Research and analysis

HPR volume 11 issue 39: news (3 November)

Updated 15 December 2017

Management of scarlet fever in childcare settings: updated guidance

PHE has updated guidelines on the management of scarlet fever outbreaks in schools, nurseries and other childcare settings that were first published in interim form in 2014, when a dramatic rise in cases was seen in England [1].

The guidelines have been updated to reflect the changing epidemiology and feedback from Health Protection Teams (HPTs) on their implementation in practice.

Key changes to the guidelines are:

• updated information on the epidemiology of scarlet fever in England
• greater emphasis on the need to alert health professionals, and schools, when there is an upsurge in scarlet fever activity at the beginning of the season, so as to improve case ascertainment
• addition of a checklist to assist HPTs with their risk assessments
• new information about risk associated with co-circulating group A Streptococcus and influenza
• highlighting of trigger points for schools/nurseries to seek further help from HPTs (eg when hospitalisations and complications are reported, when chickenpox or influenza are co-circulating, etc).

Reference

1. PHE website. Guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings (October 2017).

Non-fatal overdose among PWID (England): 2017 report in summary

In response to the rising numbers of drug overdose deaths, both globally and in the UK, the Unlinked Anonymous Monitoring Survey of people who inject drugs (PWID) [1] has included questions on non-fatal overdose and naloxone administration since 2013. A first summary report on the data generated by these questions has been published, covering data from 2013-2016 in England, that shows a significant increase in the level of self-reported non-fatal overdose among PWID: from 15% reporting overdose in the preceding year in 2013 to 19% in 2016 [2].

In 2016, 19% of PWID reported that they had overdosed to the point of unconsciousness in the preceding year, of which over half (51%) reported this occurring more than once. Of those who reported an overdose in the preceding year 47% reported having naloxone administered, an opioid-antagonist which can reverse respiratory depression and sedation thus preventing overdose deaths. Reported overdose was 31% among those who had previously been in treatment for their drug use, highlighting this to be a particularly high risk group for non-fatal overdose.

Recommendations in the report for clinicians and general drug services regarding overdose prevention include the provision of opioid substitution therapy, needle and syringe programmes and take-home naloxone [3,4]. Increased efforts are required to support more people to engage with and benefit from these services and interventions.

References

1. PHE (July 2017). People who inject drugs: HIV and viral hepatitis unlinked anonymous monitoring survey tables(psychoactive): 2017 update.
2. PHE (November 2017). Non-fatal overdose among people who inject drugs in England: 2017 report. Data from the Unlinked Anonymous Monitoring Survey of HIV and Hepatitis in People Who Inject Drugs. HPR 11(39), 3 November.
3. Department of Health and devolved administrations (2017). Drug Misuse and Dependence: UK guidelines on clinical management.
4. PHE (March 2017). Health matters: preventing drug misuse deaths

Yersinia pestis (plague) information posted on PHE webpages

A large outbreak of plague in Madagascar has prompted creation of new guidance on the PHE webpages, first published on 23 October [1].

Most human cases of plague occur in Africa, with Madagascar considered the most highly endemic country. Seasonal increases (mostly of the bubonic form) in Madagascar usually occur between September and April; but in 2017 the season began earlier than usual, is predominantly pneumonic, and is affecting areas that do not usually experience outbreaks, including major urban centres. Pneumonic plague is transmissible from person to person.

As of 30 October 2017, 1,801 clinically compatible cases (suspected, probable and confirmed) had been reported across the country, of which 1,111 were clinically classified as pneumonic [2].

Clinical and laboratory guidance has been developed for England [1].

The probability of a case occurring in a person returning to the UK is very low; however, certain features of this outbreak increase the risk of infection to low-moderate for international travellers to, and those working in, Madagascar [1].

Travel advice has been updated by NaTHNaC [3]. Travellers to Madagascar are advised to use DEET-based insect repellent to protect against flea bites and:

• avoid direct contact with sick or dead animals
• avoid close contact with anyone who has symptoms or who is diagnosed with pneumonic plague
• avoid crowded areas where cases of pneumonic plague have been recently reported.

References

1. PHE website. Plague: epidemiology, outbreaks and guidance(updated 1 November 2017).
2. WHO (31 October 2017). Situation Report.
3. NaTHNaC (31 October 2017). Plague in Madagascar - Update.

Infection reports in this issue of HPR

The following reports are published in this issue of HPR.

• Non-fatal overdose among people who inject drugs in England: 2017 report
• Laboratory reports of hepatitis A and C in England and Wales, April to June 2017
• Laboratory reports of respiratory infections in England and Wales: weeks 40-43/2017