Key Health Data for the West Midlands 2001
Chapter 7: Communicable Disease
List
of Tables
List
of Figures
Main Body
7: Communicable Disease
8: Perinatal Mortality
9: Crime
10: Sports Facilities
11: Housing Quality
12: Inequalities, Focusing on the early years
7.1 Meningococcal Disease
Neisseria meningitidis (meningococcus) can cause meningitis or septicaemia (blood poisoning) or both. Meningococcal meningitis carries a 5% case-fatality and septicaemia 20%. Both may also cause permanent sequelae in survivors (eg deafness, fits, loss of limbs/digits). Meningococcal meningitis and meningococcal septicaemia are both statutorily notifiable by the clinician treating the patient to the proper officer of the local authority in which the patient resides. Figure 7.1 shows that notifications of meningococcal disease more than doubled from 1994 to 1999 and that this increase was almost entirely due to an increase in meningococcal septicaemia. Part of this increase may be due to improved ascertainment, but as laboratory reports also increased and there was a proportionally much greater increase in serogroup C disease, much of this increase is likely to be real.
A study in the West Midlands has shown that approximately one third of cases of meningococcal disease are not recorded in routine notification figures: this is one reason why we set up enhanced surveillance of meningococcal disease (using cases ascertained from a variety of sources) in the West Midlands in 1996. Figure 7.2 shows the annual number of cases identified by the enhanced surveillance scheme for the period 1996 to 2000. Both routine notification and enhanced datasets show that the number of cases of meningococcal disease fell in 2000, the first fall in annual figures since 1994.
Figure 7.3 (based on laboratory confirmed cases in the enhanced dataset) show that the decrease appears to be due to a decrease in the proportion of cases due to serogroup C infection. A new conjugate vaccine serogroup C meningococcus was introduced in November 1999: children aged under 15 months and teenagers aged 15-17 years were targeted first, with a catch up programme for all other children aged 1-16 over the next year. Figures 4-6 show that the number of cases of group C disease fell in 2000 in 0-4 year olds and 5-17 year olds, but increased in those aged over 18. No such falls were seen for group B disease. Provisional data for 2001 suggest that further falls in group C disease are occurring in the first full year of routine immunisation against this serogroup.
Figure 7.3 shows a substantial increase in
the previously rare W-135 serogroup. Thirteen of the 23 cases of this
serogroup were of the strain associated with the Hajj (pilgrimage to Mecca):
vaccination against W-135 is now recommended for all pilgrims to the Hajj.
Enhanced surveillance data suggest that this strain did not become established
in the West Midlands population in 2000, although it does remain a potential
threat.
7.2. Meningococcal Disease In The West Midlands
7.3. E. coli O157 in the West Midlands
Escherichia coli O157 is a cause of gastroenteritis with potentially serious complications, particularly haemorrhagic colitis, haemolytic uraemic syndrome and thrombocytic thrombocytopenic purpura. It is the commonest cause of kidney failure in children. One outbreak in Scotland in 1996 caused the deaths of 20 people. The West Midlands region has been running an enhanced surveillance system for E. coli O157 since January 1999 and is the only region to have such a system.
An average of 70 cases per annum were reported from West Midlands laboratories over the period 1995-2000, with yearly numbers varying in line with the number and size of identified outbreaks (Figure 7.7) E. coli O157 shows a strong seasonal distribution with an increase from June/July to September each year (Figure 7.8). There is marked variation in rates by Health Authority (Figure 7.9) and local authority (Figure 7.10), with the highest cumulative rates for the 3 years of enhanced surveillance being in the rural counties of Shropshire and Herefordshire and in North Staffordshire, which was the centre of an outbreak in 2001. Over the last few years outbreaks of varying size have been identified in the West Midlands linked to nursing homes, a retail premises, a wedding and travel to Devon.
7.4. E.coli O 157 in the West Midlands
38 out of 213 cases gave no local authority
name. Of these cases, the Health Authorities were as follows: Shropshire
13, South Staffordshire 9, North Staffordshire 8, Worcestershire 5, Herefordshire
2 and Warwickshire 1.
*2001 data provisional , including one case whose residence is
outside the West midlands and therefore not included on the map.
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Figure 7.10. Rates per 100,000 population by Local Authority for E.coli 0157 |
7.5. Cryptosporidiosis
Cryptosporidium parvum is a protozoan parasite which causes a gastrointestinal illness. It is contracted from cattle, sheep or infected humans. It has considerable public health (and political) interest because of its ability to cause large waterborne outbreaks. Because of the potential link to water supplies, CDSC (West Midlands) collates data on place of residence of all cases of cryptosporidiosis to map against water supply areas. Figure 7.11 shows cases in 2000 against water supply zone: no waterborne outbreaks were identified in 2000 and cases can be seen to be concentrated mainly in urban areas. Figure 7.12 gives rates by PCT: the highest rates for 2000 were in north and east Staffordshire (covering Leek, Burton and Uttoxeter) and the borough of Dudley (particularly the Stourbridge area).
7.6. Cryptosporidiosis in the West Midlands
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Figure 7.11. Cryptosporidiosis mapped against water supplies, January to December 2000 |
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Figure 7.12. Cryptosporidium rates by PCT |
| Table 7.1. Rate of Cryptosporidiosis per 100,000 population | |
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contact Carol Richards on
0121 414 3368
© Department of Public Health
and Epidemiology, University of Birmingham