Research and analysis

HPR volume 11 issue 37: news (20 October)

Updated 15 December 2017

Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) annual report in summary

PHE has published its annual Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) report, presenting latest data from surveillance of antimicrobial resistance in Neisseria gonorrhoeae [1].

Current first-line treatment for gonorrhoea involves dual therapy with ceftriaxone and azithromycin, but treatment effectiveness is threatened by antimicrobial resistance.

Between 2015 and 2016, gonococcal isolates collected through PHE’s sentinel surveillance system showed:

• no resistance to ceftriaxone
• a decline in azithromycin resistance from 9.8% to 4.7%
• an increase in cefixime resistance for the second consecutive year from 0.4% to 1.7%
• a decline in resistance to ciprofloxacin from 41.9% to 33.7% and to penicillin from 17.6% to 13.9%.

Between January 2015 and June 2017, gonococcal isolates referred to PHE’s national reference laboratory confirmed:

• two cases of ceftriaxone resistance (MIC >0.125 mg/L)
• 325 cases of azithromycin resistance (MIC >0.5 mg/L) of which 81 exhibited high-level resistance to azithromycin (MIC ≥256 mg/L)
• one case of treatment failure after dual therapy with ceftriaxone and azithromycin, reported in April 2015; no further cases have been confirmed by the reference laboratory as of June 2017.

Practitioners should ensure all patients with gonorrhoea are treated and managed according to national guidelines and be alert to changes in antimicrobials recommended for front-line use [2]. Sexual health services should report possible cases of treatment failure to PHE via the online HIV and STI web-portal (contact HIVSTI@phe.gov.uk for details).

References

1. PHE (2017). Surveillance of antimicrobial resistance in Neisseria Gonorrhoeae. Key findings from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP). Data up to June 2017.
2. Bignell C, Fitzgerald M (2011). “UK national guideline for the management of gonorrhoea in adults, 2011”. Int J STD AIDS 22(10): 541-7.

Laboratory confirmed pertussis in England: data to end-August 2017

Between January and August 2017, 2954 laboratory confirmed cases of pertussis were reported across all ages to the enhanced surveillance programme in England compared to 3839 in the same period in 2016. Total cases for the first eight months of the year were 23% lower in 2017 than for the same period of 2016 but higher than 2015 and 2014. Overall pertussis activity in England persists at raised levels compared to the years preceding the outbreak that occurred in 2012.

Disease incidence, as expected, continues to be highest in infants less than three months. However, cases of pertussis in all infants <1 year of age were lower in the first eight months of 2017, than in 2016 (118 and 171 cases respectively), but higher than the equivalent periods in 2015, 2014 and 2013 (113, 88, 96 cases respectively). Confirmed cases aged 6-11 months were higher (35 cases) in 2016 than in any year since the introduction of enhanced surveillance in 1994. Between January and August 2017 there were nine laboratory confirmations in this age group. This infant age group is known to have high levels of protection after completion of the primary immunisation course.

There have been no reported deaths in infants with pertussis as an underlying cause confirmed in 2017. Eighteen deaths have been reported in young babies with confirmed pertussis who were born after the introduction of the pregnancy programme on 1 October 2012. Sixteen of these 18 babies were born to mothers who had not been vaccinated against pertussis; all of the 18 babies were too young to be fully protected by infant vaccination.

Overall trends as at end-August 2017

Overall pertussis activity between January and August 2017 was lower than in the same period in 2016 in all regions of the country. Cases in infants <1 year of age remain low despite the continued high activity in older age groups . It continues to be important to maintain high coverage in pregnant women and young children [1] to optimise protection. This is relevant particularly in light of the ongoing raised levels of pertussis in those over 1 year of age.

Reference

1. Pertussis Vaccination Programme for Pregnant Women: vaccine coverage estimates in England HPR 11(34), September 2017.

English Surveillance Programme for Antimicrobial Utilisation and Resistance fourth annual report

The fourth annual report of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) will be published on Monday 23 October [1] – coinciding with the launch of an eight-week, national advertising campaign – Keep Antibiotics Working – involving leaflets and materials distributed to the public in GP surgeries and pharmacies across England [2].

ESPAUR was established in 2013 in response to the cross-government UK five-year antimicrobial resistance (AMR) strategy [3]. Its latest report records evidence of continued improvements in antibiotic stewardship across healthcare during its fourth year of activity.

References

1. PHE website. The ESPAUR report 2017 will be available, from 23 October 2017, on the webpage: English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report.
2. PHE website. Resources for the Keep Antibiotics Working campaign are available from the PHE campaign resource website.
3. PHE (December 2015). UK five year antimicrobial resistance strategy 2013 to 2018.

Infection reports in this issue of HPR

The following two infection reports are published in this issue of HPR.

• Recent trends in Lymphogranuloma venereum (LGV) diagnoses in the United Kingdom: 2003-2016
• Enterobacter spp and related organisms in EWNI (voluntary surveillance): 2016