Research and analysis

HPR volume 8 issue 44: news

Updated 23 December 2014

1. Group A streptococcal infections: first report on seasonal activity, 2014/15

Public Health England is continuing to monitor notifications of scarlet fever cases in England in the early phase of the 2014/15 season, following the high levels recorded last winter/spring. According to the first report on Group A Streptococcus activity for the 2014/15 season [1], as of mid-November 2014, national scarlet fever activity is showing a typical seasonal pattern, gradually increasing from a low level of notifications each week, nevertheless elevated compared with previous years. Invasive disease rates remain within the norm for this time of year.

The full report on Group A Streptococcus infections activity for the 2014/15 season is included in the PDF version of this issue of HPR.

1.1 Reference

1. “Group A streptococcal infections: seasonal activity, 2014 to 15” (see “Group A Streptoccus infections: activity during the 2014 to 2015 season”).

2. Annual updates on voluntarily reported Acinetobacter spp. and streptococcal bacteraemia published

Trends in overall rates of bloodstream infections caused by Streptococcus spp., and Acinetobacter spp., respectively, are published in the Infection Reports section of this issue of HPR [1,2].

The reports include analyses of the trends in bacteraemia reports, and of age, sex distribution and geographical distribution. Data and commentary on antimicrobial susceptibility among the bacteraemia isolates received are also presented.

Group A and group B streptococcal bacteraemia increased in 2013. Resistance to erythromycin has risen in Group B and group G streptococci in 2013.

An increase in the rate of Acinetobacter spp. bacteraemia is reported nationally between 2012 and 2013. Resistance to a number of antibiotics among Acinetobacter Baumannii isolates has generally declined between 2009 and 2013

2.1 References

1. Voluntary surveillance of pyogenic and non-pyogenic streptococcal bacteraemia in England, Wales and Northern Ireland: 2013. Downloadable at: https://www.gov.uk/government/publications/pyogenic-and-non-pyogenic-streptococcal-bacteraemia-annual-data-from-voluntary-surveillance.

2. Voluntary surveillance of bacteraemia caused by Acinetobacter spp in England, Wales and Northern Ireland: 2013. Downloadable at: https://www.gov.uk/government/publications/acinetobacter-spp-bacteraemia-annual-data-from-voluntary-surveillance.

3. Ebola virus disease: international epidemiological summary

Up to the end of 16 November (15 November for Liberia), a total of 15,145 clinically compatible cases (CCC) of Ebola virus disease (EVD), including 5,420 deaths have been reported in the six currently affected countries (Guinea, Liberia, Sierra Leone, Spain, the USA and Mali) and two previously affected countries (Nigeria and Senegal) since December 2013.

Reported case incidence is no longer increasing nationally in Guinea and Liberia. However, transmission remains high in certain hotspots in both countries. In contrast, incidence continues to increase in Sierra Leone, particularly in the western and northern regions (see PHE map), with 533 confirmed cases reported in the last week.

In Mali, as of 20 November, the cluster of cases of infection in Bamako has now reached five, all of whom have died. This latest cluster is unrelated to Mali’s first case who was diagnosed in Kayes on 23 October.

To date, a total of 21 EVD cases have been cared for outside of Africa; 16 repatriated cases (hospitalised in USA, Spain, UK, Germany, France, Norway and Switzerland), two imported cases (both diagnosed in USA) and three incidents of local transmission (in Spain & USA).

The table below summarises Ebola virus disease international epidemiological information as at 16 November 2014

Country	Total CCCs	Cases in past 21 days	Total deaths
Guineau	1971	315	1192
Liberia	7069	532	2964
Sierra Leone	6073	1394	2964
Mali	6	5	6
Nigeria	20	0	8
Senegal	1	0	0
Spain	1	0	0
USA	4	0	1
TOTAL	15 145	2246	5421

Further information on the international epidemiological situation can be found in PHE’s weekly Ebola Epidemiological Update.

4. HIV in the UK: overview for 2013

Public Health England has published its analysis of HIV prevalence and incidence data for 2013, which shows that the number of people living with HIV in the United Kingdom has now reached an all-time high of almost 110,000 [1,2].

Around a quarter of people (26,100) are unaware of their infection and may be putting partners at risk of transmission through unprotected sex, according to the report. However, the proportion of people diagnosed with HIV at a late stage of the infection fell from 57% in 2004 to 42% in 2013 [1,2,3]. This is encouraging because those diagnosed late are likely to have lived with the infection undiagnosed for at least 3-4 years and have a 10-fold increased risk of death within a year of diagnosis compared with those diagnosed promptly.

PHE published the figures in advance of National HIV Testing Week, which runs from 22 to 30 November 2014 [4], in advance of World AIDS Day (1 December). National HIV Testing Week aims to increase access to testing services in both healthcare and community settings and promote testing to groups at risk of HIV in the UK: men who have sex with men (MSM) and black African heterosexual men and women.

MSM remained the group most affected by HIV, with 43,500 (6%) estimated to be living with the condition through the analysis. The prevalence of HIV among MSM was concentrated in London, where one in eight MSM (13%) were affected, compared with one in 26 MSM (4%) outside London. HIV incidence continues at high levels with no sign of a decrease. The relatively high number of newly acquired infections in MSM (2,800) compared to the number estimated to be undiagnosed (7,000) indicates the majority of those unaware of their HIV infection are likely to have acquired their infection relatively recently. It is recommended that all MSM have an HIV/STI screen at least annually, and every three months if having unprotected sex with new or casual partners.

Heterosexual, black-African men and women were the second largest group affected by HIV, with 38,700 living with the infection. The report draws attention to the fact that around one-third of the black African heterosexuals with HIV (38% of black-African men with HIV and 31% of black-African women with HIV) were unaware that they had the infection, with rates even higher outside of London. It is recommended that all black-African men and women have an HIV test and a regular HIV and STI screen if having unprotected sex with new or casual partners.

4.1 References

1. “HIV in the United Kingdom: 2014 Report.” Downloadable at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/377194/2014_PHE_HIV_annual_report_19_11_2014.pdf.

2. “Public Health England. HIV in the United Kingdom: 2013 Report.” Downloadable at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/326601/HIV_annual_report_2013.pdf.

3. Trends in late HIV diagnoses and in persons accessing HIV-related care in the UK: data to December 2013, HPR 8(39), 10 October 2014.

4. Terrence Higgins Trust (2014). National HIV Testing Week, 22-30 November 2014].