England: PHE Press Release On MERS Case Transiting London

Photo Credit NIAID

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As you might expect, epidemiological investigations are underway all along the route of travel of the healthcare provider diagnosed today with MERS (see CDC: First Imported MERS Coronavirus Case In the United States) who left Riyadh on the 24th and flew – via London – to Chicago and then took a bus on to Indiana. 

 

The risk to the public is considered `very low’ at this time, but out of an abundance of caution aggressive contact tracing is being done on both sides of the Atlantic.

 

This afternoon, Public Health England issued the following press advisory (h/t @Ironorehopper).

 

Case of suspected MERS-CoV detected on flight through London

Organisation:

Public Health England

Page history:

Published 2 May 2014

Topic:

Public health

PHE was today advised of a suspected case of MERS-CoV in a person flying from Riyadh to Chicago and transiting through London.

Public Health England was today advised of a suspected case of Middle East Respiratory Syndrome (MERS-CoV) in a person flying from Riyadh to Chicago and transiting through London on Thursday, April 24 2014. Positive diagnosis was confirmed by the United States Centre for Disease Control on Friday evening (UK time).

 

The passenger, who is not a UK national, was on British Airways Flight 262 from Riyadh to London, and transferred at Heathrow for onward travel to the USA, where they were later hospitalised with suspected MERS-CoV.

 

The risk of the infection being passed to other passengers on Flight 262 is extremely low. However, as a precautionary measure, Public Health England has contacted UK passengers who were sitting in the vicinity of the affected passenger to provide health information.

 

Any UK based passengers on Flight 262 on April 24 who have since become unwell or experienced respiratory symptoms, such as shortness of breath are advised to contact NHS 111.

 

PHE will also work with the US health authorities to contact any UK passengers on the April 24 onward flight from London to Chicago, American Airlines Flight 99.

 

The period between exposure and when symptoms might develop (the incubation period) for MERS-CoV is currently considered to be up to 14 days. Any illness that passengers might experience more than 14 days after the flight (i.e. starting on or after Friday 9 May), would not be considered to be related.

 

There is presently no evidence of sustained person-to-person transmission of MERS-CoV, and the risk of contracting infection in the UK remains very low.

 

MERS-CoV is a new type of coronavirus, first identified in a Middle Eastern citizen in 2012. Although cases continue to be reported from the Middle East, no new cases of MERS-CoV have been detected in the UK since February 2013.

 

Professor Nick Phin, Head of Respiratory Diseases for Public Health England said: “The risk is very low and human to human transmission of MERS-CoV is extremely rare, but we would ask any passengers from British Airways Flight 262 on 24 April to contact NHS 111 if they’re experiencing respiratory symptoms or have felt unwell since their flight.”

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UK : Sharp Rise In Scarlet Fever Cases In 2014

Photo Credit CDC

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Although not as common as it was in our great-grandparent's day, Scarlet Fever (aka scarlatina) remains a seasonal threat, affecting a small percentage of people who contract strep throat. It’s incidence usually peaks during the winter and spring.

 

Scarlet fever is caused by the same bacteria that causes `strep throat’ (Group  A Streptococcus), and is characterized by fever, a very sore throat, a whitish coating or sometimes `strawberry’  (red & bumpy) tongue, and a rough feeling  `scarlet rash’ that first appears on the neck and chest.

 

It primarily affects children under the age of 12.  Adults generally develop immunity as they grow older. Untreated, this bacterial infection can lead to:

• Rheumatic fever
• Kidney disease
• Ear infections
• Skin infections
• Abscesses of the throat
• Pneumonia
• Sepsis
• Arthritis

For more on the disease, here is the CDC’s Scarlet Fever: A Group A Streptococcal Infection information page.

 

In 2011 and 2012 we followed an unusual erythromycin resistant (but still sensitive to Penicillin & other 1st generation cephalosporins) scarlet fever outbreak in Hong Kong (see Hong Kong: Scarlet Fever In 2012), which sadly, resulted in a small number of fatalities. 

 

While less common, a more serious yet related illness is call iGAS (invasive Group A Strep), which indicates infection of the bloodstream, deep tissues, or lungs, and may result in severe (and frequently fatal) cases of necrotizing fasciitis and streptococcal toxic shock syndrome.

 

This year, Public Health England is reporting a sharp rise in scarlet fever cases, with the highest number of cases reported in the first two months of the year since 1990; a number roughly double that seen in recent years.   Scarlet fever outbreaks tend to be cyclical, with peaks occurring roughly every 4 years.

 

Infection report : Volume 8 Number 9 

Advance Access report published on: 4 March 2014

Group A streptococcal infections: seasonal activity, 2013/14

Surveillance data for group A streptococcal (Streptococcus pyogenes; GAS) infections are indicating higher levels of scarlet fever incidence so far this season (2013/14) than seen in recent years. Increased levels of invasive and non-invasive GAS infection typically occur between December and April, with peak season usually in March/April.  An update on the current seasonal activity for group A streptococcal infections is given below.

Scarlet fever

Routine monitoring of surveillance data has identified widespread increases in scarlet fever notifications in February 2014, beyond those seasonally expected. A total of 868 notifications of scarlet fever with onset dates during weeks 5 to 8 of 2014 were made to Public Health England (PHE) compared to an average of 444 for the same period over the past four years (range: 365 to 591; figure 1). These are the highest notification totals for this time of year since 1990.

The increase has been seen across England with regional totals for weeks 5 to 8 of 2014 (compared to 2013) as follows: 99 in the East of England (81 for same period in 2013), 74 in East Midlands (30), 92 in London (45), 67 in the North East (53), 179 in the South East (101), 109 in the South West (46), 62 in the West Midlands (32) and 108 in Yorkshire and Humber (95). The only region where fewer notifications have been made in weeks 5 to 8 in 2014 is the North West region with 78 notifications compared with 108 in weeks 5 to 8 of 2013.

Invasive Group A streptococcus

A total of 106 invasive GAS (iGAS) isolates, defined as isolation of GAS from a normally sterile site, were referred to the Respiratory and Vaccine Preventable Bacteria Reference Unit at Colindale PHE from laboratories in England, Wales and Northern Ireland for specimens taken between weeks 5 and 8 2014, a slight reduction on the average (125 reports) but with the range (101-160 reports) for the same period in the previous five years (figure 2). 

Three English regions have referred slightly higher than average (2009 to 2013) iGAS isolates for February 2014, North East (12 isolates), London (18 isolates) and the North West (21 isolates). All other regions in England are referring lower numbers of isolates than normal for this time of year.

Antimicrobial susceptibility results from routine iGAS laboratory reports for January indicate erythromycin non-susceptibility is at 5%, which is within the usual range.  The susceptibility testing of iGAS isolates against other key antimicrobials (tetracycline, clindamycin and penicillin) indicate no changes in resistance being observed. There have been no reports of penicillin resistance in iGAS isolates in England to date.

(Continue . . . )

The good news here is that, unlike in Hong Kong in 2012, only about 5% of the strep cases tested have shown resistance to erythromycin.

The PHE recommends:

Clinicians, microbiologists and HPTs should be mindful of potential increases in invasive disease and maintain a high index of suspicion in relevant patients as early recognition and prompt initiation of specific and supportive therapy for patients with iGAS infection can be life-saving.

 

If history is any guide, we should begin to see the number of scarlet fever/iGAS cases in England begin to decline over the next 6 to 8 weeks.

 

 

Surviving Winter’s Ills Without Abusing Antibiotics

Credit CDC, FDA, HHS

 

 

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As mentioned yesterday (see The Lancet: Antibiotic Resistance - The Need For Global Solutions), today marks European Antibiotic Awareness day and kicks off the CDC’s Get Smart About Antibiotics Week.  With each year that passes, more and more bacterial strains are finding ways to evade our dwindling arsenal of antibiotics – and so public health officials are working hard to improve the stewardship of the ones that still remain effective.

 

To that end, this week agencies like the World Health Organization, the CDC, and the ECDC are working to educate the public on when antibiotics are appropriate treatments, and when they are not.  Since most winter respiratory illnesses are viral in nature, antibiotics simply don’t work – and using them inappropriately can lead to increased resistance.

 

So today, a quick tour of (and some excerpts from) the messaging coming from these organizations.

 

From the World Health Organization we get European Antibiotic Awareness Day 2013: everyone is responsible.

18-11-2013

Antibiotic resistance affects the entire WHO European Region, driven by the overuse, underuse and misuse of antibiotics. Although some efforts have been made to combat indiscriminate use, many countries have no national regulation or enforcement on antibiotic usage; healthy animals are given antibiotics to promote growth or prevent disease, and commercial companies promote antibiotics irresponsibly. In too many countries, members of the general public can buy antibiotics over the counter (without a prescription) and use them at will. Doctors often prescribe antibiotics easily or inappropriately, and people take them to treat viral infections such as influenza and the common cold, against which they do not work.

(Continue . . .)

 

While today Public Health England is in myth busting mode, explaining that:

 

Green phlegm and snot ‘not always a sign of an infection needing antibiotics

Advice on European Antibiotics Awareness Day (18 November) to raise awareness of the risks of inappropriate use of antibiotics.

Having green phlegm or snot is not always a sign of a bacterial infection that will require antibiotics to get better, says Public Health England (PHE) and the Royal College of General Practitioners (RCGP).

 

This advice is issued on European Antibiotics Awareness Day (18 November) which aims to raise awareness of the risks associated with the inappropriate use of antibiotics and how to use them responsibly.

Research by PHE’s Primary Care Unit has found that 40% of the general public believed that antibiotics would help a cough with green phlegm get better more quickly rather than clear phlegm (6%).

 

White blood cells are produced by the body to attack any foreign materials the body does not recognise such as pollutants, dirt, pollen or microbes, and are carried in your phlegm and snot. Some white blood cells contain a green substance (a protein) so if more of these cells are present the greener your phlegm or snot will be.

 

Phlegm therefore comes in a range of colours from white to mustard-yellow to varying shades of green. Coloured phlegm or snot does not mean you need antibiotics.

 

In most healthy people, phlegm or snot production with or without a cough will stop as your cold or flu-like illness clears up, although it may take up to 3 to 4 weeks.

 

And from the CDC, some advice on how to deal with the miseries of a winter illness without resorting to antibiotics.

 

How to Feel Better

What can I do to feel better if antibiotics won’t treat my illness because it’s caused by a virus?
For upper respiratory infections, such as sore throats, ear infections, sinus infections, colds, and bronchitis, try the following:

• Get plenty of rest
• Drink plenty of fluids
• Use a clean humidifier or cool mist vaporizer
• Avoid smoking, second-hand smoke, and other pollutants (airborne chemicals or irritants)
• Take acetaminophen, ibuprofen or naproxen to relieve pain or fever (read about what is safe to give your child)

For children and adults, over-the-counter pain relievers, decongestants and saline nasal sprays may help relieve some symptoms. Remember, always use over-the-counter products as directed. Many over-the-counter products are not recommended for children younger than certain ages.

Over-the-counter medicines may help relieve symptoms such as runny nose, congestion, fever and aches, but they do not shorten the length of time you or your child is sick.

Learn more by reading below about over-the-counter medicines. Here are some helpful tips for how to feel better depending on how you or your child feels.

Sore Throat

• Soothe a sore throat with ice chips, sore throat spray, or lozenges (do not give lozenges to young children)
• Use a clean humidifier or cool mist vaporizer
• Take acetaminophen, ibuprofen or naproxen to relieve pain or fever (read about what is safe to give your child)

Ear Pain

• Put a warm moist cloth over the ear that hurts
• Take acetaminophen, ibuprofen or naproxen to relieve pain or fever (read about what is safe to give your child)

Runny Nose

• Use a decongestant or saline nasal spray to help relieve nasal symptoms (read about what is safe to give your child)

Sinus Pain/Pressure

• Put a warm compress over the nose and forehead to help relieve sinus pressure
• Use a decongestant or saline nasal spray
• Breathe in steam from a bowl of hot water or shower
• Take acetaminophen, ibuprofen or naproxen to relieve pain or fever (read about what is safe to give your child)

Cough

• Use a clean humidifier or cool mist vaporizer or breathe in steam from a bowl of hot water or shower (read about what is safe to give your child)

Over-the-Counter (OTC) Medicines

Questions and Answers for Parents about Over-the-Counter (OTC) Medicines

Related Materials

SFAM: Podcast On MERS-CoV

 

 

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Earlier this month Public Health England hosted a conference on the emerging MERS Coronavirus (see PHE coronavirus conference: 9 July 2013) bringing together experts both from the UK, and around the globe.

 

Today, SfAM (the Society for Applied Microbiology) posted a 13-minute podcast on their website with interviews conducted during this conference.

 

Follow the link below to either download the (12 mb) MP3 file, or listen online.

 

 

An update on MERS-CoV

A brand new respiratory virus is circulating in the Middle East and of 80 cases, 44 people have died. MERS-CoV, as it has become known, is a coronavirus with close relatives in bats. In this podcast, experts speaking at a recent Public Health England conference talk about what we know so far and the important questions still to answer.

We hear from John Watson, head of respiratory diseases at Public Health England; Brian McCloskey, director of global health at Public Health England; Monica Galiano, head of genomic sequencing at Public Health England's Virus Reference Department; and Ab Osterhaus, head of the Virology Department at the Erasmus Medical Centre in the Netherlands.

Listen to the podcast here: