Guidelines for the public health management of typhoid and paratyphoid in England: practice guidelines from the National Typhoid and Paratyphoid Reference Group.

OBJECTIVES: The Typhoid and Paratyphoid Reference Group (TPRG) was convened by the Health Protection Agency (HPA) and the Chartered Institute of Environmental Health (CIEH) to revise guidelines for public health management of enteric fever. This paper presents the new guidelines for England and their rationale. METHODS: Methods include literature reviews including grey literature such as audit data and case studies; analysis of enhanced surveillance data from England, Wales and Northern Ireland; review of clearance and screening schedules in use in other non-endemic areas; and expert consensus. RESULTS: The evidence and principles underpinning the new guidance are summarised. Significant changes from previous guidance include: • Algorithms to guide risk assessment and management, based on risk group and travel history; • Outline of investigation of non-travel cases; • Simplified microbiological clearance schedules for cases and contacts; • Targeted co-traveller screening and a "warn and inform" approach for contacts; • Management of convalescent and chronic carriers. CONCLUSIONS: The guidelines were launched in February 2012. Feedback has been positive: the guidelines are reported to be clear, systematic, practical and risk-based. An evaluation of the guidelines is outlined and will add to the evidence base. There is potential for simplification and consistency between international guidelines.

An outbreak of infectious syphilis among young heterosexuals in an English town.

We describe a recent outbreak of syphilis in young heterosexuals in the north west of England. A cluster of 12 cases of syphilis (7 primary and 5 early latent) was identified in Rochdale in heterosexuals aged 20 or under. Nine were women. Five were asymptomatic at presentation. This outbreak occurred in a group not usually associated with syphilis transmission in the north west. Not all the identified cases could be linked, and so potentially this outbreak is a sentinel of a larger problem.

Mapping of sexual health promotion in North West England, 2008.

OBJECTIVE: To map sexual health promotion activity and resources across North West England. STUDY DESIGN: Survey. METHODS: A survey of all sexual health promotion activity commissioned by primary care trusts (PCTs) was carried out using a self-completion questionnaire for PCT sexual health commissioners in North West England. RESULTS: Sixteen out of 24 PCTs responded. Some PCTs had difficulty in identifying the relevant commissioner. Most activity was focused on young people, especially around the National Chlamydia Screening Programme (NCSP) and teenage pregnancy, and on particular high-risk groups such as lesbian, gay and bisexual people, those living with human immunodeficiency virus and commercial sex workers. All PCTs commissioned education/training and a condom distribution service. Other common activities included outreach work, and producing and disseminating materials. Most services were confined to one PCT. Most PCTs were unable to identify the resources committed to sexual health promotion. The emergent themes in the analysis of service development ideas and comments were all linked to commissioning: commissioning and strategy; funding; needs assessment; service development and provision; contracting and monitoring; evaluation and evidence; and regional perspective. CONCLUSIONS: A simple tool to map sexual health promotion activities commissioned by PCTs was developed. Many PCTs could not identify a commissioner for sexual health or the resources committed to sexual health promotion. Sexual health promotion activity focused on young people (linked to the NCSP and teenage pregnancy) and particular high-risk groups, with resultant gaps and a mismatch with the epidemiology. The most frequently commissioned activities were education/training and condom provision (despite the limited evidence base). A series of recommendations to PCTs, sexual health networks and providers are made.

An outbreak no longer: factors contributing to the return of syphilis in Greater Manchester.

BACKGROUND: In the past few years, increased diagnoses of syphilis have been reported in cities around Britain and Europe. Enhanced surveillance of cases began in 1999 to identify the epidemiology of this increase in Greater Manchester. METHODS: Information was collected on all cases of syphilis newly diagnosed in genitourinary medicine (GUM) clinics in Greater Manchester between January 1999 and November 2002. The data collected included demographic information and information about other sexually transmitted infections, sexual behaviour, perception of risk of infection, and awareness of syphilis transmission. RESULTS: The majority of cases identified were white homosexual men resident in Greater Manchester. Of the 414 cases diagnosed, 74% had either a primary or secondary stage of syphilis infection and 37% of cases were HIV positive. High numbers of individuals practised unprotected oral sex despite good awareness of the risk of infection with syphilis. There is evidence that the way people are meeting sexual contacts is changing, with increasing numbers meeting most of their partners through the internet. CONCLUSIONS: These findings have implications for targeting interventions. The provision of rapid diagnostic and treatment services is likely to be key for the control of syphilis and potentially of subsequent increases in HIV in the region.

Follow up in north west England of cases of enteric fever acquired abroad, April 1996 to March 1998.

Cases of enteric fever in the north west of England who acquired infection abroad between April 1996 and March 1998 were surveyed to determine the workload associated with the follow up of contacts of cases and the yield from their investigation. No asymptomatic secondary cases were detected, and it is argued that low risk asymptomatic contacts of cases of enteric fever acquired abroad do not need to be screened.

Follow-up of sporadic cases of food-borne infection: comparison of a postal questionnaire with a personal visit.

The aim of the study was to evaluate the follow-up of sporadic cases of suspected food-borne illness by either a postal questionnaire or a personal visit by environmental health staff. This was achieved by comparing the practice in two authority areas within the West Pennine Health Authority in the north west of England. We included all identified cases of suspected food poisoning, campylobacteriosis, cryptosporidiosis, salmonellosis and dysentery occurring in the district between 1 July and 30 September 1996. The main outcome measures were: (1) the proportion of all cases which were successfully followed-up by each method; (2) the timeliness of follow-ups; (3) qualitative estimation by environmental health staff of the data obtained. Visiting by environmental health staff was successful in obtaining information from 76.3% (106/139) of cases, while the postal questionnaires elicited a 52% (50/96) response rate. We found that 70.5% of visits occurred within one week of notification. Although 69.8% (67/96) of questionnaires were issued within one week of notification, only 16% of replies to the questionnaire were received within this period. The information provided on the returned questionnaires was found by environmental health staff to be generally as useful as that obtained by visiting.

A study of risk factors for Campylobacter infection in late spring.

A case-control study was carried out to investigate possible reasons for the large increase in the number of cases of infection caused by Campylobacter species reported in the Regional Epidemiology Section of Manchester Public Health Laboratory in late spring each year. The hypothesis tested was that a risk factor peculiar to campylobacter infection is responsible for this phenomenon. Interviews about a wide variety of risk factors were conducted with 29 patients suffering from campylobacter enteritis and 41 out of a control group of 42 with acute diarrhoeal illness from other causes. The only statistically significant association with campylobacter infection was having had milk bottle tops pecked by birds, while previously recognised associated factors such as outdoor activities, pet ownership and consumption of chicken showed no significant association. Interviewees identified the birds responsible as magpies.