Research and analysis

HPR volume 11 issue 5: news (3 February)

Updated 15 December 2017

1. WHO extends areas at risk of yellow fever transmission in Brazil in response to ongoing outbreak

The outbreak of yellow fever in south-eastern Brazil continues. As of 2 February 2017, 708 suspected human cases are under investigation and 151 cases have been confirmed. A total of 140 deaths among suspected and confirmed cases have also been reported. The majority of cases have been reported in the south-eastern state of Minas Gerais (773 suspected and confirmed cases) with further cases reported in the states of Espírito Santo, Bahia, São Paulo and Tocantins [1]. Currently all cases are regarded as sylvatic and no urban outbreaks have been reported.

Yellow fever is endemic in parts of Brazil, with occasional sylvatic outbreaks. This is the highest number of confirmed cases reported in Brazil in the last 25 years. In response to this outbreak, public health authorities in Brazil have distributed 8.2 million doses of yellow fever vaccine to the affected states [1].

In view of the rapidly evolving situation, the World Health Organization (WHO) has revisited the areas at risk for yellow fever transmission in Brazil and extended the areas to include Espírito Santo state (with the exception of the urban area of Vitoria), the northern parts of Rio De Janeiro state, and new areas in south east Bahia state [2].

In agreement with these revisions from WHO, the National Travel Health Network and Centre (NaTHNaC) states that yellow fever vaccination should now be considered for travellers visiting these additional areas following individual risk assessment. Detailed information is available on the NaTHNaC Brazil Information pages [3].

Further information about yellow fever is also available on the PHE website.

1.1 References

1. Brazilian Ministry of Health (report in Portuguese, 2 February).
2. WHO (31 January). Temporary Yellow Fever vaccination recommendations for International Travellers related to current situation in Brazil
3. NaTHNaC (18 January). Yellow Fever outbreak in Brazil.

2. The national hepatitis B dried blood spot service: a three-year review

Since the national launch in September 2013 of a free dried blood spot testing service for infants born of hepatitis-infected mothers in England, there has been good uptake across the country, mainly via GP practices but also in other community settings.

A progress report on the national service, after three and a half years’ of its operation, is published in this issue of HPR [1]. Summary data presented in the report indicate that, since the national roll out of the service, more than 2000 samples (up to 31 December 2016) had been received, 98% having been taken in primary care, or in community or home settings, as intended. (An aim of the service was to avoid the need for infants to be referred to secondary care for testing.)

A total of 12 PHE Centres and/or NHS England areas, and an additional 18 hospital trusts, have joined the service, leading to high coverage across the country. Nevertheless, continued advocacy is needed to increase the reach of this service, the progress report concludes, particularly in areas of high antenatal HBV prevalence.

2.1 Reference

1. PHE (3 February 2017). Testing of infants born to hepatitis B infected mothers: a three-year review of the national DBS testing service.

3. Investigation of hepatitis A clusters in England prompts issue of targeted sexual health advice

PHE has issued targeted sexual health advice to the MSM community having identified clusters of hepatitis A cases across England, mostly among gay and bisexual men, some of which are associated with travel to Spain.

Linked cases of hepatitis A have been under investigation for several months in several European countries [1]. Cases are mainly male, some having self-identified as men who have sex with men (MSM) and/or having travelled to Spain in the eight weeks before symptom onset. One case with no travel history reported sexual activity with an unidentified partner who had returned from Spain.

As part of the investigation PHE has been working with the third sector and NHS Choices to disseminate advice to the MSM community. The advice is that good hand and personal hygiene are the most effective ways to reduce the spread of the hepatitis A virus as well as changing condoms between any kind of sex; also that those who consider themselves at risk should seek advice from sexual health services about whether they would benefit from hepatitis A immunisation.

3.1 Reference

1. ECDC (December 2016). Rapid risk assessment: hepatitis A outbreaks in the EU/EEA mostly affecting men who have sex with men.