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the Communicable Disease Report Weekly Current Issue: Volume 15 Number 14 Published on: 7 April 2005 NEWS STORIES: Marburg haemorrhagic fever in Angola – update Third phase of pneumococcal vaccination programme launched European zoonoses network launches public website Erratum: Graph legend alteration in Late diagnosis and mortality in HIV-infected men who have sex with men (MSM) INFECTION REPORTS Enteric: General outbreaks of foodborne illness in humans, England and Wales: weeks 10-13/05 Salmonella infections, (faecal specimens) England and Wales, reports to the HPA (salmonella data set): February 2005 Common gastrointestinal infections, England and Wales, laboratory reports: weeks 10-13/05 Less common gastrointestinal infections, England and Wales : laboratory reports, weeks 1-13/05 Trends in selected gastrointestinal infections – 2004 DIARY Immunisation Training at HPA Colindale – 2005 CDR SUBSCRIPTION: To subscribe to CDR Weekly, please visit: <http://www.hpa.org.uk/cdr/contact.htm> CDR Weekly, Vol 15 no 13: News Current Issue: Volume 15 Number 14 Published on: 7 April 2005 News | Last updated 7 April 2005 Next update due: 14 April 2005 News Marburg haemorrhagic fever in Angola – update Third phase of pneumococcal vaccination programme launched European zoonoses network launches public website Erratum: Graph legend alteration in Late diagnosis and mortality in HIV-infected men who have sex with men (MSM) Marburg haemorrhagic fever in Angola – update An outbreak of Marburg haemorrhagic fever that has been occurring in Angola, south west Africa since October 2004 (1), is continuing. As of 6 April 2005, there were 181 cases including 156 deaths (case fatality rate, 86%) reported by the Ministry of Health (2). This is the largest recorded outbreak of the disease to date and the first to occur in an urban setting. Cases and deaths have been reported from five northern provinces in Angola: Uige, Luanda, Cabinda, Malange, and Kuanza Norte, although all cases have so far originated from Uige province only. While children under the age of 5 years initially accounted for around 75% of cases, recent cases have included an increasing number of adults. The World Health Organization (WHO) and the Global Outbreak and Response Network (GOARN) (3) are continuing to provide assistance with five mobile teams investigating rumours and searching for additional cases. Over 100 contacts are being followed up. The Angolan Ministry of Health is also working with WHO to finalise a national plan of action for control of the outbreak. Although there have been rumours of suspect cases reported to have been imported from Angola, (including the neighbouring Democratic Republic of the Congo, South Africa, Portugal, and Italy) no such cases have so far been confirmed (4, 5). The United Kingdom Foreign and Commonwealth Office has for some time not recommend leisure travel to Angola due to civil conflicts, and advises against all but essential travel to northern provinces of North and South Lunda, and the interior of Cabinda (6). There is not currently any advise against travel to Angola due to the threat of Marburg virus. Imported European cases of Marburg virus are extremely rare. International travellers, who may go to Angola however, need to be aware of the possible risk of infection if they come into close contact with a case. In this unlikely event, travellers should seek medical advice immediately if they experience any symptoms such as fever, diarrhoea, abdominal pains, and vomiting on return to the United Kingdom (UK) (1). Marburg virus disease may be easily confused with other febrile illnesses such as malaria, yellow fever, and typhoid. Healthcare professionals are reminded to take a full travel history from anyone with suspicious symptoms; official guidance on the management of viral haemorrhagic fevers is available on the Health Protection Agency website at <http://www.hpa.org.uk/infections/topics_az/VHF/ACDP_VHF_guidance.pdf>. Marburg virus is in the same family, Filoviridae, as the Ebola virus, and produces a similar clinical illness with a rapidly progressing and severe haemorrhagic fever; mortality rates can reach 90% or more as in this current outbreak. There is no vaccine or specific treatment for Marburg as yet, although research into possible vaccine candidates is being undertaken (7). The main route of transmission is thought to be by direct contact with bodily fluids of an infected person or animal. Previous outbreaks have usually begun in rural areas, but the natural reservoir for both Marburg and Ebola viruses is unknown. Experiments to find the natural reservoir of filoviruses have been conducted on over 3000 vertebrates and 30,000 arthropods, but have so far proved negative (8). Further information on Marburg virus can be obtained from the WHO website at <http://www.who.int/csr/disease/marburg/factsheet/en/>. References 1. Health Protection Agency. Marburg virus disease in Angola. Commun Dis Rep CDR Wkly [serial online] 24 March 2005 [cited 6 April 2005] 15(12): News. Available at <http://www.hpa.org.uk/cdr/archives/2005/cdr1205.pdf>. 2. Angola: Marburg Haemorrhagic fever – Angola (17): South African case suspected. Archive no 20050405.0984. In Promed Mail [online]. Boston US: International Society for Infectious Diseases, 5 April 2005 [cited 6 April 2005]. Available at <http://www.Promedmail.org>. 3. Angola: Marburg Haemorrhagic fever – Angola (15). In promed mail [online]. Boston US: International Society for Infectious Diseases, 4 April 2005 [cited 6 April 2005]. Available at <http://www.Promedmail.org>. 4. World Health Organization [online]. Global outbreak alert and response network. Geneva: WHO, 2005 [cited 5 April 2005]. Available at: <http://www.who.int/csr/outbreaknetwork/en/>. 5. Angola: Marburg hemorrhagic fever – Angola (13). In promed mail [online]. Archive no 20050402.0951. Boston US: International Society for Infectious Diseases, 1 April 2005 [cited 6 April 2005]. Available at <http://www.Promedmail.org>. 6. Foreign and Commonwealth Office [online]. Travel Advice by Country: Angola. [cited 5 April 2005]. Available at <http://www.fco.gov.uk/servlet/Front?pagename=OpenMarket%2FXcelerate%2FShowPage&c=Page&cid=1007029390590&a=K CountryAdvice&aid=1013618385594>. 7. Warfield KL, Swenson DL, Negley DL, Schmaljohn AL, Javad Aman M, Bavari S. Marburg virus-like particles protect guinea pigs from lethal Marburg virus infection. Vaccine 2004; 22: 3495-502. 8. Leirs H, Mills JN, Krebs JW, Childs JE, Akaibe D, Woollen N, et al. Search for the Ebola virus reservoir in Kikwit, Democratic Republic of the Congo: reflections on a vertebrate collection. J Inf Dis 1999; 179(Suppl 1):S155-63. CDR Weekly, Vol 15 no 13: News Third phase of pneumococcal vaccination programme launched The Chief Medical Officer for England has announced that everybody aged 65 years and over who have not previously been immunised against pneumococcal infection should be offered pneumococcal polysaccharide vaccine (1). This is the third phase of the immunisation programme originally announced in August 2003. People aged 80 years and over were offered the vaccine in 2003/04 (2) and people aged 75 years and over were offered the vaccine in 2004/05. For individuals aged five years and over in at-risk groups, such as such as those with heart conditions, chronic lung disease and chronic liver disease., and for all those aged 65 years and over, a single dose of 23-valence pneumoccocal polysaccharide vaccine is recommended. References 1. Older people to be offered jab against pneumococcal infection Press release 2005/0165. London: Department of Health, 5 April 2004. Available at <http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4107747&chk=7DTGpo>. 2. Chief Medical Officer. Update on the influenza and pneumococcal immunisation programmes. PL CMO (2004)4. London: Department of Health, 2004. Available at <http://www.dh.gov.uk/assetRoot/04/08/73/40/04087340.pdf>. European zoonoses network launches public website Med-Vet-Net, the European network of excellence for zoonoses research has recently launched a public website at <www.medvetnet.org>. The website aims to provide a gateway for public information on zoonoses (infectious diseases transmitted by animals). As work within the Network progresses, it will also provide research results and publications. Med-Vet-Net, which officially commenced on 1 September 2004, is a European Union funded network of excellence comprising 16 partners across Europe, including the Health Protection Agency, Veterinary Laboratory Agency, and the Society for Applied Microbiology in the United Kingdom (1). It integrates veterinary, medical, and food science research on infectious diseases transmitted from animals to man. It is funded for five years at a cost of 14.4 million (£10 million) by the European Union (EU) 6th Framework Programme, within the ‘Quality and Safety of Food’ Priority Area. Around 61% of the disease agents known to be pathogenic to man are zoonotic – such diseases include salmonellosis, rabies, and cryptosporidiosis. In 6bn/yr. addition to the human pain and misery caused by these diseases, the cost to the EU is thought to be well in excess of References 1. Newell D, Jestin A. MED-VET-NET: bringing together veterinary, medical and food scientists across Europe. Eurosurveillance Weekly [serial online] 2004 [cited 6 April 2005]; 8 (38). Available at <http://www.eurosurveillance.org/ew/2004/040916.asp#2> CDR Weekly, Vol 15 no 13: News Erratum: Graph legend alteration in Late diagnosis and mortality in HIV-infected men who have sex with men (MSM) The legend in figure 1from Late diagnosis and mortality in HIV-infected men who have sex with men (MSM), published in CDR Weekly, Vol 15, no.12, 24 March 2005 had an error, which has now been corrected. The orange coloured line (solid line) was originally published as representing the percentage of ‘Estimated short-term mortality of MSM not diagnosed late’. This line actually represents ‘Estimated short-term mortality of MSM diagnosed late’, and has now been amended accordingly. Correspondingly, the dashed line now represents ‘Estimated short-term mortality of MSM not diagnosed late’. The amended graph is shown below (figure 1). The Original article (now including explanatory note) is available at: <http://www.hpa.org.uk/cdr/archives/2005/cdr1205.pdf>. Figure 1 HIV trends in new diagnoses, late diagnoses, and short-term mortality of MSM: 1993 to 2001 CDR Weekly, Vol 15 no 14: Enteric Current Issue: Volume 15 Number 14 Published on: 7 April 2005 Infection Reports | Enteric Last updated: 7 April 2005 Next update due: 12 May 2005 Enteric Cuurent content: Published 10 February 2005, Volume 15 Number 14 General outbreaks of foodborne illness in humans, England and Wales: weeks 10-13/05 Salmonella infections, (faecal specimens) England and Wales, reports to the HPA (salmonella data set): February 2005 Common gastrointestinal infections, England and Wales, laboratory reports: weeks 10-13/05 Less common gastrointestinal infections, England and Wales : laboratory reports, weeks 1-13/05 Trends in selected gastrointestinal infections – 2004 General outbreaks of foodborne illness in humans, England and Wales: weeks 10-13/05 Preliminary information has been received about the following outbreaks. Location of Health Protection Month of Number Cases Suspect Organism food prepared Evidence Unit outbreak ill positive vehicle or served West Hertfordshire S.Enteritidis PT24 School February >7 7 None – M (microbiological): identification of an organism of the same type from cases and in the suspect vehicle, or vehicle ingredient(s), or detection of toxin in faeces or food; D (descriptive): other evidence, usually descriptive, reported by local investigators as indicating the suspect vehicle or food; S (statistical): a significant statistical association between consumption of the suspect vehicle(s)and being a case. Salmonella infections, (faecal specimens) England and Wales, reports to the HPA (salmonella data set): February 2005 Details of serotypes of the 530 salmonella infections recorded in February 2005 are given in the adjacent table below. In March 2005, 244 salmonella infections were recorded, and preliminary information was recorded on one outbreak. Total Salmonella February 2005 (provisional data)* 530 S.Enteritidis (PT4) 55 S.Enteritidis (other PTs) 217 S.Typhimurium 96 S.Virchow 18 Others (typed) 144 *Figures quoted from the Health Potection Agency salmonella data set are for isolates confirmed and typed by Laboratory of Enteric Pathogens (LEP). CDR Weekly, Vol 15 no 14: Enteric Common gastrointestinal infections, England and Wales, laboratory reports: weeks 10-13/05 Number of reports Total Cumulative received reports total to Laboratory reports 10/05 11/05 12/05 13/05 10-13/05 13/05 13/04 Campylobacter 421 376 262 81 1139 5519 8695 Escherichia coli O157* 7 6 – 10 23 61 43 Salmonella† 80 76 41 6 203 1418 1554 Shigella sonnei 8 6 2 1 17 141 159 Rotavirus 1031 978 494 169 2672 6952 6968 Norovirus 135 93 16 3 247 1374 611 Cryptosporidium 11 20 5 3 39 260 594 Giardia 46 37 13 6 102 482 797 * Vero cytotoxin producing isolates (data from Health Protection Agency's Laboratory of Enteric Pathogens (LEP). † Data from Health Protection Agency's Laboratory of Enteric Pathogens. Less common gastrointestinal infections, England and Wales : laboratory reports, weeks 1-13/05 Laboratory reports Total reports Cumulative total to Cumulative total to 1-13/05 13/2005 13/2004 Adenovirus 9 9 8 Astrovirus 65 65 108 Calicivirus 6 6 19 Shigella flexneri 42 42 61 Aeromonas 17 17 34 Plesiomonas 5 5 9 Vibrio 5 5 5 Yersinia 8 8 7 Entamoeba histolytica 20 20 32 Blastocystis hominis 49 49 91 Dientamoeba fragilis 17 17 64 Trends in selected gastrointestinal infections: 2004 Campylobacter infections Campylobacter continues to be the most common laboratory-confirmed bacterial cause of gastrointestinal infection in England and Wales (figure 1). In 2004, 42,146 cases were reported to the Health Protection Agency’s Centre for Infections, 9% less than the 46,178 cases reported in 2003 and a 27% less than the 57,674 cases in 2000 when the number of cases reported was at its highest. CDR Weekly, Vol 15 no 14: Enteric Figure 1 Annual incidence of selected gastrointestinal pathogens, England and Wales:1992 to 2004 *Provisional data. Salmonella infections A total of 12,725 cases of salmonella infection have been confirmed by the Health Protection Agency’s Laboratory of Enteric Pathogens (LEP) was reported in 2004, to date. This is 15% less than the 14,954 reports in 2003, and a 60% less than the peak of 31,480 reports in 1997. Much of this decline is due to the fall in S. Enteritidis infection (from 22,254 cases in 1997 to 8203 cases in 2004, a fall of 63%) and in particular for S. Enteritidis phage type (PT) 4 (from 14,771 cases in 1997 to 2201 cases in 2004, a fall of 85%) (figure 2). Figure 2 Annual incidence of salmonella infection, showing the role of S. Enteritidis (PT4 and non-PT4) and S. Typhimurium, England and Wales: 1992 to 2004 *Provisional data. The number of cases of other phage types of S. Enteritidis reported fell by 15% between 2003 and 2004, with 7082 and 6002 respectively, but the general trend since 2000, when there were 3548 cases, has been upwards. This has largely been due to increases in infection with S. Enteritidis PT1 and PT14b (figure 3). CDR Weekly, Vol 15 no 14: Enteric Figure 3 Annual incidence of the top five phage types of S. Enteritidis (excluding PT4), England and Wales: 1992 to 2004 *Provisional data. Other gastrointestinal infections The provisional total for laboratory confirmed cases of cryptosporidiosis in 2004 was 3375, compared with 5863 in 2003, a fall of 42%. Rotavirus continues to be a major cause of diarrhoeal disease in children, with over 14,000 laboratory-confirmed cases in 2004. The number of laboratory-confirmed cases of Shigella sonnei infection rose from 631 in 2003 to 749 in 2004, an increase of16%. A provisional total of 701 isolates of Vero cytotoxin-producing Escherichia coli O157 (VTEC O157) were confirmed by the LEP in 2004, a slight increase (4%) on 2003 total (675 isolates). CDR Weekly, Vol 15 no 14: Diary Current Issue: Volume 15 Number 14 Published on: 7 April 2005 Diary Immunisation Training at HPA Colindale – 2005 Immunisation Training at HPA Colindale – 2005 THe Health Protection Agency's Immunisation Department, at the Centre for Infections, will be running two Immunisation Study days at Colindale this year: 1. 12 May 2005 “Scientific Issues in Immunisation” This day will include presentations on topical areas in vaccine policy and vaccine development. Presentations this year will focus on the current issues, future strategies and progress with new vaccines for the control of several communicable diseases. 2. 7 June 2005 “Immunisation Training for PCT Immunisation Leads” Following the success of last years’ PCT lead study day, this day will once again focus on some of the practical issues faced by Immunisation leads in the day- to-day running of an immunisation service. For draft programmes and registration forms for both events please see ‘Full Events Listings’ on the HPA website or go to <http://www.hpa.org.uk/hpa/events/default.htm>. For further details contact training co-ordinator Yvette Howell (tel: 020 8200 6868 ext 4427; email: firstname.lastname@example.org), or immunisation training and advice nurses Laura Lane (tel: 020 8200 6868 ext 4680; email: email@example.com) and Claire Cameron (tel: 020 8200 6868 ext 6150; email: firstname.lastname@example.org).
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