Research and analysis

HPR volume 13 issue 4: news (1 February)

Updated 20 December 2019

Further actions on HIV control in the UK

Details of ongoing support for further HIV control actions in the UK, notably the goal of reaching zero new HIV transmissions in the UK by 2030, have been announced by DHSC [1].

An expert group is to be established to develop a UK elimination action plan focusing on high-risk groups, particularly gay and bisexual men, people who inject drugs and black and minority ethnic group populations. This complements the award of £600,000, DHSC funding through PHE, for 14 new HIV Innovation Fund projects for 2018/2019, covering a range of community-led interventions including online campaigns, outreach testing, and media and art activities [2].

Selection of Innovation Fund projects funded via PHE involves local authority participation and is facilitated by interrogation of PHE’s HIV surveillance database. Key data collated by PHE are: number of new diagnoses made annually; the number of “late” diagnoses; and the diagnosed prevalence. These data can be analysed at local authority level via an online tool that allows a range of outputs to be generated [3].

UNAIDS 90-90-90 targets on HIV control – relating to: per cent of cases being diagnosed; per cent of those diagnosed being treated: and per cent of those being treated being virally suppressed – were achieved for the first time in the UK in 2017 [4].

References

1. GOV.UK website (30 January). Secretary of State speech.
2. Innovative HIV prevention projects reached 170,000 people in 2018, PHE website news story, 30 January.
3. Sexual and Reproductive Health Profiles (“Fingertips”).
4. PHE (2018). Progress towards ending the HIV epidemic in the UK: 2018 report.

EVD outbreak in eastern DRC: sixth update

The outbreak of Ebola virus disease in eastern Democratic Republic of the Congo (DRC) continues unabated more than six months after the first case was officially confirmed on 1 August 2018.

As of 29 January 2019, 698 confirmed and 54 probable cases have been reported in North Kivu and Ituri provinces [1]. Of these, 145 were newly confirmed cases reported between 1 and 29 January. As expected after the post-election disturbances in late December, the apparent decline in cases reported in the week ending 31 December was not sustained and weekly case numbers have risen again during January (see figure) [2,3]. Since the start of the outbreak there have been 465 deaths.

New and total confirmed cases by week. Data provided by DRC MoH [1]

The main hotspot of transmission is currently Katwa, where the outbreak is being driven by a combination of healthcare and community transmissions, including funerals. Several factors have been identified in Katwa as contributing to both the increase in cases, and the difficulties in follow-up: disruptions in urban areas preventing a range of control measures; community refusal for treatment, follow-up and vaccination; demonstrations and ‘ville morte’ days, which prevent response activities.

Overall, 18 health zones have reported cases since August 2018, with 11 reporting cases in the last 21 days. Two new health zones have been affected since the last update, of which one (Kayina) provides evidence of an extension of the outbreak southwards, although still within North Kivu. This new health zone is in a high security risk area, likely to have implications for an effective local response.

During January, a very high proportion (~80%) of new cases were amongst individuals either not identified as contacts of confirmed cases, or known contacts not under active monitoring at the time of symptom onset or diagnosis, indicating persistent issues with contact identification and monitoring. These, together with continuing security incidents, mean that the outbreak continues to present significant challenges to response activities.

The risk to the UK public remains very low to negligible. The situation is being monitored closely and the risk assessment is regularly reviewed.

Further information sources

• PHE website Ebola collection Ebola virus disease: clinical management and guidance
• NaTHNaC website for travel advice Travel Health Pro website
• WHO website EVD homepage Ebola virus disease
• FCO website DRC advice.

References

1. DRC Ministry of Health daily updates (in French).

2. DRC Ministry of Health update 30 January 2019 (in French).

3. WHO AFRO External Situation Report 26, 30 January 2019.

Second UK One Health report published

The second UK One Health Report has been published on the GOV.UK website [1], the product of a cross-government initiative bringing together data on the levels of antibiotic use in humans and animals. It presents resistance to high priority antibiotics in four bacteria that are common to both humans and animals in the UK, as well as comparative data on antimicrobial resistance (AMR) in isolates from retail meat.

The report finds that the total combined quantity of antibiotics used in human and veterinary medicine dropped by 19% between 2013 and 2017 (see figure). The levels of resistance dropped between 2013 and 2017 for the majority of antibiotics tested in bacterial isolates from healthy food-producing animals.

ANTIBIOTIC USE (TONNES) IN ANIMALS* AND HUMANS** BETWEEN 2013 AND 2017. *Combined tonnage of antibiotic use food-producing animals only and antibiotic use in horses, companion animals and food-producing animals. **For the human sector, usage data include all publicly funded prescriptions in primary and secondary care, but not from the private sector. Therefore this figure does not cover all human use as there is no method to collect private prescriptions.

Other highlights include:

• EU-harmonised key outcome indicators on antibiotic use and resistance presented in the report show the progress made in reducing antibiotic use and resistance in both veterinary and human medicine; the majority of indicators have reduced or remained stable between 2013 and 2017
• in 2017, the use of antibiotics per bodyweight was higher in humans than in food-producing animals with 123 mg/kg and 37 mg/kg respectively; both sectors have reduced their use between 2013 and 2017 (by 9% in people and 40% in food-producing animals)
• overall the levels of resistance dropped between 2013 and 2017 for the majority of antibiotics tested in bacterial isolates from healthy food-producing animals, whereas antibiotic resistance stayed the same or increased in human medicine.

Release of the One Health report follows publication by the Government last week of the latest 5-year National Action Plan (NAP) on AMR [2] and the UK’s 20-year vision for AMR [3]. The vision sets out the ambition for AMR to be contained and controlled by 2040, covering health, animals, the environment and the food chain.

References

1. VMD/FSA/PHE (January 2019). UK One Health Report: antibiotic use and antibiotic resistance in animals and humans.
2. DHSC policy paper (24 January 2019). “UK 5-year action plan for antimicrobial resistance 2019 to 2024”
3. DHSC policy paper (24 January 2019). “UK 20-year vision for antimicrobial resistance”.

Infection report in this issue

This issue includes:

Laboratory reports of respiratory infections made to PHE from PHE and NHS laboratories in England and Wales: weeks 1 to 4, 2019.