Research and analysis

HPR volume 9 issue 27: news (7 August)

Updated 29 December 2015

1. Hepatitis C in the UK annual report

Morbidity and mortality attributable to HCV-related liver disease continue to rise across the UK, according to the latest annual hepatitis C report published by Public Health England on World Hepatitis Day on Tuesday 28 July [1].

In the UK, hospital admissions for hepatitis C-related end stage liver disease and liver cancer have nearly tripled over the last decade, rising from 950 in 2004 to 2,658 in 2013, while deaths have more than doubled from 190 in 2004 to 424 in 2013. UK registrations for liver transplants where post-hepatitis C cirrhosis was an indication for transplant rose from 45 in 1996 to 175 in 2014. More than 160,000 individuals in England (214,000 across the UK) are thought to be chronically infected with hepatitis C, many unaware of their infection.

Laboratory-confirmed new diagnosis rates have risen steadily since 2010, when statutory notification by diagnostic laboratories was first introduced: 11,539 new cases were notified in England in 2014, up by more than one third from the 7,892 cases reported in 2010. Over the past year, a major increase of 24% was observed in London, which accounted for nearly a third of all cases reported in England in 2014 [2]. The new report is the tenth for England, and the seventh also to present consolidated data on hepatitis C virus (HCV) infection rates for the UK as a whole. Besides mortality and morbidity data, the report includes chapters dedicated to: prevention activity relating to the highest risk group, people who inject drugs (PWID); diagnosis, testing and awareness of infection; and treatment and care.

UK data on testing and diagnosis are presented for the population at large and for a spectrum of ‘risk’ groups under surveillance: PWID in particular (more than 50% of whom test positive for HCV infection in England and Wales); people in prisons; black and minority ethnic populations; and blood donors (among whom HCV infection rates have fallen, across the UK, to 19.3 and 0.3 infections per 100,000 donations in new and repeat donors, respectively).

On treatment, and the monitoring of treatment uptake, the report notes that antivirals are available in the UK that will successfully clear HCV in the majority of patients and new drugs are becoming available that are easier to administer, offer improved rates of viral clearance and cause fewer side effects. However, it is also noted that the cost of new treatments, when coupled with the numbers potentially requiring them, raises issues of affordability for UK health services – which underlines the importance of monitoring treatment uptake, assessment of treatment impact and the identification of geographical and other variations in service delivery.

1.1 References

1. PHE, HP Scotland, PH Wales, HSC Northern Ireland, (July 2015). Hepatitis C in the UK: 2015 report. Related materials and earlier annual reports available from PHE webpage Hepatitis C in the UK.

2. PHE (January 2015). Hepatitis C in London (annual review, 2013 data).

2. Operational guidance for HPTs on responding to the detection of legionella in healthcare premises

Public Health England has issued new operational guidance for use by Health Protection Teams (HPTs) who are called on to give advice to infection control staff within acute trusts (or who participate in incident control teams or trust water safety groups) following the detection of legionella in water systems on healthcare premises.

The guidance, Responding to the Detection of Legionella in Healthcare Premises [1], describes situations where acute trusts may contact HPTs following the detection of elevated legionella counts in water systems and the extent of HPT involvement that can be expected in such circumstances. It includes an accompanying risk assessment algorithm for use by HPTs responding to such situations.

Responsibility for monitoring legionella counts and other aspects of compliance with the HSE Approved Code of Practice (L8), and other related technical requirements, rests with trusts themselves. Nevertheless, the guidance has been issued because PHE HPTs are frequently called on to advise on the appropriate level of response to elevated legionella counts, irrespective of whether cases of legionellosis have been reported or not.

PHE has also advised its HPTs that an updated Legionnaires’ Disease surveillance form (for England and Wales) has been published on the PHE website and should be used by HPTs for all newly reported cases, with immediate effect [2].

2.1 References

1. PHE (August 2015). Responding to the detection of legionella in healthcare premises: guidance for PHE heath protection teams. Part of the PHE health protection collection Legionnaires’ disease: guidance, data and analysis.

2. PHE (August 2015). National surveillance scheme report form (PDF version). Available, with other related documentation, from the Legionnaires’ disease: national surveillance scheme webpage.

3. Ebola virus disease: international epidemiological summary (at 5 August 2015)

The Ebola Virus Disease (EVD) outbreak in West Africa continues with cases reported in 2 countries this week. As of 2 August 2015, a total of 27,898 clinically compatible cases of EVD have been reported associated with this outbreak, 11,296 of which have died.

There were 2 confirmed cases of EVD reported in the past week: 1 in Guinea and 1 in Sierra Leone, compared to 4 in Guinea and 3 in Sierra Leone in the previous week. This is the third consecutive week for which a decline in weekly incidence was reported, and is the lowest weekly number of confirmed cases since March 2014.

The new case in Guinea was a registered contact who was previously lost to follow-up. The patient travelled extensively in both Guinea and Sierra Leone prior to diagnosis and is likely to have generated a number of high-risk contacts.

The new case in Sierra Leone is one of 600 registered contacts of the previous week’s case from Tonkolili. Further cases are anticipated in this area.

No new cases were reported in Liberia where 6 cases have been confirmed since 29 June 2015. Investigations are ongoing into the source of this outbreak

Number of new confirmed cases reported per week (3 May to 2 August 2015) in affected countries in West Africa. (Data Source: WHO Ebola Situation Report 5 August 2015)

Further information on the epidemiological situation can be found in PHE’s weekly Ebola epidemiological update and from the Ebola outbreak distribution map.