Managing the risk of viral haemorrhagic fever transmission in a non-high-level intensive care unit: experiences from a case of Crimean-Congo haemorrhagic fever in Scotland.

BACKGROUND: A case of Crimean-Congo haemorrhagic fever (CCHF) was imported into Scotland in 2012. AIM: To discuss the public health response to the case, and the control measures taken to prevent secondary transmission. METHODS: Following confirmation of the case, an incident management team (IMT) was convened to ensure that: (i) all individuals exposed to the case and/or their blood/body fluids were identified, assessed and followed-up appropriately; and (ii) the appropriate disinfection or disposal of equipment was used to manage the patient, laboratory specimens obtained from the case, and their environment. FINDINGS: Contact tracing identified 19 individuals who required follow-up and monitoring. No secondary cases occurred. Identification of laboratory specimens obtained prior to diagnosis proved challenging. The majority were traced, temporarily stored in sharps boxes and subsequently incinerated. A small number could not be recovered and consequently would have been disposed of through the routine hospital waste system. Biochemical and haematology analysers were decontaminated according to the manufacturers' instructions and liquid waste was discharged to drains. The patient's mattress, sphygmomanometer and pulse oximeter probe were incinerated. Decontamination of the clinical environment was undertaken following guidance from national experts. CONCLUSIONS: While national guidance for the management of cases of viral haemorrhagic fever (VHF) available at the time in the UK informed the approach taken to manage the risk of secondary transmission, a number of practical issues relating to infection control aspects of managing a patient with VHF in a non-high-level isolation unit environment were encountered. Close liaison between national experts and the IMT was key to the expedient response to the emerging issues.

Compliance to oseltamivir and subsequent occurrence of self-reported adverse drug reactions among nursery and primary school children following exposure to Influenza A(H1N1)v.

During the containment phase of Influenza A(H1N1)v, a nursery, a primary school and an afterschool club were closed after two pupils were found confirmed cases. Classmates were prescribed postexposure oseltamivir. Compliance was expected to be low. The objective of this study was to assess compliance, the number of children developing adverse drug reactions (ADRs) and the reasons for stopping the course prematurely. We conducted a survey among parents of all classmates of the two cases. Parents were asked about compliance and adverse drug events in a questionnaire or underwent a telephone interview. Response was high, 88%. Seventy-nine percent of the children were compliant to the prescribed dose of oseltamivir. One in four children experienced at least one ADR. Children who took a higher daily dose (treatment dose) developed significantly more often ADRs. No children developed Influenza A(H1N1)v. We found that a high overall compliance to prescribed oseltamivir can be achieved in very young children (1-11 years). The proportion of children developing ADRs was much lower than described in two other recent UK investigations. Possibly, this is related to the socioeconomic status of the population under investigation.

An outbreak of infection with Bacillus anthracis in injecting drug users in Scotland.

An investigation is currently underway to explore and control an outbreak of Bacillus anthracis among drug users (mainly injecting) in Scotland. Contaminated heroin or a contaminated cutting agent mixed with the heroin is considered to be the most likely source and vehicle of infection. Heroin users have been advised of the risk. The risk to the general public is regarded as very low.

Severe illness and death among injecting drug users in Scotland: a case-control study.

Between April and September 2000, 60 injecting drug users in Scotland died or were hospitalized with severe illness. Laboratory investigations suggested that Clostridium novyi and other bacteria were important aetiological agents. To determine associated environmental/behavioural factors a case-control study was undertaken with 19 'definite' and 32 'probable' cases in Glasgow, Scotland. For every deceased case (n=19), up to three proxy individuals were interviewed. Three controls were identified for each case. Multivariate logistic regression analyses compared (i) all cases and controls; (ii) definite cases and matched controls; (iii) probable cases and matched controls. In all three analyses injecting into muscle or skin and injecting most of the time with a filter used by someone else were the variables most strongly associated with illness. Comparing only muscle-injecting cases and controls, cases were significantly more likely to have injected larger amounts of heroin per average injection than were controls. The findings make an important epidemiological contribution to the understanding of the public health and clinical implications of the contamination of illicit drugs by histotoxic clostridia.

Epidemiology of multiple sclerosis in Glasgow.

STUDY OBJECTIVE: The objectives of the study were to establish the prevalence and incidence of multiple sclerosis in Glasgow and to assess the epidemiological importance of deprivation and ethnicity. DESIGN: The study was a descriptive cross-sectional study. Multiple sources of ascertainment were used to identify cases. SETTING AND PATIENTS: The study was carried out in the population of three Local Health Care Cooperatives (LHCCs) in the area of Greater Glasgow NHS Board. The total population was approximately 169,000. MAIN RESULTS: In total, 245 patients with multiple sclerosis were identified. The mean age of patients was 49.8 years, the female to male ratio was 3.2:1, and the mean duration of disease was 16 years. The overall prevalence was 14.5 per 10,000, and the overall incidence 5.7 per 100,000 per year. Both the prevalence and incidence of multiple sclerosis were higher in the more affluent population. The crude prevalence in the Asian population was 6.3 per 20,000. CONCLUSIONS: The epidemiology of multiple sclerosis in Glasgow was similar, in most respects, to the epidemiology described in other parts of the U.K. There was evidence for the importance of deprivation as a determinant of both incidence and prevalence of disease. The reasons for the higher incidence and prevalence of multiple sclerosis in less deprived populations are not clear.

Low dependency residents in private nursing homes in Glasgow.

OBJECTIVES: To investigate why nursing home care had been recommended for elderly people who were assessed subsequently as being of low dependency. DESIGN: Examination of community care assessment documentation for low dependency residents to assess reasons for recommending nursing home care; comparison of these with data from a subsequent SCRUGs (Scottish Care Resource Utilisation Groups) assessment. SETTING AND SUBJECTS: Three hundred and four residents within eight private nursing homes in Glasgow. RESULTS: Twenty six percent of the residents were described as being of low dependency. Of these, 44% had dementia and 6% personal care needs alone; 29% had medical problems which required nursing input, but not necessarily to a level requiring nursing home care. Information in the community care assessment often described a higher level of need than that identified subsequently. From the information given in the medical component of the community care assessment it was often unclear why the decision to recommend nursing home care was made. CONCLUSION: Admission to nursing homes may be encouraged by over-emphasiZing care requirements, by placing emphasis on safety rather than independence and by inadequate recording of information. Elderly people who cannot remain at home need improved assessment procedures, better understanding of their needs and a wider range of accommodation options.

Hepatitis B immunisation of infants at risk.

A retrospective cohort review survey assessed hepatitis B immunisation uptake in at-risk infants over 4 years and a GP questionnaire identified the problems of poor communication and uncertainty of responsibility for immunisation as barriers to successful implementation of the immunisation programme. Incorporating appointments for hepatitis B immunisation within the national child immunisation recall system would help improve uptake but, in the meantime, a manual appointment system could be incorporated within existing child immunisation systems.