Research and analysis

HPR volume 10 issue 9: news (4 March)

Updated 16 December 2016

1. Zika virus: updated guidance for pregnant women

PHE and NaTHNaC have updated their guidance relating to travel to areas where there is active transmission of Zika virus, including areas in South and Central America and the Caribbean. A new recommendation is that pregnant women should postpone all non-essential travel to those areas [1,2]. This reflects increasing evidence that supports an association between Zika virus infection and microcephaly in developing foetuses.

Where travel to areas with active transmission cannot be postponed, pregnant women and those planning pregnancy should avail themselves of advice from their healthcare provider about the risks that Zika may present before they travel, and in some circumstances after they return. The principal, protective advice applicable to all travellers, but particularly pregnant women who cannot postpone travel, is to practise scrupulous mosquito bite avoidance.

PHE, the British Medical Association and the Royal College of General Practitioners have issued joint guidance for healthcare professionals in primary care who may be consulted by patients, including pregnant women, who are travelling to or returning from the affected areas [3]. This includes guidance on pre-departure travel advice, medical complications that may be associated with Zika virus infection, and management of returning travellers including assessment and diagnosis of patients with current symptoms suggestive of Zika virus infection. Additionally, new advice is available about Guillain-Barré syndrome, and also Zika virus and immunosuppressed patients.

Adopting a precautionary approach, guidance from PHE and its partners recommends measures to decrease the risk of male-to-female sexual transmission of Zika virus, particularly transmission to pregnant women and women planning pregnancy. This includes recommendations on condom use for men who have returned from affected areas (for a six-month period in the case of a male partner who has experienced symptoms compatible with Zika virus infection, and 28 days for men who have not had symptoms). Additionally, returned male travellers who are partners of pregnant women are advised to use condoms for the duration of pregnancy.

Links to all professional guidance produced by PHE and its partners are available on PHE’s main Zika guidance webpage [4].

1.1 References

1. ‘Zika virus: updated travel advice for pregnant women’, PHE website news story, 1 March 2016.

2. National Travel Health Network and Centre (2 March). Zika - Risk Assessment.

3. PHE, BMA, RCGP (February 2016). Zika virus infection: guidance for primary care (updated 1 March).

4. PHE. Zika virus: health protection guidance collection (updated 3 March).

2. Increase in Mycoplasma pneumoniae infections in England

PHE has published an annual report on laboratory-confirmed Mycoplasma pneumoniae (Mpn) infections recorded in England and Wales in 2015 [1]. It is based on data extracted from PHE’s SGSS voluntary surveillance database that collates laboratory reports of Mpn detection by PHE and NHS laboratories.

This annual report includes laboratory reports based on either serological or genomic test methods. Genomic methods are considered to produce a more robust indication of acute infection.

A total of 578 cases of Mpn infection were reported during 2015, an increase from 429 cases in 2014. The proportion of cases reported by genomic methods has increased from 12% in 2014 to 28% in 2015.

Although, overall, national numbers of reports remain low (fewer than 35 per week), it has been noted that, according to the latest data extracted from the SGSS database, Mpn case reports from laboratories in England have risen in the first two months of 2016 (not covered by the annual report) (see graph). No cases have been reported from Wales in 2016.

The currently observed trend in Mpn cases is consistent with a seasonal increase in the three-weekly average numbers of cases each winter, although this is higher than that observed in previous years.

Clinicians are alerted to the increased Mpn activity and are requested to consider testing for Mpn by by nucleic acid amplification tests (NAATs), or similar tests, where clinically appropriate. Reporting laboratories are requested to send Mpn NAAT-positive specimens, or extracted DNA, to the Respiratory and Vaccine-Preventable Bacteria Reference Unit, PHE Colindale, for confirmation and determination of point mutations associated with macrolide resistance (free of charge on referred positives).

Laboratory reports of Mycoplasma pneumonia in England and Wales

2.1 Reference

1. PHE (March 2016). Annual report of Mycoplasma pneumonia laboratory surveillance data, 2015, England and Wales.

3. NHS Lanarkshire hepatitis C look-back exercise

Patients who may have been treated by a former NHS Lanarkshire (Scotland) healthcare worker are being contacted as part of a patient notification exercise which has been endorsed by the UK Advisory Panel for Healthcare Workers Infected with Blood Borne Viruses [1,2].

The former healthcare worker tested positive for hepatitis C infection in 2008 and immediately stopped carrying out healthcare procedures and did not return to clinical practice.

NHS Lanarkshire is working with other NHS boards and health agencies in other parts of the UK to notify patients who may have had a surgical procedure carried out by the former healthcare worker between 1982 and January 2008. Advice from Scottish and UK experts is that the risk of the hepatitis C virus having been transmitted to a patient during surgery involving the healthcare worker is low.

Patients – mainly from Lanarkshire, but also across Scotland and the rest of the UK – have been sent letters informing them of the situation and recommending that they arrange an appointment for a blood test. Of the 8,383 patients being contacted 7,313 are from Lanarkshire.

Patients are receiving a detailed question and answer sheet with their letter which includes information about hepatitis C and how to arrange to be tested. Health Protection Scotland has endorsed the recommendation from the board that people take up the offer of a blood test to ensure that anyone who does have the virus can receive the right treatment. Treatment for hepatitis C is known to be highly effective.

3.1 References

1. NHS Lanarkshire website. Public Health Situation: Hepatitis C.

2. ‘Scotland leads hepatitis C patient notification exercise’, PHE website news story, 23 February 2016.

4. New SMIs for the laboratory investigation of infections associated with bone and joints

UK Standards for Microbiology Investigations (UK SMI) have recently issued three documents relating to the investigation of infection associated with bone and joints. The SMIs are standards for use in clinical bacteriology laboratories and cover the sample pathway from receipt in the laboratory through to issuing of reports.

Information regarding rapid methods, such as nucleic acid amplification tests (NAAT) and matrix assisted laser desorption ionisation – time of flight (MALDI-TOF) mass spectrometry have been included in each of the documents as these methods are now routinely used within clinical microbiology laboratories [1,2]. Advantages of rapid methods include shorter turnaround times and the ability to identify organisms that are slow to grow or that are un-culturable.

In addition, the use of blood culture monitoring systems for enrichment has also been included in two of the documents. Continuous monitoring systems are well established for blood culture; the introduction of these fully automated, continuous-monitoring systems has led to earlier detection and better identification of pathogens. This technology is now being used for the investigation of other sample types including bone marrow and orthopaedic implant samples. The method has been shown to have equivalent sensitivity to conventional enrichment broth for the culture of orthopaedic implant associated samples when incubated for five days [3]. Similar studies have not yet been published regarding use for bone and soft tissue specimens associated with osteomyelitis and therefore it is not currently included in the procedure for this sample type.

The issued documents can be found via the following links:

• UK SMI B38 – Investigation of bone marrow
• UK SMI B42 – Investigation of bone and soft tissue associated with osteomyelitis
• UK SMI B44 – Investigation of orthopaedic implant associated infections

4.1 References

1. Clark AE, Kaleta EJ, Arora A, Wolk DM (2013). Matrix-assisted laser desorption ionization-time of flight mass spectrometry: a fundamental shift in the routine practice of clinical microbiology. Clin Microbiol Rev 26: 547-603.
2. Espy MJ, Uhl JR, Sloan LM, Buckwalter SP, Jones MF, Vetter EA, et al (2006). Real-time PCR in clinical microbiology: applications for routine laboratory testing. Clin Microbiol Rev 19: 165-256.
3. Minassian AM, Newnham R, Kalimeris E, Bejon P, Atkins BL, Bowler IC (2014). Use of an automated blood culture system (BD BACTEC) for diagnosis of prosthetic joint infections: easy and fast. BMCInfectDis 14: 233.