Research and analysis

HPR volume 8 issue 37: news

Updated 23 December 2014

1. Impact of first infant vaccination programme in England for rotavirus confirmed

The first full year’s data on the impact of the newly-introduced national infant immunisation programme on rotavirus in England have confirmed the earlier indications that the programme has been exceptionally successful.

The programme was launched in summer 2013, ahead of the 2013/14 season, recruiting under-one-year-olds into a two-dose regime, the first dose being given at six weeks.

Whereas the first-eight-months results on laboratory-confirmed cases showed an overall reduction of 67% compared with the 14-year, pre-programme average [1], the first full-year’s data has indicated a 71% reduction was achieved.

The full-year laboratory data was presented at the second PHE annual conference earlier this month [2]. The as-yet unpublished full-year data suggest that the seasonal (Autumn) peak in confirmed, all-age rotavirus cases was effectively eliminated in 2013/14, despite the fact that only under-one-year olds were vaccinated, indicating that the “herd immunity” impact of the programme was significant: the rotavirus disease incidence was manifested also in in 2-5 year-olds, and in adults.

Significant reductions were also seen in numbers of GP-reported cases and in those reported by A&E departments. Sentinel surveillance analysis of levels of testing also confirmed that the reduction in lab-confirmed cases was a true reflection of reduced disease incidence and not the result of reduced levels of testing

1.1 References

1. “Early evidence of the impact of the national rotavirus immunisation programme”, HPR 8(12): immunisation, 28 March 2014.

2. “The early impact of rotavirus vaccine”, Shamez Ladhani, Second PHE annual conference, Warwick, 16 September 2014.

2. Annual report on tuberculosis surveillance in the UK

The latest UK annual TB report [1] shows a small decline in the number of TB cases notified and the rate of TB in the UK in 2013, compared to 2012. Following a decline in TB incidence throughout most of the twentieth century, the rate of TB in the UK increased from the early 1980s until the mid-2000s, and have been at a high but relatively stable ever since [2]. The incidence of TB in the UK remains high compared to most other Western European countries, with 7,892 cases reported in 2013, an incidence of 12.3 per 100,000 population.

TB continues to disproportionately affect the most deprived communities, with 70% of all TB cases coming from the 40% most deprived areas. TB is concentrated in large urban centres, with rates in London, Leicester, Birmingham, Luton, Manchester and Coventry more than three times the national average. Almost three quarters of TB cases (73%) were born outside the UK; only 15% of these were recent migrants. The rate of TB amongst the non-UK born population was 18 times the rate in the UK born, at 70 per 100,000. More than a quarter (28%) of patients with pulmonary TB started treatment more than four months after symptom onset.

The proportion of TB cases with resistance to isoniazid has fluctuated over the past decade, and remains at the same level in 2013 as in 2004. The proportion of cases with MDR-TB (multi-drug resistant TB) has remained stable at 1.6% over the past three years. The majority of cases with MDR-TB were born outside the UK (87%); with the highest number of cases from India, Pakistan and Somalia, and the highest proportions were in those from the Ukraine, Lithuania, Latvia and Sierra Leone.

In 2013, 82% of culture confirmed cases from the UK had their strains typed at 23 loci or more. Between January 2010 and December 2013, 54% (8,890/16,602) of cases with isolates typed were in in 1,854 molecular clusters. The proportion of UK born cases that clustered was higher than the proportion of non-UK born cases that clustered. There was considerable variation in lineage by country of birth.

The proportion of drug sensitive cases with an expected treatment duration of less than 12 month who had completed treatment by 12 months has improved gradually over the past decade, reaching 83% of those notified in 2013. The proportion of drug sensitive cases who died has decreased over the last 10 years, to stabilise at 5% in 2011 and 2012. Drug sensitive cases with at least one social risk factor have worse treatment outcomes than those without; 6% of those notified in 2012 died and 7% were lost to follow up. The proportion of drug resistant TB cases who completed treatment by 24 months was low (48%), with many still on treatment (23%) or lost to follow up (19%).

Public Health England and NHS England will shortly publish the Collaborative TB Strategy for England 2015-2020, which sets out the improvements that need to be achieved across 10 key areas to bring about a sustained decline in TB in England, and the mechanisms by which these should be achieved. Improvements in TB control across the country, particularly among the most vulnerable groups, will require the social and economic determinants of the disease to be addressed, in addition to the provision of strong and effective public health and clinical services. Following implementation of the Strategy, we look forward to monitoring the improvements that we hope will be achieved over the next decade.

2.1 References

1. Tuberculosis annual report, Public Health England, 2014.

2. Tuberculosis Update, Health Protection Agency, 2013.

3. PHE surveillance and health data products user survey

Public Heath England is carrying out a survey to inform the development of its surveillance and health data outputs: health protection data, health profiles, health improvement data tools, etc. This includes products such as Health Protection Report.

An online questionnaire is available at: Surveillance and Health Data Products User Survey. The fourth page of the survey includes HPR in a list of PHE surveillance products about which views are specifically requested. HPR subscribers are encouraged to participate. The survey will close on Wednesday 8 October.

HPR is now published on the GOV.UK domain: the landing page for issues published during 2014 (volume 8) is: https://www.gov.uk/government/publications/health-protection-report-volume-8-2014.

Back issues published in earlier years on the now-decommissioned hpa.org.uk website can be retrieved from: http://webarchive.nationalarchives.gov.uk/20140714084352/http://www.hpa.org.uk/hpr/archives/.

Health professionals wanting to locate guidance documents relating to infections – particularly information on less common infections that is not yet available on the gov.uk site – can browse the legacy site (at as mid-July 2014) via: http://webarchive.nationalarchives.gov.uk/20140714084352/http://hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/.