14/40 - Health Protection Scotland

HPS Weekly Report
CURRENT NOTES
8 October 2014
Volume 48 No. 2014/40
ISSN 1753-4224 (Online)
Vale of Leven Hospital Inquiry
48/4001 It has been announced that the report of the Vale of Leven
Hospital Inquiry will be published on Monday 24 November 2014.
CONTENTS
CURRENT NOTES
• Vale of Leven Hospital Inquiry
527
• Ebola virus - risk of
transmission via substances of
human origin
527
• WHO delivers tetanus toxoid
vaccine to Ukraine
528
• Norovirus season begins 528
• Salmonella cases – Celtic Park
529
• Environmental incidents SEISS reports
530
SURVEILLANCE REPORT
Measles, mumps, rubella and
whooping cough illness, routine
childhood vaccine uptake and
HPV vaccine uptake
531
NOTIFIABLE TABLE
Notifiable diseases 541
Statutory Notification of
Infectious Diseases
Week ended 26 September 2014
543
The Inquiry was set up by Scottish Ministers to investigate
the occurrence of Clostridium difficile infection at the Vale of
Leven Hospital from 1 January 2007 onwards. The Inquiry also
investigated the deaths associated with C. difficile which occurred
between 1 December 2007 and 1 June 2008.
The Cabinet Secretary for Health, Wellbeing and Cities Strategy,
announced the Inquiry in the Scottish Parliament in April 2009. The
Inquiry, chaired by Lord MacLean, and set up under the Inquiries Act
2005, began its work on 1 October 2009. [Source: Inquiry website:
http://www.valeoflevenhospitalinquiry.org/]
Ebola virus - risk of transmission via substances of human
origin
48/4002 On 6 October, the European Centre for Disease
Prevention and Control (ECDC) published a technical report ‘Risk of
transmission of Ebola virus via donated blood and other substances
of human origin in the EU’.
ECDC notes that the epidemic of Ebola virus disease (EVD) in West
Africa in 2014 has increased the risk of Ebola virus transmission
via donated blood and blood components, cells, tissues and organs
(substances of human origin - SoHO). There are no specific EU
regulations or recommendations for the safety of SoHO donated by
patients who have recovered from EVD; people exposed to Ebola
virus; or people who have visited or reside in EVD-affected areas.
While Ebola virus transmissions through donated blood, tissues or
organs have not been described, asymptomatic replicative infections
with Ebola virus have been. Travellers from Ebola-affected countries
are deferred for donation because malaria-risk countries overlap
with the current Ebola-risk countries in Africa. However, ECDC has
pointed to a need for specific guidelines to maintain the safety of
SoHO donation by people who have been exposed to Ebola virus.
There is a possibility that the current outbreaks in West Africa and
the Democratic Republic of Congo will spread to areas where there
is no malaria risk.
The risk of Ebola virus transmission through SoHO is related to the
presence of Ebola virus in the donor’s blood, tissues and organs.
The presence and concentration of virus in organs, tissues, blood
and other bodily fluids changes during the course of the infection. The virus concentration peaks
when the patient is most sick, and viruses can be detected and isolated from breast milk and
semen weeks after recovery. There are limited data available on when patients become viraemic
and infectious during the incubation period. The assumption is that the rate of virus replication and
excretion into bodily fluids is not high enough in the pre-symptomatic phase to result in person-toperson transmission through day-to-day contacts in the community. However, there are no data
on when viraemia starts during the incubation period. During the symptomatic phase of EVD, the
virus is present in high concentrations in all bodily fluids, tissues and organs. When the disease
is fatal, the dead body remains highly contagious. After recovery from the acute phase, a patient
may continue to excrete live and infective viruses for long periods.
There are currently insufficient data on which to base deferral period recommendations for
recovered EVD patients, contacts of EVD cases and people who have visited the EVD-affected
countries but do not have a documented exposure. EVD has an acute onset of prominent
symptoms that is believed to be temporally related to the viraemia. This makes it unlikely that
patients in the viraemic phase would be accepted for donation of SoHO, because it would be
obvious that they were ill.
The ECDC’s report can be accessed at http://ecdc.europa.eu/en/publications/_layouts/forms/
Publication_DispForm.aspx?List=4f55ad51-4aed-4d32-b960-af70113dbb90&ID=1178.
The World Health Organization has published further information on ‘What we know about
transmission of the Ebola virus among humans’ at http://www.who.int/mediacentre/news/ebola/06october-2014/en/ (6 October).
Further information regarding the EVD outbreak in West Africa is available on the Health
Protection Scotland website at http://www.hps.scot.nhs.uk/search/atozdetail.aspx?subject=166.
WHO delivers tetanus toxoid vaccine to Ukraine
48/4003 On 26 September 2014, the World Health Organization (WHO) delivered a second
tranche of medicine to Kyiv (Kiev). The shipment included 300,000 doses of tetanus toxoid (TT)
vaccine, which is intended to meet Ukraine’s needs until the end of 2015. As of 25 September,
there were over 8332 wounded in Ukraine, according to WHO and the Office of the High
Commissioner for Human Rights (OHCHR).
Many people have been injured as a result of the crisis in the Donbas region. Open injuries have
a potential for serious bacterial infections, including gas gangrene and tetanus; these in turn may
lead to long-term disabilities, chronic wound or bone infection and death. Wound infection is of
particular concern when injured patients do not receive immediate care or when large numbers of
injured survivors exceed the available capacity for trauma care.
Moreover, in emergencies affecting populations in which TT immunization levels are already low,
as in Ukraine, special attention also needs to be paid to preventing maternal and neonatal tetanus
by immunizing women of childbearing age and by improving the hygienic conditions in which
women give birth. [Source:WHO Regional Office for Europe News Release, 3 October 2014.
http://www.euro.who.int/en/countries/ukraine/news/news/2014/10/who-delivers-tetanus-toxoidvaccine-to-ukraine]
Norovirus season begins
48/4004 Following an increase in levels of norovirus (commonly known as the winter vomiting
bug) across Scotland, Health Protection Scotland (HPS) has confirmed that the norovirus season
has begun.
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528
Norovirus generally causes mild gastrointestinal symptoms such as vomiting and/or diarrhoea but
can be more serious among the elderly and people who are already unwell.
Last week’s HPS norovirus report (available at http://www.hps.scot.nhs.uk/giz/
norovirussurveillance.aspx) showed that four NHS boards experienced norovirus activity, with six
hospitals reporting a total of seven ward closures.
Norovirus is a highly infectious virus that causes outbreaks in the community, healthcare and care
settings every year.
This is about the time of year when norovirus season usually starts. Letting everyone know
that norovirus season has started enables preparedness plans to be put in to action. Health
professionals across NHS Scotland are working to minimise the likelihood of outbreaks arising
and the public is being asked to play their part too.
To help reduce the risk of outbreaks in hospitals, care settings and the wider community, members
of the public who think they have norovirus are again being asked to ‘Stay at Home’ until at least
48 hours after any symptoms have passed. As norovirus is so infectious, it is important that
everyone plays their part in reducing outbreak risks. To do this, hospitals may suspend access to
particular wards to protect patients, staff and visitors from norovirus.
With the public’s help, the impact of any norovirus outbreaks that do occur can be limited and
disruption to healthcare services minimised. HPS will continue to monitor the situation on a weekly
basis and will support NHS boards as. [Source: HPS News Release, 3 October 2014. http://www.
hps.scot.nhs.uk/news/newsdetailtemp.aspx?id=658]
Salmonella cases – Celtic Park
48/4005 The Public Health Protection Unit of NHS Greater Glasgow and Clyde (NHSGGC) is
liaising with other health boards, Health Protection Scotland, the Food Standards Agency (FSA)
and Glasgow City Council Environmental Health to investigate 11 cases of Salmonella.
The cases are all recovering in the community. One individual, with an underlying health condition,
required a short period in hospital but has since been discharged. The 11 cases are from the
Greater Glasgow and Clyde, Lanarkshire and Highland areas and nine have been formally
confirmed through laboratory testing.
Investigations have confirmed that all 11 people ate within the hospitality facilities at Celtic Park
on Sunday 21 September 2014. Environmental health officers visited the premises as soon as
this cluster of cases became apparent. They were satisfied that the food production processes
within the Celtic Park kitchen, which caters for its hospitality areas, were appropriate and the food
business operator concerned is co-operating fully with the investigation.
Investigations are currently focusing on the external suppliers of ingredients. The FSA has advised
however that it is not currently aware of any other Salmonella incidents relating to any of the foods
involved.
On 3 October, the lead consultant in public health medicine at NHSGGC indicated that, given
the 24-72 hour incubation period usual for Salmonella infections, there was little likelihood of
additional linked cases. NHSGGC has stressed that this appears to have been an isolated cluster
of cases, that there was no ongoing risk to customers and that the food handling and hygiene
at Celtic Park was satisfactory. [Source: NHSGGC News Release, 3 October 2014. http://www.
nhsggc.org.uk/content/default.asp?page=s1192_3&newsid=18574&back=home]
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529
Environmental incidents - SEISS reports
48/4006 The Scottish Environmental Incident Surveillance System (SEISS) has recorded the
following incident in the past week:
• Emergency services were called after a gas leak at the Grangemouth industrial complex on
30 September. Roads were closed around the Ineos site on Bo’ness Road as the police and
fire services responded to reports of a leak of butane gas at about 10.45. An Ineos spokesman
confirmed the on-site incident management team was mobilised in response to the leak. Noone was injured and a police spokesman said there was no wider risk to people living nearby.
Hundreds of staff and pupils at nearby schools were advised to stay indoors as a precaution
during the incident. Road closures were removed by 12.00. [http://www.bbc.co.uk/news/ukscotland-tayside-central-29427464]
For more detailed information on SEISS please refer to the SEISS web-site (http://www.hps.scot.
nhs.uk/enviro/ssdetail.aspx?id=107) or contact either Ian Henton or Colin Ramsay at HPS on
0141 300 1100.
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530
Surveillance Report
Measles, mumps, rubella and whooping cough illness, routine
childhood vaccine uptake and HPV vaccine uptake
Prepared by: Kevin Pollock and Alison Smith-Palmer, Immunisation Team
This quarterly report presents notifications and laboratory confirmed cases of vaccine preventable
diseases measles, mumps, rubella and whooping cough for the quarter ending week 36, 2014 and
childhood vaccine uptake figures for the quarter ending 30 June 2014. In addition, HPV vaccine
uptake figures are presented for S2 girls in the school year 2013-14, with an update on uptake for
the school year 2012-13.
Measles
In the first 36 weeks of 2014 there were 40 notifications of clinically suspected measles (Table
1), nine of which were notified in the last quarter (weeks 25-36). This is a significant decrease
compared with the number notified in the first 36 weeks of 2013 (156 notified cases). There have
been nine laboratory-confirmed cases so far in 2014, with five of these being reported in the last
quarter (weeks 25-36). Up to week 36 in 2013, there were 51 laboratory-confirmed and three
epidemiologically linked cases (Table 2).
TABLE 1: Vaccine preventable diseases: notifications (clinical suspicion of disease) to week
36/2014
Weeks
Measles
Mumps
Rubella
Whooping cough
Number of notifications received
weeks
weeks
weeks
weeks
21-24/2014 25-28/2014 29-32/2014 33-36/2014
5
3
3
3
20
14
17
24
0
2
0
1
25
32
34
30
Cumulative totals
2014 to
2013 to
week 36
week 36
40
156
204
413
18
17
270
952
TABLE 2: Vaccine preventable diseases: laboratory confirmed cases to week 36/2014 Weeks
Measles
Mumps
Rubella
Bordetella
pertussis
Number of laboratory confirmed cases
weeks
weeks
weeks
weeks
21-24/2014 25-28/2014 29-32/2014 33-36/2014
0
0
4
1
5
11
21
4
0
0
0
0
37
38
44
40
Cumulative totals
2014 to
2013 to
week 36
week 36
9
51
106
219
0
1
345
1003
In 2014, the majority of cases were sporadic and eight of nine cases were unvaccinated (those
who have not received the recommended two doses of MMR vaccine); vaccine status for one
case was unknown. Measles cases are under scrutiny in Europe, as measles is targeted for
elimination by the World Health Organization (WHO). The European Centre for Disease Control
(ECDC) publishes a monthly summary of measles activity,1 for which Health Protection Scotland
submits national data.
Mumps
In the first 36 weeks of 2014, there were 204 mumps notifications, a decrease from the 413
notifications in the same period in 2013 (Table 1). In the first 36 weeks of 2014, there were 106
laboratory-confirmed cases of mumps, a significant decrease from 219 laboratory-confirmed
cases seen in the first 36 weeks in 2013 (Table 2).
HPS WEEKLY REPORT Volume 48 No.2014/40
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531
Since 2004 there has been an ongoing widespread outbreak of mumps which has affected all
areas of the UK. Although case numbers have fallen overall since the peak in 2005, mumps cases
continue to occur steadily in Scotland. This outbreak is mainly affecting the young adult age group
(aged 15-24 years), who are often under-immunised against mumps as they have not routinely
been offered two doses of MMR vaccine. Among those cases where age was reported in 2014
(n=94), the median was 26 years. Only three cases were aged under 15 years.
Rubella
There were 18 notifications of rubella in the first 36 weeks of 2014, with no laboratory confirmed
cases. For the same period in 2013 there were 17 rubella notifications and one laboratory-confirmed
case. Rubella cases are under scrutiny in Europe, as rubella is targeted for elimination by WHO.
ECDC publishes a monthly summary of rubella activity,1 for which Health Protection Scotland
submits national data.
Whooping cough (Pertussis)
The incidence of pertussis increased dramatically in 2012 and has remained well above historical
levels, as has been the pattern in England and Wales. In the first 36 weeks of 2014 there
were 345 laboratory-confirmed cases of Bordetella pertussis reported to HPS, a decrease of
658 compared to the 1003 reported during the first 36 weeks of 2013. Although the number of
laboratory reports is now lower than during 2013, it is still more than five times higher than during
the first 36 weeks of 2010 and 2011 when there were 56 and 60 reports respectively.
Young infants are the group most likely to develop complications from infection with Bordetella
pertussis, which can require hospitalisation and in severe cases can be fatal. In response to
the increase in pertussis and in order to protect young infants in the first few weeks of life before
they are old enough to start the routine childhood immunisation programme at eight weeks,
a vaccination programme was introduced in October 2012 to offer pertussis vaccination to all
pregnant women between 28 and 38 weeks gestation (inclusive). Vaccination of pregnant women
aims to boost immunity in the pregnant woman which is passed across the placenta to the
unborn child and should provide protection during early weeks of life. As pertussis continues to
circulate in Scotland well above historical levels, immunisation of pregnant women continues to be
important.
As the immunity this programme confers is only short-term protection for the first few weeks of life,
it is important that infants are also included in the routine childhood schedule in order to receive
longer term protection.
Childhood vaccines uptake
Vaccine uptake remains generally high in Scotland. Quarterly uptake figures for children reaching
ages 12 months, 24 months and five years by 30 June 2014 are shown in Tables 3, 4 and 5
respectively. Annual uptake of primary immunisation showing trends over time in uptake at 24
months is shown in Figure 1 and for uptake at five years in Figure 2. These are prepared by
NSS ISD (National Services Scotland – Information Services Division) and were released on
26 September 2014.2 There is further commentary on these uptake figures in the ISD statistics
publication.
HPS WEEKLY REPORT Volume 48 No.2014/40
8 October 2014
532
TABLE 3: Primary immunisation uptake rates by 12 months old, evaluation quarter: 1 April to 30
June 2014. Born 1 April to 30 June 2013
NHS board of
residence1
AA
BR
D&G
FF
FV
GR
GG&C
HG
LN
LO
OR
SH
TY
WI
NHS board
unknown
Scotland
Number in
cohort2
889
268
323
966
826
1,517
3,020
774
1,774
2,395
53
75
1,038
51
4
13,973
% completed primary course by 12 months
DTP/Pol/Hib3
MenC
PCV
No.
%
No.
%
No.
871
98.0
881
99.1
873
263
98.1
263
98.1
263
316
97.8
318
98.5
316
945
97.8
951
98.4
945
791
95.8
805
97.5
795
1,449
95.5
1,467
96.7
1,451
2,950
97.7
2,966
98.2
2,954
740
95.6
754
97.4
740
1,742
98.2
1,754
98.9
1,746
2,335
97.5
2,348
98.0
2,338
50
94.3
50
94.3
49
74
98.7
75
100.0
74
1,022
98.5
1,028
99.0
1,021
50
98.0
50
98.0
50
..
13,601
..
97.3
%
98.2
98.1
97.8
97.8
96.2
95.6
97.8
95.6
98.4
97.6
92.5
98.7
98.4
98.0
..
..
..
..
13,713
98.1
13,618
97.5
Source: SIRS Date: August 2014
1. The data presented reflects the current configuration of NHS boards (i.e. from 1 April 2014). NHS board
of residence on the Scottish Immunisation & Recall System (SIRS) is recorded in the pre-April 2006
configuration of NHS boards. For boards affected by reconfiguration the data have been mapped to
the current configuration of NHS boards based on the child’s home postcode as appropriate. There
are a small number of records that do not have a postcode recorded and therefore the NHS board is
unknown.
2. Children reaching 12 months of age during the evaluation quarter 1 April to 30 June 2014 (i.e. born 1
April to 30 June 2013).
3. The 5 in 1 vaccine (comprising DTP/Pol/Hib) was introduced in September 2004. For children
vaccinated in Scotland this is now recorded as a single vaccine. For children who received primary
immunisations outwith Scotland, where the vaccination may not have been given as one injection, only
those who have received three doses of each vaccine (diphtheria, tetanus, pertussis, polio and Hib)
are counted as completing the primary course.
.. Not Applicable.
Key:
DTP/Pol/Hib = diphtheria, tetanus, pertussis, polio and Hib (three doses).
MenC = meningococcal serogroup C conjugate vaccine (one dose).
PCV = pneumococcal conjugate vaccine (two doses).
HPS WEEKLY REPORT Volume 48 No.2014/40
8 October 2014
533
TABLE 4: Primary and booster mmunisation uptake rates by 24 months old
NHS
Number
board of
in
residence1 cohort2
AA
BR
D&G
FF
FV
GR
GG&C
HG
LN
LO
OK
SH
TY
WI
NHS
board
unknown
Scotland
984
249
335
963
865
1,675
3,218
863
1,758
2,459
58
80
1,009
57
5
% completed booster course by
24 months
% completed primary course by 24 months
DTP/Pol/Hib3
MenC
PCV
No
976
246
332
939
852
1,638
3,153
840
1,733
2,414
58
78
995
57
%
99.2
98.8
99.1
97.5
98.5
97.8
98.0
97.3
98.6
98.2
100.0
97.5
98.6
100.0
No
966
241
327
923
840
1,576
3,091
830
1,716
2,351
56
76
974
57
%
98.2
96.8
97.6
95.8
97.1
94.1
96.1
96.2
97.6
95.6
96.6
95.0
96.5
100.0
..
..
..
..
14,578 14,316
98.2 14,029
MMR1
No
%
971 98.7
242 97.2
327 97.6
927 96.3
850 98.3
1,607 95.9
3,131 97.3
836 96.9
1,723 98.0
2,393 97.3
57 98.3
75 93.8
986 97.7
57 100.0
..
96.2 14,187
..
No
957
238
326
907
833
1,585
3,073
804
1,698
2,328
52
72
965
55
..
97.3 13,898
Hib/MenC
%
97.3
95.6
97.3
94.2
96.3
94.6
95.5
93.2
96.6
94.7
89.7
90.0
95.6
96.5
..
No
967
237
327
912
836
1,592
3,089
813
1,710
2,320
51
73
971
56
..
95.3 13,959
%
98.3
95.2
97.6
94.7
96.6
95.0
96.0
94.2
97.3
94.3
87.9
91.3
96.2
98.2
..
PCVB
No
966
238
327
909
836
1,579
3,080
816
1,711
2,323
52
71
964
56
..
95.8 13,933
%
98.2
95.6
97.6
94.4
96.6
94.3
95.7
94.6
97.3
94.5
89.7
88.8
95.5
98.2
..
95.6
Source: SIRS Date: August 2014
1. The data presented reflects the current configuration of NHS boards (i.e. from 1 April 2014). NHS board
of residence on the Scottish Immunisation & Recall System (SIRS) is recorded in the pre-April 2006
configuration of NHS boards. For boards affected by reconfiguration the data have been mapped to
the current configuration of NHS boards based on the child’s home postcode as appropriate. There
are a small number of records that do not have a postcode recorded and therefore the NHS board is
unknown.
2. Children reaching 24 months of age during the evaluation quarter 1 April to 30 June 2014 (i.e. born 1
April to 30 June 2012).
3. The 5 in 1 vaccine (comprising DTP/Pol/Hib) was introduced in September 2004. For children
vaccinated in Scotland this is now recorded as a single vaccine. For children who received primary
immunisations outwith Scotland, where the vaccination may not have been given as one injection, only
those who have received three doses of each vaccine (diphtheria, tetanus, pertussis, polio and Hib) are
counted as completing the primary course.
.. Not Applicable.
Key:
DTP/Pol/Hib = diphtheria, tetanus, pertussis, polio and Hib (three doses).
MenC = meningococcal serogroup C conjugate vaccine (two doses under 12 months).
PCV = pneumococcal conjugate vaccine (two doses under 12 months).
MMR1 = measles, mumps, and rubella vaccine (one dose over 12 months).
Hib/MenC = Hib/MenC Booster (one dose over 12 months).
PCVB = pneumococcal conjugate vaccine booster (one dose over 12 months).
HPS WEEKLY REPORT Volume 48 No.2014/40
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534
For the third quarter of 2014, uptake rates by 24 months of age for completing primary courses of
diphtheria, tetanus, pertussis, polio, Hib (Haemophilus influenzae type B), MenC (meningococcal
serogroup C) and PCV (pneumococcal conjugate vaccine) across Scotland remain high and
stable between 95% and 99%. Uptake of one dose of MMR (measles, mumps and rubella
vaccine) by 24 months was 95.3% (compared with 95.8% in the previous quarter). Uptake rates
for the two booster vaccines by 24 months (Hib/MenC and PCV given at 12 and 13 months of
age) were 95.8% for the Hib/MenC booster and 95.6% for the PCV booster (96.0% and 95.8%
respectively for the previous quarter). See Table 4 and Figure 1.
FIGURE 1: Quarterly primary and booster immunisation uptake rates by 24 months - reports to 30
June 2014
100.0
Mar-14
Mar-13
Mar-12
Mar-11
Mar-10
Mar-09
Mar-08
Mar-07
Mar-06
Mar-05
Mar-04
Mar-03
Mar-02
Mar-01
Mar-00
Mar-99
Mar-98
Mar-97
70.0
Mar-96
80.0
Mar-95
Percentage
90.0
Year and quarter
Diphtheria
Tetanus
Pertussis
Polio
MenC
PCV
MMR1
Hib/MenC
Hib
DTP/Pol/Hib
PCVB
For those reaching five years of age, uptake of at least one dose of MMR was 97.5% (the same
as that in the previous quarter) and remains above the 95% target for children receiving at least
one dose by the age of five (i.e. before starting school), see Table 5 and Figure 2. Uptake of two
doses of MMR (MMR2) was 93.2% (down from 93.4% in the previous quarter). The overall trend
suggests that MMR2 uptake at age five years has plateaued in the last year (see Figure 2) and
remains below the 95% uptake target.
HPS WEEKLY REPORT Volume 48 No.2014/40
8 October 2014
535
TABLE 5a: Primary immunisation uptake rates by five years old
% completed primary course by five years3
NHS
Number
board of
in
residence1 Cohort 2
AA
BR
D&G
987
304
377
D
T
No
%
No
981
303
374
99.4
99.7
99.2
981
303
374
P
%
99.4
99.7
99.2
Pol
Hib
MenC
PCV
MMR1
No
%
No
%
No
%
No
%
No
%
981
303
374
99.4
99.7
99.2
981
303
374
99.4
99.7
99.2
981
303
372
99.4
99.7
98.7
960
296
370
97.3
97.4
98.1
968
297
369
98.1
97.7
97.9
971
297
369
98.4
97.7
97.9
FF
1,091 1,072
98.3 1,072
98.3 1,072
98.3 1,072
98.3 1,070
98.1 1,031
94.5 1,040
95.3 1,065
97.6
FV
GR
GG&C
HG
908
897
1,666 1,636
3,015 2,963
849
835
98.8 897
98.2 1,636
98.3 2,963
98.4 835
98.8 897
98.2 1,635
98.3 2,963
98.4 835
98.8 897
98.1 1,636
98.3 2,963
98.4 834
98.8 897
98.2 1,630
98.3 2,951
98.2 832
98.8 873
97.8 1,533
97.9 2,824
98.0 793
96.1
880
92.0 1,547
93.7 2,856
93.4
805
96.9
892
92.9 1,615
94.7 2,924
94.8
820
98.2
96.9
97.0
96.6
LN
1,956 1,933
98.8 1,933
98.8 1,933
98.8 1,932
98.8 1,931
98.7 1,892
96.7 1,906
97.4 1,908
97.5
99.2 2,428 99.2 2,427 99.2 2,422 99.0 2,279
98.0
50 98.0
50 98.0
50 98.0
48
97.4
75 97.4
75 97.4
75 97.4
69
98.9 1,066 98.9 1,066 98.9 1,066 98.9 1,022
100.0
56 100.0
56 100.0
56 100.0
55
93.1 2,337
94.1
47
89.6
72
94.8 1,022
98.2
55
95.5 2,396
92.2
47
93.5
70
94.8 1,055
98.2
55
97.9
92.2
90.9
97.9
98.2
LO
2,447 2,428 99.2 2,428
OK
51
50 98.0
50
SH
77
75 97.4
75
TY
1,078 1,066 98.9 1,066
WI
56
56 100.0
56
NHS
board
7
..
..
..
unknown
Scotland 14,869 14,676 98.7 14,676
..
..
..
..
..
..
..
..
..
..
..
..
98.7 14,675 98.7 14,673 98.7 14,643 98.5 14,052 94.5 14,208 95.6 14,491
..
97.5
Source: SIRS Date: August 2014
1. The data presented reflects the current configuration of NHS boards (i.e. from 1 April 2014). NHS board
of residence on the Scottish Immunisation & Recall System (SIRS) is recorded in the pre-April 2006
configuration of NHS boards. For boards affected by reconfiguration the data have been mapped to
the current configuration of NHS boards based on the child’s home postcode as appropriate. There
are a small number of records that do not have a postcode recorded and therefore the NHS board is
unknown.
2. Children reaching five years of age during the evaluation quarter 1 April to 30 June 2014 (i.e. born 1
April to 30 June 2009).
3. The 5 in 1 vaccine (comprising DTP/Pol/Hib) was introduced in September 2004. Although the
vaccination is now given as one injection, at the time this cohort were vaccinated it was recorded
separately on SIRS and therefore rates may differ slightly. This may be due to children who have
received a single vaccine outwith Scotland or due to local recording practices.
.. Not Applicable.
Key for booster courses:
Hib/MenC = Hib/MenC booster (one dose over 11 months).
PCVB = pneumococcal conjugate vaccine booster (one dose over 12 months).
D = diphtheria vaccine (fourth dose).
T = tetanus vaccine (fourth dose).
P = pertussis vaccine (fourth dose).
Pol = polio vaccine (fourth dose).
MMR2 = measles, mumps, and rubella vaccine (second dose).
HPS WEEKLY REPORT Volume 48 No.2014/40
8 October 2014
536
TABLE 5b: Booster immunisation uptake rates by five years of age
% completed primary course by five years
NHS
Number
board of
in
residence 1 cohort 2
Hib/MenC
No
987
967
AA
304
298
BR
377
370
D&G
1,091 1,060
FF
908
888
FV
1,666 1,554
GR
3,015 2,878
GG&C
849
809
HG
1,956 1,909
LN
2,447 2,360
LO
51
47
OK
77
69
SH
1,078 1,045
TY
56
55
WI
NHS
7
..
board
unknown
Scotland 14,869 14,315
%
PCVB
No
D
%
No
T
%
No
P
%
No
Pol
%
No
MMR2
%
No
%
98.0
942
95.4
945 95.7
945
95.7
945
95.7
945
95.7
938
95.0
98.0
287
94.4
300 98.7
300
98.7
300
98.7
300
98.7
290
95.4
98.1
364 96.6
364
96.6
364
96.6
364
96.6
1,006 92.2 1,006
92.2
1,006
92.2
1,006
858
94.5
858
94.5
858
362
96.0
97.2 1,017
93.2
97.8
872
96.0
93.3 1,520
91.2
1,581 94.9 1,581
94.9
1,581
94.9
95.5 2,786
92.4
2,811 93.2
2,811
93.2
2,811
93.2
95.3
793 93.4
858 94.5
361
95.8
92.2 1,003
91.9
94.5
849
93.5
1,581
94.9 1,555
93.3
2,810
93.2 2,780
92.2
93.4
784
92.3
793
93.4
793
93.4
793
790
93.1
97.6 1,876
95.9
1,888 96.5 1,888
96.5
1,888
96.5
1,888
96.5 1,864
95.3
96.4 2,279
93.1
2,252 92.0 2,252
92.0
2,252
92.0
2,251
92.0 2,241
91.6
92.2
45
88.2
48 94.1
48
94.1
48
94.1
48
94.1
46
90.2
89.6
68
88.3
65 84.4
65
84.4
65
84.4
65
84.4
61
79.2
96.9 1,009
93.6
1,022 94.8 1,022
94.8
1,022
94.8
1,022
94.8 1,021
94.7
98.2
98.2
98.2
55
98.2
55
98.2
98.2
..
55
..
96.3 13,909
..
93.5
55 98.2
..
..
55
..
..
..
13,993 94.1 13,993 94.1 13,993
..
..
94.1 13,991
..
55
..
94.1 13,859
..
93.2
Source: SIRS
1. The data presented reflects the current configuration of NHS boards (i.e. from 1 April 2014). NHS board
of residence on the Scottish Immunisation & Recall System (SIRS) is recorded in the pre-April 2006
configuration of NHS boards. For boards affected by reconfiguration the data have been mapped to
the current configuration of NHS boards based on the child’s home postcode as appropriate. There
are a small number of records that do not have a postcode recorded and therefore the NHS board is
unknown.
2. Children reaching five years of age during the evaluation quarter 1 April to 30 June 2014 (i.e. born 1
April to 30 June 2009).
.. Not Applicable.
Key for booster courses:
Hib/MenC = Hib/MenC booster (one dose over 11 months).
PCVB = pneumococcal conjugate vaccine booster (one dose over 12 months).
D = diphtheria vaccine (fourth dose).
T = tetanus vaccine (fourth dose).
P = pertussis vaccine (fourth dose).
Pol = polio vaccine (fourth dose).
MMR2 = measles, mumps, and rubella vaccine (second dose).
HPS WEEKLY REPORT Volume 48 No.2014/40
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537
FIGURE 2: MMR1 and booster immunisation uptake rates, by five years of age, by quarter,
Scotland
Percentage vaccine uptake
100
95
90
85
80
11
01
Ju
1
ne
20
12
De
c2
01
Ju
2
ne
20
13
De
c2
01
3
Ju
ne
20
14
De
c2
20
0
ne
Ju
De
c2
01
10
9
20
ne
Ju
De
c2
00
09
8
20
ne
Ju
De
c2
00
08
7
Ju
ne
20
00
07
c2
20
De
ne
Ju
De
c2
00
6
75
Year and quarter
MMR1
Hib/MenC
PCVB
Diphtheria
Tetanus
Pertussis
Polio
MMR2
HPV vaccine uptake
HPV immunisation was introduced in Scotland in 2008 as part of the routine childhood schedule,
to help protect girls against developing cervical cancer in later life. The HPV vaccine protects
against two types of HPV (types 16 and 18) that cause more than 70% of cervical cancers.
Historic immunisation involved three doses of vaccine delivered over a six-month period and was
routinely given in school to 12-13 year old girls (school year S2). HPV vaccine uptake rates are
prepared annually by NSS ISD and were published on 30 September 2014.2
HPV vaccine uptake for the routine S2 school year in 2013-14 is shown in Table 6. Uptake for
dose 1 was 93.6%, for dose 2 91.7% and for dose 3 was 81.4%. These figures are similar to those
seen in September 2013 for S2 girls in 2012-13 (dose 1 93.5%, dose 2 91.8%, dose 3 82.0%).
The fall in uptake for dose three reflects that doses are missed during the school year which
cannot be caught up in that school year due to scheduling of visits to school. Figure 3 shows how
uptake of three doses of vaccine has increased in the year following school year (when the girls
move into S3) as missed doses are caught up. For S2 girls vaccinated in 2012-13, uptake of three
doses of vaccine was 82.0% in the September of 2013, but had increased to 91.4% by September
2014 at the end of the S3 year.
HPS WEEKLY REPORT Volume 48 No.2014/40
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538
TABLE 6: Annual HPV immunisation uptake rates by the end of the school year for the S2 routine
cohort in school year 2013/14,1,2,3 by NHS board of school
Final uptake rates one year later for this S2 routine cohort of girls in 2013/14 will be published in
September 2015.
Number
NHS board
of girls in
of school
cohort2
AA
1,864
BR
577
D&G
731
FF
1,750
FV
1,641
GR
2,719
GG&C
5,707
HG
1,594
LN
3,545
LO
4,060
OR
96
SH
131
TY
2,052
WI
135
NHS board
4
unknown3
Scotland
26,606
1,744
551
697
1,634
1,573
2,557
5,424
1,418
3,353
3,691
89
117
1,938
122
% uptake
of 1st
dose
93.6
95.5
95.3
93.4
95.9
94.0
95.0
89.0
94.6
90.9
92.7
89.3
94.4
90.4
..
..
Number
1st dose
24,910
93.6
1,723
539
684
1,580
1,543
2,532
5,325
1,363
3,294
3,560
85
116
1,922
119
% uptake
of 2nd
dose
92.4
93.4
93.6
90.3
94.0
93.1
93.3
85.5
92.9
87.7
88.5
88.5
93.7
88.1
..
..
Number
2nd dose
24,387
91.7
1,665
469
556
1,356
1,340
2,427
4,523
1,127
3,085
2,986
83
109
1,824
114
% uptake
of 3rd
dose
89.3
81.3
76.1
77.5
81.7
89.3
79.3
70.7
87.0
73.5
86.5
83.2
88.9
84.4
..
..
Number
3rd dose
21,665
81.4
Source: CHSP School (May 2014)/SIRS (August 2014)
1.Uptake rates are based on immunisations recorded on SIRS as at 11 August 2014. Final uptake rates for
these girls one year later will be published in September 2015.
2. The cohort relates to girls recorded on CHSP School in class year S2 as at 12 May 2014. These girls
were in the second year of secondary school during school year 2013/14 and were around 12 to 13
years of age.
3. The data presented reflects the current configuration of NHS boards (i.e. from 1 April 2014). NHS board
on CHSP School is recorded in the pre-April 2006 configuration of NHS boards. For boards affected by
reconfiguration, the data have been mapped to the current configuration of NHS boards. There are a
small number of records with a default school code where the NHS board is unknown.
.. Not Applicable
HPS WEEKLY REPORT Volume 48 No.2014/40
8 October 2014
539
FIGURE 3: Dose 3 HPV immunisation uptake rates for girls in S2 during the first five years of the
immunisation programme
100.0
90.0
Percentage uptake
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
2008/09
2009/10
2010/11
2011/12
School year
End of school year
2012/13
2013/14
1 year later
References
1. European Centre for Disease Prevention and Control (ECDC). Measles and rubella monitoring
reports. Available from: http://ecdc.europa.eu/en/healthtopics/measles/epidemiological_data/
Pages/measles_surveillance_reports.aspx. (accessed 26 September 2014).
2. NSS ISD. Childhood Immunisations uptake rates, quarter and year ending June 2014.
Available from: http://www.isdscotland.org/Health-Topics/Child-Health/Immunisation/.
(accessed 26 September 2014).
The last Vaccine uptake and childhood disease Surveillance Report was in Issue 14/27
The next Vaccine uptake and childhood disease Surveillance Report will be in Issue 14/50
HPS WEEKLY REPORT Volume 48 No.2014/40
8 October 2014
540
Notifiable diseases
Part 2 (Notifiable Diseases, Organisms and Health Risk States) of the Public Health etc.
(Scotland) Act came into effect on 1 January 2010 and sets out new duties for registered medical
practitioners, NHS boards and directors of diagnostic laboratories. GP practices should familiarise
themselves with the Scottish Government guidance on the new notification requirements at: http://
www.scotland.gov.uk/Topics/Health/Policy/Public-Health-Act.
Registered medical practitioners report notifiable diseases based on ‘clinical suspicion’. As such,
notifications may not be subject to laboratory report confirmation. The published figures will record
therefore how many diseases have been clinically suspected.
Patient notifications can, however, be reclassified. When, for example, a suspected (and notified)
tuberculosis case is subsequently reported as negative by a laboratory (and found not to be a
health protection risk) it would subsequently be removed from the disease totals.
Diseases to be notified by registered medical practitioners with effect from 1 January 2010:
Notifiable Diseases which come into effect on 1 January 2010
*Anthrax
*Meningococcal disease
*Botulism
Brucellosis
*Cholera
Mumps
*Necrotising fasciitis
*Paratyphoid
*Clinical syndrome due to E. coli
O157 infection (see note 1)
*Diphtheria
*Haemolytic Uraemic
Syndrome (HUS)
*Haemophilus influenzae
Type b (Hib)
*Measles
*Pertussis (Whooping Cough)
*Severe Acute Respiratory
Syndrome (SARS)
*Smallpox
Tetanus
Tuberculosis (respiratory or
non-respiratory) (see Note 2)
*Tularemia
*Plague
*Poliomyelitis
*Typhoid
*Viral haemorrhagic fevers
*Rabies
*West Nile fever
Rubella
Yellow Fever
It is recommended that those diseases above marked with an * require urgent notification, i.e.
within the same working day.
Note 1: Escherichia coli O157
Clinical suspicion should be aroused by (i) likely infectious bloody diarrhoea or (ii) acute onset non-bloody
diarrhoea with a biologically plausible exposure and no alternative explanation. Examples of biologically
plausible exposures include:
• contact with farm animals, their faeces or environment;
• drinking privately supplied or raw water;
• eating foods such as undercooked burgers or unpasteurised dairy products;
• contact with a confirmed or suspected case of VTEC infection.
Further guidance is available at: http://www.hps.scot.nhs.uk/giz/e.coli0157.aspx.
Where a case is notified as HUS (Haemolytic Uraemic Syndrome) it should NOT also be notified
as ‘Clinical syndrome due to E. coli O157 infection’.
HPS WEEKLY REPORT Volume 48 No.2014/40
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541
Note 2: Tuberculosis
For the purposes of notification, respiratory TB or non-respiratory TB should be taken to have
the same meanings as the World Health Organisation definitions of pulmonary TB and nonpulmonary TB respectively:
Pulmonary TB is tuberculosis of the lung parenchyma and/or the tracheobronchial tree.
Non-pulmonary TB is tuberculosis of any other site.
Where tuberculosis is clinically diagnosed in both pulmonary and non-pulmonary sites, this should
be treated as pulmonary TB.
Registered medical practitioners have been advised to contact their local NHS Board Health
Protection Team for advice should they have any doubts about the diagnosis of suspected cases.
Non-notifiable diseases
Registered medical practitioners are no longer required to notify the diseases listed below.
• Bacillary dysentery
• Chickenpox
• Food poisoning
• Scarlet fever
• Viral hepatitis
These diseases are now covered by a list of notifiable organisms details of which will be reported
by laboratories to health protection teams.
HPS WEEKLY REPORT Volume 48 No.2014/40
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542
Statutory Notification of Infectious Diseases
Week ended 26 September 2014
A National Statistics release
Infectious Disease
Anthrax
Botulism
Brucellosis
Cholera
Clinical Syndrome E. coli O157
Diphtheria
Haemolytic Uraemic Syndrome (HUS)
Haemophilus Influenzae Type B (Hib)
Measles
Meningococcal Infection
Mumps
Necrotizing Fasciitis
Paratyphoid Fever
Pertussis
Plague
Poliomyelitis
Rabies
Rubella
Severe Acute Respiratory Syndrome
(SARS)
Smallpox
Tetanus
Tuberculosis: Respiratory
Tuberculosis: Non-respiratory
Tularemia
Typhoid Fever
Viral Haemorrhagic Fevers
West Nile Fever
Yellow Fever
TOTAL
Total from
Current
Current Previous
first week
week
week
week
of year:
last year
2013
1
1
1
1
1
1
1
5
1
2
160
2
2
3
62
2
8
5
444
1
7
5
14
13
982
17
2
1
13
4
5
37
Amendments: Add 1 Pertussis (1 x wk 38)
AA Ayrshire & Arran
FF Fife LO Lothian
TY Tayside
BR
FV
LN
WI
NHS BOARD ABBREVIATIONS
Borders
DG Dumfries & Galloway
Forth Valley
GR Grampian Lanarkshire
OR Orkney Western Isles
3
1
27
174
122
6
1983
Total from
first week
of year:
2014
2
1
5
8
1
4
2
49
48
232
9
6
314
21
1
183
96
4
2
988
Source: Health Protection Scotland,
NHS National Services Scotland
GGC Greater Glasgow & Clyde
HG Highland
SH Shetland
Correspondence to: The Editor, HPS Weekly Report, Health Protection Scotland, Meridian Court,
5 Cadogan Street, Glasgow, G2 6QE, Scotland
T 0141-300 1100
F 0141-300 1172
E [email protected]
W http://www.ewr.hps.scot.nhs.uk/
Printed in the UK. HPS is a division of the NHS National Services Scotland.
Registered
as a newspaper
© Health
Scotland 2014
543
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