Communicable Disease Report

Outbreaks of respiratory syncytial virus (RSV) infection occur each winter and

of flu-like illness seen in the community and accounts for a high proportion of

cases of acute respiratory infection in very young children. Almost all the RSV

infections reported to the PHLS Communicable Disease Surveillance Centre have

been diagnosed in children under the age of 1 year (figure 1), in whom the clinical

illness is most often described as bronchiolitis. During periods of high activity,

however, the infection may be responsible for cases of acute respiratory disease

in other age groups, including elderly people.

weeks 48 - 52/95

weeks 48 - 52/95

(To be despatched with next

issue)

%

<1m 1-11m 1-4y 5-9y 10-14y 15-44y 45-64y 65y+ NK

0

25

50

75

100

Age

The proportion of cases of RSV infection diagnosed by virus isolation rose

from 1.3% in 1990 to 5.3% in 1995. Overall, in these six years 91% of cases were

diagnosed by detection of antigen, 4% by isolation, and 2% by serology.

Clinical indices show that influenza activity has continued at increased levels

in recent weeks in England. Data from the Royal College of General Practitioners

spotter practices this season show rates of influenza and flu-like illness to be

highest in children aged 0 to 4 years, which may reflect the high level of RSV

activity also circulating in this age group. Figure 2 shows a simultaneous rise in

laboratory reports of influenza A and RSV infection in the general population this

winter.

40 41 42 43 44 45 46 47 48 49 50 51 52

0

200

400

600

800

1000

1200

0

50

100

150

200

250

300

Influenza A

RSV

RSV

Influenza A

Week

2

Number of reports received Total Average for

reports weeks 48-52

Laboratory reports 48/95 49/95 50/95 51/95 52/95 48-52/95 (last 5 years)

EM faeces) 42 31 39 51 25 188 189 *

meningitis; M 8y with Guillain-Barré syndrome. Two

patients were immunocompromised: 1 after bone marrow

transplant (BMT), 1 with leukaemia. One patient had

concurrent cytomegalovirus infection. Two regions

reported more than 10% of cases: Trent (35 cases) and

Yorkshire (20). Ninety-eight patients (53%) were aged

under 5 years.

region.

rises, 361 single high titres): 172 patients had pneumonia,

64 had bronchiolitis, and 2 had croup. M 12y with

pericardial effusion and suspected myocarditis; M 19y

with Miller Fisher syndrome (variant of Guillain-Barré

syndrome); M 19y with suspected meningitis; M 33y with

suspected pericarditis; M 80y died; F 40y whose husband

has psittacosis; F 67y with suspected myocarditis; F 89y

was part of a small outbreak in a geriatric hospital in

Wessex. Fifteen patients were immunocompromised:

was HIV-1 antibody positive, 1 with cystic fibrosis, 2 whose

underlying conditions were not stated. Six patients had

concurrent infections: 4 with respiratory syncytial virus

glandular fever. Three regions reported more than 10% of

cases: S Western (166 cases), W Midlands (131), and Trent

(103). Five hundred and fifty-eight patients (66%) were

aged 15 years or over.

titres): one patient had pneumonia. M 39y had travelled

abroad (Ethiopia). No region reported more than 2 cases.

Seven patients (70%) were aged 15 years or over.

untyped, 2. Fifteen patients had bronchiolitis, 1 had

pneumonia, and 4 had croup. Two patients were

immunocompromised: 1 with leukaemia, 1 with BMT.

One patient had concurrent infection with RSV. Two

regions reported more than 10% of cases: W Midlands

were aged under 5 years.

20 had pneumonia, and 3 had croup. Ten patients were

immunocompromised: 4 with leukaemia, 2 with BMT,

congenital immunodeficiency. M 2m with osteomyelitis;

premature M 7m with hydrocephalus and Hirschsprung’s

disease. Two patients had concurrent infections: 1 with

poliovirus type 1, 1 with influenza A. Three regions

reported more than 10% of cases: Trent (784 cases),

four hundred and ninety patients (94%) were aged under

5 years.

and 1 had croup. Five patients were immunocompromised:

2 with leukaemia, 2 after organ transplants,1 whose

underlying condition was not stated. M 11m died. Four

regions reported more than 10% of cases: Northern (14

cases), Trent (10), S Western (6), and Mersey (6). Thirtyone

patients (74%) were aged under 5 years.

Number of reports received Total Average for

reports weeks 48-52

Laboratory reports 48/95 49/95 50/95 51/95 52/95 48-52/95 (last 5 years)

NA not available.

pneumonia. Seven patients had contact with birds:

cockatiels 2 (in one case bird died), parrot 1 (bird died),

unspecified 4, including 1 who had unspecified animal

contact also. M 74y with pleurisy.

six months in Kenya.

3

including M 86y who died, and 3 females aged 48 to 69

years) had pneumonia; 2 had non-pneumonic infections

with travel: Spain 3, Belgium and France, Italy, Turkey,

one each. One infection was acquired in hospital.

Johnson syndrome; M 67y had concurrent infection with

influenza A; F 53y after splenectomy. Two regions reported

more than 10% of cases: S Western (10 cases) and

under 10 years.

Coagulase negative 288 2 8 41 290 3378

group A 29 1 1 7 30 461

group B 53 4 24 14 57 739

group C & G 34 – 1 21 34 448

enterococci 233 4 8 111 237 2174

No. of reports received Age Total Cumulative

CSF only or reports total

* methicillin resistant strains of Staphylococcus aureus.

whom were receiving haemodialysis and 6 total parenteral

nutrition (TPN); 10 were intravenous drug users; 9 had

endocarditis; 32 had septic arthritis; 5 had urinary tract

infection (UTI) or had undergone genital tract surgery; 16

had prosthetic heart valves or pacemakers; 11 had received

vascular grafts.

Three hundred and seventy-eight methicillin resistant

strains were reported (including 93 blood isolates):

Yorkshire 27 (1); Trent 13 (4); E Anglia 2 (2); NW Thames

11 (10); Wessex 69 (2); Oxford 23 (1); W Midlands 20 (20);

Mersey 20 (2); N Western 4 (1); S Western 12 (0);

infection; 13 with IV lines were receiving TPN; 11 had

endocarditis. Premature M 11d receiving peritoneal dialysis

died; M 42y after heart, lung, and liver transplant; M 58y

after renal transplant; F 69y with renal failure, who died,

and 2 patients with peritonitis were all receiving continuous

ambulatory peritoneal dialysis (CAPD).

Also reported: F 26y (vaginal isolate).

all had skin infection, including M 53y who died (necropsy

IV lines) 2 patients with skin infection, F 85 years died.

Also reported: F 86y with septic arthritis (joint aspirate

isolate).

chemotherapy and 6 females aged 80 to 91 years all had

skin infection; M 88y with pneumonia and F 81y with

septicaemia both died; 2 patients with IV lines; 2 with

septic arthritis.

13 patients had polymicrobial infection. Six patients died,

catheterised; 6 after biliary tract surgery; M 75y with

26: 4 patients had polymicrobial infection. One patient

died; 7 had IV lines, including 1 receiving TPN and 2

Three were immunocompromised and one was receiving

haemodialysis. Twenty-one patients had endocarditis,

including M 45y with dental and brain abscesses, F 33y (an

injecting drug user), and F 76y with a prosthetic heart

valve. Ten had undergone biliary tract surgery; 4 had IV

lines, including M 65y with leukaemia. Another patient

had leukaemia and one died in utero.

children aged 1 to 4 years. One hundred and sixty-one

patients had pneumonia, including 3 infants, 1 of whom

died, and 11 children aged under 5 years (5 males, 6

females). Nineteen patients were immunocompromised.

Also reported: 2 patients (joint aspirate isolates).

shunts.

(blood isolate also).

Data are for England and Wales only, unless otherwise stated. Weekly numbers are provisional and should not be used to indicate trends.

Staphylococci

Coagulase negative 288 – – – – – – –

group A 29 1 – – – – – –

group B 53 1 – – 2 – – –

group C & G 34 2 – 1 2 – 1 (–) –

enterococci 233 1 – – 26 – 3 (–) –

Age Endocarditis IVDA

Total Acute Intravascular Pace- (with (with

wound isolate).

retrograde cholangiopancreatography.

with IV lines.

pneumonia, who died; F 2y with chest infection; F 78y.

neutropenia.

endocarditis.

The Chartered Institute of Environmental Health is holding its 15th annual one day conference on 21 February 1996 at the

Dartford campus of the University of Greenwich. Topics include the prevention and control of food poisoning, hepatitis,

control of communicable diseases at ports, and fitness to work. The conference fee is £68. Please contact the conference

secretary for further details: Mr Dick Langridge, 1 The Heath, South Tankerton, Kent, CT5 3HJ (tel 01227 763763, ext 4526

or 01227 264340).

pathogenic mechanisms and host defences, diagnosis, the epidemiology of infection within and beyond the stomach, and

management of the infection. Further details and an application form may be obtained from Professor C Roberts, PHLS

Headquarters, 61 Colindale Avenue, London, NW9 5DF. Please enclose a stamped addressed envelope.

published to November 1995 that relate to occupational transmission or acquisition of HIV infection, and updates of the

1993 edition. The document also provides a comprehensive list of references. Single copies are available on request from