HEALTH PROTECTION TEAM

Public Health Unit

Issue 43 April 2007December 2001

Disease / Feb 07 / Mar 07
DYSENTERY / 0 / 1
CAMPYLOBACTER / 20 / 36
CHICKENPOX / 316 / 227
FOOD POISONING: total / 9 / 17

AEROMONAS

/ 3 / 5
CRYPTOSPORIDIUM / 1 / 3
E COLI O157 / 3 / 2
ENTAMOEBA / 0 / 0
GIARDIA / 0 / 0
SALMONELLA / 1 / 5
YERSINIA / 1 / 2
LEGIONELLOSIS / 0 / 0
LEPTOSPIROSIS / 0 / 0
LISTERIA / 0 / 0
LYME DISEASE / 3 / 3
MALARIA / 1 / 1
MEASLES / 0 / 0
MENINGOCOCCAL INF / 1 / 0
MUMPS / 6 / 8
Q FEVER / 0 / 0
RUBELLA / 0 / 1
SCARLET FEVER / 1 / 0
TB RESP / 1 / 1
TB NON RESP / 0 / 0
TYPHOID / 0 / 0
VIRAL HEPATITIS: total / 13 / 14
HEPATITIS A / 0 / 0
HEPATITIS B ACUTE / 1 / 0
HEPATITIS C / 10 / 9
HEPATITIS B CHRONIC / 2 / 5
WHOOPING COUGH / 3 / 0


“YOU’VE GOT FOOD POISONING”

Not all outbreaks of gastro-intestinal illness in the community are food-related e.g. Norovirus is predominantly airborne. The Health Protection Team and the Environmental Health Officers who investigatesuch cases face unnecessary difficulties when they are dealing with patients who have been informed by a health professional that they have “food poisoning”.

It would assist the investigating officers if patients are made aware that food-related infection cannot be confirmed until environmental investigations have been completed.

WHOOPING COUGH NOTIFICATION

Colleagues are reminded that a clinical suspicion of a case of whooping cough should be notified as soon as possible to the Health Protection Team (01224 558520) without waiting for laboratory confirmation. If it is to be of benefit, Public Health action required for vulnerable contacts (immunisation, chemoprophylaxis) should be commenced within 21 days of the onset of symptoms in the index case, therefore prompt notification of suspected cases is essential.

ADVICE TO PREGNANT WOMEN DURING THE LAMBING SEASON

Pregnant women who come into close contact with sheep during lambing may risk their own health and that of their unborn child from infections such as chlamydiosis, toxoplasmosis and listeriosis, which are common causes of abortion in ewes.

To avoid the possible risk of infection, pregnant women are advised that they should:

  • Not help to lamb or milk ewes
  • Avoid contact with aborted or newborn lambs or with the afterbirth
  • Avoid handling clothing, boots etc. which have come into contact with ewes or lambs.
  • Seek medical advice if they experience fever or ‘flu like symptoms where they may have acquired infection from the farm environment.

The leaflet “While you are pregnant: How to avoid infection from food and from contact with animals” is available free of charge to GPs and midwives from the Scottish Executive Health Department, Public Health Division, Branch 1, 3E(S), St. Andrews House, Edinburgh, EH1 3DG.

OUTBREAKS OF DIARRHOEA AND/OR VOMITING IN CARE HOMES.

Viral, or presumed viral, diarrhoea and vomiting has been common this winter and practices are requested to inform the Health Protection Team (tel. 01224 558520) if a cluster of cases is found. Early involvement of this team in the management of such outbreaks will ensure that the appropriate control measures are applied and that the spread of the illness is minimised.

HEALTH PROTECTION SCOTLAND TB STUDY DAY

29thMay 2007

At

The RoyalCollege of Physicians and Surgeons, Glasgow.

Registration forms available from Rebecca Flanagan at HPS (0141 300 1170). Cost £15. Lunch included. For more information contact Susan Duthie (01224 558520)

LYME DISEASE – RISK FROM TICK BITES

The Health Protection Agency has issued a reminder of the risks of tick bites when visiting forested woodland and heathland areas.The peak times for tick bites are late spring, early summer and autumn and Lyme Disease has been acquired in several popular holiday destinations such as the Lake District and the ScottishHighlands.

Lyme Disease is a notifiable condition, caused by a spirochete, Borrelia burgdorferi and is transmitted to humans by the bite of infected Ixodes (deer/sheep) ticks. The transmission of the spirochete does not occur until the tick has been in place for 36-48 hours. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash (expanding, erythematous with central, ‘bull’s eye’ clearance) called erythema chronicum migrans. The skin rash develops between 3 and 32 days following the tick bite. If Lyme Disease is left untreated, other manifestations may occur and these may include large joint polyarthritis (usually asymmetrical), aseptic meningitis, peripheral nerve root lesions, radiculopathy, meningoencephalitis and myocarditis.

Lyme Disease diagnosis is based on symptoms, physical findings (e.g., rash), and a history of probable exposure to ticks - common among forest walkers, forestry workers, farmers and gamekeepers. Laboratory testing is helpful in the later stages where confirmation of the disease is by demonstration of elevated IgM antibody. Most cases of Lyme Disease can be treated successfully with a few weeks of antibiotics, usually doxycycline or amoxicillin. Patients with complications may require treatment for months. Patients diagnosed or suspected to be suffering from Lyme Disease should not be given steroids or any other immunosuppressant since this may result in serious complications.

Preventive advice to individuals who are potentially at risk should include using insect repellent, wearing long trousers and removing ticks promptly. Individuals taking forest walks in tick-infested areas should inspect exposed skin for ticks every few hours and, if possible, at the end of the day's outdoor activity should completely check their bodies. Clothes should also be checked.

Ticks can be removed by gently gripping them as close to the skin as possible, using fine-toothed tweezers, and pulling steadily away from the skin. Some veterinary surgeons and pet supply shops sell inexpensive tick-removal devices, which are useful for people frequently exposed to ticks.

Colleagues are requested to notify cases of Lyme Disease to the Health Protection Team. Monitoring of notifications will help to identify high-risk areas and enable us to offer appropriate advice to the public.

COMPLETION OF LABORATORY REQUEST FORMS

The NHSGrampian policy can be found at:

Incomplete or incorrect completion of request forms and/or sample labels ultimately represents a threat to patient safety. National guidelines exist for “Patient Sample and Request Form Identification Criteria” and external governance of laboratory services, through the process of accreditation, requires that each of the laboratory specialties follow and enforce these guidelines in the acceptance and processing of test requests.

When completing request forms it is essential that the following details should be included

  • Patient’s Full Name
  • Date of birth
  • Full ten digit CHI number or Hospital Unit number, if available
  • Specimen type(e.g. blood, urine, marrow, sputum) and where appropriate (e.g. pathology samples and swabs for microbiology) anatomical site
  • Investigations required
  • Date and time of collection
  • Clinical history – relevant to the tests being requested
  • Patient location / destination of report

Inclusion of the following information is desirable but not essential

  • Requesting practitioner
  • Patient’s home address
  • Laboratory specialty to which the sample is being submitted

As well as maintaining and improving standards of information provided in test requesting, the laboratories also have a duty to improve efficiency, safety and turnaround within the mechanisms by which test requests are made and to reduce risk of transcription errors during receipt and processing of requests.

IMMUNISATION UPDATE (APRIL 2007)

FREE “GREEN BOOKS” FOR IMMUNISERS

NHS health professionals who are routinely involved in immunisation are each entitled to a single free copy of The Green Book. In order to receive a copy, please e-mail the following information to for the attention of Cate, requesting a copy.

  • Name
  • Work address
  • Job title +/- professional registration number

Practice Managers may wish to draw up a list of eligible staff and submit a block order.

PRINTING ERROR – 2006 “GREEN BOOK”

Please note – the first line on page 282 should read “The dTaP/IPV vaccine, which contains a lower dose of diphtheria antigen….”

IMMUNISATION QUERIES - CHANGED ARRANGEMENTS

The Health Protection Team receives hundreds of telephone calls each year requesting advice in connection with immunisation. In order to enable us to manage this workload more efficiently we are commencing a 6 month trial period of restriction on the hours during which we will accept immunisation queries.

From Tuesday 1st May 2007, telephone calls concerning immunisation querieswill only be acceptedbetween the hours of 9 a.m. and 11 a.m on Tuesdays, Wednesdays and Thursdays.

No telephone queries will be accepted outwith these hourswith the exception of those relating to post-exposure rabies vaccine.

The answers to 76% of the queries in 2006 were found in “The Green Book” alone and colleagues are reminded that the “The Green Book” should always be consulted before assistance is sought from the Health Protection Team.

Staff should also note that it is not always possible to provide an immediate answer to more complex queries, as some further research may be necessary. Where our help is needed it is therefore advisable to place the query in advance of the patient’s scheduled attendance, rather than asking for advice at the actual time of vaccination.

HIB AND MENC VACCINE FOR PATIENTS WITH AN ABSENT OR DYSFUNCTIONAL SPLEEN

Changed recommendations

Prior to 2006 it was recommended that patients with an absent or dysfunctional spleen should receive a single dose of Hib vaccine and a single dose of MenC vaccine. “The Green Book” 2006 now recommends thata booster dose of Hib/MenC should be given after at least 2 months.

Haemophilus influenzae b immunisation

Vaccination against Haemophilus influenzae b(Hib) is recommended for all post-splenectomy patients. Those who were fully immunised with Hib as part of the routine childhood programme should be offered one additional dose of Hib-containing vaccine. Unimmunised individuals aged 10 years and over should receive two doses of combined Hib/MenC vaccine, 2 months apart. (Green Book, 2006)

Meningococcal immunisation

Meningococcal C conjugate vaccine is recommended for all people with an absent or dysfunctional spleen.

Children under one year should be vaccinated according to the UK schedule, receiving two doses in infancy and a booster dose at 12 months.

Children over one year of age and adults should be given two doses of Hib/MenC vaccine two months apart.

Those who were fully immunised with MenC as part of the routine childhood programme, who then develop splenic dysfunction should be offered one additional dose of MenC vaccine.

Unimmunised individuals aged 10 years and over should receive two doses of combined Hib/MenC vaccine, 2 months apart. (Green Book, 2006)

When travelling to a high risk area for meningococcal infection, patients will still require the additional protection conferred by the polysaccharide A and C or quadrivalent (A,C,W,Y) vaccines.