Research and analysis

HPR volume 9 issue 23: news (3 July)

Updated 29 December 2015

1. Group A streptococcal infections: sixth report on seasonal activity (2014 to 2015)

Public Health England (PHE) is continuing to monitor notifications of scarlet fever cases in England following the substantial elevation in notifications reported in the first quarter of 2015. Surveillance of scarlet fever shows a continuing decline in levels of notified cases in England over recent weeks, although levels do remain slightly elevated.

According to the sixth report on Group A Streptococcus activity for the 2014/15 season [1], as of June 2015 scarlet fever activity has declined across the country and is showing a typical seasonal pattern. Invasive disease rates are above average, but remain within the upper bounds of normal seasonal levels for this time of year. No identification of novel strains or unusual increases in specific strain types has been seen.

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

1.1 Reference

1. PHE (3 July 2015). Group A streptococcal infections: sixth update on seasonal activity, 2014/15 (see “Group A Streptococcus infections: activity during the 2014 to 2015 season”).

2. Legionnaires’ disease annual report for England and Wales, 2014

The latest annual report on Legionnaires Disease in residents in residents of England and Wales has been published by Public Health England [1], describing the epidemiological features of confirmed cases with onset of symptoms in 2014 [1].

A total of 331 confirmed cases were reported in 2014, of which 56.2% were deemed to be community-acquired (a category which includes cases that may have been associated with travel within the UK). Forty two per cent of all cases (139) were associated with travel abroad. Six cases (1.8%) were thought to have been healthcare-associated (nosocomial).

Cases associated with travel abroad increased as a proportion of all England and Wales cases: from 30.9% (88) of all cases, in 2013, to 42.0% (139) in 2014. Travel to China, Thailand and United Arab Emirates ranked highly, taking account of the extent of travel to those countries by England and Wales residents. However, in terms of absolute numbers, once again travel to Spain was the destination associated with the highest number of cases (15) in England and Wales residents during 2014.

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. Those aged between 60 years and above account for the highest proportion of cases overall. Almost three-quarters, 73.4%, of cases in 2014 reported at least one underlying condition/risk factor which is in line with 2013 figures when 74.7% cases suffered one or more underlying conditions. Smoking followed by heart disease, diabetes and immunosuppression were the most commonly recorded underlying conditions.

The crude case fatality rate is lower in 2014 at 7.6% compared to 2013 when it reached 11.2%. By type of exposure, fatality rate is slightly higher, 13.6%, for nosocomial cases compared to cases exposed in the community, 12.1, and more than three times the rate for cases linked to travel abroad. Those aged 70 years and above show by far the highest fatality rate of any age group.

Cases were detected in all regions of England and PHE will shortly publish separate epidemiological reports for each area covered by its 16 Centres, and a report for Wales.

Fifteen clusters or outbreaks were identified in England and Wales in 2014, fewer than in 2012 and 2013; none were associated with hospitals or healthcare facilities. The number of cluster-outbreaks associated with travel abroad remained the same as in 2013 at 11. The number of community- and UK-travel-associated cluster-outbreaks both decreased compared to 2013 from four to three community-acquired cluster-outbreaks, and from three to one UK-travel-associated cluster-outbreak.

2.1 Reference

1. PHE (June 2015). Legionnaires’ disease in England and Wales 2014.

3. HSE establishes workplace health expert committee

The Health and Safety Executive has established a new scientific and medical advisory committee to provide independent, expert advice on emerging workplace health issues and trends – and on new evidence, and the quality of the current evidence base, relating to existing workplace health issues [1].

The Workplace Health Expert Committee (WHEC) will be concerned primarily with chemical and physical hazards, and with behavioural and organisational factors in the workplace – such as shiftwork – that could lead to physiological and psychosocial ill health.

Through its website, WHEC will encourage collaborative working with stakeholders and partners whilst helping to identify issues of potential concern to Government Departments and business [2]. It will inform HSE policy through the supply of advice to the Executive’s chief scientific advisor and director of research, Professor Andrew Curran, and to its Board.

It will not be concerned with wellbeing, sickness absence management or rehabilitation, as these issues are dealt with elsewhere in government. Nor will the committee consider individual cases of ill health or disease. The nine-member committee is chaired by Professor Sir Anthony Newman Taylor, professor of occupational and environmental medicine in Imperial College and a non-executive director of Imperial College Healthcare NHS Trust.

Official statistics show that around 13,000 people die each year from occupational lung disease and cancer as a consequence of past workplace exposure, primarily to chemicals and dusts. In addition, an estimated 1.2 million people who worked in 2013 to 2014 were suffering from an illness they believed was caused or made worse by work, of which 535,000 were new cases which started in the year [1].

3.1 References

1. “HSE launches new workplace health expert committee”, HSE press release 22 June 2015.
2. Workplace Health Expert Committee website.