Health Protection Update Croydon Health & Wellbeing Board Barry Walsh June 2012

Outline Introduction to HPA and SWL HPU Key HP issues for Croydon  Tuberculosis  Immunisation  HIV – late diagnosis HP transition issues for SW London References

Health Protection Agency 2004 – 2013 National Organisation SW LONDON HPU based in Tooting Covering 1.4m population Works on behalf of directors of Public Health for 5 PCTs Reactive work dealing with outbreaks and surveillance of communicable diseases/ chemical & radiation incidents Merging with others to form Public Health England April 2013

South West London Health Protection Unit Map of London with SWL highlighted

Tuberculosis in South West London 5

6 Uptake of MMR in Croydon, Source: COVER, HPA

7 Primary immunisations in Croydon at one year, Source: COVER, HPA

Pertussis in SWL BoroughConfirmedSuspected Croydon 63 Kingston 32 Merton 103 Richmond 91 Sutton 41 Wandsworth 95 SWL Total 4115 Pertussis cases in SW London: 12/3/12 – 11/6/12

Measles in SWL BoroughConfirmedProbablePossible Croydon 4 (3)10 (7)2 Kingston 003 Merton 013 Richmond 032 Sutton 305 Wandsworth 2 (1)3 (1)6 SWL Total Measles cases in SW London: 12/3/12 – 11/6/12 (number of which are travellers in brackets)

10 Human Papilloma Virus (HPV) vaccine uptake in Croydon, Source: HPV uptake, Department of Health

Influenza vaccine uptake 2011/12 (provisional data as at February 2012) 11

Influenza vaccine uptake in frontline healthcare workers (provisional data as at February 2012) 12 Source: Influenza vaccine uptake, Department of Health

13 Proportion of HIV cases diagnosed very late in SWL PCTS, 2010 Source: Late Diagnosis Data, HPA

April 2012Duncan Selbie appointed as Chief Executive designate for PHE from 1 July 2012 May 2012PHE organisational design agreed May 2012Executive team roles advertised - filled by July July 2012PHE People Transition Policy published, including terms and conditions framework July – Oct 2012Pre-transfer appointments and new post process October 2012Detailed terms and conditions available October 2012Pre-transfer appointments completed; redeployment commences October 2012Formally consult with individual staff and unions on transfers December 2012PHE People Transition Policy – Phase 2 April 2013PHE established Public Health England timeline

Health Protection concerns on transition Ability to get health professional support for outbreak at very short notice: Big bang Simultaneous multiple small bangs – more difficult

Examples: Outbreak of Hepatitis A in a school – Friday evening - immunisation clinic required Post exposure prophylaxis for HIV in school playground following needle stick injuries. Cluster of invasive group A Streptococcus in care home at weekend requiring prophylactic antibiotics. Look backs – hepatitis/ HIV in healthcare settings Recall Immunisation of children where wrong vaccines administered

Strategic challenges in transition Contracts over control of infection in subcontracted services e.g. renal dialysis where outbreak occurs Control of infection in community Lack of clarity ‘where the buck stops’ e.g. immunisation Localism – challenges to national programmes on immunisation e.g. Varicella vaccine Maintaining cluster working on immunisation TB, health care associated infection, occupational health

Further information Please see the HPA website For further information on surveillance at SWLHPU please contact For further information on SWL HPU geographical links please contact or For further information on health protection in Croydon please contact For further information about environmental health in Croydon please phone