2007 News Archive

Training Fellowships for Intervention Epidemiology in Europe

The ECDC plans to recruit for the 14th cohort of fellows in the European Programme for Intervention Epidemiology Training (EPIET), starting in September 2008. The aim of the EPIET training is to enable the fellow to assume service responsibilities in communicable disease epidemiology. The in-service training will focus on outbreak investigations, disease surveillance, applied research, and communications with decision makers, the media, the public and the scientific community. Fellows will attend a three-week intensive introductory course and then be located in a host institute in one of the participating training sites in EU Member States and Norway.

Detailed information about the EPIET programme can be obtained from the EPIET programme website at www.epiet.org

Vacancy notice for application can be found on the website for European Centre for Disease Prevention and Control at http://ecdc.europa.eu/Recruitment.html

Outbreak of Ebola Haemorrhagic Fever in Uganda

The World Health Organisation has been monitoring an extensive outbreak of Ebola haemorrhagic fever in the Bundibugyo District of western Uganda on the border with the Democratic Republic of Congo. The number of suspected cases has now risen to 93, including 22 fatalities. Initially the diagnosis was thought to be Marburg fever as the clinical picture appeared more consistent with this haemorrhagic disease. Laboratory analysis has confirmed the presence of a new species of the virus in nine of these cases. Four health care workers are among the fatalities. To date 327 contacts have been identified and tracing and follow-up of these contacts is being undertaken. 

Laboratory support is being provided by laboratory experts from the Centers for Disease Control and Prevention (CDC), Atlanta, USA.

Isolation wards have been established in local hospitals and additional training in counselling, infection control and burial is being provided. Agencies in the field, including UNICEF, Médecins Sans Frontières and WHO, are providing support to the health authorities with logistics and provision of drugs and Personal Protection Equipment. Active case finding in more remote communities is ongoing. Ecological studies into the new species of Ebola that has been detected in this outbreak are also being planned.

WHO is currently advising that there is no indication for restrictions on travel or trade with Uganda.  However it would seem prudent to avoid the affected areas - see http://foreignaffairs.gov.ie/home/index.aspx?id=8594

World AIDS Day, December 1st 2007

World AIDS day is commemorated around the globe on December 1st. The theme of World AIDS day 2007 is Leadership and the World AIDS campaign for 2005-2010 is “Stop AIDS. Keep the Promise”. Further information on the World AIDS campaign and World AIDS Day 2007 can be found at http://www.worldaidscampaign.info/.

Twenty-six years after the first reported case of AIDS, the global AIDS epidemic continues to grow. According to the latest figures published by UNAIDS and the WHO in their 2007 AIDS Epidemic Update, an estimated 2.5 million people were newly infected in 2007 and there are now 33.2 million people living with HIV worldwide. In 2007, 2.1 million people died of AIDS-related illnesses. While Africa remains the global epicentre, no country is unaffected by the AIDS pandemic. Further information on the global HIV and AIDS pandemic can be found on the UNAIDS website www.unaids.org.

Reports on HIV and AIDS in Ireland can be accessed on the HPSC website at
http://www.ndsc.ie/hpsc/A-Z/HepatitisHIVAIDSandSTIs/HIVandAIDS/. The latest report relates to Quarter 1&2 2007.

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 49 sentinel general practices who report weekly on the number of patients with influenza-like illness.

The network was established by the Health Protection Surveillance Centre, in partnership with the Irish College of General Practitioners and the NVRL in 2000.

Commenting on the case, HPSC Specialist in Public Health Medicine, Dr Derval Igoe said that the first confirmed case of influenza in Ireland this season is a reminder to all people in high-risk groups get vaccinated against influenza now.

“These include:

• 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 and carers of those in risk groups.

“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.”

Influenza has been detected slightly earlier this year than last year’s influenza season, when the first case was reported in November 2006. Overall a total of 126 laboratory confirmed cases of influenza were detected through the sentinel network during the 2006/2007 season, peaking in February 2007.

The weekly influenza surveillance reports along with further information on influenza and flu vaccine are available at www.hpsc.ie and www.immunisation.ie.

MMR vaccination for 3rd level students (academic year 2007-2008)

If you are a student starting college and are under 25 years of age you could be at risk of getting mumps during the next academic year. Many Irish universities and colleges had major mumps outbreaks in 2004 and 2005. Despite a marked decline in recent years cases continue to occur, particularly among non-vaccinated individuals.

Since 2004 teenagers and young adults have been most affected by mumps. Most individuals affected by mumps either never received, or received just one dose of MMR (Measles, Mumps and Rubella) vaccine. Two doses are needed to provide maximum protection.

MMR vaccination is now routinely recommended for all third level students aged 17-24 years of age who have not received two doses of MMR. Both the vaccine and the visit to the GP is free to students who need it. The cost of the programme is being supported by the HSE. Speak with your GP or the Student Health services at your college or university.

Addendum to Mortality Data reported in ‘Summary Report of Influenza Season 2005/2006’

The HPSC ‘Summary Report of Influenza Season 2005/2006’ stated that “3,567 pneumonia and influenza deaths (20.0% of all deaths) were registered with the General Register Office (GRO) during the 2005/2006 season’. These “pneumonia and influenza” deaths included all deaths where either influenza or pneumonia was listed as the disease or condition leading to death, or the antecedent cause(s) or other significant conditions. (Aspiration pneumonia, pneumonitis and pneumococcal meningitis were excluded).

International studies have shown that influenza causes significant morbidity and mortality every year. This mortality occurs mainly in the elderly. However, excess deaths (deaths over and above the expected number of deaths for the particular season, place and time) are often not registered specifically as influenza deaths. Only a small number of deaths are registered each year as being due to influenza. It has been shown that the increase in respiratory deaths correlate closely with the increase in deaths due to influenza. Therefore monitoring trends in pneumonia and influenza deaths can be used as a proxy for monitoring trends in influenza-non-attributed deaths. HPSC currently monitors all cause mortality, and mortality due to pneumonia and influenza on a weekly basis using national non-coded death registration data from the GRO. 

The current best Irish national estimate of the number of deaths annually from influenza and its complications is 300-400 deaths per year and is based on extrapolation of studies done in the UK and the US.

Further information on influenza is available on the HPSC website www.hpsc.ie

References available on request

Chikungunya Fever in Emilia Romagna, Italy

An outbreak of Chikungunya fever, a viral infection carried by mosquitoes, has been reported in the small town of Castiglione di Cervia (Emilia Romagna, Italy). Cases first appeared in mid July 2007, and a significant number of people have now been affected.

Chikungunya fever is commonly found in East Africa, Southeast Asia and in the Indian sub-continent. A large outbreak was reported in Réunion and countries of the Indian Ocean Basin in 2006 (http://www.ndsc.ie/hpsc/A-Z/Vectorborne/ChikungunyaFever/News/MainBody,2053,en.html).

Illness generally follows 4-7 days after the bite of an infected mosquito and presents with sudden onset of fever with joint and muscle pain (that can at times be very severe) with headache and conjunctivitis.  The joints of the wrists, ankles, hands and feet are most commonly affected.  Rashes on the chest and abdomen are common and in the large outbreak in Réunion and countries of the Indian Ocean Basin in 2006, almost a quarter of patients had bleeding from the nose or gums. Fortunately, it tends to be a mild illness with most patients recovering fully.

There is currently no vaccine against the virus responsible for causing Chikungunya. Travellers to affected areas are advised to take sensible precautions against mosquito bites (advice on protecting yourself from mosquito can be found on HPSC’s website http://www.ndsc.ie/hpsc/A-Z/Vectorborne/TravelAdviceforInternationalTravellers). 

Although the risk of serious disease is low, certain groups are at higher risk, including:

• Pregnant women
• People with weakened immune systems (such as patients living with cancer or HIV/AIDS) and
• People suffering from severe chronic illness (such as heart, lung or kidney disease and diabetes).

Prevention: It is advised that pregnant women, patients with weakened immune systems and people suffering from severe chronic illness should consult their physicians prior to the travel to areas known to be affected by Chikungunya in order to assess their risk and obtain advice on personal preventive measures.

All travellers to areas known to be affected by Chikungunya should take the following preventive measures to minimise the exposure to mosquito bites while in the areas:

• Use of anti-mosquito devices (insecticide-treated bed nets, coils, smudge pots, spray, repellents) and wearing long sleeve - long leg clothes, especially during the hours of highest mosquito activity (morning and late afternoon). Mosquito repellent based on a 30% DEET concentration is recommended.
• Before using repellents, pregnant women and children under the age of 12 years should consult a physician or pharmacist
• For newborn children under three months, repellents are not recommended; instead, insecticide-treated bed nets should be used.

Further Information
Further information on Chikungunya is available at:

ECDC - Health Topics: Chikungunya
HPSC - Topics A-Z: Chikungunya

Increase in Measles cases in the UK - Summer 2007

In a recent press release (30th August 2007), the Health Protection Agency UK has reported an increase in measles cases in England and Wales in 2007. Nearly 500 confirmed cases of measles were reported in the UK so far this year compared to 756 cases for the whole of 2006 (provisional data). Between June to August 2007 more than 300 confirmed cases of measles were reported. Such a large increase over a short period of time is of deep concern.

The UK health authorities have urged parents to make sure that their children are up to date with MMR immunisation to prevent further spread of the disease.

Current situation in Ireland
Although the HPSC has not seen an increase in measles cases in Ireland compared to previous years, there is concern that measles cases from the UK could be imported into Ireland, particularly as there is so much travel between the two countries. 

Ireland experienced a large outbreak in 2000, with over 1600 measles cases reported. Three children died as a result of infection acquired during that outbreak. Low levels of MMR vaccination among children meant that large numbers of children were susceptible to infection, and the virus spread rapidly throughout the country.

MMR vaccination uptake in Ireland (Q1 2007)
Most recent figures indicate that 86% of Irish children at 24 months of age have received one dose of MMR (Immunisation report Q1 2007). In recent years there has been a gradual increase in MMR uptake. But to prevent measles outbreaks occurring a sustained MMR uptake rate of at least 95% is needed.

Measles is a highly infectious disease that can cause serious complications, particularly among children less than 5 years of age and adults. The infection is characterized by a general body rash, a fever, and one or more of the following; cough, conjunctivitis, and runny nose.  Measles is a notifiable disease.

MMR to protect against measles
MMR vaccine protects against measles. The vaccine is safe and effective. It is routinely given when children are 12-15 months of age, and a booster is given at 4-5 years of age.

All parents are urged to ensure that their children are vaccinated with MMR at the appropriate age to protect against measles infection. MMR vaccine is available from the GP.

All children who are entering school for the first time (junior infants) should have at least one MMR already. Older children (> 5 years of age) should already have received two doses of MMR. If they have not, please bring your child to your GP who can administer the vaccine free of charge.

For more information on the measles in Ireland please see: http://www.ndsc.ie/hpsc/A-Z/VaccinePreventable/Measles/Factsheet/

For more information on the measles outbreak in the UK please see: http://www.hpa.org.uk/hpa/news/articles/press_releases/2007/070830_mmr.htm

Recent reports on national immunisation uptake statistics are available at: http://www.ndsc.ie/hpsc/A-Z/VaccinePreventable/Vaccination/ImmunisationUptakeStatistics/

Australia reports first polio case since 1986

On July 13 2007 Australian Health Authorities reported a case of polio in a 22-year-old male who recently returned by plane to Australia from Pakistan. Click here for further details.

The last case of wild type poliovirus infection in Australia occurred in 1986 and the Western Pacific Region, including Australia, was certified as polio free in 2000. Any case of polio is a significant public health concern.

The Australian Health Protection Committee are implementing a national action to contact trace all passengers who travelled with the infected passenger and to isolate his Australian home contacts. The patient, who has recovered from his initial paralysis, will remain in hospital in isolation until he is diagnosed polio free

Passengers on Thai Airlines flight TG999 from Bangkok arriving in Melbourne on 2nd July 2007 were asked to contact the National (Australian) Public Health Info Line on 1800 004 599 for further information.

HPSC is not aware of any Irish residents who may have been on this flight. However, if any individual in Ireland was on this flight they are encouraged to contact their local HSE Department of Public Health.

Polio is a highly infectious disease that can be prevented through immunisation. All Irish children should receive four doses of polio vaccine as part of the childhood immunisation programme. However, any individuals (child or adult) who are unsure of their immunisation status, particularly if they are travelling abroad to countries where polio is still reported (Nigeria, Pakistan, India, Afghanistan, Niger, Somalia, Angola, DR Congo, Chad, Myanmar) should inform their doctor and receive polio vaccine as necessary. 

Ireland, together with the WHO European region was certified polio free in 2002. The last case of polio was reported in Ireland in 1984.

More information on polio can be found on the HPSC website by clicking here.

Cork TB Outbreak Case Update

Outbreak of measles among Irish Travellers in England, March to May 2007

The Health Protection Agency (HPA) in England and the Norwegian Institute of Public Health, (NIPH) have reported two large outbreaks of measles in their countries. These two outbreaks, which are clearly linked, have resulted in over 100 measles cases in recent months. 

Since the end of March 2007, 92 cases have been reported in many regions of the England: London, East of England, South East, South West, East Midlands, and Yorkshire and the Humber. A further 16 cases have been reported, or are under investigation in Norway. Most cases have never received MMR vaccine.

Both outbreaks have links to members of the Irish travelling community from England. A large gathering of Irish Travellers in south-east London on 3 April 2007 is believed to be the venue where extensive transmission initially took place. Subsequent travel of measles infected individuals throughout England and Norway has spread the disease in this community, with on-going person-to-person transmission continuing to non-immune individuals. The strain of measles virus obtained from cases in Norway and the UK is similar (D4).

As of 15th June 2007 no measles cases among Irish travellers (resident in Ireland) have been identified by the HPSC. However, all children should routinely receive two dose of MMR vaccine, after 12 months of age and at 4-5 years of age. Vaccination is the only way to prevent measles infection.

The full report can be found in Eurosurveillance weekly published 14th June 2007;  http://www.eurosurveillance.org/ew/2007/070614.asp#1

Antenatal testing identifies cases of HIV

Update on Avian Flu in Wales

The North Wales Avian Influenza outbreak is over

The National Public Health Service (NPHS) for Wales has declared the recent Avian Influenza outbreak over. All those whose health was being monitored after possible contact with infected poultry and/or people are well and have come through the incubation period without developing any symptoms.

Further information may be obtained on the NPHS website.

General Information on Avian Influenza
The advice from the Department of Agriculture and Food in Ireland is not to handle dead or wild birds unless necessary. For queries relating to dead birds please contact the Department of Agriculture and Food on the Avian Influenza helpline: 1890 252 283.

At present, recommendations on travel, personal protection and food safety remain unchanged.  Current travel advice is available here. The WHO level of pandemic alert remains unchanged at phase 3. This is defined as a virus new to humans that is causing infections, but does not spread easily from one person to another. The latest updates from the WHO are available on the WHO website.

Further information on avian influenza is also available on the HPSC website.

Further updates are also available from:

• NPHS
• Welsh Assembly
• Health Protection Agency
• Department of Environment Food and Rural Affairs (DEFRA)
  

Information on US XDR-TB Case

The European Commission has released the following press statement on today Thursday, May 31, 2007 regarding the case of a US passenger with extensively drug resistant tuberculosis (XDR-TB) travelling on flights between Europe and North America. There were no Irish citizens on any of these flights.

Press Release from European Commission

Extensively drug-resistant tuberculosis: EU Member States agree on coordinated measures concerning infected air passenger

At a meeting chaired by the European Commission and held at the European Centre for Disease Control (ECDC) in Stockholm on 30 May, authorities responsible for taking measures in the EU Member States agreed to follow the ECDC's advice, requested by the Commission on 29 May, on the case of a US passenger with extensively drug-resistant tuberculosis (XDR-TB) travelling on flights between Europe and North America. As a precautionary measure and following recommendations from the World Health Organization (WHO), the ECDC's advice is to perform contact tracing for passengers 2 rows ahead, 2 rows behind and the row of the infected passenger, and the cabin crew concerned. The ECDC's advice is that the risk for these persons is very limited, other passengers are not considered at risk. The passengers will be contacted by the corresponding national health authorities, as the Member States are responsible for tracing their own nationals. The distribution of the relevant information from the airlines for this process will be coordinated by ECDC.

Background
The European Commission had on 29 May requested the ECDC to provide a risk assessment to the Commission and public health authorities across Europe, following an alert posted by Italy on the EU Early Warning and Response System (EWRS) on the case of a US passenger with extensively drug-resistant tuberculosis (XDR-TB) travelling on flights between Europe and North America.

The two concerned flights are:

• Air France # 385 departing Atlanta on May 12 and arriving in Paris on May 13, 2007
• Czech Air # 0104 departing Prague, Czech Republic to Montreal, Canada on May 24, 2007

Further Information

• News from ECDC
• Risk Assessment from ECDC on US Air Passenger with XDR-TB
• Further information on TB

Update on Avian Influenza in Wales

A smallholding in North Wales is at the centre of an outbreak of avian influenza. The influenza virus responsible for the outbreak is influenza A H7N2, a strain of low pathogenicity, which generally causes mild illness in birds and has been associated in the past with only mild illness in humans.

All movements on and off the premises have been prohibited since 23 May 2007 and a 1 km restriction zone around the farm was put in place. All the poultry on the farm were culled.

The National Public Health Service (NPHS) for Wales is currently investigating a number of people who were associated with the incident who have experienced either flu like symptoms or conjunctivitis. As of 29 May 2007, 13 avian flu contacts had been identified who have or have flu like illness or conjunctivitis. No one is seriously ill and the risk to the general public is low. People who have had prolonged close contact with infected poultry and/or people associated with the outbreak have been offered a 10 day course of antiviral medication called Tamiflu.

Despite this incident the current level of risk to humans from H7N2 remains extremely low. Nonetheless, any possibility of exposure is taken very seriously and the National Public Health Service for Wales is working closely with the Animal Health and Welfare department in the Welsh Assembly to ensure that all necessary actions are being taken to protect those people who may have been exposed to the virus. Further information may be obtained on the NPHS website.

General Information on Avian Influenza
The advice from the Department of Agriculture and Food in Ireland is not to handle dead or wild birds unless necessary. For queries relating to dead birds please contact the Department of Agriculture and Food on the Avian Influenza helpline: 1890 252 283.

At present, recommendations on travel, personal protection and food safety remain unchanged.  Current travel advice is available here. The WHO level of pandemic alert remains unchanged at phase 3. This is defined as a virus new to humans that is causing infections, but does not spread easily from one person to another. The latest updates from the WHO are available on the WHO website.

Further information on avian influenza is also available on the HPSC website.

Further updates are also available from:

• NPHS
• Welsh Assembly
• Health Protection Agency
• Department of Environment Food and Rural Affairs (DEFRA)
  

Three-week Course in Communicable Disease Intervention Epidemiology

This three-week course run by EPIET will be held in Menorca. It provides a comprehensive introduction to intervention epidemiology methods. It is practically oriented and aims to encourage and equip participants for future field investigations in European countries. It is open to public health professionals, physicians, veterinarians, microbiologists, biostatisticians and environmental health specialists.

The course starts on the 23rd of September 2007 and the deadline for applications is 3rd June 2007. Go to http://www.epiet.org/course/course2007.html#Programme for further information about the course and application details. 

Outbreak of TB in Cork

Advice for the Public during Cryptosporidiosis Outbreak

An extensive cryptosporidiosis outbreak has been identified in the HSE Western area.  HSE advice for the public is available here in English, French, German and Spanish.  Information is also available from Galway City and County Council Water Services. 

Outbreak of Cryptosporidiosis in Galway

An extensive cryptosporisiosis outbreak has been identified in the HSE Western area with 125 laboratory-confirmed cases reported in March (up to 29/3/2007) compared with a March 2006 total of just 6 cases. A small number of human isolates have tested positive for Cryptosporidium hominis. Staff in public health, environmental health and clinical microbiology are undertaking an investigation in conjunction with colleagues in the relevant local authorities to determine the cause of the outbreak.
 
Although prior to 19th March, there had been little firm evidence to link the human illness with water, Galway City and County Council put in place an extensive, precautionary boil water notice on Thursday 15th March 2007 on the advice of HSE West. This notice affected about 90,000 people.
 
On 19th March 2007, test results from the suspected water supplies demonstrated significantly elevated levels of cryptosporidium oocysts in two of the water supplies. Preliminary typing results indicate the presence of both C. hominis and C. parvum in the water supply. Neither of the two supplies is treated by filtration. As a result, the boil water notice has been extended. The Environmental Protection Agency has requested an action plan (short, medium and long term) from the local authorities and this is expected soon.

It is quite possible that the area could have hosted international guests (particularly from the UK and other European countries, US and Canada) in the weeks prior to St Patrick’s Day. In order to identify visitors to Ireland who may have been exposed to contaminated water, an alert is being circulated through Enter-net (international surveillance network for gastrointestinal infections) and the EU’s Early Warning and Alert System (EWRS).

Further updates are available at www.galwaycity.ie. Information on cryptosporidiosis is available at www.hpsc.ie/hpsc/A-Z/Gastroenteric/Cryptosporidiosis/.

World TB Day - 24th March 2007

World TB Day is held on March 24th each year and provides an opportunity to raise awareness about the international health threat presented by tuberculosis (TB). It is a day to recognise the collaborative efforts of all countries involved in fighting TB. TB can be cured, controlled, and with diligent efforts and sufficient resources, eventually eliminated.

The theme for World TB Day 2007-“TB Anywhere is TB Everywhere” reinforces the message that through unified action on all levels we can work towards a world free of tuberculosis. It calls for collaboration and shared responsibility to achieve this. TB is a disease without borders and must be tackled through co-ordinated international action including financial investment in TB control, surveillance, and research and development.

World TB Day 2007 also aims to emphasise the importance of the need for decision-makers to protect communities from the threat of extensively drug-resistant TB (XDR-TB) and HIV-related TB.

By mobilising communities, raising awareness, encouraging governments and donors to invest in TB control and calling for strengthened commitment, countries can ensure that TB is placed prominently on the global agenda and is eliminated by 2050 through a unified global campaign.  

TB - The Facts
TB remains a leading cause of death worldwide with up to 9 million cases and 1.6 million deaths reported per year. It is a disease closely related to poverty and more than 80% of the infected cases live in developing countries. 

In 2004, (the latest validated figures) there were 432 cases of TB reported in Ireland, a notification rate of 10.2 cases per 100,000 population.  In 2005, there were 461 cases provisionally reported to HPSC, a notification rate of 10.8/100,000. The rate in the indigenous population was 8.8 per 100,000 in 2005 while the rate in foreign-born persons was 38.0 per 100,000. The number of TB cases reported in Ireland has declined in the last decade with 612 cases reported in 1991, a rate of 18.2 per 100,000. The decline has been even more considerable since the early 1950s when 7,000 cases of TB were notified annually.

However, we must remain vigilant concerning TB treatment and control as “TB Anywhere is TB Everywhere” reminds all countries of their collective responsibility to combat this curable disease. Global TB control is required to achieve TB elimination in all countries including those with a low incidence of disease.

More information on TB is available at:

HPSC website
http://www.hpsc.ie/hpsc/A-Z/VaccinePreventable/TuberculosisTB/

The Global Plan to Stop TB 2006-2015 
http://www.who.int/tb/about/en/index.html 

Stop TB Partnership World TB Day 2007 
http://www.stoptb.org/events/world_tb_day/2007/

CDC website for World TB Day, 2007
http://www.cdc.gov/nchstp/tb/WorldTBDay/default.htm

WHO Factsheet on TB  
http://www.who.int/mediacentre/factsheets/fs104/en/index.html

Update on the Outbreak of Avian Influenza in UK

On 13th February 2007, the Veterinary Laboratory Agency (VLA) UK, confirmed that the laboratory analysis of the Suffolk and Hungary H5N1 avian influenza viruses is now complete.  The VLA analysis has revealed a very high similarity (99.96%) at the whole genome level between the H5N1 viruses found in the Suffolk and  Hungarian outbreaks. These results indicate that the viruses are essentially identical.  No further cases of bird flu have been found beyond those on the infected premises near Lowestoft, UK.

As required by European Union legislation, control measures were put in place around the affected premises on the evening of 1 February, and a cull of all poultry on the farm began on 3 February. The operation was completed on 5 February. Among the total of 159,000 turkeys on the farm, 2,500 were reported to have died due to avian influenza and the rest were culled.

A three-kilometre protection zone and a 10-kilometre outer surveillance zone have been imposed around the farm to prevent further spread to neighbouring flocks and farms. Within the protection and surveillance zones, poultry movement restrictions are in place, and farmed birds must be isolated from wild birds. A wider zone of 2,000 square kilometres has also been established around the protection and surveillance zones, and poultry in this zone must also be isolated from wild birds and can only be moved under license. As of Friday 16th, the ban on bird gatherings in the non-restricted parts of England has been lifted and gatherings permitted again under general licence. The ban will remain in place within the entirety of the Restricted Zone, as per the legal requirements.

In 2007, the UK is the 2^nd EU Member State, along with Hungary, to report a case of highly pathogenic avian influenza H5N1 in poultry.

Risk to Humans

Despite this incident, the current level of risk to humans from H5N1 has been assessed as extremely low. Nonetheless, any possibility of exposure is taken very seriously, and measures to protect the considerable number of people involved in the culling and disposal operations that may have been exposed to the virus have been put in place. Specifically, this involves the wearing of personal protective equipment and antiviral drugs and seasonal influenza vaccine being offered to those who have been in close contact with the infected poultry. Potentially exposed people have been advised to monitor their own health and report any symptoms.  The Health Protection Agency (HPA), UK has now carried out testing on a total of four people who have been involved in the avian flu outbreak on a poultry farm in Holton, Suffolk. Three workers who were tested last week all had symptoms that could indicate the possibility of avian influenza and which required further investigation according to Agency protocols. A fourth person who did not work directly with poultry was tested as a precautionary measure and received a negative result over the weekend. All the patients are now being treated under normal clinical care, or have been discharged from hospital where appropriate.

Global Context

H5N1 avian influenza remains predominantly a disease of birds. All evidence to date indicates that close contact with dead or sick birds is the principal source of human infection with the H5N1 virus. Especially risky behaviours identified include the slaughtering, de-feathering, butchering and preparation for consumption of infected birds. In a few cases, exposure to chicken faeces when children played in an area frequented by free-ranging poultry is thought to have been the source of infection. In all human cases to date there has been no evidence of efficient human-to-human transmission and human infections remain a rare event.  As of the 19^th February 2007, 274 confirmed human cases and 167 (61%) deaths from avian influenza A (H5N1) have been reported to the WHO from Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Nigeria, Thailand, Turkey and Vietnam. 

The advice from the Department of Agriculture and Food in Ireland is not to handle dead wild birds unless necessary. For further information please consult the Department of Agriculture and Food website. For queries relating to dead birds please contact the Department of Agriculture and Food on the Avian Influenza Hotline: 1890 252 283.

At present, recommendations on travel, personal protection and food safety remain unchanged. Current travel advice is available here. The WHO level of pandemic alert remains unchanged at phase 3. This is defined as a virus new to humans that is causing infections, but does not spread easily from one person to another. The latest updates from the WHO are available on the WHO website.

Update on the Outbreak of Avian Influenza in UK

An outbreak of H5N1 avian influenza, which occurred on 1 February 2007, has been confirmed on a large closed poultry farm in Suffolk, east England, according to the United Kingdom ministry of agriculture (DEFRA, http://www.defra.gov.uk/). The UK State Veterinary Service was contacted by a private veterinarian who suspected an avian notifiable disease. Laboratory testing of poultry found dead on the farm was undertaken at the European Community laboratory in Weybridge, UK. The samples were shown to contain the highly pathogenic Asian strain of the H5N1 avian influenza virus. The same strain was responsible for a recent outbreak in Hungary. In 2007, the UK is the 2^nd EU Member State, along with Hungary, to report a case of highly pathogenic avian influenza H5N1 in poultry. 

As required by European Union legislation, control measures were put in place around the affected premises on the evening of 1 February, and a cull of all poultry on the farm began on 3 February. The operation was completed on 5 February. Among the total of 159,000 turkeys on the farm, 2,500 were reported to have died due to avian influenza and the rest were culled.

A three-kilometre protection zone and a 10-kilometre outer surveillance zone have been imposed around the farm to prevent further spread to neighbouring flocks and farms. Within the protection and surveillance zones, poultry movement restrictions are in place, and farmed birds must be isolated from wild birds. A wider zone of 2,000 square kilometres has also been established around the protection and surveillance zones, and poultry in this zone must also be isolated from wild birds and can only be moved under license. All organised bird gatherings, including shows, markets and fairs, and pigeon races, have been banned throughout Britain until further notice.

Risk to Humans

Despite this incident, the current level of risk to humans from H5N1 has been assessed as extremely low. Nonetheless, any possibility of exposure is taken very seriously, and measures to protect the considerable number of people involved in the culling and disposal operations that may have been exposed to the virus have been put in place. Specifically, this involves the wearing of personal protective equipment and antiviral drugs and seasonal influenza vaccine being offered to those who have been in close contact with the infected poultry. Potentially exposed people have been advised to monitor their own health and report any symptoms. The Health Protection Agency (HPA) in the UK has now carried out testing on three workers who have been involved in the avian flu outbreak. All three had symptoms that could indicate the possibility of avian influenza and which required further investigation according to HPA protocols. All three have tested negative for avian flu and are now being treated under normal clinical care, or have been discharged from hospital where appropriate .

Global Context

H5N1 avian influenza remains predominantly a disease of birds. All evidence to date indicates that close contact with dead or sick birds is the principal source of human infection with the H5N1 virus. Especially risky behaviours identified include the slaughtering, de-feathering, butchering and preparation for consumption of infected birds. In a few cases, exposure to chicken faeces when children played in an area frequented by free-ranging poultry is thought to have been the source of infection. In all human cases to date there has been no evidence of efficient human-to-human transmission and human infections remain a rare event.  As of the 12^th February 2007, 272 confirmed human cases and 166 (61%) deaths from avian influenza A (H5N1) have been reported to the WHO from Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Nigeria, Thailand, Turkey and Vietnam. 

The advice from the Department of Agriculture and Food in Ireland is not to handle dead wild birds unless necessary. For further information please consult the Department of Agriculture and Food website. For queries relating to dead birds please contact the Department of Agriculture and Food on the Avian Influenza Hotline: 1890 252 283.

At present, recommendations on travel, personal protection and food safety remain unchanged. Current travel advice is available here. The WHO level of pandemic alert remains unchanged at phase 3. This is defined as a virus new to humans that is causing infections, but does not spread easily from one person to another. The latest updates from the WHO are available on the WHO website.

Further information on avian influenza is also available on the HPSC website.

Increase in Influenza-like illness

During week 5 2007 (week ending February 4th), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland increased to 44.5 per 100,000 population from a rate of 22.5 per 100,000 for week 4.  This rate exceeds the threshold at which the UK National Institute of Clinical Excellence (NICE) guidelines (2003) for the use of antiviral drugs is triggered.  Much of the increase is from cases of influenza A (H3, H1 and unsubtyped) in the 15 to 64 year age group and in 0 to 4 year olds. 

In line with the NICE guidelines, the use of antiviral drugs for the prevention or treatment of influenza is now recommended.  A summary of the NICE guidance is given below:

Antivirals

Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community may be found here

Algorithm for the use of antiviral drugs for the prevention (prophylaxis) of influenza may be found here

Note: The NICE algorithm on prescribing oseltamivir (Tamiflu) for prophylaxis refers to using oseltamivir (Tamiflu) in persons aged 13 years and older.  In January 2006, oseltamivir was licensed for prophylactic use in children aged one year and over.  In the meantime until NICE completes its review, it would be appropriate to use oseltamivir (Tamiflu) for prophylaxis in persons aged 1 year and over according to the other conditions laid out in the NICE algorithm for prophylaxis of influenza.  Prescribers should also note a concomitant change to the licensed duration of post-exposure prophylaxis in children and adults which is now ten (10) days (as opposed to the previous seven (7) days).

Influenza Vaccine
As influenza like illness rates are increasing and influenza A is circulating, it is also important that persons in at-risk groups for influenza are vaccinated as these groups are at higher risk of developing complications from influenza.  
 
Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2002 (Chapter 7) :

• All persons aged 65 years or older
• Persons with chronic illness requiring regular medical follow-up such as chronic heart disease, chronic lung disease, chronic renal disease, diabetes mellitus etc.
• Persons who are immunosuppressed due to disease or treatment, including asplenia or splenic dysfunction
• Children and teenagers on long-term aspirin therapy
• Residents of nursing homes, old people's homes and other long stay facilities where rapid spread is likely to follow introduction of infection
• In addition to these groups, vaccination should also be considered for health care workers both for their own protection, as these are a group likely to come into contact with influenza during outbreaks, and for the protection of their patients.

The Immunisation Guidelines for Ireland 2002 are available at http://www.ndsc.ie/hpsc/A-Z/VaccinePreventable/Vaccination/Publications/ImmunisationGuidelines/

HPSC is monitoring the situation regarding Avian Influenza

The UK Department for Environment Food and Rural Affairs (Defra) has confirmed H5N1 avian influenza on a poultry farm in North Suffolk, England.  It has been identified as the highly pathogenic Asian strain, similar to the virus found in Hungary in January.  The results were laboratory confirmed by experts at the State Veterinary Service.  The affected premises were put under restriction on Thursday (1st February) evening and, as required under EU legislation, Defra have commenced a cull of all poultry on the infected premises and imposed a 3-kilometre protection zone and a 10-kilometre outer surveillance zone around the farm area. This is to prevent further spread to neighbouring flocks and or farms.

Despite this incident the current level of risk to humans from H5N1 remains extremely low. Nonetheless, any possibility of exposure is taken very seriously and the Health Protection Agency has worked closely with Defra and local NHS partners to ensure that all the necessary actions are being taken to protect those people who may have been exposed to the virus.  These actions include the offering of antiviral drugs and seasonal influenza vaccine where appropriate to people who have been in close contact with the infected poultry.

The UK is the second EU Member State, along with Hungary, to report a case of highly pathogenic avian influenza H5N1 in poultry. 

H5N1 avian influenza remains predominantly a disease of birds. All evidence to date indicates that close contact with dead or sick birds is the principal source of human infection with the H5N1 virus. Especially risky behaviours identified include the slaughtering, de-feathering, butchering and preparation for consumption of infected birds. In a few cases, exposure to chicken faeces when children played in an area frequented by free-ranging poultry is thought to have been the source of infection. In all human cases to date there has been no evidence of efficient human-to-human transmission and human infections remain a rare event.  As of the 3rd February 2007, 271 confirmed human cases and 165 (61%) deaths from avian influenza A (H5N1) have been reported to the WHO from Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Nigeria, Thailand, Turkey and Vietnam. 

The advice from the Department of Agriculture and Food in Ireland is not to handle dead wild birds unless necessary. For further information please consult the Department of Agriculture and Food website. For queries relating to dead birds please contact the Department of Agriculture and Food on the Avian Influenza Hotline: 1890 252 283.

At present, recommendations on travel, personal protection and food safety remain unchanged.  Current travel advice is available here. The WHO level of pandemic alert remains unchanged at phase 3. This is defined as a virus new to humans that is causing infections, but does not spread easily from one person to another. The latest updates from the WHO are available on the WHO website.

Further information on avian influenza is also available on the HPSC website.

EPIET invites applications for training fellowships

Subject to agreement on funding, the European Programme for Intervention Epidemiology Training invites applications for up to 16 fellowships for a 24-month training programme in communicable disease field epidemiology starting in September 2007. Applicants must be nationals of a EU member country, Switzerland or Norway and should have experience in public health, a keen interest in fieldwork, and be pursuing a career involving public health infectious disease epidemiology. They should have a good knowledge of English and of at least one other EU language, and be prepared to live in a different participating country for a period of 24 months.

The aim of the training is to enable the fellow to assume service responsibilities in communicable disease epidemiology. The in-service training will focus on outbreak investigations, disease surveillance, applied research, and communications with decision makers, the media, the public, and the scientific community. Fellows will attend a three-week intensive introductory course and then be located in a host institute in one of the 25 participating European countries, Switzerland or Norway. Further training modules are organised during the two-year programme.

Detailed information can be obtained from the EPIET programme website at www.epiet.org.  Vacancy notice for application can be found on the ECDC website at http://ecdc.europa.eu/Recruitment.html.

Five Nations Health Protection Conference - Call for Papers

The Five Nations Health Protection Conference will be held on the 22nd and 23rd of May 2007 in Belfast Waterfront Hall, Belfast, Northern Ireland.

The conference will address important public health issues that have arisen since the last meeting and provide fresh perspectives on established areas of disease prevention and control. Abstracts for papers and posters can be submitted via the conference website www.5nations.com or www.5nations.org.uk which goes live on the 5th of January.