Control (ECDC) and the European Food Safety Authority (EFSA) published a joint rapid outbreak assessment relating to a multi-country outbreak of Salmonella Enteritidis [1,2].

Between 1 May and 12 October 2016, seven EU/EEA countries reported 112 confirmed cases and 148 probable cases of Salmonella Enteritidis related to this outbreak.

An outbreak of the same strain had previously been investigated in Scotland, England and Wales between February and May 2016 when descriptive epidemiological evidence and food chain analysis carried out in Scotland had indicated a potential link to consumption of imported eggs.

Whole genome sequencing (WGS) and phylogenetic analysis, performed by PHE, has confirmed that the recent cases reported in Belgium, Denmark, Luxembourg, the Netherlands, Norway, Sweden and the United Kingdom are genetically related. Based on the WGS analysis, the isolates are considered to form part of two distinct but epidemiologically related genetic clusters.

Nine of the confirmed cases have reported travel to Hungary or Poland; and Croatia reported a cluster of S. Enteritidis cases with an epidemiological link to the outbreak. Therefore these three countries are also judged to be affected by this outbreak.

Through collaborative working between ECDC, EFSA and member states, extensive environmental and food investigations, whole genome sequencing results and the tracing-back investigation of eggs, a link between the outbreak and an egg packing centre in Poland has been established. Competent authorities in Poland and in EU member states where eggs from the facility were distributed have already introduced restrictive measures to withdraw the product and stop its distribution in the market.

1.1 References

1. “Multi-country outbreak of Salmonella Enteritidis linked to eggs is ongoing in EU/EEA countries”, ECDC press release, 28 October 2016.
2. “Multi-country outbreak of Salmonella Enteritidis phage type 8, MLVA type 2-9-7-3-2 and 2-9-6-3-2 infections”, ECDC/EFSA Joint Rapid Outbreak Assessment, 28 October 2016.

2. Impact of NHS commissioning of prison health services reviewed

Progress made during the first decade of commissioning of prison health services by the NHS in England and Wales is described in a rapid review of evidence of the impact of NHS-commissioned health services in prisons, recently published by PHE [1].

The UK (Scotland and Northern Ireland having more recently followed the same course) is now among a small number of European countries (along with France, Italy, Norway, Sweden and Finland) that mandate national health services to provide prison healthcare (as opposed to ministries of justice, or the interior).

As a result of this experience of NHS commissioning, the UK’s prison healthcare system has been cited in the international literature as a model of good practice. The new, peer-reviewed PHE evidence review, commissioned by the Department of Health last year to assess the impact of NHS commissioning and thus inform future policy, concludes that, “prison healthcare services have undergone ‘transformation’ during the 10-year period of NHS commissioning … since 2006, leading to significant improvements in quality of care” [1].

2.1 Health and Justice Annual Review 2015/16

At the same time as the rapid evidence review report, PHE has published its second annual report on the activities of its Health and Justice Team, the Health and Justice Annual Review 2015/16 [2].

The challenge of prevention and control of communicable disease in the confined environment of Prescribed Places of Detention (PPDs) is the subject of a health protection chapter in the new annual review, covering blood-borne viruses (BBVs), tuberculosis and influenza in particular. A number of TB and flu outbreaks during 2015/16 are reported; more welcome is the steady progress reported in improving the coverage of BBVs testing, by virtue of the ongoing BBV opt-out testing programme.

However, a wide range of health issues other than infections are covered by the annual review. This is a consequence of PHE’s responsibilities now extending to health and wellbeing initiatives directed not only at those within PPDs (in England and Wales that is prisons, secure children’s homes, immigration removal centres, police detention centres, etc) but also all those, although not detained, who are “in contact with the criminal justice system”. The aim is to “reduce health inequalities, reduce offending and re-offending behaviour, support healthier living within the prison estate and to ensure continuity of care across both custody situations and the wider community”. Thus the annual review stresses the indirect, positive benefit for the wider community of improving the health and wellbeing of detainees. It is accepted, for example, that the BBV opt-out testing programme, and reduction of BBVs prevalence in the prison population, contributes to prevention and control of such infections in the wider community.

Nevertheless, in his foreword to the new report, PHE national lead for health and justice Dr Eamonn O’Moore notes that a most serious challenge for prison health services in England and Wales in 2015/16 was substance misuse and its consequences, the increasing availability of so-called “new psychoactive substances” in particular.

Dr O’Moore is also director of the UK Collaborating Centre for the WHO (Europe) Health in Prisons Programme, a unique function PHE’s Health and Justice Team has performed since 2014. The team is part of the agency’s Health Equity and Mental Health Division, under the umbrella of the Health and Wellbeing directorate.

2.2 References

1. PHE (October 2016). Rapid review of evidence of the impact on health outcomes of NHS commissioned health services for people in secure and detained settings to inform future health interventions and prioritisation in England.
2. PHE (October 2016). PHE health and justice annual review 2015/16.