HPR volume 8 issue 40: news
Updated 23 December 2014
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1. Annual updates on voluntarily reported bacteraemias published
Trends in overall rates of bloodstream infections caused by Enterobacter spp., Serratia spp. and Citrobacter spp. [1], and Proteus spp., Morganella morganii spp. and Providencia spp. [2], respectively, are published in two annual reports in the Infection Reports section of this issue of HPR [1,2].
The reports include analyses of the five-year trends in bacteraemia reports, and of age, sex and geographical distribution. Data and commentary on antimicrobial susceptibility among the bacteraemia isolates received are also presented.
Relatively small changes are reported in overall numbers of bacteraemia reports nationally between 2012 and 2013. However, the analyses on antibiotic susceptibility data indicate that for some organisms, significant increases were found in the proportion of isolates resistant to some classes of antibiotics.
1.1 References
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“Voluntary surveillance of bacteraemia caused by Enterobacter spp., Serratia spp. and Citrobacter spp. in England, Wales and Northern Ireland: 2009-2013”, HPR 8(40): infection reports, 17 October 2014.
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“Voluntary surveillance of bacteraemia caused by Proteus spp., Morganella morganii and Providencia spp., England, Wales and Northern Ireland: 2013”, HPR 8(40): infection reports, 17 October 2014.
2. Legionnaires’ disease annual report for England and Wales, 2013
The latest PHE annual report on Legionnaires Disease in residents of England and Wales has been published describing the epidemiological features of confirmed cases with onset of symptoms in 2013 [1].
A total of 284 confirmed cases were reported in 2013, of which more than two-thirds were deemed to be community-acquired (a category which includes cases that may have been associated with travel within the UK). Thirty one per cent of cases (88) were associated with travel abroad. Five cases (1.8%) were thought to have been healthcare-associated/nosocomial. For the foreign travel-related cases, Spain was the destination associated with the highest number of cases reported (15). However, the destination with the highest incidence rate was India, with 7.6 cases per million visits, followed by Malta, with 6.5 cases per million visits.
Legionnaires’ disease remains an important cause of both morbidity and mortality in England and Wales. The elderly continue to account for most infections and deaths, for which the age profile is heavily weighted to the over-sixties. Heart disease continues to be the most commonly recorded underlying condition.
Fewer than half the number of clusters/outbreaks were identified in 2013 compared to 2012 (seven compared with 20 in 2012). No nosocomial outbreaks were identified.
The proportion of cases identified by polymerase chain reaction (PCR) testing has doubled since 2012 (from 18% to more than 36% in 2013).
2.1 Reference
- Legionnaires’ disease in England and Wales 2013. Further analysis of the 2013 data, with regional breakdowns, will be published here in due course.
3. Enterovirus 68 detections in the USA and Canada
Following reports of cases of severe respiratory and neurological illness associated with Enterovirus 68 (EV-D68) infection in the USA [1] and Canada, ECDC has issued a Rapid Risk Assessment for Europe including a recommendation there be increased systematic enterovirus testing (including typing) of cases of severe undiagnosed respiratory illness in view of the possibility that EV-D68 may be the causative pathogen [2].
From mid-August to 1 September 2014, 500 individuals (mostly children) from 42 US states were confirmed to have respiratory illness caused by EV-D68, compared with fewer than 100 during the previous four year period. Similarly increased incidence has been reported in Canada. In the UK, 12 cases of laboratory confirmed EV-D68 infection, mainly in young children, have been reported since 2012. As also highlighted by ECDC, there is a moderate risk that EV-D68 is currently circulating in Europe but this will be mostly undetected as cases can often be asymptomatic/mildly symptomatic and the virus is not currently part of routine respiratory screening. Clinicians should be alert to unusual clusters of severe unexplained respiratory or neurological illness.