Research and analysis

HPR volume 11 issue 42: news (24 November)

Updated 15 December 2017

HSE annual health and safety statistics

Twelve thousand lung disease deaths annually are estimated to be linked to past occupational exposures, according to latest Official Statistics, and 18,000 new cases of breathing or lung problems are self-reported as being caused or made worse by work. These are among the conclusions, relating to occupational ill-health, of annual health and safety statistics recently published by the Health and Safety Executive [1,2].

The legacy of asbestos use continues to dominate mortality statistics, accounting for approximately 40% of annual mortality from respiratory disease; lung cancer associated with other agents accounted for approximately 23%, COPD for approximately 32%, and – in 2016/17 – coalworkers’ pneumoconiosis for 587 deaths, asbestosis/silicosis for 19 deaths, and allergic alveolitis/bissinosis two deaths. HSE estimates that mesothelioma deaths (2,542 in 2016/17), due to asbestos exposures prior to 1980, will peak and start to decline from 2018/19.

HSE has published five detailed statistical commentaries on asbestos-related disease, work-related asthma, COPD, silicosis and coal worker’s pneumonconiosis, and other occupational lung diseases (allergic alveolitis, bissinosis and allergic rhinitis) [3].

Although overall prevalence of self-reported work-related breathing or lung problems has been relatively constant over the last decade, HSE notes that, “there is some evidence of an increase in the annual incidence during the latest three years: the estimate of 18,000 new cases per year (95% confidence interval: 13,000-22,000) was statistically significantly higher than the estimate of 10,000 new cases per year (95% CI: 7k to 14k) in the previous three year period”. A separate assessment of trends in the incidence of specific occupational respiratory diseases based on statistical modelling of reports to the SWORD scheme has also been published [4]: there was an overall downward trend in incidence of asthma, but not so in respect of some specific causative agents, such as flour.

Skin disease

A report on work-related skin disease, based on data from the EPIDERM surveillance scheme operated by the University of Manchester in collaboration with dermatologists, notes that cases of occupational contact dermatitis (OCD) – the most common type of work-related skin disease – continues to be caused by agents including soaps, cleaning materials and working with wet hands, with the highest rates seen by dermatologists among florists, hairdressers, beauticians, cooks and certain manufacturing and healthcare-related occupations [5].

Although the estimated annual rate of new cases of OCD is likely to have reduced, this is not necessarily the case for OCD caused by exposure to some specific agents, the HSE report notes. The longer-term downward trend in annual incidence appears to have been particularly influenced by a reduction in cases caused by allergens rather than by irritants, to some extent associated with reduced use of powdered latex gloves, particularly among healthcare workers. Work by the University of Manchester also suggested that increased numbers of cases of irritant dermatitis may have resulted from initiatives to increase hand hygiene. Other analyses by the University of Manchester show a reduction in allergic contact dermatitis due to chromates that is likely to be a result of reduced exposures in cement following the introduction of EU legislation in 2005, and that there has been an increase in the incidence of allergic contact dermatitis (ACD) caused by acrylates among beauticians; also an increase in ACD in healthcare workers attributable to isothiazolinones.

References

1. HSE (1 November 2017). Health and safety statistics: 2016/17 annual release.
2. HSE (1 November 2017). Work-related ill health and occupational disease in Great Britain.
3. HSE (November 2017). Occupational lung disease in Great Britain 2017.
4. Carder M, McNamee R, Gittins M, Agius R. (2017). Time trends in the incidence of work-related ill health in the UK, 1996-2015: estimation from THOR surveillance data.
5. HSE (November 2017). Work-related skin disease in Great Britain 2017.

Human Animal Infections and Risk Surveillance (HAIRS) group annual report in summary

The Human Animal Infections and Risk Surveillance (HAIRS) group is a multi-agency and cross-disciplinary United Kingdom horizon scanning group, chaired by the PHE Emerging Infections and Zoonoses section. The group continued to meet monthly during 2016 to discuss emerging issues affecting human and animal health in the UK and internationally.

A summary of activities undertaken by the group in 2016 has been published by PHE [1]. Topics and incidents considered by the group in 2016 ranged from high profile outbreaks (eg Salmonella Enteritidis PT8 in feeder mice) to first reports of rare disorders (eg CWD in Norway). Vector-borne diseases (VBD) continue to be discussed and assessed by the group. Spain reported the first human cases of locally-acquired CCHF in Western Europe, with the index patient probably acquiring the infection in northwest Spain, near Madrid. A secondary nosocomial case also occurred, but no further transmissions were detected. CCHFV had been detected in ticks in Spain previously. Other sporadic cases are thought possible, though the probability of CCHF infection in Spain is low. A risk assessment was undertaken by the HAIRS group, and the risk to the UK population was deemed to be very low [2].

Aedes albopictus was recorded in England for the first time by PHE surveillance when eggs were identified in a mosquito trap at a service station along the M20 in Kent [3]. Control measures were implemented and no further evidence of Ae. albopictus mosquitoes was found. VBD risk assessments were revised to take account of this finding, but as long as the mosquito is not established in the UK, the risk of disease transmission remains very low [4,5].

Further information on HAIRS group activities can be found on the HAIRS webpage [6].

References

1. PHE (November 2017). HAIRS report 2016.
2. HAIRS Group (March 2013). HAIRS risk assessment: Crimean-Congo haemorrhagic fever.
3. PHE (2016). Mosquito finding underlines importance of UK surveillance systems, HPR 10(37).
4. PHE (February 2017). HAIRS risk assessment: chikungunya virus.
5. HAIRS Group (September 2017). HAIRS risk assessment: Zika virus.
6. PHE website collection. Human animal infections and risk surveillance group (HAIRS)

Measles outbreaks linked to importations from Europe

In September 2017 the World Health Organization (WHO) confirmed that the UK achieved measles elimination in 2016 [1]. This achievement is testament to the hard work done by health professionals in the NHS to ensure that children and adults are fully protected with two doses of the measles, mumps and rubella (MMR) vaccine.

However, absence of endemic measles transmission in the UK does not mean that measles has been wiped out. Measles remains endemic in many countries around the world and there are currently several large measles outbreaks across Europe. In the 12-month period between 1 September 2016 and 31 August 2017, the highest number of cases was reported by Romania (4,982), Italy (4,814) and Germany (967), accounting for 39%, 38% and 8% respectively of all EU/EEA cases [2].

PHE continues to see imported measles cases in the UK and limited onward spread can occur in communities with low vaccine coverage and in age groups with very close mixing. For example recent importations from Romania have led to outbreaks in Leeds and Liverpool. Almost all of these recent cases have been in children who were unvaccinated.

Health Protection Teams and NHS England local teams should work together to raise awareness of the current measles situation within the local health economy to improve case ascertainment and ensure prompt public health action. GPs should note that recent travel to countries with ongoing measles outbreaks – Romania, Italy and Germany – increases the likelihood of a measles diagnosis. Practices should also maximise opportunities to offer two doses of MMR vaccine to anyone who is not up to date, especially if registering on arrival from countries where MMR programmes are not well established.

References

1. WHO Regional Office for Europe (26 September 2017). Measles no longer endemic in 79% of the WHO European Region (press release).
2. European Centre for Disease Prevention and Control. Monthly measles and rubella monitoring report: October 2017.

Infection reports in this issue of HPR

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

• Laboratory-confirmed measles, rubella and mumps (England): July-September 2017
• Non-travel associated Shigella spp infections in adult males (England): 2004 to 2017.