Research and analysis

HPR volume 10 issue 7: news (19 February)

Updated 16 December 2016

1. Group A streptococcal infections: update on seasonal activity, 2015 to 2016

Public Health England continues to monitor notifications of scarlet fever cases in England following the high levels recorded last spring. According to the second report on group A Streptococcus activity for the current 2015/16 season [1], typical seasonal increases in scarlet fever activity are being reported across England and, as of early-February 2016, activity remains elevated suggesting this may be the third year in a row with high levels of scarlet fever incidence. Invasive disease rates are above average, but remain within the upper bounds of normal seasonal levels for this time of year.

1.1 Reference

1. Group A streptococcal infections: update on activity during the 2015 to 2016 season.

2. Behavioural techniques and antimicrobial stewardship

A PHE-funded study has indicated the potential for behavioural techniques to be used in antimicrobial stewardship activity: specifically demonstrating, in a nation-wide randomised trial, that providing feedback to high-prescribing GPs – about their divergence from “social norms” – was a more successful means of reducing unnecessary prescribing of antibiotics than a patient-focussed intervention [1].

The study, triggered by a campaign developed to coincide with European Antibiotic Awareness Day 2014, involved two mail-based interventions targeting 1581 practices across England that had antibiotic prescribing rates in the top 20% for their area. In one half of the trial, GPs were sent a letter – signed by the Chief Medical Officer – saying that, “80% of practices in your local area prescribe fewer antibiotics per head than yours”, with suggestions on how to reduce unnecessary prescriptions. The second half of the trial tested the effect of an education campaign, targeted at patients, that promoted reduced use of antibiotics by means of posters and leaflets displayed in GP practices.

The results showed that intervention involving feedback from a high-profile messenger (in this case the CMO) to high-prescribing GPs significantly cut their prescribing over a six month period, leading to 73,000 fewer prescriptions and direct savings of over £92,000 in prescription costs. In contrast, there was no evidence of the patient-focussed intervention having a significant effect.

The trial was a collaboration between PHE and the Department of Health.

That such ‘feedback interventions’ can complement conventional approaches to antibiotic stewardship is acknowledged in a Comment article associated with the study report [2]; however, this sets the effect achieved in context: “The investigators highlight that their feedback intervention could reduce primary-care prescribing in England by 0.85%, against a five-year aim [in the UK antimicrobial resistance strategy 2013-2018] of reducing prescribing in primary care by 4%. Between 2000 and 2014, UK primary-care antibiotic use expanded by 46%, from 14.3 to 20.9 defined daily doses per 1000 inhabitant days. During the same period, antibiotic use fell in several European countries, and UK consumption is now twice that of the Netherlands. Inpatient consumption also continues to increase.”

2.1 References

1. Hallsworth M, Chadborn T, Sallis A, Sanders M, Berry D, Greaves F, et al (2016). Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet Online First, 18 February.

2. Gould IM, Lawes T (2016). Antibiotic stewardship: prescribing social norms. Lancet Online First, 18 February.

3. ECDC opinion on antivirals for treatment and prophylaxis of influenza

Current recommendations on the use of the neuraminidase inhibitors oseltamivir and zanamivir for the treatment and prophylaxis of influenza disease are appropriate, according to an expert opinion developed and published for public consultation by ECDC [1,2].

ECDC notes a significant variation in use of antivirals across the EU, and an under-utilisation that may be partly explained by continued debate about their effectiveness and safety. But having reviewed three large systematic reviews and meta-analyses on their use the European centre concludes that potential public health benefits are being missed. The meta-analyses supported the use of antivirals for both treatment and the prevention of influenza. Two of the main reviews found they reduced the amount of time until the first relief of symptoms while one also found that all symptoms were alleviated more than one day earlier with antiviral use. When administered early, antivirals were proven useful as prophylaxis and in reducing the effects of the disease on those already exposed.

3.1 References

1. ‘Recommendations on antivirals in European countries are appropriate, but remain underutilised in practice: new ECDC report published.”ECDC press release, 17 February 2016.

2. ECDC (17 February2016). Public consultation: Expert Opinion on neuraminidase inhibitors for prevention and treatment of influenza.