Research and analysis

HPR volume 11 issue 9: news (3 March)

Updated 15 December 2017

1. WHO identifies bacteria for which new antibiotics are most urgently needed

The WHO has published a first list of antibiotic-resistant “priority pathogens” – comprising 12 families of bacteria that are seen to pose the greatest threat to human health. Drawn up in a bid to guide and promote research into, and development of, new antibiotics – the list is part of WHO’s efforts to address the growing global antimicrobial resistance phenomenon and particularly highlights the threat of gram-negative bacteria that are resistant to multiple antibiotics.

It covers three categories of pathogen, classified according to the urgency of need for new antibiotics: critical, high, and medium priority. The most critical group includes multi-drug resistant bacteria potentially causing severe or fatal bloodstream infections and pneumonia, a particular threat in hospitals and in nursing homes and among patients whose care requires devices such as ventilators and blood catheters. This category includes: Acinetobacter, Pseudomonas and various Enterobacteriaceae (including Klebsiella, E. coli, Serratia, and Proteus). These bacteria have become resistant to a large number of antibiotics, including carbapenems and third generation cephalosporins.

The second and third categories in the list contain other increasingly drug-resistant bacteria that cause more common diseases such as gonorrhoea and food poisoning caused by salmonella.

1.1 Reference

1. WHO (27 February 2017). WHO publishes list of bacteria for which new antibiotics are urgently needed.

2. Grain industry respiratory health research report

HSE has published the results of a detailed literature search on evidence of respiratory disease associated with exposure to grain dust, whose constituents have the potential to cause chronic respiratory disease, including asthma, and inflammation of the lung [1].

The review confirms that the respiratory effects of chronic exposure to high concentrations of grain dust – generated by wheat, oats, barley, rye and corn – are cumulative. Over many decades of exposure this may cause thickening of the airways, and chronic obstructive pulmonary disease in some individuals. The health effects are attributable both to grain dust itself and the microbial contaminants it contains. Bacterial toxins (eg endotoxin) may be a key factor provoking inflammatory reactions but other microbial toxins and constituents of grain dust are also implicated.

High exposures are also associated with acute responses, including declines in lung function and irritation and inflammation of the airways, which may occur in those occasionally exposed (eg seasonal farm workers involved in grain harvesting). However, these effects may be reversed.

There is limited evidence that grain dust exposure causing occupational asthma despite its containing allergens, the HSE report notes. However, this may be due to a “healthy worker” effect, whereby those already having, or developing, asthma leave employment earlier than others. The risk of developing extrinsic allergic alveolitis – a delayed, respiratory allergy – has reduced in recent years as a result of the avoidance of damp conditions in stored grain.

The preparation of the literature review was funded by HSE. However the conclusions of the research report and the opinions it contains are those of the authors alone and do not necessarily reflect HSE policy.

2.1 Reference

1. Evans G, Smith I (2016). Risks to respiratory health in the grain industry. HSE Research Report 1083.

3. Five Nations Health and Justice Collaboration statement on new psychoactive substances in custodial settings

The Five Nations Health and Justice Collaboration has issued a statement on new psychoactive substances in custodial settings aimed at raising awareness of the challenge NPS cause for the criminal justice system as a whole and the particular burden they impose, indirectly, on NHS resources and on emergency services, primary care and mental health services in particular [1].

The Collaboration statement has identified new psychoactive substances as a serious concern because, although the extent of NPS misuse in prisons has not been quantified, and hard evidence on misuse trends is not available, surveys carried out by the Welsh, Scottish and English prison services indicate increasing use of NPS in prisons across the UK and Republic of Ireland. The United Nations Office for Drugs and Crime (UNODC) World Drug Report (2016) states that between 2008 and 2015, a total of 644 new psychoactive substances (NPS) had been reported by 102 countries and territories to the UNODC early warning advisory on NPS, suggesting that NPS is a growing concern globally.

The Collaboration statement notes that users of new psychoactive substances are at risk of physical, psychological and behavioural adverse effects on health and that growth in use within the prison estate mirrors the phenomenon of increasing use, with its serious consequences, in the wider community. The increase in drug-related deaths in Scotland as a whole from four, in 2009, to 706 in 2015, is referred to.

The 2015 Scottish Prison Service Survey indicated that 27% of respondents claimed to have used NPS prior to prison, of whom 60% claimed to have used synthetic cannabinoids, 60% claimed to have used stimulants and 31% claimed to have used hallucinogens. Eleven per cent of prisoners responding to the survey reported NPS usage while in prison.

In England, a consultation on NPS use in custody, commissioned by NHS England in 2016, involved over 600 people in nine prisons and indicated that, of those who used substances in prison, one in three were using NPS. The negative impacts reported by prisoners themselves included increasing addiction, debt and violence amongst prisoners and poorer mental and physical health outcomes, which then exacerbated bullying and violence.

In its statement, the Collaboration has recommended:

• that clinical management plans for prisoners under the influence of NPS should be developed in collaboration with the prison clinical leads, local emergency services and custodial providers
• the further development of systems to monitor drug problems and patterns of use in prison, including diverted medications, so as to inform health and security policy and operational responses
• appropriate training for prison staff on the clinical/symptom management of NPS and appropriate harm reduction advice
• research on NPS use in prisons, including: monitoring of substance use trends and the related operational impact on prisons; and a rigorous evaluation of interventions aimed at tackling NPS use in prisons.

The Five Nations Health and Justice Collaboration is a forum for discussion and debate, providing a collective authoritative voice on health and wellbeing, and health and social care for people in contact with the criminal justice system in settings across England, Scotland, Wales, Northern Ireland and the Republic of Ireland. The collaboration aims to facilitate the sharing of best practice, mutual learning and improved collective capability of health and justice partners in the five nations as well as informing the work of the UK Collaborating Centre for the WHO Health in Prisons Programme.

3.1 Reference

1. PHE (28 February 2017). Five Nations Health and Justice Collaboration Statement on the presence of new psychoactive substances in custodial settings.

4. Infection reports in this issue of HPR

The following infection/vaccine coverage reports are published in this issue of HPR. The links below are to the relevant webpage collections or publications.

• Tetanus/diphtheria/polio school leaver booster programme: vaccine coverage estimates (England): September 2015 to August 2016

• Laboratory reports of respiratory infections made to PHE from PHE and NHS laboratories in England and Wales: weeks 5 to 8, 2017.