An Infection Control Programme in Primary Schools and the Wider Public Health Impact

Young schoolchildren are recognised as being at particular risk of contracting and transmitting enteric infection. (Finn and Crook, 1998/1999).

A collaborative infection control programme was designed, piloted and evaluated in six primary schools in conjunction with the local authority's public protection and education departments and the local health protection team. These pilots helped to inform the programme rolled out to all primary and special needs schools during 2002 to 2003.

A baseline sanitation survey was undertaken with the scores used to prioritise schools for infection control audits. High priority schools were audited. Medium and low priority schools were sent self-assessment packs, the results of which were subsequently validated.

Risks were communicated to each school at the time of visit with a follow-up written report. All schools received advice and support on infection control, including recommendations for improvements, updated policies and supporting educational materials.

Key findings from the programme were lack of adequate facilities for handwashing such as soap, paper towels and hot water; ineffective cleaning programmes and working practices, including awareness of Control of Substances Hazardous to Health (COSHH) (1999) and waste disposal.

Infection control guidelines have been produced for schools, together with an ongoing programme of infection control follow-up audits.

Oseltamivir adherence and side effects among children in three London schools affected by influenza A(H1N1)v, May 2009 – an internet-based cross-sectional survey

This report describes the results of a cross-sectional anonymised online survey on adherence to, and side effects from oseltamivir when offered for prophylaxis, among pupils from one primary and two secondary schools with confirmed cases of influenza A(H1N1)v in London in April-May 2009. Of 103 respondents (response rate 40%), 95 were estimated to have been offered oseltamivir for prophylaxis, of whom 85 (89%) actually took any. Less than half (48%) of primary schoolchildren completed a full course, compared to three-quarters (76%) of secondary schoolchildren. More than half (53%) of all schoolchildren taking prophylactic oseltamivir reported one or more side effects. Gastrointestinal symptoms were reported by 40% of children and 18% reported a mild neuropsychiatric side effect. The results confirmed anecdotal evidence of poor adherence, provided timely information with which to assist decision-making, and formed part of the body of growing evidence that contributed to policy changes to restrict widespread use of prophylaxis for school contacts of confirmed cases of influenza A(H1N1)v.

Public health and economic costs of investigating a suspected outbreak of Legionnaires' disease

This paper provides one of the first assessments of the burden of both the public health investigation and the economic costs associated with an apparent outbreak of Legionnaires' disease (LD) in South East London. In addition to epidemiological, microbiological and environmental investigations, we collected data on the staff time and resources committed by the 11 main organizations responsible for managing the outbreak. Of the overall estimated costs of 455,856 pounds, only 14% (64,264 pounds) was spent on investigation and control of the outbreak compared with 86% (391,592 pounds) spent on the hospital treatment of the patients. The time and money spent on public health services in this investigation appear to represent good value for money considering the potential costs of a major outbreak, including the high case-fatality rate in LD generally and the high health-care costs. Further research is needed to determine optimum strategies for the cost-effective use of health system resources in investigations of LD. Whether the threshold for investigation of cases should be based on observed incidence rates or the cost-effectiveness of investigations, or both, should be debated further.

Measles outbreaks in London, United Kingdom - a preliminary report

2007 saw the highest number of measles cases reported in England and Wales since current surveillance began in 1995, with 971 confirmed cases reported, compared with 740 reported in 2006 [1]. London was the region with the highest number of cases, and a large outbreak of measles in north-east London contributed to this high number of cases [2]. There were several outbreaks of measles elsewhere in Europe in 2007, and case have been reported this year in Switzerland [3], France [4] and Denmark [5].

Outbreak of measles among Irish Travellers in England, March to May 2007

The Health Protection Agency (HPA) in England has been investigating an outbreak of measles in the Irish Traveller community. Between 23 March and 26 May 2007, 92 cases have been reported from six of England’s nine regions: London, East of England, South East, South West, East Midlands, and Yorkshire and the Humber.

Improving malaria surveillance in inner city London: is there a need for targeted intervention?

Malaria in south east London is under-notified, and a previous local study has described how available data can underestimate the incidence. An active surveillance system was established and data on malaria cases diagnosed between the 1st January and 31st December 2000 were gathered from local laboratories, the Malaria Reference Laboratory (MRL) and a neighbouring health authority. In total 320 cases were identified in local residents (42.33 per 100,000). Of these 320, 293 were laboratory confirmed (38.75 per 100,000) and there were 47 notifications on clinical suspicion. Only 6.8% (20) laboratory-confirmed cases were formally notified. Males of African descent aged 25-39 years who travelled to West Africa were most affected, and 92.5% of the cases were of P. falciparum infection. The surveillance programme confirmed that formal malaria notifications are unreliable. The most important group of residents for targeted health intervention are members of ethnic minority groups, born in endemic areas and travelling to their countries of origin to visit family or friends.

An outbreak of hepatitis A among young men associated with having sex in public venues

An increase in hepatitis A virus (HAV) infection was noted among young men in the former Thames regions during 1997. A retrospective case-control study, using a standardised questionnaire at interview, was conducted in the area most affected (London and East Sussex) to investigate the hypothesis that this increase was mainly among homosexual men and to establish the risk factors associated with transmission. Forty-eight cases and 161 controls completed questionnaires. Forty-one cases (85%) described their sexuality as homosexual (p < 0.0001). Cases were more likely than controls to have eaten shellfish (Odds Ratio (OR) 2.4; 95% Confidence Interval (CI) 1.16, 5.04) during the two months before onset of illness. Cases had more sexual partners (p = 0.015), and more casual sexual partners (p = 0.007) than controls. Cases were more likely to have had sex in a gay sauna (OR 3.5; 95% CI 1.53, 8.30), or in a gay club, pub or disco (OR 2.9; 95 CI 1.29, 6.63) than controls. After adjusting for confounding factors, cases were more likely to have eaten shellfish (adjusted [adj] OR 3.0; 95% CI 1.33, 6.59) and to have had sex in a gay sauna (adj OR 3.9; 95% CI 1.42, 10.59). Public health messages need to inform homosexual men about recognised risk factors such as eating shellfish and travel abroad to endemic areas, as well as sexual risks. Homosexual men can benefit from hepatitis A vaccine. We would suggest that in an outbreak situation men who have multiple anonymous partners and have sex in public venues should be targeted as a priority for health education and immunisation.

High incidence of primary tuberculosis

An usually high rate of both tuberculosis infection and active disease is reported in 11 of 38 nursery children in contact with a case of smear positive pulmonary tuberculosis, emphasising the susceptibility of young children to this disease. This report also underlines some important principles in case finding and disease control.

Survey of food safety awareness among HIV positive individuals

A survey was carried out by personal interview to assess the awareness of basic food hygiene and food safety amongst 77 HIV-positive individuals attending a single hospital. There was some confusion and lack of knowledge about aspects of food storage and despite the fact that 74% of subjects had modified their diet since learning their HIV status (mainly for nutritional reasons) only 25% reported receiving information on food safety. Of the subjects interviewed 96%, 66% and 23% were aware of the risks of infection from Salmonella, Listeria monocytogenes and Cryptosporidium, respectively; although most were not aware of the UK Government's advice on the consumption of eggs, soft cheese, pâté and cook-chill foods. Over 40% of those interviewed reported that they did not drink tap water (most drank bottled water instead), but few were aware of infections potentially transmitted through water. Although pets represent a potential source of a wide variety of infectious agents, there was a high level of awareness of this problem. This study highlights the need for improving the availability of information on food hygiene and infections acquired through food and water to HIV-positive individuals.