HPR volume 9 issue 10: news (20 March)
Updated 29 December 2015
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1. Chikungunya imported into England, Wales and Northern Ireland in 2014
In 2014, 295 cases of chikungunya were reported in England, Wales and Northern Ireland (EWNI), a 12-fold increase compared to 2013 (24 cases), according to the latest annual data published by PHE’s Travel and Migrant Health section [1,2].
Chikungunya is a travel-associated infection and does not occur in the UK. The majority of EWNI cases (88%) have been acquired on trips to the Caribbean and South America, where a large outbreak, which started in December 2013 in the French Caribbean territory of St Martin [3], has now affected most of the countries and territories in the Caribbean and the Americas. Travellers to these destinations are advised seek pre-travel advice from their GP, a specialist travel clinic or pharmacy at least six to eight weeks before they travel [4].
The disease is spread by day-biting Aedes spp. mosquitoes and is more usually found in parts of Asia and Africa but in recent years new areas of the world have become affected, including the Caribbean, parts of America and some islands in the Pacific. It is one of a number of vector-borne, tropical diseases – including dengue fever and malaria – for which sporadic outbreaks and clusters have occurred in Europe in recent years and for which the disease risk could be affected by climate change in future [5].
1.1 References
- PHE. “Chikungunya in England, Wales and Northern Ireland: 2014”.
- “Travellers to the Caribbean warned about chikungunya”, PHE press release, 20 March 2015.
- “Chikungunya in the Caribbean” HPR January 2014.
- NaTHNaC (February 2015). “Chikungunya virus: Caribbean and the Americas – update 12”.
- Medlock JM, Leach SA (2015). “Effect of climate change on vector-borne disease risk in the UK”, Lancet Infectious Diseases (online) March 23.
2. Quarterly trends in mandatory HCAI reports: data to end-December 2014
PHE’s latest quarterly epidemiological commentary on trends in reports of Staphylococcus Aureus (MRSA and MSSA) and E. Coli bacteraemia, and of Clostridium Difficile infections, mandatorily reported by NHS acute Trusts in England up to October-December 2014, has been published on the GOV.UK website [1].
The report, including tabular and graphical information, provides data for the October-December 2014 quarter (updating the previous report published on 11 December 2014). Some key facts are listed below.
2.1 MRSA bacteraemia
While the total number of MRSA bacteraemia have decreased in the current quarter (October-December 2014, n=213) compared to the same quarter in the previous year (October-December 2013, n=218), there has been a 17.0% increase since July-September 2014 from 182 to 213.
Furthermore, the number of Trust-assigned MRSA bacteraemia has decreased 27.1% from 107 in October-December 2013 to 78 in October-December 2014. However, in the same time period the number of CCG-assigned MRSA bacteraemia increased by 18.9% from 111 to 132.
2.2 MSSA bacteraemia
October-December 2014 saw the highest number of MSSA bacteraemia since the inception of the mandatory surveillance programme in January 2011 (n=2,571).
2.3 E Coli bacteraemia
The total number of E. Coli bacteraemia has increased steadily since July 2011, when the mandatory surveillance programme was initiated, with seasonal peaks between July-September each year. The data for October-December 2014 shows a continuation of this trend, with the highest recorded counts of E. Coli bacteraemia for October-December to date (n=8,820), which follows the seasonal peak seen in July-September 2014 (n=9,476).
2.4 C. Difficile infection (CDI)
Between July-September 2014 and October-December 2014 there was a 15.5% decrease in the counts of C. Difficile infections from 3,970 to 3,353. However, even with this recent decline, October-December 2014 still had a greater number of C. Difficile infections reported than in the same quarter in the previous year (October-December 2013: n=3,298), a phenomenon also observed for April-June 2014 (n=3,970 vs. April-June 2013 n=3,671) and July-September 2014 (n=3,440 vs. July-September 2013 n=3,386). This has resulted in the first calendar year since the inception of the CDI mandatory surveillance programme where there has not been a decline from the previous year (2014 n=13,679 vs. 2013: 13,767).
2.5 Reference
- PHE (12 March 2015). Quarterly Epidemiological Commentary: Mandatory MRSA, MSSA and E. coli bacteraemia, and C. difficile infection data (up to October-December 2014).
3. Ebola virus disease: international epidemiological summary (as at 15 March, 2015)
As of 15 March 2015, the World Health Organization reports a total of 24,701 clinically compatible cases (CCC) of Ebola virus disease (EVD) including10,194 deaths associated with the West African EVD outbreak (see table). While the majority of cases have been reported from Guinea, Liberia and Sierra Leone, cases have also been reported from Mali, Nigeria, Senegal, Spain, the United Kingdom (UK) and the United States of America (USA).
Ebola virus disease international epidemiological information as at 15 March 2015.
| Country | Total CCCs | Total deaths | Current status |
|---|---|---|---|
| Guinea | 3389 | 2224 | Ongoing transmission |
| Liberia | 9526 | 4264 | Ongoing transmission |
| Sierra Leone | 11,751 | 3691 | Ongoing transmission |
| Mali | 8 | 6 | EVD free |
| Nigeria | 20 | 8 | EVD free |
| Senegal | 1 | 0 | EVD free |
| Spain | 1 | 0 | EVD free |
| UK | 1 | 0 | EVD free |
| USA | 4 | 1 | Awaiting EVD free status |
| TOTAL | 24,701 | 10,194 | – |
In the currently affected countries in West Africa (Guinea, Liberia and Sierra Leone), a disparate epidemiological situation exists. For the third consecutive week (to 15 March), Liberia reported no new confirmed EVD cases. In contrast, in Guinea and Sierra Leone there were a total of 150 new confirmed cases (95 in Guinea and 55 in Sierra Leone) reported in the past week (to 15 March). Constant vigilance is required in Guinea, Liberia and Sierra Leone to prevent further geographical dispersion of cases. The complex nature of this outbreak means that EVD control in West Africa will require significant and sustained effort.
In Guinea, the 95 new confirmed cases were clustered in an area around and including the capital Conakry (25 cases), with the nearby prefectures of Boffa (three cases), Coyah (20 cases), Dubreka (two cases), Forecariah (42 cases), and Kindia (three cases) the only other prefectures to report cases. This is the highest weekly confirmed case total for Guinea in 2015 and a significant increase on last week’s total of 58 confirmed cases. There are still significant challenges in terms of contact tracing and community engagement in Guinea with 18 unsafe burials recorded and instances of community resistance reported in four prefectures in the week to 15 March.
In Liberia, no new confirmed cases have been reported in the last three weeks (to 15 March). All contacts associated with the last known chain of transmission have now completed 21-day follow-up. The situation in Liberia appears promising. However, it is important to note that even when no ongoing transmission is reported in Liberia, the porous nature of its borders with other affected countries means that the risk of further outbreaks continues until West Africa is EVD free.
In Sierra Leone, a total of 55 confirmed cases were reported in the week to 15 March. This is the lowest weekly total since late June 2014, at the start of the outbreak in Sierra Leone. The majority of new confirmed cases in the last week were reported in the capital Freetown (29 cases). Other districts reporting confirmed cases this week were Bombali (six cases), Kambia (four cases), Port Loko (11 cases) and Western Rural (three cases). While there has been substantial improvement in the epidemiological situation in Sierra Leone in the last two months, the fluctuating trend in new cases in certain districts, as well as ongoing reports of community resistance, unsafe burials and transmission events associated with traditional healers, may impede control measures.
New confirmed cases reported per week (21 September 2014 to 15 March 2015) in countries reporting persistent transmission
Further information on the international epidemiological situation can be found in PHE’s weekly Ebola epidemiological update.