Public Health Update

Members will wish to note the current situation with regard to the outbreaks of cryptosporidiosis in North Wales, of E.coli O157 in South Wales and of Avian flu in Turkey.

Cryptosporidiosis

On Wednesday 4 January 2006 one further case of Cryptosporidium was confirmed in the Anglesey and Gwynedd area bringing the total number of cases of infection in the Anglesey and Gwynedd area since 1 October to 226.  This is an increase of 10 confirmed cases since my statement of 23 December 2005.  

The Outbreak Control Team (OCT) has reviewed the current status of the outbreak, the findings of current investigations and the ongoing need for a Boil Water Notice.  Despite a slowing in the number of laboratory confirmed cases of cryptosporidium since the Boil Water Notice took effect, new cases are still being diagnosed. The OCT cannot be confident that the risk of infection is no longer present and consider it is possible that lifting the Boil Water Notice now, could result in a resurgence of cryptosporidiosis cases.

The OCT has therefore advised Welsh Water to reissue the Boil Water Notice as a precautionary measure. To allow for a flexible response, the Notice has been issued for an indefinite period.  

Members of the Outbreak Control Team are reviewing the issues on a daily basis and remain confident that water from the Cwellyn Reservoir is the probable source of the outbreak. However, Cwellyn water treatment works has been operating normally throughout the period during which there has been an increase in illness caused by cryptosporidium. Testing has found only low levels of cryptosporidium in the water supply; well within treatment standards.  However, enhanced monitoring of the reservoir for cryptosporidium oocysts is being undertaken.

As a precaution and to reassure people about their tap water, Welsh Water is introducing additional treatment to water supplies from Llyn Cwellyn. The company is installing equipment that will apply ultra violet light treatment to water at their Cwellyn works. This process will make any cryptosporidium oocysts non-viable in the water.  Once this extra stage of treatment is operational the Outbreak Control Team will advise Welsh Water to lift the Boil Water Notice.

People who have received written advice to boil their tap water before drinking and food preparation should continue to do so.  Many of the cases seen in the community are arising from secondary person to person spread. People should be especially thorough with their own hand washing.  The infection can pass very easily between young children so adults should supervise toileting and hand washing in this age group.

Welsh Water has sent letters to the 28,000 affected households and businesses reaffirming the need to continue to boil water. Environmental health officers have sent further written advice to managers of food businesses, dental practices and swimming pools reminding them of earlier advice to minimise the risk of illness. The lifting of the Boil Water Notice will be accompanied by a letter to all affected individuals.

On Tuesday 3 January 2006 I visited North Wales and met with representatives from the Cryptosporidiosis Outbreak Control Group.  The meeting took place at the Gwynedd Local Health Board offices in Caernarfon and included representatives from the National Public Health Service and Welsh Water.  I also had an opportunity to visit Llyn Cwellyn. I also met with experts from the University of Aberystwyth and the Cryptosporidium Reference Unit on Friday 6 January.  What is clear from my discussions is how much still has to be learned about this parasite.  With the advent of DNA research technology new insights are becoming apparent.  While the boil water notice is undoubtedly causing inconvenience for those affected, this outbreak should bring fresh insights to the water industries across the UK in the management of our water supplies.  

As with any major outbreak, I would anticipate the early publication of a report by the Outbreak Control Team, in line with the national template for communicable disease outbreak management.
 
People with health concerns can continue to ring the special NHS Direct helpline number: 0845 600 6086 between 9-6 on weekdays and 9–4 at weekends.

E.coli

In my last statement I informed Assembly Members that the Outbreak Control
Team had declared that the outbreak of  E.coli O157 in South Wales was over.  

The South Wales E.coli outbreak was the biggest Wales has ever seen with 158 cases across 42 schools. Of the total number of cases, about 65 per cent were primary – where the infection was caught from the original source.

The first cases were notified to the National Public Health Service for Wales on 16 September and the outbreak was declared that day. The likely source was identified and withdrawn over the next few days. There was then two weeks in which, because of the incubation period for the infection to take effect, cases continued to be reported. All the people who acquired the infection in a school were exposed to the source before control measures were implemented.

Further investigation into the cases at Abercynon Infants School has shown that the cases there were not connected to the main outbreak. The strain of E. coli found is genetically different. There is no evidence of a link to other cases and the chronology in which they were reported does not fit with the main outbreak.  So, in the same way as the cases found in Brecon, the Abercynon cases are being managed separately to ensure that other people are not at risk.  There are 15 cases in the Abercynon outbreak.

The report of Chief Medical Officer’s Review of the E.coli outbreak in South Wales was published on 6 January 2006 and has made 22 recommendations.  The review by Wales' Acting Chief Medical Officer, Dr David Salter, looked at the systems and processes in place before and during the outbreak to ensure any immediate lessons are learned and applied.  It was limited in what it could look into because of the ongoing South Wales Police investigation.

The report makes eight recommendations for the Food Standards Agency (FSA). It calls on the FSA to review existing food legislation and guidance to local authorities in relation to how often they should inspect premises and whether there is any need for further legislation. It will also need to look at whether the local authority correctly applied this legislation in relation to the premises of John Tudor and Son.  

There are seven recommendations for local authorities, including the need for them to work closely with the FSA to introduce any new measures to improve food hygiene and to look at whether they have enough staff to deal with a food poison or infection outbreak. It also calls on councils to invite school governing bodies to review advice on school cleaning, in particular toilets to ensure pupils have access to soap and hot water.

There are three recommendations for the National Public Health Service (NPHS) and the Outbreak Control team. These include the need for them to consider alternative forms of communicating to the public other than through the media. The NPHS could, for example, make greater use of its website so the public can access the latest accurate information on an outbreak. It also calls on the NPHS to ensure that for large outbreaks, a full written report is completed and published as soon as possible to ensure we can continually learn from experience.

Among the three recommendations for the Welsh Assembly Government, the report calls for a Steering Group to be set up to ensure that all the recommendations are taken forward and implemented. It also says the Assembly Government should work to resolve the difficulties of trying to run a review alongside a police investigation.

Finally, the report recommends that the Wales Centre for Health should work closely with the Outbreak Control Team in helping to improve communication with the public during an outbreak.

I accept the recommendation to set up a Steering Group to monitor progress on the report's recommendations. I will now consider who will need to be part of the group.   The next step will be to start the Assembly Public Inquiry into the Outbreak

Avian Flu in Turkey

On the basis of the information received surrounding recent reports of a cluster of human fatalities from avian flu in Turkey, the World Health Organization (WHO) will not yet be changing the alert level status for Pandemic flu. We are currently at WHO Phase 3 - Human infection(s) with a new subtype, but no human to human spread, at most rare instances of spread to a close contact.  

It is reported that those people who have died in Turkey were infected with the H5N1 strain, and were living in close contact with poultry. However, the WHO advise that they will be keeping a very close eye on the situation as it develops.  There is currently no evidence to suggest that the virus has mutated into a form that could pass between humans.

The Ankara cases have yet to be confirmed by WHO laboratories.  It is not yet clear how these people contracted the disease, although there have been reports of ducks with the virus in the city concerned.   Along with our colleagues in the other departments of health, my officials and I will continue to monitor the situation closely.