Research and analysis

HPR volume 12 issue 13: news (13 April)

Updated 21 December 2018

Group A streptococcal infections: third report on seasonal activity in summary

PHE continues to monitor notifications of scarlet fever cases in England following the high levels recorded this season.

According to the third report on group A streptococcus activity for the current season, in this issue of HPR [1], scarlet fever notifications remain elevated but indicate a decline in recent weeks. Following the typical seasonal pattern, cases of invasive disease are increasing, with rates above average for the time of year.

GPs, microbiologists and paediatricians are reminded of the importance of prompt notification of scarlet fever cases and outbreaks to local PHE health protection teams, obtaining throat swabs (prior to commencing antibiotics) when there is uncertainty about the diagnosis, and ensuring exclusion from school/work until antibiotic treatment has been received for 24 hours [2]. Due to rare but potentially severe complications associated with GAS infections, clinicians and HPTs should continue to be mindful of the recent increases in invasive disease and maintain a high degree of clinical suspicion when assessing patients.

References

1. Group A streptococcal infections: third report on seasonal activity, 2017/18, HPR 12(13): infection report.
2. PHE (2014). Interim guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings.

Outbreak of listeriosis in the EU: an update

A joint ECDC-EFSA Rapid Outbreak Assessment (ROA) was published on 22 March 2018, describing a multi-country outbreak of listeriosis, thought to be linked to consumption of frozen corn [1]. At that time, the outbreak comprised 32 cases from the UK, Austria, Denmark, Finland and Sweden. Listeria monocytogenes isolates from food and environmental samples detected in Austria, Finland, France and Sweden were found to be closely related by whole genome sequence (WGS) analysis to the outbreak strain causing human illnesses. The common food item amongst these samples was frozen corn. Traceability information indicated the frozen corn was produced in Hungary and packed in Poland and those member states where it had been distributed (Estonia, Finland, Poland and Sweden) withdrew and recalled the product from the market. The recalled products were not known to be distributed to the UK and further investigations are ongoing to verify the root source of contamination in the food chain and establish the vehicle of infection in the UK.

Detection of this multi-country outbreak was facilitated by the use of WGS across member states. This allowed, for the first time, timely and robust comparisons of L. monocytogenes isolates at an unprecedented level of discrimination, from both clinical cases and food. While a small number of human cases reported consuming frozen corn products, epidemiologically linking cases to a vehicle remains challenging: listeriosis can have a long incubation period (up to 70 days) making it difficult to rely on patient food consumption recall and this is often hampered further by the severity of illness and extreme age of the patient. Although patients are followed up routinely with a standardised questionnaire seeking data on consumption, this is not exhaustive and in this incident, for example, the questions did not cover the hypothesis under investigation. Furthermore, the relatively small number of cases over a prolonged timeframe means analytical studies are not possible.

Since the publication of the ROA, detection of new cases in the outbreak has continued and currently 41 outbreak cases across Europe, including 6 deaths, have been detected: 10 in February and March 2018. The new cases include 3 in the UK, bringing the UK total to nine cases. PHE has developed a focussed, follow-up questionnaire which is being administered to outbreak cases. Collection and collation of these additional data is needed to inform both UK specific and EU wide investigations with the aim of identifying the vehicle(s) of infection and ultimately prevent further infection with this rare but serious pathogen.

Reference

1. ECDC/EFSA (22 March 2018). Multi-country outbreak of Listeria monocytogenes serogroup IVb, multi-locus sequence type 6, infections probably linked to frozen corn [joint rapid risk assessment].

Shingles immunisation programme in 2018: practitioner update

The latest issue of Vaccine Update – PHE’s bulletin for immunisation practitioners – is devoted to the shingles immunisation programme in England [1,2]. It includes information about:

• a change to recommended timing of shingles immunisation: the vaccine may now be offered throughout the year
• a reminder to clinicians about exclusion criteria for this vaccine, and
• reference to the recently-published first evaluation of the programme’s public health impact, after 3 years’ operation [3].

References

1. Vaccine Update (issue 276, April 2018).
2. PHE/NHS England (9 April 2018). The shingles immunisation programme: evaluation of the programme and implementation in 2018 (letter to health protection and other health professionals)
3. Amirthalingam G, Andrews N, Keel P, Mullett D, Correa A, de Lusignan S, et al (February 2018). Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study Lancet Public Health 3(2).

NICE guidance on Lyme disease

The National Institute for Health and Care Excellence has issued new guidance on Lyme disease [1].

‘NICE Guideline NG95: Lyme disease’ aims to raise awareness of when Lyme disease should be suspected and to facilitate prompt and consistent diagnosis and treatment [1].

Reference

1. NICE (April 2018). NICE Guideline NG95: Lyme disease.

Infection reports in this issue

• Group A streptococcal infections: third report on seasonal activity, 2017/18, HPR 12(13): infection report

• Foodborne illness in humans: general outbreaks in England and Wales: weeks 9 to13, 2018

• Salmonella and shigella infections (faecal specimens) England and Wales, reports to PHE: February/March 2018

• Common GI infections, England and Wales: laboratory reports: weeks 9 to13, 2018

• Reported norovirus outbreaks (suspected and lab-confirmed) in hospitals: weeks 9 to13, 2018