Infectious DiseasesEmerging Threats

Beware respiratory symptomsAugust 14th – a Friday informed of 4 cases all of whom had been hospitalised with respiratory symptoms. Two were currently in ITU, one in Mansfield and the other on the isle of Skye!

Possible diagnoses• Legionnaire's disease

• Flu / some other similar respiratory virus ( we were aware of parainfluenza outbreaks elsewhere)

• History for the patient in Mansfield of exposure to pigeons so we wondered if this was Psittacosis.

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Legionnaire’s ruled out by urinary antigen testing

An additional worker found to also be unwell but not hospitalised

August 28th patient in ITU diagnosed with Psittacosis

The other 4 checked and apart from one all were still unwell.

All asked to go for antibody testing and their GPs asked to treat them appropriately (14 days of a Tetracycline)

Three out of the remaining four positive for antibodies to Psittacosis

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How did they get it?The group of offices is infested with pigeons

The pigeons roosted near the vents for the air conditioning

The guano from the pigeons had Chlamydia psitacci and it was blown into the office in concentrated form

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Welcome to a meal rich in SalmonellaMarch 9th 2015 became a ware of a possible outbreak of Salmonella associated with eating at a pub-restaurant

Between February and April there were 53 cases

PHE now carries out genetic sequencing on all Salmonella isolates

Isolates from these 53 people were unique and are the same (database in England of over 80,000 isolates)

This indicates a point source at the pub-restaurant

Carvery food implicated

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BackgroundThis is a busy pub-restaurant

It serves between 6000 and 8000 meals a day

It is open from 8.00 a.m. – breakfast - until midnight - 7 days a week

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The next phaseMay to June a further 11 cases

Further interventions with the pub-restaurant chain

All sequenced and all the same as the original unique strain

Likelihood that this is from a staff member therefore staff sampled – again

4 identified as having the strain but all likely to be victims and not the origin of the outbreak

Management team changed

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And the current phaseSince August 8th – a further 11 cases

Likely to be from a staff member

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Outbreak curve

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What nextSamples from all staff with involvement of HR and occupational health

Requests for stool samples will come from occupational health who will therefore receive the results

Issues

Staff compliance – role of rectal swabs

Informing staff of results – how? who?

Managing the positives – exclusion from work, treatment, etc.

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MERS Co VMiddle Eastern Respiratory Syndrome Coronavirus

First reported in Saudi Arabia in 2012

Major outbreak in South Korea affecting hospitals

1589 lab confirmed cases causing 567 related deaths

Transmission continues in Saudi with a mixture of new primary cases and secondary cases

Advice re travel – avoid contact with camels, camel milk and camel products

Risk greatest to healthcare workers 11

Meningitis

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Meningitis

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Meningitis

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And the implications?Children vaccinated against Meningitis B

Teenagers to be vaccinated against W135 using a conjugate vaccine

For travel purposes use the conjugate A C Y W135 vaccine

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Respiratory Infections – preventing transmission

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Endocarditis and heater cooler units in Cardiac By-pass

Infection caused by Mycobacterium chimaera

This is a species within the Mycobacterium avian intracellulare group

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Aerosol release of particles

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Aerosol release – detection of bacteria

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And for you?New cases continue to be identified

Same risks for Legionella as well!

This clearly could also affect staff – therefore unexplained fevers in these staff need to be considered carefully

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What about flu?

Last season’s vaccine was a poor match because of drift

Early estimates suggested 3% efficacy but that has improved to 30%

At the moment the vaccine this year looks to be a good match but it is very early to be sure

The Live Attenuated Intranasal Vaccine given to children offers better protection because

• There are two Influenza Bs

• The mechanism of action is primarily nasal mucosa and offers wider protection

Immunising children offers protection to adults

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10 Key Areas in the Strategy

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Where does Occupational Health come inEmployers may well have a workforce with high numbers of migrants

There are opportunities to work with your CCGs to screen these migrants for latent TB

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Why bother?Infectious TB is expensive

It involves screening of the workforce and attendance at clinics

If there is transmission you are into RIDDOR reporting and could as part of that have a HSE visit

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Trent Occupational Medicine Symposium

8th October 2015