Research and analysis

HPR volume 14 issue 1: news (15 January)

Updated 23 December 2020

Update on lead exposure in children in England: 2018 cases

Public Health England (PHE) has published the second annual report on lead exposure in children in England. The report summarises the surveillance of cases reported to PHE from 1 January to 31 December 2018. Children under 16 years old with an elevated blood lead concentration ≥0.48μmol/L (equivalent to ≥10μg/dl) require case management by PHE Health Protection Teams to receive public health interventions to identify and remove the source of lead.

Forty-five cases of lead exposure in children were notified to PHE in 2018. The main epidemiology findings are:

• most cases (73%) were directly notified by surveillance by participating laboratories; 11 were notified to PHE through other routes
• the number of cases detected was lower than the expected incidence of lead exposure based on international population survey data
• the average detection rate for England between 2015 and 2018 was 3.76 cases per million children aged 0 to15 years, although there was large regional variation between PHE Centres
• cases were typically 1 to 4 years of age, male, and resident in more deprived areas

The key messages and recommendations include:

• lead is a persistent environmental contaminant that has toxic effects in humans even at low blood lead concentrations, although risk is reduced as levels drop
• children exhibiting pica – or other hand-to-mouth behaviour – in environments with lead hazards are likely at highest risk of exposure
• clinicians should be aware of important sources of lead exposure, children most at risk, and presenting symptoms or signs of exposure
• cases with a blood lead concentration above the public health intervention level for lead should be notified to PHE health protection teams for active public health case management

Surveillance of surgical site infections in NHS hospitals in England: annual report

The latest annual report summarising data submitted to the national Surgical Site Infection Surveillance Service (SSISS) by 201 NHS hospitals and 8 independent sector NHS treatment centres in England has been published. Surveillance data for 132,254 procedures and 1,183 surgical site infections (SSIs) detected during inpatient stay, or on readmission to hospital, were submitted in 2018 to 2019.

NHS trusts performing any of four orthopaedic surgical categories (hip replacement, knee replacement, reduction of long bone fracture and repair of neck of femur) are required to undertake surveillance of SSI for a minimum of one 3-month surveillance period per financial year. In 2018 to 2019 all eligible trusts complied with this mandate. Trust-level SSI risk results for these mandatory orthopaedic categories can be found as accompanying supplementary tables.

The annual report presents SSI risk benchmarks for each of 17 surgical categories, trends in annual SSI incidence and variation among participating hospitals. It also includes risk-stratified SSI incidence, and characteristics of SSI including microbial aetiology.

Key findings include:

• cumulative SSI incidence was highest for large bowel surgery at 8.7% and lowest for hip and knee replacement surgery (<1%)
• the distribution in SSI risk across hospitals participating in mandatory orthopaedic surveillance remains narrow; however, 7 high outlier notifications were identified (4 for knee replacement, 2 for hip and 1 for repair of neck of femur) in 2018/19
• over the last 10 years, spinal surgery has seen the greatest increase in SSI risk from 0.9% in 2009/10 to 1.5% in 2018/19; in contrast, coronary artery bypass graft surgery saw the greatest decrease (5.7% in 2009/10 to 2.3% in 2018/19)
• Enterobacterales made up the largest proportion of causative microorganisms for SSI, accounting for 30.0% of SSI across all surgical categories in 2018 to 2019

Health protection surveillance reports in this issue of HPR

Environmental hazards surveillance report

Lead Exposure in Children Surveillance System (LEICSS) annual report, 2018.

Infection reports

Common animal-associated infections quarterly report (England and Wales): third quarter 2019.

Laboratory surveillance of Proteus, Morganella, and Providencia bacteraemia in England, Wales and Northern Ireland: 2018.

Laboratory surveillance of Klebsiella spp. bacteraemia in England, Wales and Northern Ireland: 2018.

Laboratory surveillance of uncommon pathogens causing bacteraemia in England, Wales and Northern Ireland: 2018.

Laboratory reports of hepatitis C in England and Wales, 2008 to 2018: an update.

Sentinel surveillance of blood borne virus testing in England: data for January to December 2018.

Vaccine coverage report

Shingles (quarter 1) vaccine coverage report (adults eligible from April to June 2019 and vaccinated to end of September 2019) in England.