Research and analysis

HPR volume 12 issue 40: news (9 November)

Updated 21 December 2018

RSV activity starting to increase in England and Wales

Influenza activity remained low in England (and in the Devolved Administrations of Scotland, Wales and Northern Ireland) in week-ending 4 November 2018, with indicators below baseline threshold levels, according to Public Health England’s (PHE’s) latest Weekly National Influenza Report [1].

However, levels of respiratory syncytial virus (RSV) activity are increasing in the UK, as expected for the time of year. Syndromic surveillance indicators for bronchiolitis/bronchitis (emergency department attendances), cough and difficulty breathing (NHS 111 calls) in children aged under 1 year of age have increased over recent weeks in line with increasing RSV laboratory reports [2].

RSV activity typically occurs in the UK within the period from October to March each year, with most infections occurring in a relatively short epidemic of about 6 weeks. Peak numbers of RSV are reported in December and January every winter, although the size of the peak varies from year to year [3]. For the majority of cases, the infection is mild and its symptoms can be treated at home: further advice is available on the NHS website [4]. For a small proportion of individuals, the infection is severe enough to require hospital treatment.

RSV is the most common cause of severe respiratory illness, such as bronchiolitis (inflammation of the bronchioles), particularly in children under 1 year of age [5]. Repeat infections commonly follow throughout life which, although milder, can cause a significant burden in the elderly population [6].

Clinicians should now be considering the monthly administration of prophylactic palivizumab, which is licensed for use in young children at risk of severe bronchiolitis. This includes children under 2 years with chronic lung disease and oxygen dependency and infants under 6 months with severe congenital heart disease.

Further information is available from the RSV chapter (27a) of Immunisation against Infectious Disease (the Green Book) [7], and from NICE Treatment Summaries.

References

1. GOV.UK (8 November). Weekly National Influenza Report: week 45 report (up to week 44 data).
2. GOV.UK (8 November). Syndromic surveillance summary: 8 November 2018, week 44.
3. GOV.UK. Respiratory syncytial virus (RSV): symptoms, transmission, prevention, treatment.
4. NHS website. Bronchiolitis.
5. Reeves RM and others (2017). Estimating the burden of respiratory syncytial virus (RSV) on respiratory hospital admissions in children less than five years of age in England, 2007 to 2012. Influenza Other Respir Viruses 11(2): 122 to 129.
6. Elliot AJ, Fleming DM (2008). Influenza and respiratory syncytial virus in the elderly. Expert Rev Vaccines 7(2): 249 to 258.
7. PHE (2015). Immunisation against infectious disease: the green book – Respiratory syncytial virus, chapter 27a.

Public health burden of AMR in Europe assessed

The public health burden of antimicrobial resistance (AMR) in EU and EEA countries, in terms of disability-adjusted life-years (DALYs) lost, has doubled over the past decade and is now of a scale equivalent to the combined burden of HIV, influenza and tuberculosis, accounting for thousands of deaths annually in the worst affected member states.

These are among the conclusions of an innovative ECDC-coordinated study of antibiotic-resistant infections caused by 8 bacteria with 16 resistance patterns, published in Lancet Infectious Diseases [1].

The study, which estimated DALY data for EU and EEA member states in 2015, found that the two most seriously affected countries were Italy and Greece, with 448 and 427 DALYs per 1000,000 population, respectively. In contrast, the UK, which was ranked 13th among 30 countries in Europe, was estimated to have lost about 80 DALYs per 1000,000 population due to antibiotic-resistant infections.

An editorial accompanying the study report notes the severity of the international public health threat posed by AMR and reiterates the need for a coordinated global approach [2].

References

1. Cassini A and others (2018). Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infectious Diseases [online], 5 November.
2. Tacconelli E, DilPezzani MD (2018). Public health burden of AMR in Europe [editorial]. Lancet Infectious Diseases [online], 5 November.

HSE annual health and safety statistics

The Health and Safety Executive has published annual statistics for Great Britain on occupational accidents, diseases and self-reported ill-health for 2017 [1,2].

The legacy of past asbestos use continues to dominate mortality statistics, accounting for approximately 40% of the 12,000 deaths attributed to work-related respiratory disease in 2017. Lung cancer associated with other agents accounted for approximately 23% and COPD associated with other agents for approximately 32% of the total. In 2017 to 2018, coal workers’ pneumoconiosis accounted for 136 deaths, asbestosis 500, silicosis 11, and allergic alveolitis and byssinosis 5. HSE has estimated that mesothelioma deaths (2,500 in 2017 to 2018), due to asbestos exposures prior to 1980, will peak and start to decline from 2018 to 2019.

HSE publishes 5 detailed, annual statistical commentaries on occupational lung disease, such as asbestos-related disease, work-related asthma, COPD, silicosis and coal worker’s pneumoconiosis, and other occupational lung diseases (allergic alveolitis, byssinosis and allergic rhinitis) [3].

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 the estimated number of new cases of occupational contact dermatitis (OCD) reported by dermatologists in 2017 was 981, but that there was a long-term downward trend in incidence [4]. The most common causative agents in work-related skin disease were soaps, cleaning materials and working with wet hands, with the highest rates seen by dermatologists being among florists, hairdressers, beauticians, cooks and certain manufacturing and healthcare-related occupations [4].

References

1. HSE (31 October 2018). Health and safety statistics: 2017/18 annual release.
2. HSE (31 October 2018). Work-related ill health and occupational disease in Great Britain.
3. HSE (31 October 2018). Occupational lung disease in Great Britain 2017.
4. HSE (31 October 2018). Work-related skin disease in Great Britain 2017.

Infection reports in this issue of HPR

The following reports are published in this issue.

• Routine reports of foodborne illness in humans, England and Wales: weeks 40 to 43, 2018.
• Norovirus outbreaks in hospitals: weeks 40 to 43, 2018.