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					Volume 11 Number 43 25 October 2001

NEWS

Main stories this week:
Interim guidance on deliberate releases of biological agents - update

ENTERIC

Salmonella stanley and Salmonella newport in imported peanuts - update
RESPIRATORY

British Paediatric Surveillance Unit: 15th Annual Report 2000-2001
IMMUNISATION

Updated this week:
HIV/STIs

Invasive meningococcal infections, England and Wales: laboratory reports, weeks 27-34/01
BACTERAEMIA ZOONOSES DIARY BACK ISSUES

Haemophilus influenzae by age group and serotype, England and Wales: weeks 2739/01 Virus infections, England and Wales: laboratory reports, weeks 39-42/01 Surveillance of viral infections in donated blood: England and Wales, 2000 HIV infection and AIDS in the United Kingdom: monthly report - October 2001 Erratum Figures 14 and 15 in last weeks bacteraemia update were inadvertently transposed. This has now been amended. If you have any comments or encounter any problems with this website, please contact nhough@phls.org.uk Best viewed at a screen resolution of 800 x 600 pixels

Published by PHLS Communicable Disease Surveillance Centre

Last updated: 25 October 2001

CDR Weekly
25 October 2001 Next update due 1 November 2001

HOME PAGE

Contents
NEWS

Interim guidance on deliberate releases of biological agents - update
ENTERIC

Salmonella stanley and Salmonella newport in imported peanuts - update British Paediatric Surveillance Unit: 15th Annual Report 2000-2001

RESPIRATORY

IMMUNISATION

Interim guidance on deliberate releases of biological agents - update
Anthrax in the United States The number of people in the United States (US) with confirmed anthrax has risen to 11 as of 24 October, with four more suspected (1). The most recent cases are postal and mail room workers in West Trenton New Jersey and Washington DC with pulmonary anthrax. Two people in Washington have died with pulmonary anthrax, bringing the total deaths associated with anthrax to three. Only one deliberate release in the US has been discovered by detection of powder in an envelope or package. All of the others have been discovered through good clinical surveillance, and suspicion or diagnosis of clinical anthrax. This emphasises the importance of all clinicians and microbiologists being aware of what anthrax and other infections look like. Descriptions and pictures of the diseases are available through the PHLS website at www.phls.co.uk/facts/deliberate_releases.htm (look in clinical tips and clinical pictures). There have been no cases of anthrax in the United Kingdom (UK). The police in the UK have reported many alerts and call-outs of emergency services because of mail containing suspicious materials – mostly white powder. When these incidents occur the police (not the health authorities) undertake a specialist risk assessment and categorise each incident into 'credible threat' or 'no credible threat'. The vast majority of these incidents in London (where police experience with such releases is greatest) fall into the 'no credible threat' category. All environmental specimens tested have been negative for anthrax. It is therefore true to say that there is, as yet, no clinical or laboratory evidence of anthrax release in the UK. Improving and updating interim guidance The detailed interim guidance on deliberate releases of biological agents for the UK on the PHLS website is steadily being added to at the deliberate releases section at www.phls.co.uk/facts/deliberate_releases.htm. These guidelines are being field-tested and improved and therefore they are being intermittently updated on the website. Readers of CDR Weekly who have downloaded or printed copies are strongly recommended to check that they are using the most current versions. This is easily done by consulting the deliberate releases section and checking the file date. The individual date of last update is in the footer for each file. No indication for taking nose swabs Previously CDSC was suggesting that consultants in disease control (CCDCs) might take nose-swabs from exposed individuals. After further consideration and consultation with the Centers for Disease Control and Prevention (CDC) in Atlanta it has been decided that there is no useful reason for taking swabs as it does not change management. This is especially true when there is no anthrax circulating. Nose swab results are difficult to interpret as CDC (which also does not recommend swabbing) considers the test probably lacks sensitivity, and that a positive test does not imply infection has definitely occurred, as the infectious dose is high.

HIV/STIs

BACTERAEMIA ZOONOSES DIARY BACK ISSUES

Widespread use of ciprofloxacin is not justified Following detection of an exposure to a suspicious substance, the police make an expert risk assessment. Each incident is treated seriously, but experience in London indicates that the majority will be considered not to represent a 'credible threat'. If the police consider there is a 'credible threat', the only people given ciprofloxacin are those judged by a medical authority (usually the CCDC) to have been exposed. This is usually defined as those who have been in a contaminated area such as the room where the suspicious object has been found. They are usually given a three-day course. If, as has always happened to date, the result is negative, they should stop taking ciprofloxacin. See the PHLS web-site for further detail www.phls.co.uk/facts/deliberate_releases.htm Medications have been stockpiled by the Department of Health for use in emergencies and will reach those eligible for care in a few hours of assistance being sought. A small delay does not matter. CDSC is in close touch with CDC and is not aware of any instances reported from the US of exposed people developing anthrax when they have been given chemoprophylaxis in the first 48 hours after exposure. There are reports of some people asking their doctors to prescribe supplies of ciprofloxacin. This practice is not justified – indeed it would be dangerous, as widespread prescribing would empty pharmacies and make what is a very useful drug unavailable for infections other than anthrax. Widespread and indiscriminate use of this and other antibiotics would also rapidly generate antimicrobial resistance (2).
1 Centre for Disease Control and Prevention. Update: investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001. MMWR Morbid Mortal Wkly Rep 2001; 50 (42): 90919. Available online at <www.cdc.gov/mmwr/PDF/wk/mm5042.pdf>. 2 Standing Medical Advisory Committee. The path of least resistance. London: Department of Health, 1998. Available online from <www.doh.gov.uk/smacful.htm>

Salmonella stanley and Salmonella newport in imported peanuts - update
An international outbreak of S. stanley and S. newport infection associated with consumption of ‘Farmer’ brand peanuts was reported in CDR Weekly Vol 11 no 41 (1). Three countries (Australia, Canada, and the United Kingdom [UK]) have reported isolating S. stanley and/or S. newport from unopened packets of ‘Farmer’ brand peanuts (Shandong peanuts in Australia and Canada; garlic flavoured peanuts in England) originating in China, and distributed via Singapore. S. lexington has also been isolated from unopened packets of ‘Farmer’ brand roasted peanuts in Canada. No human cases of S. lexington have been reported (1-4). A European alert has been distributed through the Enter-Net system but no other countries have reported cases associated with this product. Work carried out by the PHLS Laboratory of Enteric Pathogens (LEP) has shown that the S. stanley isolated from peanuts in England are fully sensitive to antibiotics and have a distinctive pulsed field gel electrophoresis (PFGE) profile (SstX2). The SstX2 profile has been found in S. stanley isolates from nine human cases in the UK: seven in England and Wales by LEP and in two in Scotland. Two of the cases are known to have consumed ‘Farmer’ brand peanuts. All human isolates human tested were reported between 3 July to 24 September 2001. The S. newport strain isolated from peanuts in England also has a distinctive PFGE profile that has not been observed in recent human cases, and is different to the strain responsible for the outbreak in England and Wales in June 2001, associated with prepacked ready-to-eat lettuce (5). Ninety-three cases of S. stanley have been identified in Australia (60) and Canada (33) that have the distinctive PFGE profile observed in human isolates in the UK, and are also fully sensitive to antimicrobial agents. S. stanley isolates from peanuts in all three countries have the same distinctive pulsed field profile. Fifty per cent and 25% of cases in Australia and Canada respectively report eating ‘Farmer’ brand Shandong peanuts. Cases of S. newport associated with the peanuts have occurred in Australia and Canada but not in the UK. The human isolates of S. newport in Australia and Canada and the peanut isolates from England and the other two countries have identical PFGE profiles. ‘Farmer’ brand peanut products have been recalled in all three countries and consumers advised of what products to avoid (3,4,6). CDSC would be grateful for information on any suspected or confirmed S. newport and S. stanley occurring in people known to have consumed imported peanuts. Please contact Sarah O'Brien or Bob

Adak, tel: 020 8200 6868 (ext 4422 or 4551).
1 PHLS. Salmonella stanley and Salmonella newport in imported peanuts. Commun Dis Rep CDR Wkly [serial online] 2001 [cited 23 October 2001]; 11 (41): news. Available at <http://www.phls.org.uk/publications/CDR%20Weekly/archive/news4101.html> 2 Australia New Zealand Food Authority. Shandong peanuts - salmonella contamination. [online] 10 September 2001 [cited 11 October 2001]. Available from <http://www.anzfa.gov.au/recallssafety/foodrecalls/currentconsumerlevelrecalls/ shandongpeanutssalmo1036.cfm> 3 Salmonella Stanley, peanuts - Australia: recall. ProMED-mail [online] 11 September 2001 [cited 11 October 2001]. Available from <http://www.promedmail.org/pls/promed/ promed.searchhtml.showmail?p_filename=20010911.2189&p_year=2001&p_month=09 > 4 Canada Food Inspection Agency. Imported Farmer brand peanuts may contain dangerous bacteria (Health Hazard Alert). [online] 18 September 2001 [cited 11 October 2001]. Available from <http://www.inspection.gc.ca/english/corpaffr/recarapp/20010918e.shtml> 5 PHLS. Salmonella newport infection associated with the consumption of ready-to-eat salad. Commun Dis Rep CDR Wkly [serial online] 2001 [cited 23 October 2001]; 11 (26): news. Available at <http://www.phls.org.uk/publications/CDR%20Weekly/archive/news2601.html> 6 Food Standards Agency. Some garlic flavoured peanuts found to be contaminated with salmonella. Press release [online] 10 October 2001c[cited 11 October 2001]. Available at <http://www.foodstandards.gov.uk/press_releases/uk_press/2001/pr011010peanuts.htm>

British Paediatric Surveillance Unit: 15th Annual Report 2000-2001
The British Paediatric Surveillance Unit (BPSU) has recently published its 15th Annual report (1). During the year several new studies commenced, including those on vitamin K deficiency bleeding, congential cytomegalovirus, cerebral vascular disease/stroke in childhood, and venous/arterial thrombosis. Three studies were completed – fatal/severe allergic reactions in childhood, Haemophilus influenzae infections, and severe visual blindness. Forty-four BPSU studies had been completed by December 2000. Congenital rubella surveillance (CRS) continues, at a time when the level of uptake of MMR vaccine could be insufficient to prevent long term circulation of rubella infection. Seven cases have recently been reported. Of these, five were maternal infections acquired abroad. It is likely that less severe cases of congenital rubella in infants are not always diagnosed. New diagnostic techniques and the discovery of human herpes virus-6 and -7 (HHV-6 and -7) have recently allowed more accurate diagnosis of encephalitis in children aged from 2 months to 3 years. The final number of cases (per annum) which meet the reporting case definition is about 68 (from 1998 to 2000). This is significantly less than the original estimate of 200. The age at which the majority of cases presented was between 2 and 10 months which is when HHV-6 and -7 infections are most frequently seen. These infections were as common as herpes simplex and varicella zoster virus infections. Group B streptococcal disease (GBS) is the most common cause of severe early onset neonatal infection in developed countries. The study was intended to determine the incidence of invasive GBS in infants aged less than 9 months. This was the first study of its kind in the United Kingdom (UK), and 416 cases were confirmed. GBS can be either early (less than 7 days) or late (7 to 90 days) onset. Mortality in early onset was higher than in late onset. Just over 50% of early onset GBS cases can be prevented through intrapartum antibiotic prophylaxis. The majority of cases of haemolytic uraemic syndrome (HUS), which can result in acute renal failure, are caused by E. coli O157. It is sporadic and infrequent with incidence peaking in the autumn. Incidence is highest in children aged under four years. Eighty-six per cent of cases appeared to recover normally, 11.6% had an abnormal/unclear outcome, and 2.6% died (eight of whom were under four). Mother to child transmission is the main cause of infection for most new cases of HIV/AIDS infection in childhood. Antiretroviral therapy for the pregnant woman and newborn child, elective caesarean section, and the avoidance of breast feeding have provided effective means of reducing vertical

transmission of infection from mother to child. Testing is routinely recommended to all pregnant women, particularly as treatment is available if they are aware of their HIV status. The introduction of immunisation against invasive Haemophilus influenzae b infection (Hib) has greatly reduced the incidence of disease. In 2000 there was a reduction in incidence of 94% compared with the pre-vaccination era. Substantial numbers of Hib cases could still be avoided by timely vaccination. An increase in the number of Hib cases has been seen over the last two years, the reason for which is not known. The surveillance of progressive intellectual and neurological deterioration in children (PIND) has been in place since 1997, with the main aim of diagnosing any cases of variant Creutzfeldt-Jakob disease (vCJD) in children in the UK. Of the 1086 PIND notifications four have been reported as probable/definite vCJD. Four hundred and thirty-five of the cases have a recognised cause from among 89 different conditions such as Huntingtons disease. The last in a series of reports on Reye's syndrome, which started in 1981/82, was published in May 2001. Incidence has fallen, although continued vigilance is imperative. Many cases have been atypical. Sub-acute sclerosing panencephalitis (SSPE), is a rare condition that is a late complication of measles. No cases resulting from the vaccine strain of measles have been identified. Details of the current work of the International Network of Paediatric Surveillance Units (INoPSU) members can also be found in the report. Further information about INoPSU is available at <www.inopsu.com>. The address of the new BPSU website is <http://bpsu.inopsu.com>.
1. Lynn R, Kirkbride H, Rahi J, Verity C (editors). British Paediatric Surveillance Unit: annual report 2000/01. London: BPSU, 2001. (ISBN 1900954540) <http://www.rcpch.ac.uk/library/BPSU/BPSU/BPSU/Annual%20report%202001.PDF>

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Last updated: 25 October 2001

CDR Weekly
25 October 2001

Next update due 22 November 2001 For archive data click here
HOME PAGE

Contents
Invasive meningococcal infections, England and Wales: laboratory reports, weeks 27-34/01 Haemophilus influenzae by age group and serotype, England and Wales: weeks 27-39/01 Virus infections, England and Wales: laboratory reports, weeks 39-42/01 Surveillance of viral infections in donated blood: England and Wales, 2000

Invasive meningococcal infections, England and Wales: laboratory reports, weeks 27-34/01
Method of diagnosis CSF and blood culture Group A Group B Group C Group W135 Group X Group Y Group Z Group 29E Ungroupable Ungrouped Total – 66 18 4 – 0 – – – – 88 nonculture** – 70 12 2 – 1 – – – 10 95 Other sites culture – 13 0 1 1 1 – – 1 – 17 – 149 30 7 1 2 – – 1 10 200 2 1204 255 97 5 21 – – 14 111 1709 2 1645 712 109 4 29 – – 22 137 2660 Total reports 2734/01 Cumulative Annual total total* 2001 2000

* combined CDSC and Meningococcal Reference Unit data. ** latex antigen, microscopy, polymerase chain reaction.

Haemophilus influenzae by age group and serotype, England and Wales: weeks 27-39/01
Haemophilus influenzae reports for weeks 27 to 39 (July - September) in 2001 equalled 82 compared with 72 in 2000. There were 16 serotype b isolates for cases under five years in the quarter compared with 13 in the third quarter, out of a total of 24 and 18 serotype b reports respectively.

Table Laboratory reports of Haemophilus influenzae, by serotype and age group: third quarter 2001 (2000)
Age Serotype b nc a, e, f not typed Total <1 year 5 (4) 5 (3) – (–) 1 (2) 1-5 years 11 (9) 3 (5) 1 (–) 1 (–) 5-14 15 not years years+ known 3 (1) 1 (2) – (–) – (–) 4 (3) 5 (4) 20 (23) 4 (2) 17 (16) 46 (45) – (–) 3 (–) – (–) 2 (1) 5 (1) Total

24 (18) 32 (33) 5 (2) 21 (19) 82 (72)

11 (9) 16 (14)

Update table Laboratory reports of Haemophilus influenzae, by serotype and age group: second quarter 2001 (2000)
Age Serotype b nc a, e, f not typed total <1 year 3 (5) 6 (9) 0 (1) 3 (0) 1-5 years 15 (7) 2 (4) 2 (1) 4 (2) 5-14 15 not years years+ known 3 (2) 2 (2) 1 (1) 0 (0) 6 (5) 10 (10) 39 (39) 3 (6) 20 (27) 72 (82) – (1) 1 (0) – (–) 1 (3) 2 (4) Total

31 (25) 49 (54) 8 (12) 27 (29) 115 (120)

12 (15) 23 (14)

Virus infections, England and Wales: laboratory reports, weeks 39-42/01
Laboratory reports Coxsackie A Coxsackie B Cytomegalovirus Echovirus Parvovirus B19 Varicella zoster virus Number of reports received 39/01 – 5 32 25 18 10 40/01 – 3 9 23 4 8 41/01 – – 3 13 4 7 42/01 1 – 23 10 3 12 Total reports 3942/01 1 8 67 71 29 37 Cumulative total 2001 26 98 764 595 492 377

Surveillance of viral infections in donated blood: England and Wales, 2000
Donated blood is collected from volunteer (unpaid) adult donors who do not acknowledge any medical conditions, travel history, or behaviours, that are known to be associated with an increased risk of bloodborne infections During 2000 all blood donations were individually tested for hepatitis B virus surface antigen (HBsAg), hepatitis C virus antibodies (anti-HCV), HIV antibodies (anti-HIV) and treponemal antibodies. Donations are released to the blood supply only if none of these markers of infection are detected. Additionally, nucleic acid testing for HCV RNA was applied (initially on minipools of donations followed by resolution of positive pools to identify individual positive donations) to over 95% of all blood donations. Fresh-frozen plasma was only released if found negative for HCV RNA by nucleic acid testing. (This release criterion has subsequently been added to components with a shorter shelf-life: red cells (May 2001) and platelets (August 2001). Donors who have any markers of infection detected by any method are informed of their infection, are told to stop donating blood, and are referred to appropriate services for further care. Previous donations from repeat blood donors may not have been tested for some of these markers.

Two hundred and fifty-two out of 2,548,244 donations (9.89 per 100,000 donations) collected by the English and Welsh blood services during 2000 had markers of viral infections (including two HCV NAT positives) (table). Of these 252 infected donations, 175 (69%) had HCV, 64 (25%) had HBV (including one with dual HCV and HBV infection), and 14 (6%) had anti-HIV. Both anti-HCV negative, HCV RNA positive donations detected during 2000 were collected from donors with recent infection who subsequently seroconverted for anti-HCV. One donor was new, and one was a repeat donor. New donors contributed 10% of all blood donations, but 82% of infected donations. Blood donations have been tested for anti-HIV since 1985 and for anti-HCV since 1991. The annual rates of these two markers in donations of blood from new and repeat blood donors are shown in figures 1 and 2. Table Infections detected in blood donations collected in England & Wales, 2000
Infections in blood donors Donations with confirmed marker of infection HBV (HBsAg) 64 2.51 39,816 57 21.52 4,468 7 0.31 326,189 HCV HIV Any of these (anti-HCV/ (Anti-HIV) three markers HCV RNA) 175 6.87 14,561 145 54.73 1,827 30 1.31 76,111 14 0.55 182,017 6 2.26 44,153 8 0.35 285,416 252 9.89 10,112 207 78.14 1,280 45 1.97 50,741

All donations - per 100,000 donations tested - 1 in x donations donations from new donors - per 100,000 donations tested - 1 in x donations donations from repeat donors - per 100,000 donations tested - 1 in x donations

Figure 1 HIV infected blood donations: England & Wales, 1 January 1986 to 31 December 2000

Figure 2 HCV infected blood donations: England & Wales, 1 September 1991 to 31 December 2000

The annual prevalence of HBsAg, anti-HCV, and anti-HIV among blood donors in England and Wales have generally been stable in recent years, and low compared with the rest of Europe. The prevalence of anti-HCV has decreased throughout the 1990s. The prevalence of HBsAg and of antiHCV by age group and sex of donors is shown in figure 3. Figure 3 Age and sex of infected blood donors: newly tested donors1, 2000 a) HBsAg

b) Anti-HCV

Testing of all blood donations for antibodies to HTLV I/II (using minipools constructed for HCV RNA testing) is planned to start by April 2002, pending approval, and will be added to this surveillance. Back to top

Last updated: 25 Octobber 2001

CDR Weekly
25 October 2001

Next update due 22 November 2001 For archive data click here
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HIV infection and AIDS in the United Kingdom: monthly report - October 2001
United Kingdom data from the PHLS AIDS and STD Division, Scottish Centre for Infection and Environmental Health, Institute of Child Health, London, and Oxford Haemophilia Centre (on behalf of UK Haemophilia Centre Directors’ Organisation) The United Kingdom (UK) HIV data set recorded 47,201 reports of HIV infected individuals between the beginning of AIDS reporting in 1982 and the end of September 2001; 68 of them were first reported from the Channel Islands or the Isle of Man. Twenty-six thousand seven hundred and ninety-five (57%) of the reports were of HIV infection only, and 18,173 (39%) were reported as having AIDS. Of the AIDS cases, 12,248 (67%) had died. A further 2232 (5% of the total) had died without AIDS being reported. Included in the total will be some reports of individuals who have left the country, and unrecognisable multiple reports of others; factors such as incomplete reports, transcription errors, and name (and hence soundex code) changes mean that, despite every effort to do so, matches between related records cannot always be made. The interval between HIV infection or AIDS being diagnosed or death occurring and the event concerned being reported to the surveillance system can be considerable. This means that all totals based on the year of an event are subject to revision as further reports are received, and that numbers, particularly for recent years, are likely to be higher in later summaries. In the past it has been possible to assess, on the basis of previous experience, how many further HIV diagnoses were likely to be reported. This is not practicable at present. Clinician reporting at HIV diagnosis, introduced at the beginning of 2000 (1), is too new for its associated reporting delay and its ultimate effect on the number of reports to be estimated. It is known, however, that 397 of the 3617 diagnoses in 2000 were reported by clinicians only. There are some centres where clinicians have taken up reporting and for which laboratories which have reported inconsistently in the past; laboratory reports are no longer being actively sought in every case. This means that it cannot be assumed that all the 397 new diagnoses reported by clinicians only would have been previously unreported, though the introduction of clinician reporting at HIV diagnosis will have led to an increase in the numbers reported. Even without these reports, however, the annual total would have been the highest ever for diagnoses in the UK. Exposure category by year of diagnosis All reports of HIV diagnoses for which exposure categorisation cannot be decided on the basis of the information supplied are followed up. When necessary and both the clinician and patient agree this follow-up involves interview by a research nurse. Those recorded as heterosexually infected are further divided on the basis of their partner’s probable route of infection, and if this is heterosexual, on where the patient is likely to have acquired infection. The time taken to establish these categories is often considerable, which explains the rise in those recorded in the ‘other/undetermined’ in recent years (table 1). Follow-up delay particularly affects allocation to the appropriate subcategory of those infected in the UK through exposure to partners infected heterosexually.

Table 1 HIV infected individuals* by year of first reported United Kingdom diagnosis: UK data to end September 2001
Year of diagnosis of HIV infection How infection was probably acquired Sex between men## 'HR' partner† Acquired abroad – no evidence of HR partner UK acquired – no evidence of HR partner Not determined Sub total Injecting drug use Blood products/ tissue transfer Mother to infant Other/ not determined Total Total 92-01 Grand Total 26617

<1992 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001#

12771 1639 1498 1478 1467 1539 1389 1339 1317 1407

773 13846

Sex between men and women 383 88 85 69 68 64 76 67 41 39 27 624 1007

1657

626

611

624

666

679

780

927 1159 1496

853

8421

10078

175 37 2252 2301 1496 116 528

56 10 780 187 23 57 53

65 5 766 202 17 67 63

94 6 793 168 17 63 47

97 17 848 182 19 59 62

76 14

125 22

122 37

132 64

144 141

73 272

984 588

1159 625 12869 3760 1675 771 1509 47201

833 1003 1153 1396 1820 172 21 59 56 168 27 82 52 129 9 92 68 109 17 76 98 99 22 87 182

1225 10617 43 7 13 300 1459 179 655 981

19464 2739 2613 2566 2637 2680 2721 2790 3013 3617

2361 27737

*Indiviuals with laboratory reports of infection, plus those with AIDS or death reports for whom no matching laboratory report has been received. #Reported in first nine months of the year. ##Includes 661 reports of men also exposed through injecting drug use. Heterosexual partner exposed to HIV through sex between men, IDU or blood transfusion or blood product treatment. Numbers, particularly for recent years, will increase as further reports are received.

Over all 19,464 diagnoses made before 1992 have been reported. Since 1992 there have been 27,737, giving a ratio of 1:1.42 in comparing the earlier with the later period. The ratio, however, differs considerably with the probable route of infection. It is lowest, 1:0.12, for those infected through blood or tissue transfer or blood product treatment. These routes of HIV infection were largely eliminated in the UK with the introduction of donor screening in 1985 and the heat treatment of blood products in the mid-1980s. Since then a small number of earlier infections have been diagnosed, as HIV-related disease has developed, and HIV infections associated with transfusion in high prevalence areas have been recorded. The ratio is also less than one (1:0.63) for those acquiring infection through injecting drug use (IDU). In the UK harm reduction initiatives such as the provision of clean needles have been relatively effective in limiting spread through IDU, though evidence of an increase in risky injecting practices in recent years leave no room for complacency (2). The numbers of men recorded as infected through sex with men pre- and post- the end of 1992 are fairly similar (12,771 and 13,846). The number of those reported as infected through heterosexual sex, by contrast is nearly five-fold higher for the later period. The numbers of diagnoses reported each year where infection is attributed to heterosexual sex with a high risk partner (usually a bisexual man or an injecting drug user) has tended to fall, but for those infected by heterosexual sex with partners themselves believed to have been heterosexually infected the trend has been upward. This has been true both for those recorded as having acquired HIV within the UK, and for those infected abroad, although the latter outnumber the former by 7 to 1 or more in most of the years shown. The trend in the numbers of children acquiring HIV infection through mother to infant transfer has not followed the upward trend in heterosexually infected adults, as for those born in the UK improved antenatal maternal diagnosis has meant that interventions around the time of birth have greatly reduced the chance of transmission.

The ratio of new diagnoses of HIV infection acquired through sex between men diagnosed before and after the end of 1992 is less than one only for the London region (table 2a). Elsewhere there have been as many or more diagnoses in the later period. The ratio is highest (1:1.6) in the North West and Wales. For heterosexually acquired infections the pre- to post- end 1992 ratios are higher than for homosexually acquired ones in all regions (table 2b). The ratios are relatively low (1:2.5 to 2.7) in Wales, Scotland and Northern Ireland, and relatively high in Trent, Eastern, and London (1:5.3 to 5.6). Only two heterosexually acquired infections were diagnosed and reported from the Channel Islands or Isle of Man in the earlier period, and 21 in the later. Up to the end of 1992 35% of those HIV infected through IDU were reported from London, and 40% from Scotland while since then 48% have been reported from London and only 17% from Scotland. This means that, despite the early IDU related outbreak in Scotland, over the UK epidemic as a whole considerably more diagnoses of drug related HIV infection have been diagnosed in London than Scotland. Table 2 Diagnoses of HIV infection* by probable route of HIV acquisition: UK data by region of report to end September 2001. a) Sex between men§
Total Grand >1992 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001† 92-01 Total England N&Y Trent WM NW East Lon SE SW Wales Scot NI CI/ IoM Total 409 263 345 678 239 66 47 52 120 45 42 55 49 108 34 938 131 41 24 69 6 1 55 38 41 98 31 889 152 64 25 68 11 6 39 34 60 114 44 923 102 53 30 61 7 – 49 37 39 117 27 974 149 42 21 69 12 3 33 27 58 87 29 888 117 50 24 68 6 2 33 24 54 106 30 850 101 52 14 67 6 2 37 31 47 140 34 794 108 52 18 50 6 – 42 25 53 134 38 837 142 44 21 64 6 1 21 30 14 46 20 483 70 24 20 37 8 – 417 348 467 1070 332 8589 1221 474 233 604 76 15 826 611 812 1748 571 17359 2222 904 379 1025 130 30 26617 Total Year of diagnosis

8770 1013 1001 430 146 421 54 15 149 52 36 51 8 –

12771 1639 1498 1478 1467 1539 1389 1339 1317 1407

773 13846

b) Sex between men and women
Total Year of diagnosis 2001† Total 92-01

>1992 1992 1993 1994 1995 1996 1997 1998 1999 2000 England N&Y Trent WM NW East Lon SE SW Wales Scot NI CI/ IoM Total 117 71 72 118 84 1260 189 81 53 188 17 2 2252 30 28 24 31 33 489 60 19 12 50 3 1 780 19 30 24 22 35 496 64 17 13 41 5 – 766 22 22 21 25 20 531 62 33 14 39 2 2 793 22 26 24 35 25 569 52 24 10 55 5 1 848 30 25 16 44 20 563 49 19 10 51 4 2 45 24 30 38 33 643 82 30 17 53 3 5 38 39 41 48 45 750 86 37 10 53 3 3 52 47 37 48 46 58 67 70 61 120

Grand Total

48 75 34 21 101 694 159 25 13 44 5 6

364 383 321 373 478 6841 879 281 132 498 46 21

481 454 393 491 562 8101 1068 362 185 686 63 23 12869

976 1130 81 30 12 59 7 1 184 47 21 53 9 –

833 1003 1153 1396 1820

1225 10617

c) Injecting drug use
Total Year of diagnosis 2001† Total Grand 92-01 Total

>1992 1992 1993 1994 1995 1996 1997 1998 1999 2000 England N&Y Trent WM NW East Lon SE SW Wales Scot NI CI/ IoM Total 69 85 35 88 74 796 150 50 12 931 5 6 2301 4 4 6 8 10 109 9 9 1 27 – – 187 6 3 5 8 8 88 19 9 2 52 1 1 202 4 6 8 10 8 79 13 7 4 29 – – 168 1 14 5 12 4 101 13 7 3 22 – – 182 5 7 4 9 5 80 20 9 1 32 – – 172 5 6 6 13 9 74 15 7 1 31 – 1 168 1 13 6 7 4 57 11 8 3 19 – – 129 2 3 2 3 6 55 12 8 1 16 1 – 109 4 8 3 5 5 45 9 3 2 15 – – 99

3 4 1 – 1 17 3 1 1 11 – 1 43

35 68 46 75 60 705 124 68 19 254 2 3 1459

104 153 81 163 134 1501 274 118 31 1185 7 9 3760

N&Y: Northern and Yorkshire, WM: West Midlands, NW: North West, East: Eastern, Lon: London, SE: South East, SW: South West, Scot: Scotland, NI: Northern Ireland, CI/IoM: Channel Islands/Isle of Man. * individuals with laboratory reports of infection, plus those with AIDS or death reports for whom no matching laboratory report has been received. †reported in the first nine months of the year. §includes 661 reports of men also exposed through IDU. 1 CDSC. AIDS and HIV infection in the United Kingdom: monthly report. Commun Dis Rep Wkly 2000: 10; 1,4 2 CDSC. AIDS and HIV infection in the United Kingdom: monthly report. Commun Dis Rep Wkly [serial online] 2001 [cited 25 October 2001] 11 (25); HIV/STI. Available at <www.phls.co.uk/publications/CDR%20Weekly/archive/hivarchive.html>

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posted:1/22/2010
language:English
pages:14
Description: CDR Weekly