Infectious Diseases Emerging Threats

Beware respiratory symptoms August 14 th – a Friday informed of 4 cases all of whom had been hospitalised with respiratory symptoms. Two were currently in ITU, one in Mansfield and the other on the isle of Skye! Possible diagnoses Legionnaire's disease Flu / some other similar respiratory virus ( we were aware of parainfluenza outbreaks elsewhere) History for the patient in Mansfield of exposure to pigeons so we wondered if this was Psittacosis. 2

Legionnaire’s ruled out by urinary antigen testing An additional worker found to also be unwell but not hospitalised August 28 th patient in ITU diagnosed with Psittacosis The other 4 checked and apart from one all were still unwell. All asked to go for antibody testing and their GPs asked to treat them appropriately (14 days of a Tetracycline) Three out of the remaining four positive for antibodies to Psittacosis 3

How did they get it? The group of offices is infested with pigeons The pigeons roosted near the vents for the air conditioning The guano from the pigeons had Chlamydia psitacci and it was blown into the office in concentrated form 4

Welcome to a meal rich in Salmonella March 9 th 2015 became a ware of a possible outbreak of Salmonella associated with eating at a pub-restaurant Between February and April there were 53 cases PHE now carries out genetic sequencing on all Salmonella isolates Isolates from these 53 people were unique and are the same (database in England of over 80,000 isolates) This indicates a point source at the pub-restaurant Carvery food implicated 5

Background This is a busy pub-restaurant It serves between 6000 and 8000 meals a day It is open from 8.00 a.m. – breakfast - until midnight - 7 days a week 6

The next phase May to June a further 11 cases Further interventions with the pub-restaurant chain All sequenced and all the same as the original unique strain Likelihood that this is from a staff member therefore staff sampled – again 4 identified as having the strain but all likely to be victims and not the origin of the outbreak Management team changed 7

And the current phase Since August 8 th – a further 11 cases Likely to be from a staff member 8

Outbreak curve 9

What next Samples from all staff with involvement of HR and occupational health Requests for stool samples will come from occupational health who will therefore receive the results Issues Staff compliance – role of rectal swabs Informing staff of results – how? who? Managing the positives – exclusion from work, treatment, etc. 10

MERS Co V Middle Eastern Respiratory Syndrome Coronavirus First reported in Saudi Arabia in 2012 Major outbreak in South Korea affecting hospitals 1589 lab confirmed cases causing 567 related deaths Transmission continues in Saudi with a mixture of new primary cases and secondary cases Advice re travel – avoid contact with camels, camel milk and camel products Risk greatest to healthcare workers 11

Meningitis 12

Meningitis 13

Meningitis 14

And the implications? Children vaccinated against Meningitis B Teenagers to be vaccinated against W135 using a conjugate vaccine For travel purposes use the conjugate A C Y W135 vaccine 15

Respiratory Infections – preventing transmission 16

Endocarditis and heater cooler units in Cardiac By-pass Infection caused by Mycobacterium chimaera This is a species within the Mycobacterium avian intracellulare group 17

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Aerosol release of particles 20

Aerosol release – detection of bacteria 21

And for you? New cases continue to be identified Same risks for Legionella as well! This clearly could also affect staff – therefore unexplained fevers in these staff need to be considered carefully 22

What about flu? Last season’s vaccine was a poor match because of drift Early estimates suggested 3% efficacy but that has improved to 30% At the moment the vaccine this year looks to be a good match but it is very early to be sure The Live Attenuated Intranasal Vaccine given to children offers better protection because There are two Influenza Bs The mechanism of action is primarily nasal mucosa and offers wider protection Immunising children offers protection to adults 23

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10 Key Areas in the Strategy 25

Where does Occupational Health come in Employers may well have a workforce with high numbers of migrants There are opportunities to work with your CCGs to screen these migrants for latent TB 26

Why bother? Infectious TB is expensive It involves screening of the workforce and attendance at clinics If there is transmission you are into RIDDOR reporting and could as part of that have a HSE visit 27

Trent Occupational Medicine Symposium 8 th October 2015