10: Communicable Diseases
List
of Tables
List
of Figures
Main Body
1: Boundaries
and Populations
2: Inequalities
and Deprivation
3: Ethnicity
and Health
4: Environmental
Hazards
5: Health
related behaviour
of
young people
6: Accidents
7: Cancer
8: Teeth
and fluoridation
9: Coronary
Heart Disease
10: Communicable diseases
10.1 Meningococcal infection
Meningococcal meningitis and meningococcal septicaemia are statutorily notifiable by the clinician treating the patient to the Proper Officer of the local authority in which the patient lives. Figure 10.1 shows the 5 yearly notification rate for these 2 forms of meningococcal infection combined using 1997 population estimates as the denominator. Rates vary more than tenfold between local authorities, although part of this variation is explained by differing local practices in notification.
Since 1996, CDSC (West Midlands) has been running an active enhanced surveillance scheme for meningococcal infection. 1228 cases were identified in 1996-8 with the annual incidence of disease rising from 7.0 per 100,000 in 1996 to 8.6 per 100,000 in 1998 (p=0.05). 48% of cases were laboratory confirmed, 23% of cases occurred in infants, a further 28% in those aged 1-4 years, and more cases occurred in males than females (RR = 1.25, 95% CI: 1.12-1.40). A marked increase in incidence was noted from December to February in each year.
A new conjugate vaccine against group C meningococcus was introduced in autumn 1999. Of the 531 cases in the West Midlands in 1996-8 in which a serogroup was identified, 39% (95% CI: 35-43%) were serogroup C and 59% group B.
10.2 Tuberculosis
TB is also statutorily notifiable. Figure 10.2 shows the 5 year notification rate per 100,000 population for local authorities in the West Midlands. Notification rates vary 25- fold between local authorities, with the highest rates in Birmingham, Coventry, Wolverhampton and Walsall. Recent research by CDSC (West Midlands) and Birmingham Health Authority has shown that TB incidence in a population is heavily influenced by the proportion of the total population of South Asian ethnicity and the proportion of the white population living in deprived enumeration districts (no effect of deprivation on rates in Asians was observed).
Six hundred and twenty five cases of TB were notified in the West Midlands in 1998, an annual crude rate of 11.7 per 100,000 population. Rates in Asians are 25 times higher than in whites and an increasing proportion of cases are occurring in those of Black African ethnicity. In total, 63% of notifications in 1998 were in non-white groups, who were on average younger and less likely to have respiratory disease than whites.
10.3 HIV
HIV infection is not notifiable but the West Midlands HIV Surveillance Project collects data from local service providers and the Regional Virus Laboratory to inform prevention and treatment planning.
By 31st March 1999, 1347 West Midlands residents had been diagnosed with HIV infection, of whom 394 are known to have died. 43% of cases have occurred in Birmingham residents and all districts, except Herefordshire, have had more than 40 cases. Cumulative HIV incidence rates by district are shown in figure 10.3; the rate in Birmingham is twice that of any other district at 57 per 100,000, with the next highest rates in Coventry, Wolverhampton and North Staffordshire.
Incidence of new cases in the region remains stable at just over 100 cases per annum, but there has been a 50% reduction in new cases of AIDS and 75% in deaths (due to improved drug therapy) leading to a marked increase in prevalence. More than half of newly diagnosed cases continue to occur in men who have sex with men. The proportion of cases acquired heterosexually has increased to one-third, mostly acquired abroad. 85% of recent cases are in white people, but incidence rates are around 60 times higher in those of Black African ethnicity.
Fig
10.1 Cumulative meningococcal infection rate/100.000,1994-1998
Fig
10.2 Cumulative TB rate/100,000 1994-1998
For more information please contact Carol Richards
© Department of Public Health and Epidemiology, University of Birmingham