Research and analysis

HPR volume 14 issue 11: news (12 June)

Updated 23 December 2020

Hepatitis C in England annual report

Steady reductions in the prevalence of chronic hepatitis C (HCV) infection, and in hepatitis-C-related mortality, have been achieved in England in recent years.

According to Public Health England (PHE) latest annual report, Hepatitis C in England 2020: Working to eliminate hepatitis C as a major public health threat, an estimated 89,000 people were living with chronic HCV infection in 2019 in England, a fall of nearly one-third from the estimated 129,000 living with the infection in 2015.

HCV-related mortality also fell significantly. The World Health Organization (WHO) GHHS target for a mortality reduction of 10% (between 2015 and 2020) was met, in England, by 2017. By 2018, a 20% reduction had been achieved – twice the WHO 10% 2020 target.

The range of metrics that underpin the above conclusions, which are constantly under review and development, are described in detail in the new report.

In contrast to the encouraging trends in overall HCV-related mortality and prevalence of chronic disease, there has been no reduction in the number of new infections recorded in recent years, according to data generated by PHE’s annual Unlinked Anonymous Monitoring Survey of People Who Inject Drugs (UAM-PWID).

The reductions in prevalence and mortality mentioned above are the result of collaborative work across the public health system, combined with more effective treatments that have become available since 2015.

Nevertheless, the report concludes that:

“Increasing numbers of PWID have evidence of exposure and clearance of HCV infection, suggesting that increased access to treatment, rather than improved harm reduction, is holding levels of chronic infection stable in this important group who are at risk of transmitting the virus. [….]

“[Although] much progress has been made raising awareness and increasing diagnosis over the last year [….] there is currently little evidence of any fall in the number of new HCV infections, with some evidence of an increase in 2018. Sub-optimal harm reduction among PWID represents a threat to achieving and sustaining HCV elimination goals as elimination not only relies upon scaling up of testing and treatment, but also upon adequate harm reduction provision to prevent infection and reinfection following treatment. Currently available data suggest that the WHO target to reduce the number of new infections by 30% by 2020 is unlikely to be met in England, and a radical change in our approach to HCV prevention and harm minimisation among PWID is urgently required.”

COVID-19 surveillance and guidance update

There was an overall increase in the number of institutional COVID-19 outbreaks in England in week 23 of 2020, according to the most recent National Weekly Surveillance Report (NWSR) published on 11 June. While the number of care home outbreaks continued to decline, there was an increase in hospital and ‘other settings’ outbreaks (and small increases in some community and syndromic indicators).

There was a total of 197 new acute respiratory institutional outbreaks reported in England in week 23, covering data to 10 June (compared with 151 in the previous week). Of these, 102 were in care homes (compared with 111 in the previous week). Thirty-seven outbreaks were in hospitals (compared with 8 in the previous week). Fourteen were in schools (compared with 15 the previous week), 3 in prisons (compared with 2 in the previous week), and 41 were in ‘other institutions’ (compared with 15 in the previous week).

A full explanation of the surveillance outputs covered by the weekly report is given in the PHE Health Matters blog ‘Coronavirus (COVID-19): using data to track the virus’.

Coronavirus Infection Survey

On 12 June, the Office of National Statistics (ONS) released a third set of pilot data from a new surveillance survey of COVID-19 infection among a cross-sectional sample of the population in England who would not otherwise be candidates for testing (that is those living or working outside of hospitals and care homes).

The ONS-led Coronavirus Infection Survey – a partnership between PHE, the Universities of Oxford and Manchester and Wellcome Trust – aims to statistically determine:

• the proportion of the population infected, with or without symptoms, at a particular point in time
• the number of new infections occurring over a given time period
• by testing for antibodies in blood samples, the proportion of the population that have developed antibodies to the virus and who may, therefore, be immune to future infection

The infection survey involves the regular collection of nose and throat swabs from participants of all ages; with blood samples being collected from some adults for antibody testing. It currently only covers England but the intention is to include representative households from all parts of the UK.

Data from three sampling periods – between 17 April and 10 May, between 11 and 24 May, and between 25 May and 7 June – have suggested a statistically significant downward trend in the number testing positive in England. Using data from the latter period, ONS estimates that an average of 0.06% of the community population had COVID-19 (95% confidence interval: 0.02% to 0.12%), which equates to an estimated 33,000 cases (95% confidence interval: 14,000 to 68,000).

An explanation of the distinction between the aims and outputs of the ONS Infection Survey, and those of the COVID-19 testing and epidemiological data published by PHE on a daily and weekly basis, was given in an ONS blog ‘New survey results provide first snapshot of the current number of COVID-19 infections in England’ last month.

COVID-19 guidance update

New guidance about the availability of coronavirus testing for the public, for healthcare workers and other professional groups in the UK has been published by Department of Health and Social Care (DHSC); this takes account of the launch of the NHS Test and Trace service last month.

The DHSC has also updated its guidance, Coronavirus (COVID-19): getting tested, so as to fully cover arrangements for testing that are available, either via the NHS website (for those exhibiting symptoms, following employer referral, for example) or the GOV.UK website (for essential workers and members of their households, care home staff and residents).

DHSC guidance on management of staff and exposed patients and residents in health and social care settings has been updated, including updating of flowcharts.

The Health and Safety Executive (HSE) has published specific guidance, Making your workplace COVID-secure based on maintenance of 2-metre social-distancing, so far as reasonably practicable, in workplaces (including an 8-page summary leaflet).

New international travel advice, safer travel guidance for airline passengers, has been published by the Department for Transport. More detailed international travel advice has been published on PHE-sponsored TravelHealthPro website, including:

• travel advice for UK-resident travellers
• an exceptional travel advisory notice for UK nationals not normally resident in the UK
• new information on interrupted travel vaccination schedules

In preparation for the phased dismantling of lockdown measures and easing of personal movement restrictions, the Cabinet Office has updated its coronavirus outbreak FAQs: what you can and can’t do.

Safety alert on face masks designated KN95

The HSE, the market surveillance authority for personal protective equipment (PPE) in the UK, has issued a safety alert about filtering facepiece facemasks of Chinese manufacture. The equipment, designated KN95, is declared of equivalent performance to a relevant EN standard, but a substantial number of items have been tested and found to provide inadequate protection and to have been accompanied by fake or fraudulent paperwork.

HSE notes that PPE cannot be sold or supplied unless it is CE marked except where it is supplied by the UK government for use by NHS or other healthcare workers after appropriate assessments have been undertaken by HSE. Otherwise, masks that are not CE marked must be removed from supply immediately.