H E A L T H P R O T E C T I I I O N N E W S
D E C E M B E R 2 0 0 7
Contact the team on 01224 558520 or email grampian.healthprotection@nhs.net
CONTENTS

Seasonal, Avian and Pandemic Flu

Pandemic Influenza Planning

World AIDS day
Immunisation News

Rabies Identified In a Cat In France

Rubella immune status of women of child bearing age
T h e H e a l l l t t t h P r r r o t t t e c t t t i i i o n T e a m w o u l l l d l l l i i i k e t t t o w i i i s h y o u a v e r r r y
M e r r r r r r y C h r r r i i i s t t t m a s a n d a
H a p p y N e w Y e a r r r
During the festive period the Health Protection
Team can be contacted through Aberdeen Royal
Infirmary switchboard on 08454566000 and asking for the Public Health Doctor on call
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Seasonal Human influenza occurs most years during the winter affecting about 10% of the population and although unpleasant it is not usually life threatening to healthy adults.
Vaccination is available for high-risk groups. It is natural for human flu viruses to change slightly each year but the ones currently circulating include H1N1, H1N2, and H3N2.
Avian influenza, or “bird flu”, is caused by viruses that normally only infect birds and, less commonly, pigs. A serious form of bird flu caused by H5N1 virus is currently affecting poultry around the world. On rare occasions, H5N1 has infected humans who have had direct contact with infected poultry or surfaces contaminated with secretion/excretions from infected birds.
There is no evidence of person to person spread of H5N1 influenza.
Pandemic influenza starts when a new virus emerges that people have little or no immunity to, causes serious illness and spreads easily from person to person. New viruses can occur when human flu viruses mix with animal flu viruses e.g. H5N1. Pandemic flu spreads easily from person-to-person, causes serious illness even in healthy people, and can sweep across the country and around the world in a very short time.
The concern is that avian flu will mix with human flu creating a new virus that will cause a pandemic i.e. infect people across the world. At December 2007 A/H5N1 avian influenza remains a disease of birds and the virus is poorly adapted to humans. However, when humans are infected it results in an unprecedented mortality rate of over 60%. Although
A/H5N1 is exceptionally persistent in the bird population it does not mean that this will be the source of the next pandemic.

T he Scottish Government Health Directorates has issued a suite of new/revised plans to support pandemic influenza planning.

Scottish Framework for responding to an influenza pandemic
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Guidance on the provision of healthcare in a community setting in Scotland

Planning for pandemic influenza in community care: an operational and strategic framework
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Surge capacity and prioritisation in health services (provisional)
 Guidance on preparing mental heath service’s in Scotland – for comment

Scottish Guidance on Human Resources – for comment

Possible amendments to medicines and associated legislation during an influenza pandemic

HSE workplace guidance

Analysis of Scientific Evidence base
A lso available

Ethical Framework for policy and planning

UK operational framework for antiviral medicines

Clinical Guidelines

Infection Control in Hospital and Primary Care settings
 Guidance for Schools, childcare and children’s services

Guidance for colleges and universities
A vailable on http://www.scotland.gov.uk/Topics/Health/health/AvianInfluenza
T he Grampian Pandemic Influenza Plan was revised in December 2007 and the new format will make the plan easier to use as it will link to the detailed operational plans and allow us to clearly identify the areas for further action and facilitate revision as we receive further guidance.
We plan to make this available on the NHS Grampian website in the New Year.
O perational planning continues and the main areas of work are

Business continuity planning

The impact on our capacity and capability to provide healthcare with increased staff absence and increased workload.
 Providing an integrated primary care response across NHS 24, GMED and “normal” GP and other contractor provision.
World AIDS Day
U nfortunately, in Grampian the numbers of HIV and other sexually transmitted infections continues to rise. Unprotected sexual intercourse is by far the most important risk factor for people newly diagnosed with HIV.
If an individual believes they may have exposed themselves to HIV or other sexual health infections getting an early test is important. Early treatment helps avoid long term complications and prevent further transmission. Initiatives aimed at raising awareness, encouraging discussion, promoting condom use and reducing the stigma of HIV and AIDS in Grampian are ongoing and were the focus of events organised for world AIDS day. The Grampian World AIDS Group believes that talking about HIV and AIDS raises understanding of the realities of living with HIV and awareness around how it is transmitted. T raining on Blood Borne Pathogens is available from the Health Protection Team.
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Rabies Identified In a Cat In France, Due To
European Bat Lyssavirus 1a
Incident
O n 23 November 2007, the French National Reference Centre for rabies diagnosed rabies in a domestic cat living in the town of Fontenay
Le Comte, Vendée district, Western France. The cat had never travelled outside France and had not been vaccinated against rabies.
U ntil this incident, France was considered by WHO amongst those countries with no risk of rabies in terrestrial animals, although rabies had been isolated in bats.
This demonstrates that a country's status can change suddenly as a result of disease reintroduction or emergence. However, risk of contracting rabies from a terrestrial animal originating in France remains extremely low.
Implications
F rance, along with Spain, is the most frequently visited country by UK travellers. Routine rabies pre-exposure vaccination is not advised for travellers to France although it maybe offered to those at particular risk of exposure, for example veterinarians and bat handlers.
A full, expert, risk assessment should be carried out after any animal or bat incident occurring in France and if possible the animal involved should be detained and observed for signs of rabies.
A dvice to any individual sustaining an animal or bat bite would be:

Carry out first aid by thoroughly flushing and cleansing the wound or exposure site with soap and water, apply disinfectant

Seek immediate medical attention to ascertain whether further action needs to be taken, for example administration of rabies vaccine and immunoglobulin, tetanus vaccine or antibiotic therapy.
W hen assessing risk after an exposure, the attending physician should seek the advice of the
Health Protection Team who will authorise the provision of rabies vaccine and immunoglobulin if required. In Scotland it is free of charge. Rabies is a notifiable disease.
W hen seeking to establish rubella immune status, it is not necessary to test antibody levels in every case. Green book guidance states ‘satisfactory evidence of protection would include documentation of having received two doses of rubella containing vaccine or a positive antibody test for rubella’.
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