Research and analysis

HPR volume 12 issue 1: news (5 January)

Updated 21 December 2018

Flu indicators increasing in the UK

Influenza activity in England, Wales, Scotland and Northern Ireland increased across all surveillance indicators during the last week of 2017, with notable increases for respiratory outbreaks and influenza-confirmed hospitalisations, according to the PHE’s latest Weekly National Influenza Report [1].

There were 141 new acute respiratory outbreaks reported in week 52, compared with 34 in the previous week. The rate of influenza-confirmed hospitalisations in week 52 (based on sentinel surveillance across 19 NHS Trusts in England) was 6.82 per 100,000 population, compared with 2.33 per 100,000 in the previous week. Influenza A and B were co-circulating. RSV activity was declining.

The Department of Health issued an alert to GPs on the prescription of antiviral medicines for treatment in December [2]; related PHE guidance was last updated in October 2017 [3].

References

1. PHE (4 January, 2018). Weekly National Influenza Report - week 1 report (data up to week 52, ending 31 December 2017).
2. PHE (19 December 2017). Influenza season 2017/18: use of antiviral medicines.
3. PHE (10 October, 2017). PHE guidance on use of antiviral agents for the treatment and prophylaxis of seasonal influenza (version 8.0).

Impact of shingles vaccination programme confirmed

Introduction of the herpes zoster (shingles) vaccine in England in 2013 has proved to be a effective addition to the national immunisation programme, according to a recent paper in Lancet Public Health [1].

A new analysis, presented in the paper, complements the conclusions of earlier clinical trials and other studies carried out in the USA, that indicated the programme would be cost-effective. The authors’ analysis of sentinel, primary care (RCGP) data indicate a clear reduction in primary care consultations for herpes zoster and postherpetic neuralgia, in England, in the first three years of the programme. Begun in 2013, the phased programme offers the vaccine to different cohorts of >70 year-olds, with a catch-up element for those who miss their first opportunity to be vaccinated. The paper concludes that there were estimated 35% (95% CI 28–40) and 33% (26–39) declines in herpes zoster incidence amongst the routine and catch-up cohorts, respectively, equivalent to 17 000 fewer zoster consultations among the 5·5 million individuals eligible for vaccination. The results suggest a short-term vaccine effectiveness of 62% against herpes zoster, and 70–88% against postherpetic neuralgia, in the year of vaccination.

The authors conclude that, “the real world impact of the herpes zoster vaccination programme is somewhat higher than estimated in the [earlier] clinical studies, consistent with the vaccine resulting in fewer patients with severe forms of disease presenting to health-care services. These results suggest the initial cost-effectiveness of the UK programme might have been underestimated. The shown impact of the programme should be communicated to health professionals and the public to improve coverage and maximise public health benefits in all countries where national recommendations exist”.

Reference

1. Amirthalingam G, Andrews N, Keel P, Mullett D, Correa A, de Lusignan S, Ramsay M (2017). Evaluation of the effect of the herpes zoster vaccination programme three years after its introduction in England: a population-based study. Lancet Public Health (online, 21 December). .

UK International Health Regulations National Focal Point annual report

PHE has published a report of the UK National Focal Point (NFP) activity relating to the International Health Regulations (IHR) 2005, marking 10 years since the revised regulations came into force in 2007 [1]. Under IHR (2005), countries agree to build their capacities to detect, assess, and report public health events, and are required to designate an IHR NFP to be accessible at all times for communications with the WHO IHR Regional Contact Point. The NFP has a duty to both assess any events (infectious, chemical, radiation or biological) that may potentially constitute a ‘Public Health Emergency of International Concern’ (PHEIC) and to notify them to WHO. PHE hosts the IHR NFP on behalf of all of UK territory.

The report covers UK IHR NFP activity between 2012 and 2016, during which period, WHO declared three PHEICs – the international spread of wild poliovirus, Ebola Virus Disease in west Africa and Zika virus disease (ZVD). During this period, the UK NFP reported 52 events to WHO. Of these, 50 (96%) were related to infectious diseases, two were chemical-related events, and there were no reported radiological events. A third of these events related to international outbreaks occurring in UK overseas territories (eg locally-acquired ZVD cases, chikungunya cases, etc).

Not all communications of the UK IHR NFP are with WHO. An analysis of the email communications since 2007, presented in the report, indicated a five-fold increase in email traffic between 2008 and 2016, most of which was direct communication with other countries as part of contact tracing, the report notes. The report concludes, “this suggests the implementation of IHR (2005) is successfully achieving its aim to improve global communication about public health events”.

For further information, see the UK National Focal Point webpage.

Reference

1. PHE (website). International Health Regulations: Activity of the UK National Focal Point from 2012 to 2016

Infection reports in this issue

Vaccine coverage reports:

• Vaccine coverage for the GP based catch-up meningococcal ACWY (MenACWY) immunisation programme in England to the end of November 2017

• Pertussis vaccination programme for pregnant women update: vaccine coverage in England, July to September 2017

Prenatal pertussis vaccine coverage remains high overall, at around 70%, and increased between July and September 2017, in line with previous years, according to the above-mentioned vaccine coverage report, published in this issue. The report summarises a recently published study that identifies ethnicity and deprivation as predictors of pertussis coverage that contribute to, but don’t wholly account for, geographical variation in coverage in England. GPs, practice nurses, obstetricians and midwives should continue to encourage all pregnant women to receive the pertussis vaccine to optimise protection for their babies from birth, the report concludes.

Infection report

• Laboratory reports of respiratory infections made to PHE from PHE and NHS laboratories in England and Wales: weeks 48-52, 2017