Speech by NDSC Director, Dr Darina O'Flanagan at the launch of the NDSC 2003 Annual Report
I'd like to thank the Tanaiste for coming along this morning to launch our Annual Report for 2003.
This is our fifth report and builds on work covered in previous years. It is a comprehensive source of information for anyone with an interest in infectious disease in Ireland.
2003 was a difficult year for the surveillance and control of infectious diseases. It was the year that SARS emerged and its rapid transmission around the world served as a global warning to improve public health infrastructure and hospital infection control systems.
In just five months - between March and July 2003 - we saw over 8,000 probable cases of SARS in about 30 different countries. Sadly 900 people died from the disease in the same period. We were fortunate here in Ireland - none of the 50 cases we investigated was confirmed as being caused by the SARS virus.
2003 wasn't just about SARS. Endemic diseases continued to cause problems. E. coli O157 remains a serious concern with 86 confirmed cases in 2003. One in eight children under 15 years of age with confirmed VTEC 0157 will develop haemolytic uraemic syndrome, a form of renal failure.
Members of households, which are not on the main public water supplies, are over represented among VTEC cases and the potential for waterborne outbreaks of VTEC and cryptosporidiosis is a cause for concern.
Norovirus is in the news again. And ongoing surveillance of disease outbreaks highlighted the huge burden caused by the emergence of a variant strain. It was responsible for over 154 outbreaks of gastroenteritis in 2002.
Over 5000 people were ill in the hospital sector alone due to this pathogen. As a result a subcommittee of the NDSC Scientific Advisory Committee was formed and guidelines on the management of Norovirus in hospital setting were published and launched by the then Minister for Health, Micheal Martin - in December 2003.
Sexually transmitted infections continued to rise and notified numbers in 2002 were the highest for any year on record.
An early start to the 2003 influenza season resulted in a higher incidence rate of influenza in young children. NDSC monitored the situation closely in collaboration with general practitioners, the National Virus Reference Laboratory, hospital clinicians and public health departments. We worked closely with the Department of Health and Children to further develop contingency plans on pandemic influenza and other major threats.
Data on anti-microbial consumption patterns in Ireland has been added to the report this year to inform the policies of the SARI committee, who are implementing the Strategy to control Antimicrobial Resistance in Ireland. The proportion of MRSA isolates in Ireland remains one of the highest in the countries reporting to the EARSS surveillance scheme.
On a positive note, annual immunisation rates for all vaccines improved in 2003. Uptake rates reached 92-94% in three health boards. The challenge now is to reduce the regional disparity and to continue the upward trend. Other advances include the successful piloting of Computerised Infectious Disease Reporting System during 2004 and the changes in the Infectious Disease Legislation at the end of 2003 which specified a number of important pathogens and which introduced reporting from microbiologists.
Our Annual Report is a microcosm of the work carried out by public health professionals around the country and will be an invaluable reference source for anyone with an interested in communicable diseases.
It remains for me to thank all of the staff at NDSC for their ongoing commitment and professionalism throughout the year.
First case of winter influenza identified
The National Virus Reference Laboratory (NVRL) has identified the first case of influenza A virus this winter. The case was detected by a network of 35 sentinel general practices who report weekly on the number of patients with flu like illness.
The network was established by the National Disease Surveillance Centre, in partnership with the Irish College of General Practitioners and the NVRL.
Commenting on the case, NDSC specialist in public health medicine, Dr Joan O'Donnell said that like last year the first case has been detected early in the influenza season. Overall a total of 149 positive cases of influenza were detected through the sentinel network during the 2003/2004 season, peaking in November 2003.
"As we enter the flu season it is recommended that people in high-risk groups get vaccinated against influenza.
The over 65s
People with severe illness such as chronic heart disease, chronic lung disease and diabetes
Those with lower immunity due to disease or treatment including those who have had their spleens removed
Children or teenagers on long-term aspirin therapy
Residents of nursing homes, old people's homes and other long stay facilities
Health care workers.
"The symptoms of influenza infection usually develop over a matter of a few hours and include a high temperature, sore muscles, dry cough, headache and sore throat. This is different from the common cold, which tends to come on more gradually and usually includes a runny nose and a normal temperature. Anyone in the high risk categories who develops influenza symptoms should contact their GP."
The weekly influenza surveillance reports along with further information on influenza and flu vaccine are available at www.ndsc.ie
NDSC publishes major guidelines to combat foodborne disease
The National Disease Surveillance Centre today (Thursday) published major guidelines aimed at strengthening procedures to combat foodborne disease and to provide expert advice on best practice in relation to food safety.
Commenting on the 96 page report - Preventing Foodborne Disease: A Focus on the Infected Food Handler - the chairperson of the NDSC Food Handler subcommittee, Dr Margaret O'Sullivan said that the guidelines presented another significant layer of protection between the public and the potential threat of outbreaks of foodborne disease.
"It can be difficult to assess the risk posed by food handlers infected with potentially foodborne infectious diseases as they are often the victims of, rather than the source of, an outbreak. Nevertheless, food handlers infected with certain pathogens who in some instances may not even be symptomatic - can and do pose a risk to food safety. Ongoing and rigorous emphasis must be placed on the importance of hand washing and reporting of illness by food handlers.
"All food business operators are responsible for managing food safety risks in order to protect consumers. These guidelines will provide advice and information for food business operators and for food safety professionals working in the field. Issues such as food handler health screening, assessment of fitness to work and the application of work exclusion criteria are comprehensively covered.
"There are many places along the food chain where infectious hazards can occur. The points at which food is handled and prepared are critically important. This guidance aims to reduce further the risk of introducing disease by food handlers during food handling and preparation," she said.
NDSC reiterates travel advice regarding areas affected by bird flu
The National Disease Surveillance Centre today (Friday) reiterated that travellers to areas experiencing outbreaks of H5N1 avian infection should avoid contact with live animal markets and poultry farms, following WHO confirmation of three deaths in Vietnam from the virus.
NDSC specialist in public health medicine, Dr Suzanne Cotter said that the confirmation of these human cases emphasises the risk of virus transmission from infected poultry, and added that large amounts of the virus are known to be excreted in the droppings of infected birds.
There are currently no travel restrictions to the countries affected by avian influenza, including countries which have also reported cases in humans.
Outbreaks in poultry caused by the H5N1 strain have been confirmed in the following countries to date.
Vietnam (July and January 2004) Indonesia (February 2004) Japan (January 2004) Thailand (January 2004) Cambodia (January 2004) China (January 2004) Laos (January 2004) Republic of Korea (December 2003)
Hepatitis C Consultative Council announces national hepatitis C database to learn more about illness caused by virus
The Consultative Council on Hepatitis C today (Friday) announced the establishment of a national database to learn more about hepatitis C and the illness it can cause. The database will collect and collate information on people who were infected with hepatitis C through the administration of blood and blood products within the State, including those people who are virus or antibody positive.
The database was funded by the Department of Health and Children on the recommendation of the Consultative Council on Hepatitis C, which was established by the Minister for Health in 1996. It will be based at the National Disease Surveillance Centre. Dr Elizabeth Kenny, Chair of the Consultative Council on Hepatitis C, welcomed the launch of the database and thanked the National Disease Surveillance Centre for its efforts in getting the project off the ground.
It will be overseen by a steering committee, reporting to the Consultative Council on Hepatitis C, comprising representatives from patient support groups, consultant hepatologists, service providers and the Department of Health and Children.
Commenting on the database, NDSC specialist in public health medicine, Dr Lelia Thornton said that about 1,600 people have been infected with hepatitis C through the administration of blood and blood products in Ireland.
"These include recipients of anti-D immune globulin and blood transfusion, people with haemophilia and those who received treatment for renal disease.
"Consultant hepatologists are asking patients to consent to participation in the database. A unique opportunity now exists for internationally significant research to follow the natural history of infection in this group of people and to evaluate the impact of various factors on the progression of the disease.
"Doctors are still learning about hepatitis C related illness as the virus that causes hepatitis C was only identified relatively recently. The database will help us learn more about the disease caused by the virus. Medical information on people who were infected with hepatitis C can also be used to help in planning future services for those living with the virus.
"The database will allow for the evaluation of treatment and the monitoring of uptake of services, as well as serving as a resource for future research into hepatitis C," she said.
Participation in the Hepatitis C Database is voluntary and it will not contain people's names or addresses.
NDSC urges travellers to take preventative measures against mosquito bites when abroad
The National Disease Surveillance Centre today (Monday) urged intending travellers to countries where mosquitoes are prevalent to take routine preventative measures against insect bites, following confirmation of West Nile Virus in two Irish travellers who returned from the Algarve in July. The initial diagnosis was made at the National Virus Reference Laboratory in UCD.
NDSC specialist in public health medicine, Dr Paul McKeown said that West Nile Virus infection is normally a very mild illness, causing severe disease in less than one per cent of individuals.
"The most severe disease is seen in those aged over 80; severe disease is virtually unknown in children. In this instance, neither traveller required hospitalisation. One individual has fully recovered while the other is getting better. Nonetheless, it is important that the public are aware of this small, potential risk when visiting any area where mosquitoes are common.
"West Nile Virus is spread by the bite of an infected mosquito. Four out of five people who are bitten will have no symptoms at all, while about 20% will develop a mild flu-like illness, with fever, headache, rash and aches and pains. Less than one per cent develop more severe disease which produces headache, high fever, stiff neck, sore eyes, disorientation, muscle weakness, convulsions and coma.
"People should enjoy their holidays as normal. The best way to protect against West Nile Virus, is to protect yourself against mosquito bites. Travellers should note that mosquitoes carrying West Nile Virus are most active at dawn and dusk. Where possible, people should avoid areas near water where mosquitoes are more likely to be present. Long sleeves, long trousers, socks and closed shoes should be worn and mosquito repellents used. When indoors, screens, nets and air conditioning can reduce the possibility of mosquito bites. Taking these simple measures will also help to protect against other mosquito-borne diseases.
"Returned travellers who become ill and in need of medical attention should inform their doctor that they have been abroad. There is no specific treatment or vaccine for the disease. Mild cases recover quickly with simple symptomatic ('cold and flu') treatment. More severe cases require hospitalisation and specialised supportive treatment. The Irish public health risk is minimal as West Nile Virus is not transmitted through person to person contact," added Dr McKeown.
NDSC publishes HIV figures for 2003
The National Disease Surveillance Centre today (Thursday) published figures outlining the number of HIV cases recorded in Ireland in 2003.
There were 399 newly diagnosed cases of HIV in Ireland in 2003 - a 10% increase when compared with 2002. 221 cases were heterosexually acquired. This compares with 232 cases in 2002. However, this data must be interpreted with caution, as information on risk group is unavailable for 39 of the newly diagnosed cases in 2003, making analysis of trends difficult.
196 of those diagnosed in 2003 were female, and 202 were male. 79% of these cases were in 20 to 40 year olds.
199 of the newly diagnosed cases in 2003 were among people born in sub-Saharan Africa, while 133 cases were born in Ireland. Information on geographic origin is unavailable for 41 cases.
There were 75 new diagnoses among men who have sex with men (MSMs) during 2003, compared with 46 for the previous year.
There were 47 new diagnoses among injecting drug users during 2003 compared to 50 in 2002.
NDSC specialist in public health medicine, Dr Mary Cronin, said that the number of infections among MSMs is likely to reflect an increase in risky sexual behaviour in this group.
"Increases in risky sexual behaviour, HIV and other sexually transmitted infections have been reported from Western Europe. The number of diagnoses in people born in sub Saharan Africa mirrors the epidemiology of HIV in other Western European countries and is not unexpected, given that 70% of the world's HIV cases are found in sub Saharan Africa.
"It is important to note that these figures do not represent the number of people infected with the HIV virus in Ireland, but rather provide information on the number of new diagnoses in 2003. The number of new diagnoses reported is dependent on patterns of HIV testing and reporting.
"The figures highlight the continuing need for appropriate prevention and treatment services for all risk groups in Ireland, including migrants and ethnic communities. Furthermore, given the increases in sexually transmitted diseases which facilitate the transmission of HIV infection, people should heed the safe sex message. Anyone engaging in sexual activity should practice safe sex. A properly used condom provides effective protection from HIV," said Dr Cronin.
Sexually Transmitted Infections up 7.9%
Sexually Transmitted Infections (STIs) increased by 7.9% in 2002 when compared with 2001, according to the latest available figures released by the National Disease Surveillance Centre today (Tuesday).
The largest increase was in infectious hepatitis B, which rose by 46.15%. The most commonly reported infections in 2002 were anogenital warts, non specific urethritis and C. trachomatis.
Commenting on the figures, NDSC Specialist in Public Health Medicine, Dr Mary Cronin, said that while the increases in reported cases reflect unsafe sexual practices, other factors including the availability of more sophisticated testing methods and professional awareness of STIs generally, also contributed to the increases.
"I would urge those who are sexually active to practice safe sex, as most STIs are preventable. Many STIs may have no signs or symptoms. For example, more than seven out of ten women infected with chlamydia have no symptoms and may not realise they are infected. STIs are easily treated and cured if identified, but early diagnosis and treatment is important. If left untreated, irreversible complications including infertility and ectopic pregnancies can arise.
"Having another sexually transmitted infection also increases the risk of transmission and acquisition of HIV infection. The prevention messages have never been more important as there is no cure for HIV infection or AIDS. However, with advances in treatment more people are living with the infection.
"As in 2000 and 2001, there were large numbers of syphilis infections reported in 2002. This is against a low incidence of reported syphilis cases throughout the 1990s in Ireland. These figures reflect the outbreak of syphilis amongst men who have sex with men (MSM) in Dublin during 2002, which peaked in 2001.
"The 2002 figures show a decrease in the reported numbers of cases of gonorrhoea and syphilis among males. These decreases are likely to have been partly due to interventions put in place at the time by the Eastern Regional Health Authority outbreak control team in response to the syphilis problem," said Dr Cronin.
For more information see the 2002 Annual Summary below:
2002 Annual Summary
During 2002, 10471 STIs were notified compared to 9703 in 2001, a 7.9% increase. Notified STIs have been increasing steadily each year since 1994, increasing by 157.1% between 1994 and 2002 and by 370% between 1989 and 2002. The number of STIs notified in 2002 is the highest number reported in any year on record. Notified cases of candidiasis, C. trachomatis, genital herpes simplex, infectious hepatitis B, lymphogranuloma venereum, molluscum contagiosum, non-specific urethritis, syphilis and trichomoniasis all increased during 2002, compared to 2001. Ano-genital warts, gonorrhoea and P. pubis notifications all decreased in 2002, compared to 2001. Significantly, notified cases of infectious hepatitis B increased by 46.2% and gonorrhoea decreased by 38.7%. The cumulative rate per 100,000 population for all notified STIs increased in 2002 to 267.3 per 100,000 population; compared to a rate of 247.7 per 100,000 in 2001.
During 2002, 42.4% (4434) of all STI notifications were from the ERHA, 16.4% (1721) from the MWHB, 15.4% (1617) from the SHB, 11.0% (1147) from the WHB, 8.7% (906) from the SEHB, 6.1% (637) from the NWHB, 0.07% (7) from the MHB and 0.02% (2) from the NEHB (table 5). It is important to note that STI surveillance is mainly clinic based and there are currently no STI clinics in the MHB and NEHB. The majority of all notifiable STIs in 2002 were notified from the ERHA: chancroid (n=1; 100.0%), lymphogranuloma venereum (n=1; 100.0%), syphilis (n=243; 80.2%), trichomoniasis (n=49; 67.1%), genital herpes simplex (n=220; 61.5%), gonorrhoea (n=120; 56.1%), infectious hepatitis B (n=30; 52.6%), molluscum contagiosum (n=72; 48.0%), C. trachomatis (n=910; 47.4%), candidiasis (n=546; 40.4%), ano-genital warts (n=1588; 40.4%) and P. pubis (n=24, 28.6%). The majority of notifications of non-specific urethritis (n=691; 34.1%) in 2002 were from the MWHB. STI notifications have increased in all health boards in 2002, compared to 2001, with the exception of the ERHA, where notifications decreased by 9.9%.
Where the age group was known (n=6013, 57.4%), 12.24% (736) of notified STIs were 0 to 19 years old, 61.3% (3683) were 20 to 29, 18.3% (1099) were 30 to 39 and 8.2% (495) were aged 40 years of age or older, in 2002. For all STIs, the 20-29 year age group represented the largest age group, with the exception of syphilis and lymphogranuloma venereum where the majority of cases were aged between 30 and 39 years of age.
Forty-eight percent (5066) of all notified STIs were amongst males during 2002, whilst 50.6% (5298) were amongst females. Gender data was not reported for 107 (1.0%) notifications. The majority of cases of lymphogranuloma venereum (100.0%), syphilis (71.0%), trichomoniasis (61.6%), non-specific urethritis (58.9%), P. pubis (58.3%) and molluscum contagiosum (50.7%) were amongst males. The majority of notifications of chancroid (100.0%), infectious hepatitis B (68.4%), genital herpes simplex (57.8%), gonorrhoea (57.0%), candidiasis (55.9%), ano-genital warts (53.5%) and C. trachomatis (53.0%) were amongst females.
The full report on Sexually Transmitted Infections for 2002 is available here
World TB Day - latest NDSC figures show decrease in tuberculosis
The National Disease Surveillance Centre has today (Wednesday) - World TB Day - published figures for the number of tuberculosis cases recorded in Ireland in 2001.
These latest available figures show that there were 381 cases of TB in Ireland in 2001, a 3.5% decrease compared with 2000. 63% of cases occurred in males with 37% amongst females.
63 cases (20.5%) of cases notified were in non-Irish born patients.
The regional breakdown per health board was as follows:
Eastern Regional Health Authority 173 (45.4%) Midlands Health Board 7 (01.8%) Mid Western Health Board 24 (06.3%) North Eastern Health Board 38 (10.0%) North Western Health Board 13 (03.4%) South Eastern Health Board 20 (05.2%) Southern Health Board 72 (18.9%) West Health Board 34 (08.9%)
NDSC specialist in public heath medicine, Dr Paul McKeown said that tuberculosis rates in Ireland remain at a low level.
"TB continues to be a major global health problem. It is essential that we maintain our close vigilance of this disease and that we continue screening and treatment programmes to ensure that these rates remain low," said Dr McKeown.