SCOTTISH CLINICAL VIROLOGY CONSULTANTS GROUP (SCVCG)

APPROVED MINUTES OF MEETING

Wednesday 9 November 2011 at Pentlands Science Park, Moredun

1. / Present
Ingó Johannessen (Convenor; IJ), John Bremner (JAGB), Sheila Cameron (SC), Bill Carman (WFC), Roger Evans (RE), Craig Ferguson (CF), Pamela Molyneaux (PJM), Sandeep Ramalingam (SR), Kate Templeton (KET), Dave Yirrell (DY).
By phone: Celia Aitken (CA) – joined meeting at 11:30
2. / Apologies
Heather Cubie (HAC), Anne Eastaway (AE), Paul McIntyre (PMcI)
3. / Minutes of Last Meeting (29 June 2011): Accepted as accurate record; will be forwarded to SMF for uploading on their website.
4. / HPS-SCVCG Liaison Meeting
Prof David Goldberg (DG) joined the meeting together with HPS epidemiologists Lesley Wallace (LW) and Christian Schnier (CS) to discuss ‘Sexual Health and BBV Framework: How to Monitor Progress on Suggested Indicators’. DG gave an overview of the Framework and funding dedicated to support its activities. Funding is expected to total £30M over the period 2011-2015. Broadly, this figure is divided as follows: £15M for HCV Action Plan (incl therapy, etc), £10M for BBV services (incl needle-exchange programmes, etc) and £5M for Respect and Responsibility: Sexual Health and Wellbeing. There is some freedom in terms of allocation of funds as long as outcomes are being addressed. The role of HCV Ag testing was discussed. It was suggested that the test replace the HCV Ab assay for screening if it could be agreed between SCVCG and HPS that the focus should be whether or not an individual has active HCV disease rather than Ab evidence of HCV infection at some stage. Whilst DG was in broad agreement with such an approach, he stated that HPS did not wish to exclude previous good quality HCV Ab data and re-baseline from 2012 based on the HCV Ag test alone. Further discussions are needed on this and other aspects of the Framework through SCVCG representation at key groups/committees (supporting the initiative) as well as future SCVCG meetings. LW will forward an overview of the relevant Framework-related groups/committees – although it was also raised that it would be helpful to have an overview of all HPS groups/committees that require SCVCG input.
5. / Matters Arising
i / Respiratory Viruses
- WFC presented WoSSVC’s proposal to offer rapid flu PCR testing for ITU/HDU/pregnant women with respiratory illness on weekends; KET stated RIE SVC is considering the same.
- KET presented an SEoSSVC-HPS project proposal on the epidemiology of M pneumoniae in Scotland 2007-2011 to be carried out by Naomi Gadsby, an RIE Clinical Scientist trainee. Among other things, the project aims to determine testing methods in reporting laboratories and compare number of M pneumoniae episodes with distribution of respiratory viruses using HPS and HPA data with a view to generate a UK-wide perspective.
- KET informed that the adenovirus eye project is being written up.
- DoH/HPA guidance on ‘Prevention of Infection and Communicable Disease Control in Prisons and Places of Detention’ was circulated for information. JAGB will update SCVCG on HPS infection control advice.
ii / Blood-Borne Viruses
- KET stated routine HBsAg testing prior to cardiac surgery had now stopped at RIE. This is not a Scotland-wide approach yet and requires further input from the test centres prior to formulation of a SCVCG proposal. KET and SC will lead on that front.
- SaBTO guidance from 2011 recommends NAATs for BBV in the donor transplant setting although this is not mandatory yet; where NAATs are not performed, the recommendation is that Ag assays (together with Ab tests) are included. To this end, SEoSSVC includes HCV Ag in its donor test protocols, and the aim is to address SaBTO recommendations for BBV NAATs by testing donor blood samples within 24hrs in SNBTS’s BBV PCR assays that are run daily. Other SaBTO requirements now include HTLV testing of donor samples.
- Further development of the draft SCVCG guidance on BBV screening in the haemodialysis setting awaits the outcome of an HCV Ag audit by IJ and SR.
- Draft SCVCG proposal for HBV immunisation in the OHS context will be presented by IJ and SC at the SDVG meeting this afternoon.
iii / Hepatitis E Virus
SR outlined a project undertaken by Dr Jeff Vanek, ST in Virology at RIE, which aims to collate information on recent HEV cases in Lothian. SR will update SCVCG as the data becomes available.
iv / Rubella Screening and Notification
There was discussion on the appropriate approach to rubella screening that focused on the use of one or two separate rubella IgG assays (including Architect and Vidas). It was felt that two assay platforms were required to confirm an initial negative (<10 IU/mL) result and clarify equivocal results. Equally, it was highlighted that a past history of 2 doses of MMR vaccine should obviate the need for rubella IgG testing of immunised individuals. In order to reach a consensus SCVCG approach, KET and PMcI will formulate a Scotland-wide approach to rubella IgG testing.
v / JC Virus
JAGB raised the matter of anti-JCV antibody testing for patients about to embark on natalizumab (Tysabri; Biogen Idec-Élan) in order to assess risk of PML. Meeting agreed that samples for such tests should be referred to HPA Colindale (HPS is aware of such referrals).
vi / BKVAN
IJ raised issue of increasing concern within RIE Renal Med/Tx of renal graft failures due to BKVAN which has prompted calls for more formalised screening (and management) protocols at RIE. IJ and DY will formulate an approach based on Dundee’s experience with a view to trial such a protocol in the RIE cohort (following consultation with renal colleagues) and report to SCVCG at a later date.
vii / Norovirus: SCVCG and SMF Evaluation Project
WFC and KET stated that work was underway and a further meeting was scheduled for 15 November to ascertain what norovirus testing protocols (including methodology) were currently used in Scottish laboratories and put forward proposals to standardise the approach as well as to identify gaps in the evidence base and outline research required to address them. The outcome will have an impact on infection control protocols; HPS will be kept informed.
viii / Retention and Storage of Records and Tissue Samples
KET presented RCPath guidance (2009) on retention and storage of pathological records and specimens that gives an overview of what is expected of laboratories. For example, the document highlights the need to keep antenatal blood samples for 1 year, samples pertaining to exposure incidents for 2 years, and foetal blood as well as blood samples from organ/tissue donors/recipients indefinitely. During ensuing discussion, it became clear that practice differs somewhat within SCVCG and should be aligned with the RCPath guidance.
ix / Cave Canem Excercise Report
SR fed back from a recent meeting held to highlight the continued risk of rabies in the UK from bats as well as illegally imported terrestrial animals.
x / Toxoplasma Testing and Users’ Guide
RE outlined current service as manifest in the User’s Guide and invited colleagues to suggest any areas for improvement. Whilst the dye test is considered gold standard, CA questioned its clinical utility. In support of her view, CA will present WoSSVC audit data on toxoplasma testing at next SDVG meeting on 18 May 2012. At that meeting, KET will also present toxoplasma audit data from SEoSSVC.
xi / List of Virus Tests and Locations
The list was accepted as accurate except rubella PCR is not performed at RIE; however, rubella PCR is carried out in Dundee. CA raised the issue of HPV testing in the context of borderline/equivocal cytology versus test of cure. It was suggested that HAC be invited to give an overview of HPV services in Scotland at the next SCVCG meeting to clarify matters; IJ will extend such an invitation.
xii / Other
See AOCB below
6. / Updates
i/ii / Health Protection Advisory Group/Health Protection Network (WFC)
WFC informed that HPS has undergone recent stock-taking exercise to ensure adequate integration across health boards; the exercise did not result in any major restructuring of the agency. The proposal is that HPS become an independent member of HPN which will be structured further although the outcome is still unclear. HPAG is to be disbanded.
iii / PCR Working Group (DY)
DY stated that a meeting had been held 20 September 2011 and minutes were to follow.
iv / UK Clinical Virology Network (DY)
KET informed of a joint CVN/SGM meeting to be held in Dublin 28-29 March 2012. Items on the agenda include UKCVN business, resistance to new HCV PIs, IL28b testing, acute encephalitis as well as measles and polio eradication.
v / Specialty Adviser for Virology to Scottish CMO (IJ)
IJ attended the annual Specialty Advisers meeting on 22 September 2011 that focused on undergraduate and postgraduate medical training.
vi / RCPath and Scottish Nat’l Training Programme in Virology (CA, IJ, SC, KET)
Two medics were recruited during interviews held on 19 May 2011 for a substantive ST post in Virology in Edinburgh and a LAT post in Virology in Glasgow. CA (TPD) and IJ (Deputy TPD) have drafted guidance for Micro ST 6 months’ rotation into Virology and are drafting guidance on CBDs and DOPs based on the RCPath curriculum and guidance documents. Whilst the meeting agreed it was a good idea to rotate Virology trainees from their home base into other Virology laboratories for training, it is clear that the Deaneries will not fund such an approach. Impending joint training was discussed briefly which will consist of a common stem with later specialisation along the lines of ID/Microbiol or ID/Virol although it was envisaged that Microbiol and Virol would also retain their separate CCTs.
vii / Reference Laboratories Working Group (DY/PJM)
Update at next SCVCG meeting.
viii / UK Standards for Microbiology Practice (PMcI/KET)
Update at next SCVCG meeting.
ix / National Medical Microbiology and Virology Network (IJ, KET)
Update at next SCVCG meeting.
x / ECOSS Board (PMcI)
Update at next SCVCG meeting.
xi / HIV Standards Project Recognition & Diagnosis Group (CA)
Update at next SCVCG meeting.
xii / HIS Hepatitis C Project Group (PMcI)
Update at next SCVCG meeting.
xiii / SMASAC and POCT (WFC)
Update at next SCVCG meeting.
xiv / Keele Benchmarking (CA)
Update at next SCVCG meeting.
xv / Scottish Screening Programme for Communicable Diseases in Pregnancy (PMcI/PJM)
Update at next SCVCG meeting.
xvi / Scottish Paediatric & Adolescent Infection & Immunology Network (KET)
Update at next SCVCG meeting.
xvii / Other
Update at next SCVCG meeting.
7 / AOCB
- SCVCG - Role, remit, and mechanisms of guiding best practice in Scotland
IJ suggested that the above be formalised a bit more – in particular, because of the establishment of the Medical Microbiology & Virology MCN (MMVN) as a successor of the SMF. Following discussion, the meeting agreed to develop the SCVCG as an independent advisory group for the MMVN as well as the Scottish CMO (through IJ) in addition to spear-heading development of consensus best practice guidance for clinical virology in Scotland. Some discussion ensued as to whether the SCVCG should be identified specifically on future publications that arose from projects developed within the group. Whilst this was felt to be appropriate in principle, further discussion is needed to define further this and other aspects of SCVCG.
8 / Date, Time and Venue of Next Meeting
Wednesday 21 March at 10:30am, Perth Royal Infirmary.