This is a PDF consolidation of the news items and infection reports published in HPR numbers 50 and 51,
on 13 and 20 December 2013, respectively.
Volume 7 Numbers 50-51 Published on: 13 and 20 December 2013
Current News
Surgical site infection surveillance in NHS hospitals in England, 2012/13 *
HPV vaccination programme coverage and effectiveness evaluated
*
PVL pneumonia exceedance (England, Dec 2012- May 2013) investigation report *
*
Infection Reports
Immunisation* *
Laboratory-confirmed cases of pertussis reported to the enhanced pertussis surveillance programme
(England): July to September 2013
Pertussis Vaccination Programme for Pregnant Women: Vaccine coverage estimates in England, October
2012 to September 2013
Invasive meningococcal infections laboratory reports (England): July to September 2013
Quarterly vaccination coverage statistics for children aged up to five years in the UK (COVER programme):
July to September 2013
Bacteraemia* *
Uncommon pathogens associated with bacteraemia: England, Wales and Northern Ireland, 2008-2012
HCAI * *
Trends in mandatory Staphylococcus aureus (MRSA and MSSA) and Escherichia coli bacteraemia, and
Clostridium difficile infection (CDI): data for England up to July-September 2013
Enteric*
General outbreaks of food-borne illness, laboratory reports of common gastro-instestinal infections and
hospital norovirus outbreaks (weeks 45-48/2013); and salmonella infections (October 2013)
* Published in HPR 7(50) on 13/12/2013.
** Published in HPR 7(51) on 20/12/2013.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
News [edited]
Volume 7 Numbers 50-51 Published on: 13 and 20 December 2013
Surgical site infection surveillance in NHS hospitals in England, 2012/13
The PHE's new annual report on the surveillance of surgical site infections (SSI) programme summarises data
collected by 235 NHS hospitals and independent NHS Treatment centres in England between April 2008 and
March 2013 [1]. The report presents the rate of SSIs for 17 categories of surgical procedures based on infections
detected during the patient's post-operative stay (inpatient SSI) combined with infections detected on re-admission
after initial discharge (readmission SSI).
Surgical site infections (SSIs) are defined as infections that affect the wound site itself (superficial), the deeper
layers or those involving the joint or organs. For surveillance purposes SSIs are defined as infections occurring
within 30 days of surgery, or within one year if a prosthetic implant is involved. SSIs remain a common type of
healthcare-associated infection (HCAI), accounting for an estimated 16% of all HCAIs detected in hospitalised
patients [2]. Whilst the majority of SSIs respond well to treatment, they can in some instances result in adverse
outcomes for the patient including extended hospital stay, reduced quality of life and in some instances death [3-5].
Surveillance and feedback of SSI rates enables hospitals to develop targeted interventions for reducing the burden
of SSIs. The recent release of evidence-based SSI quality standards by the National Institute for Health and Care
Excellence provides a tool to assist hospitals in measuring improvements in reducing SSI and improving patient
outcomes [6].
NHS Trusts in England performing orthopaedic surgery in one of the four mandatory surveillance categories (hip
prosthesis, knee prosthesis, reduction of long bone fracture and repair of neck of femur) are required to undertake
SSI surveillance in at least one of these surgical categories for a minimum of one quarter per financial year. Trusts
also have the option of participating in any of the additional 13 surgical categories included in the national
surveillance scheme.
The report describes hospital participation in surveillance over time, data quality indicators, trends and risk factors
for SSI. The report is accompanied by a supplement giving orthopaedic SSI rates by named NHS Trust, which will
also become available in due course from the NHS Choices and the Care Quality Commission websites.
Surveillance data for 549,495 surgical procedures and 7,950 inpatient and readmission surgical site infections
(SSIs) from 17 surgical categories were collected by 235 NHS hospitals and independent sector NHS treatment
centres between April 2008 and March 2013.
The proportion of hospitals undertaking continuous surveillance continued to increase in 2012/13 and was highest
in coronary artery bypass graft surgery (67%), followed by hip prosthesis (56%), knee prosthesis (55%), reduction
of long bone fracture (53%) and repair of neck of femur (48%).
Rates of SSI varied according to surgical category, from <1% for orthopaedic procedures to 11% for large bowel
surgery. Factors influencing the risk of SSI varied by surgical category but include elevated ASA score (poor preoperative health status), longer duration of surgery and obesity (Body Mass Index of 30 or more).
A significant decreasing trend in the rate of SSI was found for patients undergoing coronary artery bypass graft,
bile duct/liver/pancreatic surgery and reduction of long bone fracture. A borderline decreasing trend was found for
repair of neck of femur.
In contrast, significant increases in SSI rates were found for patients undergoing large bowel, cholecystectomy and
spinal surgery. Investigating the factors behind these increases should be considered a priority.
The previously identified upward trend in the rate of SSI for knee prosthesis was not sustained in 2012/13 with a
small decrease observed between 2011/12 and 2012/13.
Nine NHS Trusts were identified as high outliers in 2012/13 for the mandatory orthopaedic surveillance with an
incidence of SSI higher than expected nationally and 13 NHS Trusts identified as low outliers. These Trusts have
been contacted and asked to undertake further investigations.
SSIs with Gram-positive aetiology (both monomicrobial and polymicrobial) accounted for 54% of cases; those with
Gram-negative aetiology (both monomicrobial and polymicrobial) accounted for 27% of total cases. Gram-positive
and Gram-positive combinations comprised 13.0% of total cases. The remainder (6%) comprised cases involving
fungi and unidentified bacteria.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
References
1. “Surgical site infection surveillance in NHS hospitals in England, 2012/13” (2.2 MB PDF). Legacy HPA website:
Home › Publications › Infectious diseases › Surgical site infection reports.
2. “English National Point Prevalence Survey on Healthcare-associated infections and Antimicrobial Use, 2011:
preliminary data” (2012), http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317134304594.
3. Plowman R, Graves N, Griffin MA, Roberts JA, Swan AV, Cookson B et al . The rate and cost of hospitalacquired infections occurring in patients admitted to selected specialties of a district general hospital in England
and the national burden imposed. J Hosp Infect 2001; 47:198-209.
4. Coello R, Charlett A, Wilson J, Ward V, Pearson A, Borriello P. Adverse impact of surgical site infections in
English hospitals. J Hosp Infect 2005; 60: 93-103.
5. Cahill JL, Shadbolt B, Carvell JM, Smith PN, Quality of life after infection in total joint replacement. J Othop Surg
2008; 16(1): 58-65.
6. National Institute for Health and Care Excellence. Surgical Site Infection Quality Standards, QS49. 2013.
London, National Institute for Health and Care Excellence.
HPV vaccination programme coverage and effectiveness evaluated
Latest annual data published by Public Health England indicates that the Human Papillomavirus (HPV) national
vaccination programme coverage rate remained high in 2012 to 2013, with 86% of the target age group (12- to 13year-old girls) in England receiving the full course [1,2]. The programme began in 2008, offering routine
immunisation to 12 year-old girls and catch-up immunisation to girls up to 18 years, in three doses.
In addition, findings from a recent Public Health England study of HPV surveillance data provide the first indication
that the national HPV immunisation programme is successfully preventing HPV infection in young sexually active
women in England [3].
Results from 4,178 residual specimens from women aged 16-24 years undergoing chlamydia screening in 2010 to
2012 were compared with similar specimens taken in 2008 prior to the introduction of the HPV immunisation
programme. The post-immunisation prevalence of HPV 16/18 infection was lowest in the youngest age group (1618 years) and increased with increasing age. This increase with age was a reversal of the pattern seen prior to the
introduction of the immunisation programme and was inversely associated with estimates of age-specific
immunisation coverage. The prevalence of HPV 16/18 infection in the post-immunisation survey was 6.6%
amongst 16-18 year olds (with an estimated coverage of 65%), compared to 17.6% in the similar survey conducted
in 2008.
HPV types 16 and 18 are the two HPV types which are included in both HPV vaccines and have caused around
70-80 percent of cervical cancers. For the estimated vaccine coverage, the reductions seen are consistent with
high vaccine effectiveness and likely herd- protection. The surveillance continues and will also monitor the effects
of immunisation on non-vaccine HPV types.
The benefits delivered by the immunisation programme are in addition to the considerable benefits provided to
women by the national Cervical Cancer Screening Programme. Cervical screening remains important for women to
reduce their risk of cervical cancer as vaccination does not protect against all cancer-causing HPV types.
References
1. "National HPV vaccination coverage remains high and evidence shows programme effective in protecting
women’s health" PHE press release, 12 December 2013.
2. PHE statistics on GOV.UK. “Annual HPV vaccine coverage 2012 to 2013: by PCT and SHA”, 10 December
2013.
3. Mesher D, Soldan K, Howell-Jones R, Panwar K, Manyenga P Jit M, et al (6 November 2013, online).
"Reduction in HPV 16/18 prevalence in sexually active young women following the introduction of HPV
immunisation in England", Vaccine 32 (2014) 26-32.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
PVL pneumonia exceedance (England, Dec 2012- May 2013) investigation
report
An investigation into a national increase in PVL-positive Staphylococcus aureus (PVL-SA) pneumonia cases that
occurred in England between December 2012 and May 2013, with a high case-fatality rate, has concluded that
hospital microbiologists should remain vigilant for these cases during the current 2013/14 influenza season. PHE's
Antimicrobial Resistance and Healthcare Associated Infections Reference Unit (AMRHAI) is continuing to keep
these infections under enhanced surveillance.
More PVL-pneumonia cases than expected were seen in the 2012/13 influenza season. All AMRHAI-confirmed,
PVL-positive S. aureus blood cultures and respiratory specimens associated with lower respiratory tract infection,
from specimens dated between 1 December 2012 and 10 May 2013, were investigated with a view to describing
the cases and determining the extent of influenza co-infection.
Of the 54 cases identified, 31 (57%) were female and 23 (43%) were male with an age distribution from under one
year to over 90 years (median age 44 years). Of the 41 cases with information, the majority were of white ethnicity
(31, 76%) compared to other ethnic groups (10, 24%). One third of cases (18/54) died within 21 days of onset of
their illness. The investigation showed 20 of the 29 cases (69%) with influenza testing information, tested positive
for Influenza infection.
Clinicians are advised to maintain a high index of suspicion for PVL-SA in cases of severe pneumonia, to be aware
of potential influenza co-infection and are reminded to refer S. aureus isolates from these cases to AMRHAI for
PVL-testing. The clinical and public health management of PVL-SA cases (including pneumonia) remains
unchanged and includes microbiological sampling, antimicrobial therapy and decolonisation of cases and their
close contacts in accordance with national guidelines [1].
Reference
1. PVL sub-group of the Steering Group on Healthcare Associated Infection (2008). Guidance on the diagnosis and
management of PVL-associated Staphylococcus aureus infections (PVL-SA) in England (second edition). Legacy
HPA website: Home › Topics › Infectious Diseases › Infections A-Z › Staphylococcus aureus › Guidelines ›
Staphylococcus aureus Guidelines.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Infection reports
Volume Numbers 50-51 Published on: 13 and 20 December 2013
Immunisation* *
Laboratory-confirmed cases of pertussis reported to the enhanced pertussis surveillance programme
(England): July to September 2013
Pertussis Vaccination Programme for Pregnant Women: Vaccine coverage estimates in England, October
2012 to September 2013
Invasive meningococcal infections laboratory reports (England): July to September 2013
Quarterly vaccination coverage statistics for children aged up to five years in the UK (COVER programme):
July to September 2013
Bacteraemia* *
Uncommon pathogens associated with bacteraemia: England, Wales and Northern Ireland, 2008-2012
HCAI * *
Trends in mandatory Staphylococcus aureus (MRSA and MSSA) and Escherichia coli bacteraemia, and
Clostridium difficile infection (CDI): data for England up to July-September 2013
Enteric*
General outbreaks of food-borne illness, laboratory reports of common gastro-instestinal infections and
hospital norovirus outbreaks (weeks 45-48/2013); and salmonella infections (October 2013)
* Published in HPR 7(50) on 13/12/2013.
** Published in HPR 7(51) on 20/12/2013.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Immunisation
Laboratory-confirmed cases of pertussis reported to the enhanced pertussis surveillance
programme (England): July to September 2013
Pertussis Vaccination Programme for Pregnant Women: Vaccine coverage estimates in England,
October 2012 to September 2013
Invasive meningococcal infections laboratory reports (England): July to September 2013
Quarterly vaccination coverage statistics for children aged up to five years in the UK (COVER
programme): July to September 2013
Laboratory confirmed cases of pertussis reported to the enhanced pertussis
surveillance programme during July to September 2013
In England there were 1130 laboratory confirmed cases of pertussis (culture, PCR, serology or oral fluid) reported
to the Public Health England pertussis enhanced surveillance programme in the third quarter of 2013, from July to
September (table 1). This was a 1% increase on the number of cases reported in the previous quarter (1122 in
April to June 2013) and a 68% decrease on cases reported in the same quarter of 2012 (3519 cases between July
and September 2012). There were 54 laboratory confirmed cases reported in Wales between July and September
2013, a 10% increase on the 49 cases reported in the second quarter in 2013.
Typically pertussis activity peaks in quarter 3 and then declines (figure 1). The continued increase observed in
each successive quarter between the first quarter of 2011 and third quarter of 2012 was unusual. The HPA
declared a national outbreak of pertussis (level 3 incident [1]) in April 2012 and, as a response to the ongoing
outbreak, the Department of Health announced the introduction of a temporary immunisation programme for
pregnant women on 28 September 2012 [2]. The most recent PHE figures report that of the mothers due to give
birth in July, August and September 2013, 55.7%, 56.4% and 56.4% respectively had been immunised with a
pertussis containing vaccine in pregnancy in England [3].
Confirmed cases of pertussis fell in the fourth quarter of 2012 and this decrease continued in the first and second
quarter of 2013 with a slight increase in the third quarter in line with the usual seasonal pattern. The highest
number of laboratory confirmed cases in England continued to occur in individuals aged 15 years and over who
accounted for 86% of cases (973/1130); this compares with 84% (2959/3519) of cases in this age group reported in
the third quarter of 2012. Whilst disease incidence continued to be highest in infants <3 months, the proportion of
cases in this age group fell from 4% (147/3519) in the third quarter of 2012, to 2% (21/1130) between July and
September 2013. Confirmed cases in infants less than 3 months were 86% lower in the third quarter of 2013 (21
cases) than the equivalent quarter in 2012 (147 cases). No pertussis related infant deaths were reported between
July and September 2013 compared to 5 deaths in the same quarter in 2012.
These early data in young infants following the introduction of a programme to immunise pregnant women are
encouraging. It is important to be aware, however, that high levels of pertussis persist in older age groups. Women
should continue to be encouraged to be immunised against pertussis during pregnancy in order to protect their
babies from birth.
Laboratory-confirmed cases of pertussis by age and testing method in England, July to September 2013
Age group
Culture
PCR
Serology
Oral fluid only
Total
<3 months
9
12
–
–
21
3-5 months
1
3
–
–
4
6-11 months
2
1
–
–
3
1-4 years
2
2
10
–
14
5-9 years
1
–
26
–
27
10-14 years
3
1
69
15
88
15+ years
16
12
935
10
973
Total
34
31
1040
25
1130
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Total number of laboratory-confirmed pertussis cases per quarter in England, 2005 to 2013 (Q3)
Laboratory investigation
Bordetella pertussis PCR (for hospitalised cases <1 year old) and serological investigation by estimation of antipertussis toxin (PT) IgG antibody levels for older children and adults are provided by the Respiratory and Vaccine
Preventable Bacteria Reference Unit (RVPBRU) at the Public Health England (PHE) Microbiology Services
Division Colindale.
The PCR service for hospitalised infants under one year requires either a pernasal swab or nasopharyngeal
aspirate to be sent as soon as possible post-onset; for the pertussis serology service for older children and adults
not less than 400 µl of separated serum should be sent at least 2-3 weeks post-onset.
The laboratory also encourages submission of all Bordetella pertussis isolates for confirmation and national
surveillance purposes. Since January 2013, the RVPBRU is offering an oral fluid (OF) testing service for clinically
suspected cases, reported to the local Health Protection Team, who are aged between 5 and 16 years (<17yrs),
who have been coughing for more than two weeks and who have not been immunised against pertussis in the
previous year. A new PCR community testing pilot for all age groups began at the end May 2013 and requires a
pernasal and OF swab to be sent to RVPBRU for testing.
Further information is available on the HPA legacy website at http://www.hpa.org.uk/cfi/rsil/bordetella.htm.
References
1. Health Protection Report 6(15), 13 April 2012, http://www.hpa.org.uk/hpr/archives/2012/news1512.htm#prtsss.
2. Department of Health: https://www.gov.uk/government/news/pregnant-women-to-be-offered-whooping-coughvaccination.
3. Department of Health: https://www.gov.uk/government/publications/pertussis-vaccine-uptake-in-pregnantwomen-october-2012-to-september-2013.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Pertussis Vaccination Programme for Pregnant Women: Vaccine coverage
estimates in England, October 2012 to September 2013
Background to the pertussis vaccination in pregnancy programme
In the UK the introduction of routine national immunisation against pertussis in 1957 resulted in a marked reduction
in pertussis notifications and deaths [1]. Despite a sustained period of high vaccine coverage since the early 1990s,
however, pertussis continues to display 3-4 yearly peaks in activity with a yearly average of; 800 cases of
whooping cough, over 300 babies admitted to hospital and four deaths in babies each year [HPA unpublished
reconciled data]. The highest disease incidence occurs in infants under three months of age who are too young to
have completed the primary vaccine course and have the greatest risk of complications and death. In 2012,
pertussis activity increased beyond levels reported in the previous 20 years and extended into all age groups,
including infants less than three months of age. This young infant group is considered a key indicator of pertussis
activity [2] and the primary aim of the pertussis vaccination programme is to minimise disease, hospitalisation and
death in young infants.
A national outbreak (level 3 incident) was declared in April 2012 by the then Health Protection Agency to
coordinate the response to the increased pertussis activity [3]. In response to this on-going outbreak, the
Department of Health announced on 28 September [4] that pertussis immunisation would be offered to pregnant
women from 1 October 2012 to protect infants from birth whilst disease levels remain high. This programme aims
to passively protect infants from birth, through intrauterine transfer of maternal antibodies, until they can be actively
protected by the routine infant programme with the first dose of pertussis vaccine scheduled at eight weeks of age.
It has been confirmed that this programme will be continued in 2013/2014 until further notice, pending further
advice from the Joint Committee on Vaccination and Immunisation [5]. Early epidemiological data are encouraging
and consistent with a specific programme effect on infants but immunisation of pregnant women continues to be
important in the face of persisting raised levels of pertussis in non-infant age groups [6,7].
Vaccine coverage collection
In England, monthly data on the uptake of pertussis immunisation in pregnancy are collected through the ImmForm
website and are monitored, validated and analysed by PHE. This data collection is vital to monitor the uptake of the
programme, to identify areas of low coverage and inform public health actions.
Methods
GPs identify those women in their practice that are eligible for vaccination on their GP systems. The monthly
denominator reported is the number of pregnant women with an estimated date of delivery (EDD) in that month.
GPs should record the EDD through the patient's electronic health record. The monthly numerator is the number of
women identified in the denominator defined above who have received a dose of Repevax® at, or after, the twentyeighth week of their pregnancy and before the EDD.
At the start of the programme in October 2012, until March 2013, PCT Immunisation Co-ordinators were
responsible for collating vaccine coverage data from GP practices and manually entering it on the ImmForm
website. Since 1 April 2013, Area Team Screening and Immunisation teams have been responsible for the timely
submission and accuracy of this data.
To aid data collection from practices and reduce burden on Area Teams, a new data entry collection tool is now
available on ImmForm for GPs and other vaccinating organisations to use.
All submitted GP data were reviewed and collated by the Area Team before submission to the monthly survey.
Data collections have been requested at different organisational levels: for the October 2012 to March 2013
surveys, data were submitted at PCT level; from April 2013, data were provided at Area Team level. To allow direct
comparison of monthly coverage estimates PCT data were aggregated to Area Team level (see table).
This report updates the previous summary for the first nine months of the pertussis vaccination programme for
pregnant women [8] presenting data for the first year of the programme.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Results
The table shows the monthly estimates of pertussis vaccine coverage in pregnant women by Area Team for the
period October 2012 to September 2013. Monthly vaccine coverage at the national level increased during the first
five monthly surveys from 43.7% in October 2012 to 59.4% in February 2013. Between March and June 2013
coverage declined progressively to 50%, but subsequently increased and stabilised at around 56% in the three
months July to September.
Based on a total of 679,100 live births in England (2011), the number of pregnant women with an EDD in any one
month is estimated to around 56,600. The total number of women reported in each survey varied considerably,
both by month of report and by Area Team. The highest number of pregnant women reported in the denominator
was for December 2012 when 45,793 pregnant women with an EDD in that month were reported, approximately
81% of the expected England total; the smallest number of pregnant women reported was for August, 29,218
representing only 53% of the expected. Considerable variation was observed between the number of pregnant
women reported by Area Teams within a month, and between different months for the same Area Teams during
the first nine months of the surveillance programme [8].
In the most recent three months, minimum Area Team coverage estimates improved and only one Area Team
reported below 50% coverage (London Area Team reported coverage between 40.3-42.9% . National monthly
denominators continued to vary markedly (range 29,218 - 32,815).
Discussion
The coverage estimates reported in the first year of this surveillance programme have varied between Area Teams,
and by month of reporting at both the national and Area Team level. Coverage of eligible pregnant women
receiving pertussis vaccine before their EDD increased steadily from 43.7% in October 2012 to a peak of 59.6% in
February 2013. Between March and June coverage dipped to around 50% but subsequently increased and
stabilised at around 56% in the three months July to September during which time only one Area Team reported
less than 50% of pregnant women as vaccinated .
These data are encouraging but should be interpreted with caution, particularly at the Area Team level as
denominators reported vary considerably month-on-month and it is possible that coverage levels are indeed higher
due to under-reporting of pregnant women in the surveys; continued monitoring therefore is important.
Continued support in the delivery of this important programme is being sought from service providers (GP practices
and maternity units) through Screening and Immunisation Teams to update them on the current epidemiology of
the disease, the effectiveness of the vaccination programme and the need to maintain and improve the high
coverage achieved.
Further information on the pertussis vaccination programme for pregnant women is available at:
http://www.hpa.org.uk/Topics/
InfectiousDiseases/InfectionsAZ/WhoopingCough/ImmunisationForPregnantWomen/
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Monthly pertussis vaccine coverage (%) for pregnant women by Area Team: England, October 2012 to
September 2013
Oct
12
Nov
12
Dec
12
Jan
13
Feb
13
Mar
13
Apr
13
May
13
Jun
13
July
13
Aug
13
Sept
13
Cheshire, Warrington
and Wirral (Q44)
24.0
51.5
45.1
58.9
55.2
65.7
61.0
60.6
62.5
48.6
52.6
50.9
Durham, Darlington
and Tees (Q45)
77.5
58.0
23.0
36.8
61.5
15.2
21.8
13.9
10.5
51.8
53.8
60.8
Greater Manchester
(Q46)
45.0
60.7
71.8
59.8
69.1
72.3
54.6
48.1
47.3
51.2
59.7
60.4
Lancashire (Q47)
45.1
53.3
54.5
56.8
45.8
67.4
55.6
48.3
47.6
53.2
50.5
57.2
Merseyside (Q48)
17.7
52.3
63.7
66.4
61.8
65.7
61.4
61.2
59.1
76.4
66.6
70.4
Cumbria,
Northumberland, Tyne
and Wear (Q49)
51.6
55.5
73.8
64.6
73.1
59.8
60.4
47.9
55.0
57.4
63.4
61.5
N Yorkshire and
Humber (Q50)
60.8
38.8
17.2
23.1
17.7
18.5
17.5
18.6
15.9
65.9
70.5
71.8
S Yorkshire and
Bassetlaw (Q51)
42.1
59.9
66.0
64.9
62.7
64.7
64.2
62.7
58.0
62.4
66.7
65.2
W Yorkshire (Q52)
24.1
45.0
56.3
62.3
54.5
56.5
58.8
58.9
53.8
51.3
49.9
53.2
Arden, Herefordshire
and Worcestershire
(Q53)
50.4
67.8
76.5
73.4
77.7
72.0
63.6
53.5
58.9
52.7
58.0
59.2
Birmingham and the
Black Country (Q54)
47.7
62.3
67.8
66.6
62.0
63.6
51.5
46.0
44.4
59.0
53.9
56.8
Derbyshire and
Nottinghamshire (Q55)
51.7
63.6
71.9
73.9
69.7
70.1
73.5
69.9
71.2
68.9
70.3
68.9
East Anglia (Q56)
37.8
58.9
53.3
56.4
74.5
46.7
65.9
66.6
62.0
64.9
66.5
64.0
Essex (Q57)
38.1
54.8
77.0
75.4
60.9
66.4
59.4
60.7
55.9
58.1
58.8
58.5
Hertfordshire and the
S Midlands (Q58)
57.8
48.1
55.3
56.4
56.4
58.1
70.1
61.5
61.9
58.0
51.8
52.0
Leicestershire and
Lincolnshire (Q59)
49.1
57.8
69.6
67.4
65.6
66.8
67.0
68.0
66.3
71.1
69.1
70.2
Shropshire and
Staffordshire (Q60)
48.7
43.5
76.1
78.1
70.7
68.9
65.8
72.6
68.6
67.4
64.7
67.2
Bath, Gloucestershire,
Swindon and Wiltshire
(Q64)*
44.8
52.1
67.4
63.7
68.5
62.9
63.0
57.3
61.9
62.9
67.5
68.7
Bristol, N Somerset,
Somerset and S
Gloucestershire (Q65)*
48.2
65.9
66.2
74.6
68.5
70.0
70.6
60.8
65.8
62.9
60.3
59.1
Devon, Cornwall and
Isles of Scilly (Q66)*
43.8
61.7
71.1
76.5
65.3
76.3
77.4
85.8
75.9
57.3
67.2
68.4
Kent and Medway
(Q67)*
52.5
58.0
69.1
73.6
69.9
67.2
n/a
n/a
64.3
59.6
55.6
59.6
Surrey and Sussex
(Q68)*
40.8
55.7
70.5
75.3
71.8
67.7
62.7
66.8
66.2
63.6
61.9
62.6
Thames Valley (Q69)*
35.5
37.9
57.3
53.0
62.1
57.9
61.6
57.5
58.5
51.2
55.5
56.2
Wessex (Q70)*
35.9
55.4
63.2
67.9
52.8
68.4
61.7
59.8
61.9
57.1
57.8
59.2
London (Q71)*
35.8
41.5
36.1
48.6
53.3
49.4
34.8
34.0
33.5
40.5
42.9
40.3
ENGLAND
43.7
52.0
54.5
59.4
59.6
57.2
52.6
50.0
49.8
55.7
56.4
56.4
Area Team
Monthly reported
denominator
41643 42651 45793 35001 29790 31579 33304 34296 38537 31314 29218 32815
Note. This table was originally published on 29 November 2013 at: https://www.gov.uk/government/publications/pertussis-vaccineuptake-in-pregnant-women-october-2012-to-september-2013. Data for July, August and September was transposed for eight Area
Teams (indicated in the table by*). The corrected data are included in this revised table and an amended table will also be uploaded to
the weblink given above.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
References
1. Amirthalingam G, Gupta S, Campbell H. Pertussis immunisation and control in England and Wales, 1957 to
2012: a historical review. Euro. Surveill. 2013; 18(38). Available online:
http://eurosurveillance.org/images/dynamic/EE/V18N38/art20587.pdf.
2. Campbell H, Amirthalingam G, Andrews N, Fry NK, George RC, Harrison TG, Miller E. Accelerating control of
pertussis in England and Wales. Emerging Infectious Diseases 2012; 18(1): 38-47.
3. A level 3 incident is the third of five levels of alert under the HPA's Incident Reporting and Information System
(IERP) according to which public health threats are classified and information flow to the relevant outbreak control
team is coordinated. A level 3 incident is defined as one where the public health impact is significant across
regional boundaries or nationally. An IERP level 3 incident was declared in April 2012 in response to the ongoing
increased pertussis activity (HPR 6(15), http://www.hpa.org.uk/hpr/archives/2012/news1512.htm)
4. “Pregnant women to be offered whooping cough vaccination”, 28 September 2012. Department of Health
website, http://www.dh.gov.uk/health/2012/09/whooping-cough/.
5. Department of Health, Public Health England, NHS England. “Continuation of temporary programme of pertussis
(whooping cough) vaccination of pregnant women” https://www.gov.uk/government/publications/whooping-coughvaccination-programme-for-pregnant-women-extension-to-2014.
6. Laboratory confirmed pertussis cases in England: data to end-July. HPR 7(39): news, 27 September 2013,
http://www.hpa.org.uk/hpr/archives/2013/hpr3913.pdf.
7. Laboratory-confirmed cases of pertussis reported to the enhanced pertussis surveillance programme (England):
July to September 2013. HPR 7(51).
8. Pertussis vaccination programme for pregnant women: vaccine coverage estimates in England, October 2012 to
June 2013. HPR 7(40): immunisation, 4 October 2013, http://www.hpa.org.uk/hpr/archives/2013/hpr4013.pdf.
Invasive meningococcal infections laboratory reports (England): July to
September 2013
There In England between July and September 2013, a total of 96 cases of invasive meningococcal disease (IMD)
were reported to Public Health England (PHE, formally the Health Protection Agency) [1]. This was a 52%
decrease from the 202 cases reported in the second quarter of 2013 [2], in line with seasonal patterns, and a 25%
decrease from the 128 cases reported in the third quarter of 2012. Three cases of IMD were reported in the third
quarter of 2013 in Wales.
Of the 96 cases of IMD reported in England; 73% (70) were capsular group B, 15% (14) group W, 9% (9) group Y
and 3%(3) group C. There were no reported cases for capsular groups A, X and Z/E (table 1) in England during this
period. Of the three IMD cases reported to PHE from Wales two were capsular group B and one capsular group W.
Forty-eight per cent (46/96) of IMD cases reported in England were female. In England, children aged less than
one year accounted for 25% (24/96) of the IMD reports. More than half of infant cases (63%; [15/24]) were aged
between six and 11 months, and of these; 14 were group B and one was group Y. In nine infants with IMD aged
between zero and five months, eight had capsular group B and one group W. A fifth (19%; [18/96]) of cases were in
children aged between one and four years of which all were capsular group B (table 2). Over half of the capsular
group B cases (57%; [40/70]) were in children aged under five years of age. Individuals aged 25 to 64 years
accounted for half (50%; [7/14]) of all capsular group W disease followed by individuals aged between 15 and 24
years (36%; [5/14]). Of the nine capsular group Y cases, 44% (4/9) were in adults aged 45 and over and 22% (2/9)
were in individuals aged 15-24 years.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Table 1. Invasive meningococcal disease in England by capsular group and laboratory testing method,
weeks 27-39 (Q3), 2012 and 2013
Method of diagnosis
Cumulative total,
weeks 1 to 39
(Q1 to Q3)
Total
Blood and/or
CSF
isolate
Blood and/or
CSF nonculture
2012
(Q3)
2013
(Q3)
2012
(Q3)
2013
(Q3)
2012
(Q3)
2013
(Q3)
2012
(Q3)
2013
(Q3)
2012
2013
A
–
–
–
–
–
–
–
–
–
–
B
40
30
62
39
1
1
103
70
438
417
C
6
3
1
–
–
–
7
3
23
24
W
6
11
1
3
–
–
7
14
28
48
X
–
–
–
–
–
–
–
–
–
–
Y
6
6
1
2
1
1
8
9
50
49
Z/E
–
–
–
–
–
–
–
–
1
–
Ungrouped
–
–
1
–
–
–
1
–
5
2
Ungroupable*
2
–
–
–
–
–
2
–
3
6
Total
60
50
66
44
2
2
128
96
548
546
Capsular
groups
Other sites
culture
* Ungroupable refers to invasive clinical meningococcal isolates that were non-groupable, while ungrouped cases refers to culturenegative but PCR screen (ctrA) positive and negative for the four genogroups [B, C, W and Y] routinely tested for.
Table 2. Invasive meningococcal disease in England by capsular group and age at diagnosis, weeks 27-39
(Q3), 2013
Capsular
group
<1
1-4
5-9
10-14
15-19
20-24
25-44
45-64
65+
Total
A
–
–
–
–
–
–
–
–
–
–
B
22
18
6
1
7
4
5
2
5
70
C
–
–
1
–
–
–
1
–
1
3
W
1
–
1
–
3
2
4
3
–
14
X
–
–
–
–
–
–
–
–
–
–
Y
1
-
1
–
1
1
1
1
3
9
Z/E
–
–
–
–
–
–
–
–
–
–
Ungrouped
–
–
–
–
–
–
–
–
–
–
Ungroupable
–
–
–
–
–
–
–
–
–
–
24
18
9
1
11
7
11
6
9
96
Total
References
1. Data source: PHE Meningococcal Reference Unit
2. Health Protection Report 7(34) (23 August 2013), http://www.hpa.org.uk/hpr/archives/2013/hpr3413.pdf.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Quarterly vaccination coverage statistics for children aged up to five years
in the UK (COVER programme): July to September 2013
UK MMR coverage at two years continues to increase and is now 93.2%, up 0.2% compared to the previous
quarter [1]. The WHO target of 95% coverage has been achieved for the third successive quarter by all three
devolved administrations. In Wales, MMR coverage increased by 2.5% to 98.4% and, for the first time, coverage
exceeded 95% in all health boards and local authority areas. These two year olds would have been scheduled to
receive their first dose of MMR vaccine in the months prior to the large outbreak of measles which affected Wales
from November 2012 to July 2013, and the high coverage achieved reflects the efforts invested by Health Boards
and GPs to increase MMR coverage during the measles outbreak. [2] The improvement in coverage is also likely to
reflect an increased awareness in parents of the risks associated with measles. [2]. In England , nine of 25 English
Area Teams achieved the 95% target and a further six English Area Teams achieved 94%, increasing national
coverage in England by 0.1% to 92.7%. UK coverage of the first dose of MMR evaluated at five years remained at
94.8% with Scotland, Northern Ireland, Wales and 18 English Area Teams achieving at least 95% coverage.
Coverage of the second dose of MMR in the UK increased by 0.1% to 89.1% compared to the previous quarter,
with Wales, Northern Ireland, Scotland and 18 English Area Teams achieving at least 90%. For other vaccines
evaluated at 24 months and 5 years, UK vaccine coverage remained at very similar levels compared to the
previous quarter [1].
Country-specific comparisons for minimum coverage levels achieved for all three immunisations evaluated at 12
months (DTaP/IPV/Hib3, MenC2 and PCV2) show Scotland and Northern Ireland achieved at least 96% coverage,
Wales at least 95% and England at least 93%; within England 12 Area Teams achieved at least 95%.
A decrease of 1% (to 93.6%) was observed for UK MenC2 coverage at one year and was seen in all countries
(range -0.5% to – 1%). This drop is likely to be related to the removal of the second dose of MenC at age 16 weeks
(four months) from the routine schedule for infants from 1 June 2013 [3]. Although the children evaluated at 12
months (born between July and September 2012) were scheduled to have their primary MenC immunisations at 3
and 4 months (between October 2012 and January 2013) some may not have received both doses on time. Those
infants who received a first dose of Menjugate Kit® but not a second dose by 1 June 2013, did not need a second
dose after 1 June 2013. Those who received a first dose of Meningitec® but not a second dose by 1 June 2013
should have received a second dose of vaccine, which should preferably be either Meningitec® or Menjugate Kit®
[3]. This schedule change is likely to adversely impact on future quarterly MenC2 coverage evaluations until the
April to June 2013 quarter, when infants exclusively offered one dose of MenC will be evaluated.
New format for COVER data in England from April 2013
From April 2013, commissioning and coordination of immunisation programmes is the responsibility of NHS
England [4]. Given the transfer of responsibility for public health, however, to local authorities (LAs) on 1st April
2013, population vaccination coverage is included in the Public Health Outcomes Framework (PHOF) (Indicator
3.3) [5]. In line with all the outcomes indicators, population vaccination coverage is expected to be collected for LA
resident population. Primary Care Trusts (PCT) coverage collections in the NHS have been based around
responsible population (ie patients who are registered with a GP in the PCT or unregistered patients who reside in
the PCT area).
In order to ensure that accurate PHOF vaccine coverage data are available, the Health Protection Agency (HPA)
Immunisation Department surveyed Primary Care Trusts (PCTs) immunisation coordinators and Child Health
Information System (CHIS) managers in February 2013. The aim was to understand which CHIS systems can
currently produce reliable LA resident population data. Several responses indicated that using LA resident
population data would lead to a drop in vaccination coverage because the organisation with responsibility for
delivery of the immunisation programme is different from the organisation with responsibility for data. It was
therefore proposed, and agreed with the PHOF team, that vaccination coverage data (Indicator 3.3) be collected by
LA responsible population – meaning coverage would be supplied for patients registered with GPs based in that LA
and for unregistered patients who were resident in that LA. For LAs that are co-terminus with a PCT this will
approximate to the PCT responsible population. Those LAs not coterminous with PCT boundaries may need to
collate data from more than one CHIS to provide LA responsible population coverage data.
From April 2013, quarterly request parameters for COVER data in England have been simplified in line with the
PHOF outcome sub-indicators [6], and are requested in two formats, (i) by PCT responsible population to allow for
continuity with historical data and (ii) by LA responsible population (as defined above). Individual PCT, and where
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
available LA, data are published on the HPA website this quarter [6]. To reflect the new NHS organisations in
England COVER reports present coverage data by English Area Teams (tables 1a-4a). Former Strategic Health
Authorities tabulations are also provided for historical comparisons (tables 1b-4b).
Pilot collection of GP practice-level COVER data by NHS England in February 2014
To enable NHS England to commission effectively and to tackle inequalities in access locally vaccine coverage
data also needs to be collected at a lower geography. NHS England is piloting a collection of GP practice-level
data, to be submitted directly by providers to the Unify2 system in a single collection from their CHIS. This
collection will include data for unregistered children aggregated at CCG level. This approach has been ratified by
the Public Health Steering Group leads within NHS England, Department of Health and PHE. Providers utilising
CHISs will be contacted by their CHIS commissioners in late December 2013 to establish logins for Unify2. It is
planned that the new GP-level quarterly collection, which will match the existing COVER parameters, will
commence for the October to December 2013 quarter (2013/14 Quarter 3) collection in February 2014, at the same
time as the routine quarterly COVER return. Quarter 1, Quarter 2 and Quarter 3 GP level data will be collected
simultaneously. The new collection will only take place in England. Detailed guidance and Frequently Asked
Questions documents are currently under development and will be published on the NHS England website as soon
as they are available. For further clarification regarding the proposed changes, please contact:
[email protected].
The intention is for the NHS England and routine PHE quarterly COVER collections to run in parallel to assure data
quality and comparability. Longer term, both collections should be replaced by the Maternity and Children's Dataset
(MCDS). The Health & Social Care Information Centre (HSCIC) are developing a children and young people's
dataset as part of the MCDS. Consideration will be given to the collection of historical data for the full MCDS back
to April 2013. The MCDS will run in parallel with the collection of the existing aggregate returns until it is of
sufficient quality to be used to populate the PHOF indicators. More details about the dataset are available on the
HSCIC website at http://www.hscic.gov.uk/maternityandchildren.
Results for July to September 2013
This report presents quarterly coverage data for children in the UK who reached their first, second, or fifth birthday
during the evaluation quarter (July to September 2013). This is the second quarterly data to be collected since the
re-organisation of the NHS in England.
Children who reached their first birthday in the quarter (born July to September 2012) would have been scheduled
to receive their primary vaccinations according to the schedule introduced on 4 September 2006 [6] (three doses
diphtheria, tetanus, acellular pertussis, polio, and Haemophilus influenzae type b vaccine (DTaP/IPV/Hib vaccine),
two doses each of meningococcal serogroup C conjugate vaccine (MenC vaccine) and pneumococcal conjugate
vaccine (PCV).
Children who reached their second birthday in the quarter (born July to September 2011) would have been
scheduled to receive their third dose primary vaccinations between November 2011 and February 2012, and their
first measles, mumps, and rubella (MMR) vaccination, a booster dose of Hib and MenC vaccine (given as a
combined Hib/MenC vaccine) and PCV vaccine at the same visit at 12 months of age, between August and
October 2012 [7].
Children who reached their fifth birthday in the quarter (born July to September 2008) would have been scheduled
to receive their third dose DTaP/IPV/Hib and second MenC and PCV vaccinations between November 2008 and
February 2009. They would have been scheduled to receive their first MMR between August and October 2009,
their pre-school diphtheria, tetanus, acellular pertussis, inactivated polio booster and second dose MMR from
October 2011. Children born between July to September 2008 were scheduled to receive Hib/MenC booster
vaccine at 12 months and PCV booster vaccine at 13 months [8].
Methods of data collection for COVER coverage are described on the legacy HPA website [7].
Participation and data quality
Data were received from all Health Boards (HBs) in Scotland , Northern Ireland and Wales. In England , this is the
second quarter collecting data from the new structures in the reorganised NHS and requesting coverage data in
two formats; by PCT and by Local Authority (LA). There are some challenges in maintaining data flows for the PCT
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
level collection as these organisations formally ceased to exist on 1 st April 2013 and some Child Health
Information Systems (CHISs) have moved to extracting at the Clinical Commission Group (CCG) level; these data
were aggregated to PCT level based on GGC postcode. In addition, many CHISs are not able to currently provide
accurate LA level coverage data by the resident population, however, where LAs are coterminous with a former
PCT boundary coverage data for the responsible population PCT will approximate to the LA responsible population
[1]. For those LAs not coterminous with PCT boundaries many areas were not able to provide LA responsible
population coverage data. Coverage data by individual PCT and LA, where available, will be published on the HPA
legacy website [9].
Area Teams (AT) and Child Health Records Departments (CHRDs) submitted data for all PCTs in England,
however, 12 month data for one London PCT have been omitted from this report due to data quality issues, and
three PCTs, all using the same child health information system provider, reported data quality issues with five year
Hib/MenC data, these have also been omitted from the analysis.
Coverage at 12 months
UK coverage at 12 months for DTaP/IPV/Hib3 and PCV2 decreased by 0.3% compared to levels in the previous
quarter, and MenC2 decreased by 1.0% (table 1a) [1]. Country-specific comparisons for minimum coverage levels
achieved for all three immunisations evaluated at 12 months show Scotland and Northern Ireland achieved at least
96% coverage, Wales at least 95% and England at least 93%; within England 12 ATs achieved at least 95%
(tables 1a).
Within the UK, 126 of the 175 participating PCTs/HBs (72%) achieved at least 95% coverage at 12 months for
DTaP/IPV/Hib3, 121 (69%) achieved 95% for two doses of PCV, and 94 (54%) for two doses of MenC vaccine.
Table 1a. Completed primary immunisations at 12 months by country and English Area Team: July to
September 2013 (April to June 2013)
Country and English Area Team (AT
code)
Number of
PCTs/HBs†
DTaP/IPV/Hib3
%
MenC2
%
PCV2
%
175 ¥
94.8 (95.1)
93.6 (94.6)
94.7 (95.0)
Wales
7
96.7 (96.7)
95.9 (96.4)
96.4 (96.2)
Northern Ireland
4
97.4 (97.7)
96.8 (97.7)
97.4 (97.7)
Scotland
14
97.6 (97.6)
96.8 (97.3)
97.7 (97.7)
150 ¥
94.3 (94.7)
93.1 (94.1)
94.3 (94.6)
Cheshire, Warrington and Wirral (Q44)
4
96.8 (96.6)
96.0 (96.7)
97.1 (97.0)
Durham, Darlington and Tees (Q45)
6
96.5 (96.9)
96.0 (96.6)
96.2 (96.4)
Greater Manchester (Q46)
10
96.8 (96.5)
94.9 (96.0)
96.3 (96.2)
Lancashire (Q47)
5
91.0 (94.7)
90.2 (94.5)
90.5 (94.2)
Merseyside (Q48)
4
95.2 (95.6)
94.3 (96.2)
95.6 (96.4)
Cumbria, Northumberland, Tyne and
Wear (Q49)
7
97.3 (97.2)
96.3 (96.4)
97.2 (96.8)
N Yorkshire and Humber (Q50)
5
95.9 (96.5)
94.5 (96.0)
95.9 (96.5)
S Yorkshire and Bassetlaw (Q51)
5
96.0 (95.8)
94.9 (94.9)
95.9 (95.6)
W Yorkshire (Q52)
5
96.2 (96.1)
96.2 (95.7)
95.9 (95.9)
Arden, Herefordshire and
Worcestershire (Q53)
4
97.0 (96.3)
95.5 (95.7)
96.7 (95.9)
Birmingham and the Black Country
(Q54)
8
93.7 (92.6)
92.5 (92.2)
93.6 (92.6)
Derbyshire and Nottinghamshire (Q55)
4
95.5 (96.0)
94.3 (95.4)
95.1 (95.7)
East Anglia (Q56)
5
95.8 (95.7)
94.5 (95.3)
95.4 (95.3)
United Kingdom
England (Total)
English Area Teams
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Essex (Q57)
5
96.4 (96.3)
95.7 (96.0)
96.2 (96.1)
Hertfordshire and the S Midlands (Q58)
5
96.8 (96.5)
95.8 (96.1)
96.8 (96.3)
Leicestershire and Lincolnshire (Q59)
3
96.9 (97.1)
95.6 (96.6)
96.9 (97.0)
Shropshire and Staffordshire (Q60)
5
97.6 (97.0)
96.8 (97.0)
97.3 (97.0)
Bath, Gloucestershire, Swindon and
Wiltshire (Q64)
4
96.4 (95.9)
95.5 (95.3)
96.3 (95.5)
Bristol, N Somerset, Somerset and S
Gloucestershire (Q65)
4
96.2 (96.4)
95.3 (95.9)
96.2 (96.5)
Devon, Cornwall and Isles of Scilly
(Q66)
4
95.4 (95.6)
93.9 (95.2)
95.3 (95.4)
Kent and Medway (Q67)
3
94.3 (95.7)
93.2 (95.3)
94.1 (95.5)
Surrey and Sussex (Q68)
5
89.6 (91.6)
87.8 (91.1)
90.2 (91.1)
Thames Valley (Q69)
4
95.1 (95.7)
93.7 (94.6)
94.7 (95.4)
Wessex (Q70)
6
95.7 (95.9)
95.0 (95.6)
95.7 (95.9)
London (Q71)
30 ¥
89.3 (90.1)
87.2 (89.2)
89.5 (90.3)
† Primary Care Trusts/health boards
¥ Data from one PCT omitted due to data quality issues.
Table 1b. UK completed primary immunisations at 12 months by former Strategic Health Authority,
England: July to September 2013 (April to June 2013)
Former English Strategic
Health Authorities (SHAs)
PCT/HB†
DTaP/IPV
/Hib3 %
MenC%
PCV2%
North East
12
96.8 (97.0)
96.2 (96.4)
96.5 (96.5)
North West
24
95.5 (96.1)
94.1 (95.9)
95.3 (96.1)
Yorkshire and Humber
14
96.1 (96.2)
95.4 (95.6)
95.9 (96.0)
East Midlands
8
96.5 (96.6)
95.3 (96.0)
96.3 (96.3)
West Midlands
17
95.6 (94.7)
94.4 (94.3)
95.4 (94.6)
East of England
13
96.3 (96.2)
95.3 (95.8)
96.1 (95.9)
30 ¥
89.3 (90.1)
87.2 (89.2)
89.5 (90.3)
South Central
9
95.4 (95.7)
94.5 (95.0)
95.2 (95.6)
SE Coast
8
91.5 (93.2)
90.0 (92.8)
91.7 (92.8)
South West
14
95.9 (96.0)
94.7 (95.5)
95.8 (95.8)
London
† Primary Care Trusts/health boards
¥ Data from one PCT omitted due to data quality issues.
Coverage at 24 months
UK coverage of DTaP/IPV/Hib3 at 24 months remained at 96.6% compared to the previous quarter [1]. Surrey and
Sussex (Q68) and London (Q71) are the only ATs with DTaP/IPV/Hib3 coverage below the 95% target at 91.9%
and 93.3% respectively (table 2a).
UK PCV booster coverage remained the same compared to the last quarter and Hib/MenC booster decreased by
0.2%; both now 93.2% (table 2a) [1]. At least 92% coverage was achieved for both booster vaccines in all
countries, and in all English ATs except Birmingham and the Black Country (Q54), Surrey and Sussex (Q68) and
London (Q71).
UK MMR coverage increased by 0.2% to 93.2%, the same level as PCV and Hib/MenC boosters (table 2a) [1]. All
three devolved administrations achieved at least 95%, with Wales increasing by 2.5% to 98.4%, the highest
national coverage of MMR at 24 months ever achieved. At 92.7%, England is the only country in the UK below the
WHO 95% target although nine of the 25 English ATs have exceeded 95% coverage (table 2a).
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Country-specific comparisons for minimum coverage levels achieved for all four immunisations evaluated at 24
months show Wales, Northern Ireland and Scotland achieved at least 95% coverage and England achieved at least
92%; within England nine ATs achieved at least 95% for all four immunisations (table 2a).
Within the UK, at least 95% coverage at 24 months was achieved by 147 of the 176 PCTs/HBs (81%) for
DTaP/IPV/Hib3, 79 for Hib/MenC booster (45%), 80 (45%) for PCV booster, and 76 (43%) for MMR.
Table 2a. Completed primary immunisations at 24 months by country and English Area Team: July to
September 2013 (April to June 2013)
Country and
English Area
PCT/HB† DTaP/IPV/Hib3 %
Team (AT code*)
United Kingdom
PCV booster
%
Hib/MenC %
MMR1
%
176
96.6 (96.6)
93.2 (93.2)
93.2 (93.4)
93.2 (93.0)
Wales
7
97.9 (97.4)
96.5 (95.8)
95.8 (94.9)
98.4 (95.9)
Northern Ireland
4
98.8 (98.7)
95.9 (96.2)
96.0 (96.4)
96.0 (96.1)
Scotland
14
98.2 (98.3)
95.9 (95.8)
96.1 (96.0)
95.6 (95.2)
151
96.3 (96.3)
92.7 (92.8)
92.7 (92.9)
92.7 (92.6)
Q44
4
98.0 (97.9)
95.0 (95.1)
95.7 (95.9)
95.1 (95.2)
Q45
6
97.6 (97.5)
95.6 (95.2)
95.9 (95.6)
95.4 (94.2)
Q46
10
97.8 (97.7)
95.0 (94.6)
94.7 (94.0)
95.6 (94.9)
Q47
5
97.1 (96.6)
92.3 (92.9)
92.2 (92.6)
92.2 (92.4)
Q48
4
96.7 (97.2)
94.6 (95.9)
94.5 (95.8)
94.4 (95.6)
Q49
7
98.2 (98.2)
95.9 (96.1)
96.1 (96.8)
96.3 (95.7)
Q50
5
97.1 (97.5)
95.2 (95.5)
94.6 (95.0)
94.6 (95.3)
Q51
5
97.1 (96.9)
93.1 (93.6)
94.8 (95.0)
92.3 (92.1)
Q52
5
97.9 (97.9)
95.9 (95.5)
96.1 (96.1)
95.5 (94.7)
Q53
4
97.9 (98.0)
96.1 (96.2)
95.7 (95.7)
96.2 (96.0)
Q54
8
95.5 (94.2)
92.3 (89.2)
90.9 (88.1)
91.4 (89.6)
Q55
4
97.9 (97.7)
94.9 (94.4)
95.4 (94.9)
94.5 (94.0)
Q56
5
96.8 (97.1)
94.0 (94.2)
94.6 (94.2)
92.9 (92.6)
Q57
5
97.4 (97.3)
93.9 (93.0)
95.3 (95.2)
93.5 (92.3)
Q58
5
97.4 (97.4)
95.5 (95.4)
95.9 (95.7)
95.2 (94.7)
Q59
3
98.0 (98.1)
95.8 (95.6)
95.9 (95.8)
95.4 (95.2)
Q60
5
98.1 (98.1)
96.4 (97.1)
95.4 (97.5)
95.7 (95.7)
Q64
4
97.6 (97.3)
94.9 (94.4)
94.1 (94.2)
94.7 (94.4)
Q65
4
97.6 (97.0)
95.0 (93.6)
93.2 (91.1)
94.7 (93.0)
Q66
4
97.3 (97.3)
93.6 (94.1)
92.2 (93.1)
93.5 (93.6)
Q67
3
97.7 (98.2)
94.4 (95.4)
93.8 (95.2)
94.6 (95.6)
Q68
5
91.9 (92.1)
86.9 (86.5)
88.3 (88.3)
88.6 (88.2)
Q69
4
96.4 (96.4)
93.6 (93.8)
93.5 (94.1)
93.9 (94.1)
Q70
6
96.4 (96.8)
93.9 (94.4)
93.3 (93.7)
93.8 (94.1)
Q71
31
93.3 (93.7)
86.4 (87.3)
86.9 (87.9)
87.0 (87.5)
England (Total)
English Area Teams
* See table 1a for key to Area Team organisational code
† Primary Care Trusts/health boards.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Table 2b. Completed primary immunisations at 12 months by former Strategic Health Authority, England:
July to September 2013 (April to June 2013)
Former English
Strategic Health
Authorities
(SHAs)
PCT/HB†
DTaP/IPV
/Hib3 %
PCV booster
Hib/MenC %
%
MMR1
%
North East
12
97.9 (97.8)
95.6 (95.6)
95.9 (96.4)
95.7 (94.8)
North West
24
97.6 (97.4)
94.5 (94.7)
94.5 (94.5)
94.8 (94.7)
Yorkshire and
Humber
14
97.5 (97.5)
95.0 (95.5)
95.3 (95.5)
94.4 (94.3)
East Midlands
8
98.0 (97.8)
95.6 (95.4)
95.8 (95.4)
95.2 (94.7)
West Midlands
17
96.8 (96.2)
94.3 (93.0)
93.3 (92.4)
93.7 (92.8)
East of England
13
97.1 (97.3)
94.3 (94.2)
95.2 (95.1)
93.7 (93.2)
London
31
93.3 (93.7)
86.4 (87.3)
86.9 (87.9)
87.0 (87.5)
South Central
9
96.3 (96.4)
93.9 (93.8)
93.6 (93.7)
94.1 (94.0)
SE Coast
8
94.1 (94.4)
89.8 (89.9)
90.4 (90.9)
90.9 (91.0)
South West
14
97.5 (97.3)
94.4 (94.2)
93.1 (93.2)
94.1 (93.7)
† Primary Care Trusts/health boards
Coverage at five years
UK coverage at five years for primary course DTP/Pol3 remained similar to the previous quarter, with all countries
and all but two English ATs (Surrey and Sussex (Q68), and London (Q71)) achieving at least 95% coverage [1]
(tables 3a).
UK coverage of MMR1 at five years remained at 94.8% and all countries and all but one English AT (Surrey and
Sussex (Q68) achieved at least 90%. Scotland, Northern Ireland, Wales and 18 English ATs achieved at least 95%
coverage. UK coverage for MMR2 increased by 0.1% to 89.1% compared to the previous quarter, with Northern
Ireland, Scotland and 18 English ATs achieving at least 90% (tables 3a).
Coverage of UK DTaP/IPV booster coverage decreased 0.1% to 89.7% with all devolved administrations and all
but five English ATs achieving at least 90% coverage.
The five-year birth cohort evaluated this quarter (born between July to September 2008) were the ninth to have had
all their primary immunisations scheduled according to the revised schedule from September 2006 when Hib/MenC
booster was included for the first time [4]. UK coverage of Hib/MenC remained at 92.8% (table 3a).
Table 3a. UK completed primary immunisations and boosters at five years by country and English Area
Team: July to September 2013 (April to June 2013)
Primary
Booster
ENGLAND
Area Team
(AT) code*
Number
of PCTs
in AT
DTaP/
Hib %
MMR1 %
MMR2 %
DTaP/ IPV
%
Hib/
MenC
United Kingdom
176
96.2 (96.3)
94.8 (94.8)
89.1 (89.0)
89.7 (89.8)
92.8 (92.8)
Wales
7
97.3 (97.2)
98.3 (96.9)
92.7 (92.2)
93.1 (92.7)
94.3 (94.0)
N. Ireland
4
98.4 (98.4)
97.6 (97.7)
91.9 (92.4)
92.9 (93.3)
96.1 (96.1)
Scotland
14
98.2 (98.6)
97.3 (97.4)
93.4 (92.7)
94.3 (93.6)
96.0 (96.4)
151
95.9 (96.0)
94.3 (94.4)
88.5 (88.4)
89.0 (89.2)
92.3 (92.3)
Q44
4
97.4 (97.1)
96.5 (95.9)
92.2 (90.6)
93.3 (91.7)
94.8 (94.1)
Q45
6
97.2 (97.6)
96.2 (96.7)
92.4 (92.1)
92.3 (92.4)
94.8 (94.8)
England (Total)
English Area Teams
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Q46
10
97.2 (96.9)
96.3 (95.9)
92.2 (92.1)
92.0 (92.6)
92.2 (91.7)
Q47
5
96.9 (97.3)
95.9 (96.1)
88.3 (88.2)
88.6 (88.4)
94.2 (94.5)
Q48
4
97.6 (97.4)
96.5 (96.8)
91.9 (91.5)
91.9 (91.6)
93.6 (92.8)
Q49 ¥
7
98.4 (98.1)
96.3 (96.5)
93.7 (93.3)
94.7 (93.9)
96.6 (94.8)
Q50
5
97.0 (97.0)
96.0 (94.8)
91.4 (91.5)
92.0 (92.0)
93.9 (94.0)
Q51
5
97.1 (96.7)
95.0 (95.5)
90.2 (89.8)
91.5 (90.8)
94.9 (95.4)
Q52
5
97.7 (97.6)
96.3 (96.4)
92.1 (91.8)
92.7 (92.5)
95.9 (96.0)
Q53
4
97.7 (97.6)
96.3 (96.6)
92.6 (93.2)
94.2 (94.8)
91.8 (92.1)
Q54
8
96.4 (95.8)
94.4 (93.9)
87.2 (85.3)
87.9 (85.9)
92.2 (92.0)
Q55
4
97.4 (97.5)
95.8 (95.4)
90.7 (90.2)
91.6 (90.0)
94.8 (93.9)
Q56
5
96.1 (95.8)
93.8 (93.6)
88.9 (87.5)
90.4 (89.3)
93.0 (91.5)
Q57
5
97.1 (97.3)
94.8 (94.6)
91.0 (91.2)
92.1 (92.4)
95.5 (95.8)
Q58
5
96.6 (96.1)
95.3 (94.4)
92.3 (91.5)
93.6 (92.7)
94.9 (94.0)
Q59
3
97.2 (97.5)
96.3 (96.2)
91.3 (92.0)
95.5 (95.5)
94.0 (94.6)
Q60
5
97.7 (98.0)
96.6 (96.3)
92.6 (91.9)
93.6 (93.4)
96.1 (96.4)
Q64
4
96.5 (96.0)
95.5 (94.9)
90.7 (90.0)
92.3 (91.5)
93.3 (92.7)
Q65
4
97.6 (97.2)
95.8 (94.9)
90.0 (88.8)
91.4 (90.8)
93.4 (93.4)
Q66
4
97.1 (97.1)
95.2 (95.2)
89.4 (90.7)
91.1 (92.3)
93.5 (92.8)
Q67
3
96.9 (96.6)
95.4 (95.4)
90.7 (91.5)
92.7 (94.0)
93.5 (94.2)
Q68 ¥¥
5
90.6 (91.6)
89.7 (89.8)
81.8 (80.9)
82.6 (82.6)
82.3 (84.3)
Q69
4
95.5 (95.9)
94.7 (95.0)
90.2 (89.3)
89.9 (90.2)
93.4 (93.5)
Q70
6
95.9 (96.4)
94.1 (94.3)
89.7 (90.1)
90.6 (91.2)
91.6 (91.8)
Q71
31
93.2 (93.5)
90.6 (91.6)
80.2 (81.2)
78.8 (80.5)
87.9 (88.7)
* See table 1a for key to Area Team organisational code. ¥ Hib/MenC data omitted due to data quality issues for one PCT in AT.
¥ ¥ Hib/MenC data omitted due to data quality issues for two PCTs in AT.
3b. Completed primary immunisations and boosters at five years by former Strategic Health Authority,
England: July to September 2013 (April to June 2013)
Primary
Former English
SHAs
PCT/
HB ¥
Booster
DTaP/IPV
/Hib3 %
MenC%
MMR2 %
DTaP/ IPV %
Hib/
MenC ¥¥
North East
12
97.8 (97.8)
96.2 (96.5)
93.0 (92.7)
93.5 (93.2)
95.8 (95.1)
North West
24
97.3 (97.2)
96.3 (96.2)
91.5 (91.1)
91.7 (91.6)
93.3 (92.9)
Yorkshire, Humber
14
97.3 (97.2)
95.9 (95.7)
91.6 (91.2)
92.1 (91.9)
95.1 (95.4)
East Midlands
8
97.3 (97.3)
96.0 (95.7)
91.4 (91.2)
93.9 (92.8)
94.5 (94.2)
West Midlands
17
97.1 (96.9)
95.5 (95.3)
90.0 (89.2)
91.0 (90.4)
93.1 (93.2)
East of England
13
96.5 (96.3)
94.4 (94.0)
90.4 (89.9)
91.7 (91.3)
94.3 (93.6)
London
31
93.2 (93.5)
90.6 (91.6)
80.2 (81.2)
78.8 (80.5)
87.9 (88.7)
South Central
9
95.6 (96.0)
94.6 (94.6)
90.1 (89.7)
90.4 (90.6)
92.5 (92.2)
SE Coast
8
92.6 (93.4)
91.9 (91.9)
85.2 (84.7)
86.4 (86.8)
87.0 (87.9)
South West
14
97.0 (96.9)
95.3 (95.1)
90.0 (89.8)
91.5 (91.5)
93.3 (93.3)
¥ Primary Care Trusts/health boards
¥ ¥ Three PCTs' data omitted due to data quality issues.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Neonatal hepatitis B vaccine coverage in England: July-September 2013
Vaccine coverage data in England for three doses of hepatitis B vaccine in infants, born to hepatitis B surface
antigen (HBsAg) positive mothers, who reached the age of one year in this quarter (i.e. those born between July to
September 2012), and coverage of four doses of vaccine in infants who reached two years of age (ie those born
between July to September 2011) are presented by Area Team (table 4a). Table 4b shows coverage by SHA for
historical comparison. For both tables coverage for the previous quarter, April to June 2013, is given in brackets [1].
One hundred and fourteen of the 151 former PCTs provided 12 month data this quarter (75%), and 115 provided
24 month data, compared to 120 (117) in the previous quarter [1]. The quality of these data is variable and should
be interpreted with caution. Where a zero was reported a check was made to ensure that this was a true zero
rather than no data available. Forty PCTs provided zero returns for the 12 month data, and for the 24 month data
38 were zero returns. Eleven of the 25 ATs provided data for the whole area (table 4a); no SHA reported data from
all PCTs (table 4b). Compared to last quarter, 12 month coverage of three doses of Hep B in England increased by
6% to 85% and coverage of four doses at 24 months increased by 5% to 69% [1].
Table 4a. Neonatal hepatitis B coverage in England by English Area Team:
July to September 2013 (April to June 2013)
PCT returns
with 12 month
data
12 month
denominator
Coverage at
12 months
PCT returns
with 24 month
data
24 month
denominator
Coverage at 24
months
Q44
3 of 4
1
100 (67)
3 of 4
1
100 (100)
Q45
0 of 6
–
– (75)
1 of 6
2
100 (100)
Q46
7 of 10
38
76 (82)
7 of 10
35
66 (70)
Q47
2 of 5
0
– (33)
2 of 5
0
– (–)
Q48
4 of 4
10
90 (100)
4 of 4
2
100 (80)
Q49
7 of 7
6
100 (83)
7 of 7
12
75 (100)
Q50
3 of 5
4
75 (100)
3 of 5
0
– (–)
Q51
4 of 5
7
86 (100)
4 of 5
4
100 (100)
Q52
5 of 5
29
100 (100)
5 of 5
25
100 (96)
Q53
3 of 4
8
100 (100)
3 of 4
7
86 (100)
Q54
4 of 8
13
77 (80)
4 of 8
20
85 (100)
Q55
4 of 4
8
100 (100)
4 of 4
7
86 (85)
Q56
4 of 5
9
89 (86)
5 of 5
12
100 (100)
Q57
5 of 5
10
90 (75)
5 of 5
6
100 (43)
Q58
5 of 5
35
97 (97)
5 of 5
32
66 (87)
Q59
1 of 3
0
– (–)
1 of 3
1
100 (100)
Q60
3 of 5
12
100 (100)
3 of 5
1
100 (50)
Q64
4 of 4
11
100 (79)
4 of 4
7
100 (100)
Q65
4 of 4
1
0 (–)
4 of 4
1
0 (–)
Q66
3 of 4
2
100 (50)
3 of 4
–
– (0)
Q67
3 of 3
11
46 (68)
3 of 3
8
50 (30)
Q68
3 of 5
10
60 (80)
3 of 5
8
75 (100)
Q69
4 of 4
22
100 (100)
4 of 4
29
100 (94)
Q70
5 of 6
2
50 (100)
5 of 6
8
75 (33)
Q71
24 of 31
235
82 (72)
23 of 31
252
57 (54)
114 of 151
484
85 (79)
115 of 151
480
69 (64)
Area Team
(AT code)
England
Notes:
“ – “ indicates "no data available" for the denominator but "not applicable" for coverage.
See table 1a for key to Area Team organisational code.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Table 4b. Neonatal hepatitis B coverage in England by fromer Strategic Health Authority: July to
September 2013 (April to June 2013)
Coverage at
12 months
PCT
returns
with 24
month
data
24 month
denominator
Coverage
at 24
months
6
100 (89)
7 of 12
7
79 (100)
17 of 24
49
80 (80)
17 of 24
45
68 (73)
Yorkshire
and
Humber
11 of 14
40
95 (100)
11 of 14
30
100 (97)
East
Midlands
7 of 9
19
95 (100)
7 of 9
15
55 (87)
West
Midlands
10 of 17
33
91 (90)
10 of 17
17
86 (94)
East of
England
12 of 13
37
95 (92)
13 of 13
28
94 (75)
London
24 of 31
235
81 (72)
23 of 31
311
57 (54)
South
Central
8 of 9
29
100 (97)
8 of 9
42
98 (86)
SE Coast
6 of 8
21
52 (72)
6 of 8
21
62 (33)
13 of 14
15
86 (75)
13 of 14
8
78 (75)
114 of 151
484
85 (79)
115 of 151
524
69 (64)
English
SHAs
PCT returns
with
12 month
data
12 month
denominator
North East
6 of 12
North
West
South
West
England
Relevant links for country-specific coverage data
England
http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/immunisation
Northern Ireland
http://www.publichealthagency.org/directorate-public-health/health-protection/vaccination-coverage
Scotland
http://www.isdscotland.org/Health-Topics/Child-Health/Immunisation/
Wales
http://www.wales.nhs.uk/sitesplus/888/page/43510
Other relevant links
http://www.hpa.org.uk/infections/topics_az/cover/default.htm
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
References
1. Public Health England (2013). Vaccination coverage statistics for children up to the age of five years in the
United Kingdom, April to June 2013. HPR 7(40), http://www.hpa.org.uk/hpr/archives/2013/hpr4013.pdf.
2. Public Health Wales Health Protection Division. Vaccine uptake in Children in Wales, July to September 2013:
COVER report 108, December 2013. Cardiff , Public Health Wales. Available from:
http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=54144.
3. Department of Health/Public Health England/NHS England. Changes to the schedule for meningococcal
serogroup C conjugate vaccine(NHS England/PHE/DH letter, 7 May 2013).
4. Department of Health. National screening and immunisation programmes. Letter setting out the agreement
between the Department of Health, Public Health England and the NHS Commissioning Board 23 August 2012.
Available from: http://www.dh.gov.uk/health/2012/08/screening-immunisation-programmes/.
5. Public Health Outcomes Framework 2013 to 2016 and technical updates. Available from:
https://www.gov.uk/government/publications/healthy-lives-healthy-people-improving-outcomes-and-supportingtransparency.
6. Health Protection Agency. Quarterly COVER Reports. Legacy HPA website: Infections A-Z › Vaccine coverage
and COVER › Publications › Quarterly COVER Reports: United Kingdom.
7. Department of Health. Vaccinations at 12 and 13 months of age. Letter from the Chief Medical Officer (interim),
the Chief Nursing Officer and the Chief Pharmaceutical Officer 17 November 2010. PL/CMO/2010/3,
PL/CNO/2010/4, PL/CPHO/2010/2.
8. Department of Health. Important changes to the childhood immunisation programme. PL CMO (2006) 1.
9. Health Protection Agency. Methods of collection and publication of data for the COVER programme. Available
from: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/
VaccineCoverageAndCOVER/COVERMethods.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Bacteraemia
Uncommon pathogens associated with bacteraemia: England, Wales and
Northern Ireland, 2008-2012
This analysis is based on bacteraemia reports made by laboratories in England, Wales and Northern Ireland
between 2008 and 2012. The reports were made to Public Health England (previously to HPA) as part of the
voluntary reporting scheme and provide data on both community and hospital- acquired bacteraemia. This report
describes uncommon pathogens (genera with fewer than 50 reports in 2012) identified from blood cultures or blood
specimens where the diagnostic method was not stated. Due to late reporting, data in this report may vary from
that in previous reports.
A total of 102,268 bacterial isolates from blood samples were reported by laboratories in England, Wales and
Northern Ireland in 2012. One hundred and one uncommon genera causing bacteraemia were reported in 2012,
comprising a total of 768 bacteraemic episodes. Gram-negative organisms accounted for 57% of these episodes.
By definition of inclusion in this analysis, small numbers of reports preclude robust or meaningful analysis of trends
but of note are the general decreases in Alcaligenes, Arcanobacterium, Delftia, and increases in Granulicatella,
Rothia, and Burkholderia (see table 1 of appendix on following pages).
Summary
The purpose of this review is to describe the unusual bacterial genera not included in the monthly bacteraemia
reports published in the Health Protection Report. Although these bacteria only account for a very low proportion of
total bacteraemia reports, they can be associated with important clinical consequences, such as endocarditis [1].
Infections imported from endemic regions, such as Brucella species [2] and Burkholderia pseudomallei [3] although
rarely diagnosed in this country can cause severe illness in those affected. Others represent opportunistic
pathogens causing infection in immunocompromised patients, such as Granulicatella sp. [4], or are associated with
specific exposures, such as catheter-related bacteraemia due to Brevibacterium [5], or infections due to
Erysipelothrix rhusiopathiae in workers in contact with animals or handling animal products [6]. Examining trends in
these unusual pathogens can also provide a means for identifying emerging or re-emerging infections [7], providing
opportunities for preventive measures or education of frontline clinical staff. The fall in numbers of reports of
Alcaligenes, Arcanobacterium and Delftia and other environmental bacteria capable of causing catheter-related
sepsis may be associated with improvements in line management in the NHS [8].
Reports of bacteraemia caused by members of the Granulicatella genus have increased between 2008 and 2012,
largely due to an increase in Granulicatella adiacens species in 2012. Gradual increase in Rothia spp. reports have
been observed since 2008, accounted for by higher number of Rothia dentocariosa as well as other Rothia
species. Members of Granulicatella and Rothia genera form part of the oral cavity, the intestinal, and the
genitourinary tract, however they can result in serious clinical manifestations, such as bacteraemia and
endocarditis [4, 9]. Reports of Burkholderia have also increased during the five year period, predominantly due to
Burkholderia cepacia. This is known to cause infections in immunocompromised or hospitalized patients, and those
with underlying lung disease, such as cystic fibrosis [10].
Whilst the bacteraemia reported to this voluntary surveillance system should, according to national reporting
guidelines, reflect clinically significant disease, it should be borne in mind that some of these reports may reflect
contaminants attributed to poor sampling technique or through contamination of laboratory reagents [11, 12].
Inclusion of reports with unknown diagnostic methods should be taken into account in interpreting these data, as
some of these reports may not represent isolation from blood culture, but microbiological diagnoses by other
unspecified means. Improvements in laboratory reporting of diagnostic methods would allow the exclusion of these
reports without artificially decreasing the number of genuine bacteraemia infections.
There has been a general improvement in the identification of cultured organisms to the species level by the
increased use of automated biochemical identification systems, molecular techniques such as 16S ribosomal RNA
and, most recently, by the introduction of MALDI-TOF mass spectrometry in some laboratories. This should
increase the accuracy of species identified and permit robust trend analysis of hitherto difficult to identify species. If
confirmation of unusual bacterial pathogens is required, isolates can be sent to the relevant laboratory within the
Specialist and Reference Microbiology Division of Public Health England.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Acknowledgements
These reports would not be possible without the enduring weekly contributions from microbiology colleagues in
laboratories across England, Wales and Northern Ireland, without which there would be no surveillance data. In
addition, the support from colleagues within the Health Protection Agency, Health Protection Services, is valued in
the preparation of the reports. Please send any comments/feedback to: [email protected].
References
1. Brouqui P, Raoult D. Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev 2001; 14:177-207.
2. Ramin B, MacPherson P. Human brucellosis. BMJ 2010; 341: c4545.
3. Northfield J, Whitty CJM, MacPhee IAM. Burkholderia pseudomallei infection, or melioidosis and nephrotic
syndrome. Nephrol Dial Transplant 2002; 17:137-139.
4. Senn L, Entenza JM, Greub G, Jaton K, Wenger A, Bille J, et al. Bloodstream and endovascular infections due
to Abiotropia defective and Granulicatella species. BMC Infect Dis 2006; 6: 9.
5. Beukinga I, Rodriguez-Villalobos H, Deplano A, Jacobs F, Struelens MJ. Management of long-term catheterrelated Brevibacterium bacteraemia. CMI 2003; 10: 495-470.
6. Garcia-Restoy E, Espejo E, Bella F, Liebot J. Bacteraemia due to Erysiphelothrix rhusiopathiae in
immunocompromised hosts without endocarditis. Rev Infec Dis 1991; 13: 1252-3.
7. Akhrass FA, Wohoush IA, Chaftari A-M, Reitzel R, Jiang Y, Ghannoum M, et al. Rhodococcus bacteraemia in
cancer patients is mostly catheter related and associated with biofilm formation. PloS One 2012; 7(3): e32945
8. Department of Health (2005). Saving lives: a delivery programme to reduce healthcare associated infection
including MRSA (overview guide).
9. Shin JH, Shim JD, Kim HR, Sinn JB, Kook J-K, Lee JN. Rothia dentocariosa septicaemia without endocarditis in
a neonatal infant with meconium aspiration syndrome. J Clin Microbiol 2004; 42(10): 4891-2.
10. Matthiaou DK, Chasou E, Atmatzidis S, Tsolkas P. A case of bacteremia due to Burkholderia cepacia in a
patient without cystic fibrosis. Respir Med CME 2011; 4(3): 144-5.
11. El Zimaity D, Harrison GA, Keen AP, Price S, Evans SE, Lewis AM et al. Ochrobactrum anthropic
Pseudobacteraemia. J Infect 2001; 43:217-218.
12. PHLS. Ochrobactrum anthropi pseudobacteraemias. Commun Dis Rep CDR Wkly 2001; 11.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Table 1: Uncommon pathogens associated with bacteraemia in England, Wales and Northern Ireland:
2008-2012*
Number of bacteraemia reports
Genus
Species
2008 2009 2010 2011 2012
Gram positive bacteria
Abiotropia spp
Abiotrophia defectiva
Abiotrophia other named
Abiotrophia sp
Actinobaculum spp
Actinobaculum schaalii
Aggregatibacter spp
Aggregatibacter (Haemophilus) segnis
Aggregatibacter actinomycetemcomitans
Aggregatibacter sp
Anaerococcus spp
Anaerococcus (Peptostreptococcus) prevotti
Arcanobacterium spp
Arcanobacterium haemolyticum
Arthrobacter spp
Arthrobacter sp
Bifidobacterium spp
Bifidobacterium named
Bifidobacterium sp
Brevibacterium spp
Brevibacterium other named
Brevibacterium sp
Cellulomonas spp
Cellulomonas sp
Delftia spp
Delftia acidovorans (Comamonas acidovorans)
Dermabacter spp
Dermabacter hominis
Eggerthella spp
Eggerthella lenta (Eubacterium lentum)
Erysipelothrix spp
Erysipelothrix rhusiopathiae (insidiosa)
Erysipelothrix sp
Eubacterium spp
Eubacterium other named
Eubacterium sp
Facklamia spp
Facklamia hominis
Facklamia ignava
Flavonifractor spp
Flavonifractor plautii
Globicatella spp
Globicatella sanguis
17
12
1
4
0
0
4
0
4
0
10
10
26
26
2
2
7
3
4
16
2
14
0
0
15
15
8
8
16
16
4
4
0
7
2
5
0
0
0
0
0
0
0
12
7
1
4
0
0
2
0
2
0
12
12
12
12
2
2
10
0
10
15
1
14
0
0
10
10
2
2
12
12
4
4
0
7
5
2
0
0
0
0
0
2
2
9
5
0
4
0
0
1
0
1
0
7
7
18
18
4
4
4
0
4
21
6
15
1
1
9
9
2
2
7
7
7
7
0
5
2
3
0
0
0
0
0
4
4
17
8
2
7
1
1
2
1
1
0
11
11
11
11
4
4
7
0
7
19
1
18
0
0
7
7
1
1
12
12
4
3
1
9
5
4
1
0
1
1
1
3
3
23
17
2
4
1
1
5
0
3
2
7
7
10
10
9
9
11
3
8
36
5
31
0
0
4
4
4
4
30
30
11
10
1
13
9
4
1
1
0
0
0
0
0
Gordonia spp
Gordonia bronchialis (Rhodococcus bronchialis)
Granulicatella spp
Granulicatella adiacens (Abiotrophia adjacens)
Granulicatella elegans
Janibacter spp
Janibacter anophelis
Kocuria spp
Kocuria kristinae
Kocuria rosea
Kocuria sp
Koserella spp
Koserella trabulsii
Kurthia spp
Kurthia other named
Leuconostoc spp
Leuconostoc sp
Luteimonas spp
Luteimonas sp
Microbacterium spp
Microbacterium sp
Mobiluncus spp
Mobiluncus curtisii
Mobiluncus sp
Nocardia spp
Nocardia asteroides
Nocardia other named
Nocardia sp
Oerskovia spp
Oerskovia sp
Paenibacillus spp
Paenibacillus sp
Parvimonas spp
Parvimonas micra
Pediococcus spp
Pediococcus other named
Pediococcus sp
Peptococcus spp
Peptococcus named
Peptococcus sp
Peptoniphilus spp
Peptoniphilus harei (Peptostreptococcus harei)
Peptoniphilus sp
Psychrobacter spp
Psychrobacter phenylpyruvicus (Moraxella
phenylpyruvica)
Rhodococcus spp
Rhodococcus equi (Corynebacterium equi)
0
0
8
8
0
0
0
0
0
0
0
0
0
1
1
38
38
0
0
0
0
1
0
1
7
0
2
5
0
0
0
0
0
0
6
2
4
23
6
17
0
0
0
0
0
0
6
6
0
0
0
0
0
0
0
0
0
1
1
38
38
0
0
0
0
0
0
0
8
0
3
5
1
1
0
0
0
0
1
0
1
15
0
15
0
0
0
0
0
0
7
7
0
0
0
1
0
0
1
1
1
1
1
34
34
0
0
0
0
2
1
1
5
1
2
2
0
0
0
0
1
1
6
2
4
14
5
9
0
0
0
0
0
0
12
12
0
0
0
0
0
0
0
0
0
0
0
34
34
0
0
1
1
1
0
1
4
0
2
2
0
0
0
0
1
1
2
2
0
13
3
10
0
0
0
0
1
1
24
23
1
1
1
8
1
3
4
0
0
0
0
42
42
1
1
0
0
0
0
0
1
0
0
1
1
1
1
1
3
3
3
2
1
16
2
14
3
1
2
1
0
18
2
0
10
1
0
10
0
0
11
0
1
12
2
Rhodococcus other named
Rhodococcus sp
Robinsoniella spp
Robinsoniella peoriensis
Rothia spp
Rothia dentocariosia
Rothia sp
Ruminococcus spp
Ruminococcus gnavus
Saccharopolyspora spp
Saccharopolyspora rectivirgula (Faenia rectivergula)
Stomatococcus spp
Stomatococcus mucilaginosus
Stomatococcus sp
Streptomyces spp
Streptomyces sp
Trueperella spp
Trueperella bernardiae
Vagococcus spp
Vagococcus fluvialis
Total- Gram positive bacteria
4
12
0
0
9
2
7
0
0
1
1
9
7
2
0
0
0
0
0
0
1
8
0
0
7
3
4
0
0
0
0
3
3
0
0
0
0
0
0
0
0
10
1
1
17
4
13
0
0
0
0
6
4
2
1
1
0
0
0
0
1
10
0
0
25
7
18
1
1
0
0
1
0
1
0
0
0
0
0
0
0
10
0
0
38
11
27
0
0
0
0
5
4
1
0
0
1
1
1
1
253
192
206
216
328
3
1
2
0
1
0
1
38
0
14
4
8
12
9
1
8
1
0
1
0
0
0
0
0
0
0
0
0
0
2
0
2
43
0
18
0
7
18
9
0
9
0
0
0
0
0
0
0
0
0
3
3
0
0
4
2
2
25
0
13
1
6
5
4
3
1
0
0
0
1
1
0
0
0
0
6
2
3
1
2
0
2
23
0
12
0
8
3
2
2
0
1
1
0
0
0
1
1
1
1
9
6
2
1
3
1
2
21
1
12
0
4
4
2
2
0
1
0
1
0
0
0
0
0
0
Gram negative bacteria
Actinobacillus spp
Actinobacillus other named
Actinobacillus sp
Actinobacillus ureae
Agrobacterium spp
Agrobacterium other named
Agrobacterium sp
Alcaligenes spp
Alcaligenes denitrificans
Alcaligenes faecalis
Alcaligenes other named
Alcaligenes sp
Alcaligenes xylosoxidans xylosoxidans
Anaerobiospirillum spp
Anaerobiospirillum other named
Anaerobiospirillum sp
Arcobacter spp
Arcobacter butzleri
Arcobacter sp
Aurantimonas spp
Aurantimonas altamirensis
Azospirillum spp
Azospirillum brasilense
Bilophila spp
Bilophila wadsworthia
Bordetella spp
Bordetella bronchiseptica
Bordetella other named
Bordetella parapertussis
Bordetella sp
Borrelia spp
Borrelia other named
Borrelia sp
Branhamella spp
Branhamella sp
Brevundimonas spp
Brevundimonas diminuta
Brevundimonas sp
Brevundimonas vesicularis
Brucella spp
Brucella melitensis
Brucella sp
Burkholderia spp
Burkholderia cenocepacia
Burkholderia cepacia
Burkholderia gladioli
Burkholderia multivorans
Burkholderia other named
Burkholderia pseudomallei
Burkholderia sp
Buttiauxella spp
Buttiauxella sp
Capnocytophaga spp
Capnocytophaga ochracea
Capnocytophaga other named
Capnocytophaga sp
Cardiobacterium spp
Cardiobacterium hominis
Cardiobacterium other named
Cardiobacterium sp
Cedecea spp
Cedecea davisae
Cedecea lapagei
Cedecea neteri
Cedecea sp
Chromobacterium spp
Chromobacterium other named
Chromobacterium sp
Chromobacterium violaceum
Chryseobacterium spp
Chryseobacterium gleum
Chryseobacterium indologenes
Chryseobacterium meningosepticum
Chryseobacterium sp
5
2
0
0
3
2
0
2
0
0
45
10
7
28
3
3
0
29
1
27
0
0
0
1
0
1
1
21
0
10
11
6
4
0
2
0
0
0
0
0
4
0
1
3
20
0
16
3
1
4
2
0
0
2
7
0
7
2
2
25
5
6
14
8
7
1
34
1
31
0
2
0
0
0
0
0
14
0
1
13
1
1
0
0
2
1
1
0
0
0
0
0
0
29
0
20
6
3
6
1
1
0
4
2
0
2
2
2
28
8
3
17
4
3
1
46
4
37
0
1
0
3
1
0
0
12
1
7
4
4
2
1
1
2
0
0
0
2
1
0
0
1
21
0
14
5
2
4
2
0
0
2
5
1
4
1
1
26
9
9
8
8
7
1
47
2
37
2
1
1
3
1
0
0
7
0
2
5
6
4
1
1
3
0
0
1
2
0
0
0
0
31
0
17
11
3
4
0
3
1
0
5
1
4
3
3
27
7
7
13
8
6
2
48
2
36
1
2
2
2
3
0
0
13
0
3
10
3
2
1
0
1
0
0
0
1
2
1
1
0
35
1
22
4
8
Chryseomonas spp
Chryseomonas sp
Comamonas spp
Comamonas other named
Comamonas sp
Comamonas testosteroni
Desulfovibrio spp
Desulfovibrio desulfuricans
Desulfovibrio fairfieldensis
Dialister spp
Dialister microaerophilus
Dialister pneumosintes
Edwardsiella spp
Edwardsiella other named
Edwardsiella sp
Edwardsiella tarda
Eikenella spp
Eikenella corrodens
Eikenella sp
Empedobacter spp
Empedobacter brevis
Erwinia spp
Erwinia other named
Erwinia sp
Ewingella spp
Ewingella americana
Flavobacterium spp
Flavobacterium other named
Flavobacterium sp
Gardnerella spp
Gardnerella other named
Gardnerella sp
Gardnerella vaginalis
Hafnia spp
Hafnia alvei
Hafnia sp
Kingella spp
Kingella denitrificans
Kingella kingae
Kingella sp
Kluyvera spp
Kluyvera ascorbata
Kluyvera sp
Leclercia spp
Leclercia adecarboxylata
Legionella spp
Legionella pneumophila
Legionella sp
2
2
10
3
1
6
0
0
0
2
0
2
2
1
0
1
4
3
1
3
3
0
0
0
0
0
10
4
6
6
1
1
4
44
43
1
5
0
4
1
18
2
16
6
6
6
0
6
2
2
9
1
3
5
1
1
0
1
0
1
0
0
0
0
13
13
0
1
1
0
0
0
1
1
8
3
5
6
1
0
5
32
31
1
11
0
10
1
20
0
20
5
5
3
1
2
1
1
10
1
2
7
0
0
0
1
0
1
2
2
0
0
8
8
0
2
2
2
1
1
1
1
4
2
2
10
1
0
9
38
38
0
6
0
5
1
21
1
20
12
12
0
0
0
6
6
15
1
4
10
0
0
0
3
1
2
3
0
0
3
8
7
1
0
0
0
0
0
1
1
3
0
3
6
0
1
5
28
27
1
9
1
6
2
12
1
11
5
5
0
0
0
2
2
7
3
1
3
1
0
1
3
1
2
2
1
1
0
8
8
0
0
0
0
0
0
0
0
8
0
8
6
0
0
6
37
37
0
12
1
10
1
26
2
24
4
4
0
0
0
Leptospira spp
Leptospira autumnalis
Leptospira other named
Leptospira sp
Leptotrichia spp
Leptotrichia buccalis
Leptotrichia sp
Myroides spp
Myroides odoratus
Myroides sp
Oligella
spp
Oligella ureolytica
Oligella urethralis
Oscillospira spp
Oscillospira sp
Plesiomonas spp
Plesiomonas shigelloides
Porphyromonas spp
Porphyromonas asaccharolytica
Porphyromonas sp
Rahnella spp
Rahnella named
Rahnella sp
Ralstonia spp
Ralstonia pickettii
Rhizobium spp
Rhizobium radiobacter (Agrobacterium tumefaciens)
Roseomonas spp
Roseomonas gilardii
Roseomonas sp
Shewanella spp
Shewanella putrefaciens (Pseudomonas putrefaciens)
Shewanella sp
Shigella spp
Shigella flexneri
Shigella sonnei
Shigella sp
Sphingobacterium spp
Sphingobacterium multivorum
Sphingobacterium sp
Sphingobacterium spiritivorum
Sphingobacterium thalpophilum
Sphingomonas spp
Sphingomonas sp
Streptobacillus spp
Streptobacillus sp
Veillonella spp
5
0
1
4
1
0
1
3
3
0
4
0
1
3
4
2
2
0
0
0
3
0
1
2
3
1
2
2
0
2
8
0
0
8
3
1
2
1
0
1
5
1
0
4
3
1
2
3
2
1
3
3
0
1
1
1
1
1
0
1
2
2
0
15
15
29
29
4
1
3
6
6
0
9
7
2
0
9
3
5
1
0
4
4
1
1
28
2
1
1
0
0
0
0
6
3
3
4
4
0
8
8
24
24
4
2
2
5
5
0
3
3
0
0
8
4
1
2
1
4
4
2
2
42
2
2
0
0
0
0
0
4
0
4
4
3
1
17
17
32
32
3
2
1
2
2
0
7
3
2
2
4
2
1
0
1
2
2
0
0
45
1
1
0
0
0
2
2
5
3
2
5
4
1
2
2
18
18
9
4
5
3
2
1
10
6
2
2
10
3
3
3
1
1
1
1
1
44
1
0
1
0
0
0
0
3
1
2
1
1
0
6
6
35
35
23
12
11
2
1
1
6
1
1
4
7
1
3
1
2
4
4
0
0
31
Veillonella named
Veillonella sp
6
22
0
0
0
0
0
1
1
1
1
11
9
1
1
1
41
1
0
1
0
0
0
0
0
0
10
8
2
0
4
41
0
0
0
0
0
0
0
0
0
13
9
4
0
1
43
2
1
0
1
0
0
0
0
0
8
8
0
0
2
29
2
0
0
0
2
1
1
0
0
6
3
3
0
Total- Gram negative bacteria
441
424
426
406
440
Total- Gram positive and gram negative bacteria
694
616
632
622
768
Vibrio spp
Vibrio cholerae
Vibrio fluvialis
Vibrio hollisae
Vibrio sp
Weeksella spp
Weeksella virosa
Wolinella spp
Wolinella sp
Yersinia spp
Yersinia enterocolitica
Yersinia pseudotuberculosis
Yersinia sp
* Uncommon genera are identified on the basis of less than 50 reports from blood samples and diagnosed
by culture or unknown methods in 2012.
Infection reports
Volume 7 Number 51 Published on: 20 December 2013
HCAI
Trends in mandatory Staphylococcus aureus (MRSA and MSSA) and
Escherichia coli bacteraemia, and Clostridium difficile infection (CDI): data
for England up to July-September 2013
This quarterly epidemiological commentary describes recent trends for mandatory surveillance
of Staphylococcus aureus (MRSA and MSSA [1]) and E. coli [2] bacteraemia, and Clostridium
difficile infections [3] reported by NHS acute Trust hospitals in England up to July-September
2013.
MRSA Bacteraemia
From April 2013 all NHS organisations reporting positive cases of MRSA bacteraemia
are required to complete a Post Infection Review (PIR)1. MRSA bacteraemia cases from
April 2013 are now published by PIR assignment rather than apportionment. This is
reflected here.
The total number of MRSA bacteraemia reports has shown a decline of 12% when
compared to the same period last year – from 229 in Q3 2012 to 201 in Q3 2013.
There has been a slight decrease between Q2 2013 and Q3 2013 for both Trust
assigned and CCG assigned reports from 106 reports to 93 reports and from 131 reports
to 108 reports respectively.
Figure 1: Quarterly rates of MRSA bacteraemia, October 2011- September 2013
a) Trust apportioned rate (per 100,000 bed-days) b) All reports (per 100,000 population)
1
Please refer to http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317138536251 for more information
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Note: The Trust apportioned rates for Q2 and Q3 2013 are missing because since Q2 2013 MRSA cases have
been reported by assignment rather than apportionment, please refer to Table 1b for trust assigned reported cases
and rates.
Table 1a: MRSA bacteraemia counts and rates by quarter, January 2010- September 2013
Year and quarter
2010
2011
2012
2013
Trust apportioned Trust apportioned rates
All reports
reports
(per 100,000 bed-days)
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
279
198
186
155
149
148
103
105
117
94
96
92
116
N/A
N/A
3.01
2.25
2.09
1.75
1.72
1.71
1.21
1.21
1.31
1.10
1.13
1.07
1.32
N/A
N/A
483
421
396
331
333
319
266
269
262
224
229
219
252
237
201
All reports rates (per
100,000 population)
3.75
3.24
3.01
2.52
2.54
2.41
1.99
2.01
1.97
1.68
1.70
1.63
1.91
1.78
1.49
Table 1b: MRSA bacteraemia counts and rates by PIR assignment, April 2013-September
2013
Year and quarter
2013
Q2
Q3
Trust assigned
reports
106
93
Trust assigned rates CCG assigned CCG assigned rates
(per 100,000 bed-days)
(per 100,000 population)
reports
1.24
131
0.98
1.08
108
0.80
MSSA Bacteraemia
Trust apportioned and population rates have remained relatively stable over the 8
quarters. Following a decline between Q2 2012 and Q3 2012, a small but steady
increase is noted between Q3 2012 and Q2 2013. The decline between Q2 and Q3 2012
is not repeated in Q2 2013 and Q3 2013. The MSSA Trust apportioned cases and the
population rates have increased by 8.2% (from 7.64 to 8.27 per 100,000 bed-days) and
9.6% (from 15.85 to 17.37 per 100,000 population) respectively (Figure 2).
The highest Trust apportioned rate was in Q3 2011 with 8.55 per 100,000 bed-days
whilst the lowest was in Q3 2012 with 7.64 per 100,000 bed-days. The highest population
rate was seen in the previous quarter, Q2 2013, with 17.46 per 100,000 population,
whilst the lowest was in Q3 2012 with 15.85 per 100,000 population.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Although there is some fluctuation in the number of reports between the quarters, there
are no substantial increases (Table 2).
Figure 2: Quarterly rates of MSSA bacteraemia, October 2011- September 2013
a) Trust apportioned rate (per 100,000 bed-days) b) All reports (per 100,000 population)
Table 2: MSSA bacteraemia counts and rates by quarter, July 2011- September 2013
Year and quarter
2011
2012
2013
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Trust apportioned
reports
735
698
725
703
728
711
648
663
678
710
701
Trust apportioned rates
(per 100,000 bed-days)
8.46
8.08
8.55
8.12
8.16
8.29
7.64
7.71
7.73
8.25
8.27
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
All reports
2199
2191
2226
2167
2183
2238
2131
2186
2257
2328
2342
All reports rates (per
100,000 population)
16.79
16.55
16.63
16.19
16.41
16.83
15.85
16.26
17.11
17.46
17.37
E.coli bacteraemia
Mandatory E.coli bacteraemia surveillance commenced in June 2011. The rate of E.coli
bacteraemia was stable over the eight quarters. There was a slight rate increase in the
most recent quarter, Q3 2013, in line with the same trend seen in the same period last
year. Since the commencement of E.coli bacteraemia surveillance, Q3 2013
demonstrates the highest rate of 66.37 per 100,000 population, while the lowest was
57.63 per 100,000 population in Q1 2013 (Figure 3).
There was little variation in the number of reports from quarter to quarter; in line with the
rates. The highest number of reports was seen in Q3 2013 with 8,949 reports, while the
lowest was observed in Q1 2013 with 7,602 reports (Table 3).
Figure 3: Quarterly rates of E. coli bacteraemia reports per 100,000 population,
October 2011 – September 2013
Table 3: Quarterly counts and rates of all E. coli bacteraemia reports by quarter, July
2011 – September 2013
Year and quarter
2011
2012
2013
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Total E. coli
bacteraemia reports
8,275
8,098
7,698
8,074
8,676
7,957
7,602
8,075
8,949
Rate (per 100,000
population)
61.82
60.50
57.88
60.71
64.52
59.18
57.63
60.55
66.37
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Clostridium difficile infection
Between Q3 2011 and Q3 2013, the rate of Trust apportioned cases per 100,000 bed
days has decreased by 38.0%, from 24.12 to 14.96. Over the same period, the rate of
total CDI cases per 100,000 population declined by 27.2% from 38.28 to 27.89. It is
evident that the trends differ between Trust apportioned cases and total CDI cases.
(Figure 4).
The total number of CDI reports has decreased by 5% when compared to the same
period last year – from 3,870 reports in Q3 2012 to 3,663 reports in Q3 2013. This is part
of a gradual decrease of 39% since Q2 2010 when there were 5,981 reports (Table 4).
Trust apportioned reports have declined by 58% between Q2 2010 and Q3 2013, where
there were 2,996 reports and 1,268 reports respectively. Trust apportioned reports also
present a 16% decline between Q1 2013 and Q3 2013, from 1,503 reports to 1,268
reports respectively (Table 4).
Figure 4: Quarterly rates of C. difficile infection in patients aged 2 years and over,
October 2011- September 2013
a) Trust apportioned reports (per 100,000 bed-days) b) All reports (per 100,000 population)
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Table 4: C. difficile infection counts and rates in patients aged 2 years and over by
quarter, April 2010 – September 2013
Trust
Trust apportioned
Year and quarter apportioned rates (per 100,000
reports
bed-days)
2010
Q2
2,996
34.11
Q3
2,632
29.64
Q4
2,431
27.37
2011
Q1
2,358
27.14
Q2
2,206
25.53
Q3
2,046
24.12
Q4
1,824
21.07
2012
Q1
1,613
18.07
Q2
1,516
17.67
Q3
1,433
16.91
Q4
1,525
17.74
2013
Q1
1,503
17.14
Q2
1,343
15.60
Q3
1,268
14.96
All reports
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
5,981
5,909
4,984
4,833
4,967
4,994
4,350
3,711
3,656
3,870
3,756
3,412
3,381
3,663
All reports rates
(per 100,000
population)
46.76
45.69
38.54
37.87
38.49
38.28
33.34
28.64
28.22
29.54
28.67
26.55
26.02
27.89
Notes:
MRSA bacteraemia Trust apportioned reports: The analysis of Trust apportioned and all other reports is
based on the model outlined by the National Quality Board.
(http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_100637.pdf)
This includes patients who are (i) in-patients, day-patients, emergency assessment patients or not known;
AND (ii) have had a specimen taken at an acute Trust or not known; AND (iii) specimen is 3 or more days
after date of admission (or admission date is null), where the day of admission is day ‘1’.
st
MRSA bacteraemia PIR assigned reports: As of the 1 of April 2013, all MRSA bacteraemia cases
reported via the HCAI Data Capture System (DCS) are assigned to either an acute Trust or a CCG through
the completion of a Post Infection Review (PIR). A case is deemed to be Trust assigned where the
completed PIR indicates that an acute Trust is the organisation best placed to ensure that any lessons
learned are actioned. Further information on the PIR process can be found on the following webpage:
http://www.england.nhs.uk/ourwork/patientsafety/zero-tolerance/
MSSA bacteraemia Trust apportioned reports: The analysis of Trust apportioned and all other reports is
based on the criteria applied to MRSA bacteraemia.
CDI Trust apportioned reports: include patients who are (i) in-patients, day-patients, emergency
assessment patients or not known; AND (ii) have had a specimen taken at an acute Trust or not known;
AND (iii) specimen is 4 or more days after date of admission (admission date is considered day ‘1’).
Total reports: These are all the cases reported by an acute Trust. They consist of Trust apportioned
reports and reports NOT apportioned to the acute Trust.
Further epidemiological notes are available on the PHE website [4].
The next commentary will be published in March 2014.
References
1. Mandatory Staphylococcus aureus bacteraemia surveillance scheme
[http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/Page/1191942169773].
2. Mandatory Escherichia coli bacteraemia surveillance scheme
[http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/EscherichiaColi/MandatorySurveillance/]
3. Mandatory Clostridium difficile infection surveillance scheme
[http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/Page/1179745282408].
4. Quarterly Epidemiological Commentaries on MRSA, MSSA, Escherichia coli bacteraemia and C. difficile
infection
[http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1259151891722 ]
Enteric
General outbreaks of foodborne illness in humans, England and Wales: weeks 45-48/2013
Common gastrointestinal infections, England and Wales: laboratory reports: weeks 45-48/2013
Salmonella infections (faecal specimens), England and Wales: reports to the CIDSC, Colindale
(salmonella data set), October 2013
Hospital norovirus outbreaks (England and Wales, weeks 45-48/2013) and seasonal comparisons of
recent years’ norovirus laboratory reports
General outbreaks of foodborne illness in humans, England and Wales:
weeks 45-48/2013
Preliminary information has been received about the following outbreaks.
PHE Centre /Health
Protection Team
Norfolk, Suffolk and
Cambridgeshire
Organism
Location of
Month of Number Cases Suspect
food prepared
Evidence
outbreak
ill
positive vehicle
or served
Salmonella
Function/party November
spp.
17
Hog
roast
3
D
D = Descriptive epidemiological evidence: suspicion of a food vehicle in an outbreak based on the identification of common food
exposures, from the systematic evaluation of cases and their characteristics and food histories over the likely incubation period by
standardised means (such as standard questionnaires) from all, or an appropriate subset of, cases.
Common gastrointestinal infections, England and Wales:
laboratory reports: weeks 45-48/2013
Total
reports
Number of reports received
Laboratory reports
Cumulative
total
45/13
46/13
47/13
48/13
45-48/13
01-48/13
01-48/12
Campylobacter
1198
1062
1054
949
4263
55041
61765
Escherichia coli
O157 *
22
20
23
12
77
741
790
Salmonella †
135
104
57
18
314
6630
7323
Shigella sonnei
25
20
22
13
80
919
905
Rotavirus
35
38
53
44
170
14712
15005
Norovirus
66
82
100
108
356
6346
9310
Cryptosporidium
90
68
64
60
282
3230
5395
Giardia
90
78
76
65
309
3312
3646
*Vero cytotoxin–producing isolates: data from CIDSC's Laboratory of Gastrointestinal Pathogens (LGP), PHE Colindale.
† Data from CIDSC-LGP.
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Salmonella infections (faecal specimens), England and Wales: reports to
CIDSC, Colindale (salmonella data set), October 2013
Details of 995 serotypes of salmonella infections recorded in September are given in the table below.
In October 2013, 186 salmonella infections were recorded.
Organism
Cases October 2013
S. Enteritidis PT4
27
S. Enteritidis (other PTs)
212
S. Typhimurium
140
11
S. Virchow
Others (typed)
353
Total salmonella (provisional data)
743
Hospital norovirus outbreaks (England and Wales, weeks 45-48/2013) and
seasonal comparisons of norovirus laboratory reports
The hospital norovirus outbreak reporting scheme (HNORS) recorded 38 outbreaks occurring between weeks 45
and 48 2013, 36 of which (95%) led to ward/bay closures or restriction to admissions. Twenty-four outbreaks (63
per cent) were recorded as laboratory confirmed due to norovirus. From week 1 (January 2013) to week 48 (week
beginning 25 November, 2013) 801 outbreaks have been reported. Ninety-one per cent (731) of reported outbreaks
resulted in ward/bay closures or restrictions to admissions and 68 per cent (548) were laboratory confirmed as due
to norovirus.
Suspected and laboratory-confirmed reported norovirus outbreaks in hospitals, with regional breakdown:
outbreaks occurring in weeks 45-48/2013
Region/
PHE Centre
Outbreaks between weeks
45-48/2013
Total outbreaks 1-48/2013
Outbreaks
Ward/bay
closure
Labconfirmed
Outbreaks
Ward
closure
Labconfirmed
Avon, Gloucestershire and Wiltshire
5
5
4
67
66
58
Bedfordshire, Herts. and Northants
–
–
–
10
10
9
Cheshire and Merseyside
–
–
–
16
12
11
Cumbria and Lancashire
1
1
1
60
59
26
Devon, Cornwall and Somerset
8
8
2
149
148
78
Greater Manchester
1
1
20
–
17
Hampshire, Isle of Wight and Dorset
9
9
8
51
50
39
Lincs., Leic., Notts, and Derbyshire
–
–
–
53
51
38
London
–
–
–
19
18
18
Norfolk, Suffolk, Cambs. and Essex
–
–
–
–
–
–
North east
5
4
3
97
92
69
Sussex, Surrey and Kent
2
2
1
78
78
57
Thames Valley
2
2
1
41
40
25
West Midlands
5
5
3
36
30
17
Yorkshire and the Humber
–
–
–
104
77
86
Total
38
36
24
801
731
548
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013
Seasonal comparison of laboratory reports of norovirus (England and Wales)
In the current season to date † (from week 27, 2013, to week 48, 2013), there were 1091 laboratory reports of
norovirus. This is 28 per cent lower than the average number of laboratory reports for the same period in the
seasons 2007/08 and 2011/2012 (1510)*. The number of laboratory reports in the most recent weeks will increase
as further reports are received.
† The norovirus season runs from July to June (week 27 in year one to week 26 in year two) in order to capture the winter peak in one
season.
* Last season – 2012/2013 – the season began earlier than normal so comparisons between this current and last season would not be
valid.
Figure 1. Seasonal comparison of laboratory reports of norovirus (England and Wales)
Figure 2. Current weekly norovirus laboratory reports compared to weekly average 2006/2010
Health Protection Report Vol 7 Nos. 50/51 – 13 and 20 December 2013