The Public Health etc. (Scotland) Act 2008

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Annual Data 2012

Information relating to notifications of infectious diseases for 2012 are summarised as key points with more detailed tables and charts below. These tables and charts contain 2012 and previous years data for notifications of infectious disease.

These analyses are for confirmed notifications to the year ended 31 December 2012. 

Key Points

Anthrax

Between June 2012 and the end of March 2013, 15 cases of anthrax were reported among PWID in Europe: five in England, four in Germany, two in Scotland, two in Denmark, one in France and one in Wales. The cases are through to be linked through exposure to heroin contaminated with anthrax spores. These are the first cases of anthrax among drug users in Europe since the outbreak during 2009-10. This indicates that PWID in the Scotland, and elsewhere in Europe, remain at risk of severe illness, such as anthrax, caused by spore forming bacteria.

Clinical syndrome due to E. coli O157 infection

Clinical syndrome due to E. coli O157 infection has only been notifiable since 2010, following the Public Health etc. (Scotland) Act 2008. Notifications do not require laboratory confirmation, and should be based on clinical suspicion, which should be aroused by (i) likely infectious bloody diarrhoea or (ii) acute onset non-bloody diarrhoea with a biologically plausible exposure and no alternative explanation [http://www.scotland.gov.uk/Topics/Health/Policy/Public-Health-Act].

Examples of biologically plausible exposures include: contact with farm animals, their faeces or environments; drinking private water supplies or raw water; eating foods such as undercooked burgers, unpasteurised dairy products; or contact with a confirmed or suspected case of VTEC infection.

Where a case is notified as HUS (Haemolytic Uraemic Syndrome) it should not also be notified as Clinical syndrome due to E. coli O157 infection.

In 2012, there were 17 notifications of Clinical syndrome due to E. coli O157 infection, all of which were confirmed microbiologically.

As this is still a relatively new notification category, data are only available from two previous years, which is insufficient to allow robust comparisons of annual figures, and the system is still bedding in clinically. Notification numbers can also be expected to vary considerably from year to year, as the criteria are based on clinical suspicion alone. Surveillance and monitoring of E. coli O157 infection in Scotland are therefore based on laboratory reporting of microbiologically confirmed cases, which is seen as the better measure of infection incidence, and for which a 10-year dataset is available.

Haemolytic Uraemic Syndrome (HUS)

Haemolytic Uraemic Syndrome (HUS) is a rare disorder characterised by microangiopathic haemolytic anaemia, microthrombi, and multi-organ injury. HUS is one of the commonest causes of acute renal failure in childhood worldwide and is strongly associated with infection with verotoxin-producing Escherichia coli (VTEC) such as E. coli O157. Over the last decade, however, non-O157 serogroups of VTEC have become increasingly important in the development of HUS. Although previous surveillance of childhood HUS in Scotland identified E. coli O157 in over 90% of cases, non-O157 serogroups have also been associated with HUS. Since 2003, all clinically diagnosed cases of HUS in Scotland have been reported to Health Protection Scotland (HPS) as part of an enhanced surveillance programme.

Statutory notification of HUS cases under the Public Health etc (Scotland) Act 2008 is also a very recent development, having been in operation only since 2010. In 2012, there was one notification of HUS under the Public Health etc (Scotland) Act. Although there was only one notification of HUS in 2012, there were in fact an additional 11 cases of HUS in individuals who had microbiologically confirmed infection with E. coli O157. The data on notified cases of HUS alone does not therefore provide the complete picture of HUS incidence.

Haemophilus influenzae type b (Hib)

Haemophilus influenzae type b (Hib) became notifiable as of January 2010 under the Public Health etc (Scotland) Act 2008, and therefore there are very limited historical data. There were no Hib notifications in 2012, there had been three such notifications in 2010 and six in 2011. An enhanced surveillance scheme based on laboratory reports has been in place since the introduction of the Hib vaccine in 1992. In 2012 there were two laboratory confirmed cases of Haemophilus influenzae type b, the same as the number of laboratory confirmed cases in 2011.

Measles

Notifications for measles are made on the basis of clinical suspicion. As measles has become rare in Scotland due to high uptake of vaccination, it has become more difficult to accurately diagnose clinically. It is therefore requested that all notified cases undergo testing to ascertain if they are a true case of measles. Notifications for measles remain at a low level in Scotland. In 2012 there were 99 measles notifications and 28 laboratory confirmed cases. This compares with 82 notifications with 24 laboratory confirmed cases in 2011; and 93 notifications and 10 laboratory confirmed cases in 2010. The majority of measles cases and suspected cases continue to occur in unimmunised or under immunised individuals.

Meningococcal infection

There were 89 cases of meningococcal infection notified in 2012, compared to 103 in 2011. The overall trend has been a decline since the introduction of the Meningococcal C (Men C) vaccine in 1999, when 329 cases were notified. More than half the cases notified in 2012 (65.2%, 58 cases) were in children aged under 15 years.

Mumps

In 2012 there were 920 notifications for mumps, compared with 607 notifications in 2011 and 727 notifications in 2010. Notifications for 2008-2012 are a significant fall from a peak in 2005 (5698 notifications). Cases continue to be mainly among the young adult age group, aged 15 to 24, who are often under immunised against mumps, as they were not routinely offered two doses of MMR vaccine as children.

Necrotising Fasciitis

The reported cases of Necrotising Fasciitis in 2012 fell from 12 cases in 2011 to four cases in 2012 – this is a similar number to that of the first year of reporting in 2010 when there were two cases.   Reports were limited to NHS Fife and Lanarkshire (each reporting two cases)

Pertussis (whooping cough)

There were 2068 notifications of pertussis in 2012, a dramatic increase on the 85 notifications in 2011, of which 29.8% (616 cases) were in children aged under 15 years. In 2012 Scotland, like the rest of the UK experienced an outbreak of whooping cough (pertussis), laboratory confirmed cases of pertussis also increased dramatically in 2012 to 1924 compared to 119 in 2011. Since October 2012, an immunisation programme for pregnant women has been in place to protect infants prior to routine immunisation, the group at highest risk.

Rubella

Notifications for rubella are made on the basis of clinical suspicion. As rubella has become rare in Scotland due to high vaccine uptake, it has become difficult to accurately diagnose clinically. It is therefore requested that all notified cases undergo testing to ascertain if they are a true case of rubella. Notifications for rubella remain at a low level in Scotland. In 2012 there were 43 notifications for rubella and five laboratory confirmed cases. This compares to 20 notifications and no laboratory confirmed cases in 2011; and 39 notifications and one laboratory confirmed case in 2010.

Tuberculosis

There were 416 notifications of tuberculosis in 2012. This was a decrease of 8.9% (41 cases) compared to 2011 when 457 cases were notified.

Of the notified cases in 2012, 226 were respiratory cases, fewer than the 291 in 2011, and 190 were non-respiratory compared to 166 in 2010. Although there was an increase of 14.4% (24 cases) in non-respiratory cases, the 190 notifications are comparable to both 2009 and 2010 with 195 and 199 respectively.

The decrease in notifications is also mirrored by Enhanced Surveillance of Mycobacterial Infections (ESMI). The ESMI scheme provisionally reported 398 cases in 2012 compared to 448 in 2011, this was the second consecutive decrease in numbers reported to ESMI and follows a steady in raise in cases 2005-2010.

Typhoid/Paratyphoid

During 2012 there were 2 notifications of typhoid and 0 notifications of paratyphoid (compared to 3 notifications and 1 respectively in 2011). We have no detail on travel history for these cases, however all laboratory confirmed cases of typhoid and typhoid in 2012 indicated that their infection was associated with travel to the Indian subcontinent. HPS is confident that we would have been informed had infection been acquired indigenously. Infection abroad is usually the result of the ingestion of heavily contaminated food or water. Typhoid vaccine does not confer 100% protection and does not protect against paratyphoid infection therefore all travellers should be encouraged to exercise food and water precautions to prevent all types of enteric fever.

Tables and Charts for 2012