Research and analysis

HPR volume 12 issue 5: news (9 February)

Updated 21 December 2018

Group A streptococcal infections: first report on seasonal activity during the 2017 to 2018 season

PHE continues to monitor notifications of scarlet fever and invasive group A streptococcal disease cases in England in the early phase of the 2017/18 season. This follows high levels of scarlet fever notification recorded in recent years.

According to the first report on Group A Streptococcus activity for the 2017/18 season, published in this issue of HPR [1], national scarlet fever activity is showing a typical seasonal pattern, gradually increasing from a low level of notifications each week, nevertheless elevated compared with previous years. Similarly, following the typical seasonal pattern, cases of invasive disease are increasing, with rates slightly 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 24 hours of antibiotic treatment has been received [2]. Due to rare but potentially severe complications associated with GAS infections, clinicians and HPTs should continue to be mindful of potential increases in invasive disease and maintain a high degree of clinical suspicion when assessing patients

References

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

National rollout of HPV vaccination for MSM in GUM and HIV clinics following successful pilot programme

An HPV vaccination programme is to be introduced, in England, for MSM aged 45 or younger, delivered via GUM and HIV clinics [1].

Unlike heterosexual males, men who have sex with men (MSM) will receive little indirect protection from the National Human Papillomavirus (HPV) Vaccination Programme that offers vaccination to young females. In November 2015, after considering the likely impact and cost-effectiveness of vaccinating MSM [2] the Joint Committee on Vaccination and Immunisation (JCVI) advised that a targeted HPV vaccination programme for MSM aged up to and including 45 years attending GUM and HIV clinics should be introduced, subject to procurement of the vaccine and delivery of the programme at a cost-effective price. To explore the feasibility, acceptability, uptake, impact and equity of this, PHE implemented a pilot programme at 42 GUM and HIV clinics in England, with the first vaccinations given in June 2016. Vaccine was provided centrally free of charge and clinics were paid an administration fee of £10 per dose.

PHE’s report evaluating this pilot during the first year (April 2016 to March 17) [3] presents data from two sources: data recording systems monitoring HPV vaccination uptake and attendances at GUM and HIV clinics; and a survey which was administered to patients receiving the vaccine. The report also includes some feedback from clinics and sexual health commissioners.

Data on eligible attendances and HPV vaccination were extracted from the GUMCAD STI Surveillance System and the HIV & AIDS Reporting System (HARS) for participating pilot clinics from site-specific vaccination implementation start dates up to the end of March 2017. Recorded first-dose uptake across all clinics was 46% (8,580/18,875) with only 3% of eligible patients recorded as being offered and declining the vaccine. Anecdotal reports from clinics plus prior experience with introduction of new codes into the recording systems suggest that data recording has been incomplete and the uptake is likely to be underestimated. This new service did not increase clinic attendance rates substantially.

Surveys were administered to patients attending for the first dose of HPV vaccination at participating clinics. Survey results suggested that 8% of those receiving the first dose of HPV vaccine were new attendees and that under 11% of these patients attended just to receive the vaccine. Of those having their first HPV vaccination, 95% indicated they would like to receive the next vaccine doses at the same clinic and 85% of patients reported accessing other health services alongside the first dose of vaccine.

The pilot has shown that this programme can be delivered opportunistically in an acceptable and, as far as can be evaluated, equitable manner, without major disruption to GUM and HIV clinics. Following the success of this pilot, the government has confirmed that it will introduce a HPV vaccination programme for MSM aged 45 or younger in all GUM and HIV clinics in England from April 2018 [1]. Evaluation of the second year of the pilot and of the national programme will continue to monitor attendances and uptake, as well as – in due course – completion rates and impact on the rates of genital warts diagnoses and on the prevalence of rectal HPV infection.

References

1. Department of Health and Social Care (2018). HPV vaccination programme for men who have sex with men.
2. Lin A, Ong KJ, Hobbelen P, et al (2017). Impact and cost-effectiveness of selective human papillomavirus vaccination of men who have sex with men. Clin Infect Dis 64: 580-8.
3. PHE (2018). “Human papillomavirus (HPV) vaccination for men who have sex with men (MSM): 2016/17 pilot evaluation”.

Independent expert e-cigarettes evidence review

PHE has published a new e-cigarette evidence review, undertaken by leading independent tobacco experts, commissioned to underpin policy and regulation of e-cigarettes/vaping devices [1,2]. It is the fourth in a series of reports commissioned by PHE on e-cigarettes and updates an earlier evidence review published in 2015 [3]. The new report covers: use of e-cigarettes (EC) among young people and adults: public attitudes; the impact on quitting smoking; an update on risks to health; and the role of nicotine.

The new report considers requirements for further research, and the policy implications of its findings, under the following headings: nicotine; use of EC among young people; use of EC in adults; effect of EC use on smoking cessation and reduction; poisonings, fires and explosions; health risks of EC; perceptions of relative harms of nicotine, EC and smoking; and pricing. It also considers heated tobacco products that have come onto the market since the previous report was published.

The main findings of the review are that:

• vaping poses only a small fraction of the risks of smoking (at least 95% less harmful) and switching completely from smoking to vaping conveys substantial health benefits
• e-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more
• e-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country
• many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette
• there is much public misunderstanding about nicotine (less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine)
• the use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million
• the evidence does not support the concern that e-cigarettes are a route into smoking among young people
• UK research clearly shows that regular use of e-cigarettes among young people who have never smoked remains negligible, less than 1%, and youth smoking continues to decline at an encouraging rate.

The government’s Tobacco Control Plan for England includes a commitment to “maximise the availability of safer alternatives to smoking” and makes clear that e-cigarettes have an important part to play in achieving the ambition for a smoke-free generation [4].

References

1. McNeill A, Brose LS, Calder R, Bauld L & Robson D (2018). Evidence review of e-cigarettes and heated tobacco products.
2. “PHE publishes independent expert e-cigarettes evidence review”, PHE press notice, 6 February 2018
3. PHE (August 2015). E-cigarettes – an evidence update: a report commissioned by Public Health England.
4. Department of Health (July 2017). Towards a smoke-free generation: a tobacco control plan for England.

Infection reports in this issue

• Common animal associated infections quarterly report (England and Wales): fourth quarter 2017

• Creutzfeldt-Jakob disease (CJD) biannual update (February 2018)

• Foodborne illness in humans: general outbreaks in England and Wales: weeks 1-4, 2018

• Salmonella and shigella infections (faecal specimens) England and Wales, reports to PHE: December 2017 to January 2018

• Common GI infections, England and Wales: laboratory reports: weeks 1-4, 2018

• Reported norovirus outbreaks (suspected and lab-confirmed) in hospitals: weeks 1-4, 2018