Research and analysis

HPR volume 14 issue 3: news (11 and 12 February)

Updated 23 December 2020

Novel coronavirus information on GOV.UK: an update

Details of the UK public health response to the novel coronavirus outbreak originating in Wuhan City, China, continue to be regularly updated on GOV.UK and can be accessed via the Novel coronavirus (2019-CoV) collection page.

The latest Department of Health and Social Care (DHSC) and Public Health England (PHE) ‘Information for the Public’ webpage (updated daily at 2pm) includes regular updates on the UK situation, including advice for travellers from affected areas.

A global perspective on the evolving situation is regularly updated at: Novel coronavirus (2019-nCoV): epidemiology, virology and clinical features. The UK situation is regularly updated.

As the situation evolves, professional guidance is regularly reviewed and revised; this currently includes:

• guidance on self-isolation for patients undergoing testing
• arrangements for laboratory testing
• guidance for primary care on investigation and initial clinical management of suspected cases, including the case definition and the flowchart for management of suspected cases
• guidance on infection, prevention and control precautions
• guidance to assist professionals in advising the general public
• guidance for healthcare providers: healthcare workers who have travelled to China and other specified areas/countries
• interim guidance for first responders

Group A streptococcal infections: first report on seasonal activity during the 2019 to 2020 season

PHE continues to monitor notifications of scarlet fever cases in England following the high levels recorded in the last few years. According to the first report on group A Streptococcus activity for the current 2019 to 2020 season, typical seasonal increases in scarlet fever activity are being reported across England.

Cases of invasive disease are also increasing, with rates slightly above average for 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 or work until antibiotic treatment has been received for 24 hours [1]. Due to rare but potentially severe complications associated with GAS infections, clinicians and HPTs should continue to be mindful of the recent increases in invasive disease and maintain a high degree of clinical suspicion when assessing patients.

References

1. PHE (2017). Guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings.

Surveillance of significant occupational exposures to BBVs in HCWs in the UK

PHE has published a new Eye of the Needle report, providing an update on significant occupational exposures (SOEs) to bloodborne viruses in healthcare workers (and ancillary staff working within healthcare settings) in the United Kingdom [1].

PHE monitors occupational exposures to BBVs with follow-up to identify any subsequent seroconversions that may result. An SOE occurs when an HCW has either:

• been exposed to the blood or bodily fluids of a source patient known to be hepatitis B surface antigen positive, hepatitis C virus (HCV) RNA positive and/or HIV positive, or
• is in a high-risk group and been found to be positive with one of these infections.

Monitoring is conducted via reporting from occupational health services across England, Northern Ireland and Wales.

This short report summarises the number of SOEs reported to PHE since 1 January 1997, including whether these HCWs received hepatitis B vaccination and/or HIV post-exposure prophylaxis (PEP), and the number of seroconversions as a result of the exposure. Data from Scotland only (on seroconversions and the number of SOEs) has been extracted from the annual report, National Surveillance of Sharps Injuries in Scotland, covering January 2015 to December 2017.

Between 1 January 1997 and 30 June 2018, PHE received reports of 8,765 SOEs in HCWs in England, Northern Ireland and Wales. There were reports of 234 SOEs between January 2015 and December 2017 in Scotland. Since the previous Eye of the Needle report, in 2014, there have been two reports of confirmed HCV seroconversions, bringing the total to 23 HCV seroconversions in the UK – the last confirmed report having occurred in 2015.

All 23 reported HCV seroconversions followed percutaneous exposures from hollowbore needles reported by HCWs and ancillary workers. There have been no further reports of confirmed hepatitis B or HIV seroconversions since Eye of the Needle 2014.

Over 98% of HCWs with a known vaccine status have received the hepatitis B vaccine. Of HCWs with a known HIV PEP status following an SOE, 46% were reported to have commenced PEP.

The latest report recommends HCWs are adequately trained on how to prevent injury and continue to follow local guidelines to reduce risk of injury, as well as to report any SOEs to their occupational health provider. Occupational health services should ensure HCWs are tested and treated within the appropriate timeframes and given relevant guidance, treatment and assistance to prevent injuries occurring in future. Hepatitis B vaccination and HIV PEP should be offered to HCWs in line with appropriate guidance.

Infection reports in this issue of HPR

Group A streptococcal infections: first report on seasonal activity during the 2019 to 2020 season.

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

Creutzfeldt-Jakob disease (CJD) biannual update.