Research and analysis

HPR volume 9 issue 42: news (27 November)

Updated 29 December 2015

1. Shingles vaccination programme second annual report

PHE has published a full report on the second year of the shingles immunisation programme – covering the period 1 September 2014 to 31 August 2015 [1].

The report describes coverage (the number of patients who have ever received a vaccination) and uptake (the number who received a vaccination during a particular programme period) achieved for each eligible cohort; it also includes uptake data by gender, and data on vaccination in contraindicated groups [1].

Over 95% of GP practices in England reported coverage data showing that 59% of eligible 70-year-olds (the ‘routine cohort’) and 57.8% and 58.5%, respectively, of the 2 ‘catch-up cohorts’ (those aged 78, and 79, on 1 September 2014), received the vaccine.

The annual report presents coverage data broken down by NHS England area team. Geographical variation in coverage ranged from 48.8% in London to 63.1% in Thames Valley, with the two-thirds of area teams reporting coverage above 60%.

England is one of the few countries to have introduced a shingles vaccination programme for older adults and to be collating comprehensive coverage data.

Training resources for healthcare professionals relating to the shingles vaccination programme, and other relevant guidance, are available on the Shingles: guidance and vaccination programme pages of the GOV.UK website.

1.1 Reference

1. PHE (November 2015). Herpes zoster (shingles) immunisation programme 2014 to 2015: report for England.

2. Latest data on imported dengue fever published

Latest data on dengue fever imported into England, Wales and Northern Ireland (EWNI) have been published by PHE, covering cases reported by the agency’s Rare and Imported Pathogens Laboratory (RIPL) in 2014 [1].

In 2014 there was an overall decrease of 37% of cases reported (347) compared to 2013 (549), as against an annual average increase of 36% between 2009 and 2014.

Dengue is most commonly imported into EWNI having been acquired in Asia, south and central America or the Caribbean, with Thailand and India being the most frequently implicated countries of travel. In 2014, there was an unusual increase in cases associated with travel to Malaysia, and to Tanzania (where an outbreak occurred in the early part of the year).

Active surveillance of dengue is not conducted in the UK. Clinical and travel history details for cases are dependent upon what the diagnosing clinician provides with the laboratory request form when the sample is sent to RIPL. It is recommended that those sending samples to RIPL adhere to the guidance about what information to include on the request form, as set out in the RIPL User Manual available on the PHE website [4].

Country-specific information about dengue risk, and a general factsheet, are available on the National Travel Health Network and Centre (NaTHNaC) website [3,4].

2.1 References

1. PHE (26 November 2015). Dengue reported in England, Wales and Northern Ireland: 2014.
2. PHE. Rare and Imported Pathogens Laboratory: specimen referral guidelines and service user manual.
3. NaTHNaC website. Country information pages.
4. NaTHNaC website. Dengue factsheet (updated 13 October 2015).

3. Cost-effectiveness of MRSA screening for hospital admissions

Screening of all hospital admissions for methicillin resistant Staphylococcus Aureus (MRSA) was instituted in England in 2011, one of a number of infection control initiatives and interventions introduced to control healthcare-associated infections. The aim was to identify all colonised or infected patients so that they could be isolated and/or given suppressive treatment. Previously, national guidelines had recommended only screening patients in ‘high risk’ specialties, where infections were likely to be deep-seated and difficult to treat.

The Department of Health for England was committed to review the mandatory universal screening policy post-implementation and a report on the policy’s implementation, including a full cost-effectiveness evaluation, was published in March 2014 [1]. The findings of this report directly informed modified MRSA screening guidance to the NHS that was issued by the Department in August 2014 [2]. This recommended replacing universal MRSA admission screening with screening of high-risk specialty admissions only. The health economic model, and its findings, in terms of costs and health benefits, which provided the evidence for this modified guidance, have now been published in the Lancet Infectious Diseases journal [3].

The study, led by mathematical modellers at PHE, in collaboration with UCL, used a dynamic, transmission, health economic model to evaluate alternative MRSA screening strategies. It found that the policy of universal MRSA screening was highly likely to be a poor use of resources for the NHS in England, and that reverting to the previous strategy of targeting MRSA screening to patients admitted to high risk specialties was more likely to represent a better use of resources in the majority of hospital types and prevalence settings. (Switching from universal admission screening to screening only high-risk specialty admissions resulted in a mean difference in total costs per year of £2.7 million per acute hospital, £2.9 million per teaching, and £474,000 per specialty, hospital, for a minimal rise in infections, around 1 per year per hospital, according to the study’s conclusions.)

In place of universal screening, Trusts are now responsible for identifying and screening all patients admitted to high risk units, and those previously known to have been MRSA-positive, as well as for carrying out local risk assessments to target those at greatest risk of infection and of poor patient outcome.

3.1 References

1. Fuller C, Robotham J, Savage J, et al (2014). The national one week prevalence audit of MRSA screening.
2. ARHAI (2014). Implementation of modified admission MRSA screening guidance for NHS.
3. Robotham JV, Deeny SR, Fuller C, Hopkins S, Cookson B and Stone S (2015). Cost-effectiveness of national mandatory screening of all admissions to English National Health Service hospitals for meticillin-resistant Staphylococcus aureus: a mathematical modelling study. Lancet Infectious Diseases. Published online, 23 November 2015.