Hepatitis means inflammation of the liver. Viruses are the commonest cause but drugs and alcohol can also disturb the bodies immune system.

The hepatitis B virus is very common, and the World Health Organisation estimate that there are 350 million people chronically infected world wide and of these 2 million people die each year, but the prevalence of infection in the UK is amongst the lowest in the world, and most of the infections are acquired through adult risk behaviours. In England and Wales, injecting drug use and homosexual contact are the most frequently reported routes of transmission.  

Hepatitis B virus (HBV) infection causes acute symptoms disease in less than 10% of infected children and 30% of adults, and HBV infection can resolve. Other high risk groups are infants born to infectious mothers and ethnic minorities. Acute infections in UK residents cause less than 10% of all new chronic infections with the majority being attributable to immigrant carriers. The remaining infections are then split between 85% of infections in newborns and 4% in adults become chronic and potentially can lead to cirrhosis or cancer of the liver."Section of liver damaged by HBV. Note the enlarged cells and blistering of the capsular surface."Normal liver. It has a fine lobular texture and smooth capsular surface

Transmission

Sharing or using contaminated equipment during injecting drug use.

Vertical transmission, from an infectious mother to her unborn child, either before or during birth, or through breast feeding.

Sexual transmission.

Receipt of infected blood or blood products.

Needlestick or other sharps injury, (inparticular those sustained by healthcare workers).

Tattooing and body piercing.

Incubation

40 to 160 days

Infectivity

Highly infectious during the development of antibody and antigen development when the patients blood and body fluids contain potentially replicating virus components. If a person fails to develop antibodies then their blood remains significantly infectious.

SymptomsJaundice in a man with hepatic failure.

A short, flu like illness, including sore throat, tiredness, joint pain and loss of appetite.

Fatigue.

Nausea and vomiting.

Diarrhoea.

Loss of weight.

Jaundice.

Itchy skin.

Complications

Failure to clear the infection in 6 months leads to chronic carrier state. Many people who become chronic carriers have no symptoms and are unaware that they are infected. These people will remain infectious and will be at risk of developing cirrhosis and primary liver cancer.

Diagnosis

Blood test

Treatment

Alpha interferon an antiviral drug, or lamivudine a drug which has antiviral properties.

Prevention

Vaccination.

Precautions

Follow Standard Principles, use personal protective equipment, gloves and aprons.

Take care when handling infective materials, all body fluids and when handling soiled bed linen and clothing.

Wash hands thoroughly.

If working in a high risk environment, hospital, care home, prison, probation hostel or with homeless ensure that you are vaccinated.

References

Health Protection Agency, 2008, General Information on Hepatitis B.

Health Protection Agency, 2007, Infections among injecting drug users in the UK.

Infectious Diseases, 1996, Banister, Begg and Gillepsie. Blackwell Science Ltd.

World Health Organization Hepatitis B.

July 2009

Effects of Hepatitis on the Liver

Hepatitis means inflammation of the liver. Hepatitis A is an infection of the liver caused by a hepatovirus which is found in the gut, and multiplies in the liver causing acute onset jaundice. It is one of oldest diseases known to man and it is a global problem which can cause explosive epidemics in countries where sanitation is poor and living conditions are crowded. It is highly infectious to close contacts and spreads easily among children.

In the UK Hepatitis A is generally mild, but severity tends to increase with age. The virus is usually transmitted by the faecal oral route through person to person spread, from an infected food handler, or from ingestion of contaminated food and drink. Food borne outbreaks have been associated with the ingestion of certain shell fish such as mussels, oysters and clams that feed by filtering large volumes of sewage polluted waters. Waterborne outbreaks occur occasionally and are sometimes associated with flooding. It is also associated with injecting drug users who are homeless or live in hostels and shelters, close contact coupled with poor standards of personal hygiene and possible faecal contamination of shared injecting equipment or drugs appears to be the likely mode of transmission.

The prevalence of HAV in the UK is estimated to be 31% and the majority of adolescents and adults are susceptible to Hepatitis A infection and will remain so throughout life, with the potential for outbreaks to occur. In recent years there have been a number of outbreaks among men who have sex with men, through sexual contact (anal oral route).

Transmission

Faecal oral route.

From an Infected food handler.

From another person infected with Hepatitis A.

From contaminated food and water.

Incubation

2 to 6 weeks

Infectivity

Infectious for 2 weeks before the onset of Jaundice and for 7 days after developing jaundice.

Symptoms

Nausea and vomiting

Abdominal pain

Fever

Loss of appetite

Malaise and tiredness

Dark urine

Loose pale stools

Jaundice

Complications

Liver failure in some people it begins before jaundice develops, in others it is a progressive deterioration in liver function and a deepening jaundice.

Prevention

The most effective prevention is good sanitation and good hand and personal hygiene.

Safe drinking water

Safe food handling.

Pre –exposure vaccination which lasts for 6 to 8 weeks is offered to those travelling to endemic countries.

Close contacts may be offered immunoglobulin vaccine.

Precautions

Follow Standard Principles use personal protective equipment, gloves and aprons.

Take care when handling infective materials (urine and faeces and contaminated clothing and bedding)

Wash hands thoroughly.

References

Health Protection Agency 2005 Laboratory reports of hepatitis A in England and Wales

Infectious Diseases 1996 Banister, Begg and Gillepsie. Blackwell Science Ltd.

World Health Organization Hepatitis A

On the 25 April 2009 the World Health Organisation (WHO) declared the outbreak of swine – lineage influenza and the pandemic alert was raised to level 4 when it was verified that human to human transmission was occurring which could lead to community outbreaks. On the 27 April 2009 the World Health Organisation raised the pandemic alert to level 5 when human to human transmission had occurred in two countries within one of the WHO regions. Although most countries are not affected at this stage, the declaration of phase 5 is a strong signal that a pandemic is imminent and that the time to organise, communicate and implement planned measures is short.

Almost 1,000 laboratory confirmed cases have been identified across the five continents and at least 100 people have died in Mexico. There have been confirmed cases in Mexico, USA,El Salvador, Costa Rica, Columbia, South Korea, China, Hong Kong, New Zealand, Canada, Israel, Spain, Portugal, Italy, Austria, Switzerland, Germany, France, Netherlands, Denmark, Ireland as well as the UK. Authorities world wide have been requested to remain vigilant by the WHO. The testing for Influenza A H1N1 is carried out by the Health Protection Agency’s (HPA) laboratories, and The HPA are working to ensure that any close contacts of all patients who test positive for are offered antiviral medication as a precautionary measure. Close contacts are defined as people who have been exposed to a probable or confirmed case within te previous 7 days for longer than 1 hour and have been within a metre or less. The HPA have enhanced presence at airports to provide passengers arriving in England from infected areas information and advice. A leaflet has also been produced informing travellers of the signs and symptoms, treatment and what to do should they become infected within 7 days of returning to the UK. 

At the moment, with the only a small number of cases of human to human transmission in the UK the risk to the general public remains very low, the infection has also been mild and cases have responded positively to antiviral treatment.

The HPA has also provided information on its website for health professionals involved in assessing reported cases of possible swine flu. Both WHO and the HPA have provided information regarding the use of masks which will be revised as more data becomes available. In health care settings studies evaluating the measures to reduce the spread of respiratory viruses suggests that the use of masks could reduce the transmission of influenza, (Jeffereson et al 2008). It is also essential to provide training on the type of masks available as well as fitting and disposing of used masks. Incorrect use of a mask can increase the risk of transmission of infection rather than reducing it.

Precautionary Measures Implemented to Meet WHO Alert Phase 5

Prophylaxis treatment offered to;

• Individuals who live in the same household as a case including those who have stayed over night.
• Individuals who provided informal care to a case, coming within in less than one metre.
• Health and social care workers who provided direct clinical or personal care, or who examined a symptomatic patient without wearing appropriate personal protective equipment.
• Household visitors who stayed longer than an hour at a time when the case was symptomatic.
• Other individuals exposed to a probable or confirmed case at a distance of less than one metre with continuous exposure for more than one hour.
• Anyone caring for a case, or sitting in the same row, or two rows in front and two rows behind a case in an aircraft for one or more hours.

General Advice For Those Involved In Caring For Infected People

•  Restrict access to infected people.
•  Where possible keep a distance of a metre from the infected person.
•  Reduce the time spent in close contact with people who are symptomatic.
• Wash hands with soap and water or with alcohol handrub after each delivery and aspect of care.
• If masks are worn ensure that they cover the mouth and nose and tie tightly to minimise any gaps.
• If a patient is receiving nebulisers then a respirator mask should be worn, press the metal strip to provide a tight fit over the nose.
• Avoid touching a mask in use.
• Replace masks if it becomes damp.
• Never leave a mask hanging from the face when not in use.
• Never re use a mask
• Use lip balm and increase supply of fluids for staff who require wear masks for any length of time.
• Dispose of contaminated healthcare items immediately.
• Refrain from touching mouth and nose.
•  Do not hoover, and damp dust only.
• Improve air flow to patients room by opening window.
• Do not use fans in open wards or shared bays /rooms.

Early Signs and Symptoms of Influenza A (H1N1)

Fever, headache, muscle and joint pain, sore throat and runny nose, cough, and sometimes vomiting or diarrhoea. If you suspect that you are infected you should stay at home and seek medical advice by telephone to minimise the risk of spreading infection to others. Contact NHS Direct 0845 4647.

Advice for Patients

General infection control advice practices and good respiratory and hand hygiene can reduce the transmission of infection and this includes;

· Covering your nose and moth when coughing and sneezing, preferably with a tissue.

· Dispose of used tissues promptly and carefully.

· Wash hands frequently with soap and water to reduce the spread of virus from your hands to face to other people.

· Keep hard surfaces, door handles etc clean.

· Make sure children follow this advice, assist those who are unable to this for themselves.

1 May 2009

The Government of Mexico has reported 3 separate ourbreaks of "swine flu"

The outbreakwas first recognised on the 18 April 2009 and since then there have been 854 cases of pneumonia reported inthe capital Mexico city, of which 59 people have died. In central Mexico, SanLuis Potosi there have been 24 cases with 3 deaths and near the border with America in Mexicali there are 4 cases.

America has reported 5 cases in California and 2 cases in Texas with a further 9 suspected cases all appear to have mild flu like symptoms with only one person being admoitted to hospital.

The majority of cases have occured in in healthy young adults, which is unusal as normally influenza affects the very young and the very old and these groups have not been affected in Mexico, it is of very high concern due to geographical spread and multiple community outbreaks.

Swine Flu is a respiratory disease of pigs, the initial cases in Mexico affected people who worked with pigs and infection previously had proven to be very rare. There is now a clear peron to person transmission which is probably due to the virus mutating and a new strain of swine flu now circulating. As yet Medical staff are not clear as to why this virus is proving to be fatal inMexicobut not in America. Containment measures have been in introduced by the Mexican Aouthorities and public buildings including schools, libraries and museums have been closed and public events cancelled. Infection control advice of catching a sneeze in a hanky and hand hygiene has been promoted.

The World Health Organisation has alerted its partners in the Global Alert ResponseNetwork whichprovides an operationalframeworkto aid rapid detection, pool human and techical resources, expertise and skill to ensure that the international community is constantly alerted to the treat of outbreaks and are ready to respond.

TheWorld HealthOrganistion has in place both Epidemic and Pandemic Alert Responses and have had a Global Pandemic Preparedness Plan in place since 2005.

The Health Protection Agency reports that no cases of swine flu have been identified in the UK or in Europe, and that they are monitoring the situation closely. The Cabinet Office coordinated the implementation of Pandemic Infuenza Preparedness Plans a few years ago and these along with Emergency Preparednes Plans have been tested.

An influenza Pandemic is a world wide outbreak of influenza and this is a very occurence there were 3 in the last century.

25 April 2009

The number of mumps cases notified in England and Wales has increased in the first quarter of 2009 in association with outbreaks in several universities and colleges. This is the first increase in mumps since the large epidemic which affected university students in the academic years of 2004/5 and 2005/6.

Cases have been reported from all regions of England and Wales, with the highest case totals being in:

• South East 670
• North West 395
• London 393

The previous epidemic was attributed to a cohort of young adults born between 1981 and 1990 who were all at increased risk of mumps as they were born before the implementation of the two- dose MMR immunisation programme. This appears to be case once again, as those born after 1990 and in receipt of MMR have affectively been protected.

Transmission

Direct contact with saliva, or saliva droplets, from an infected person.

Incubation

14 to 21 days.

Infectivity

For 5 days prior to parotid swelling and 12 to 25 days after exposure.

Symptoms

Headache Fever Parotid gland swelling which can be unilateral or bilateral which are tender and cause pain on salivation. Meningitis Deafness Orchitis is common in adult men but rare before puberty, and it ranges in severity to causing extreme swelling and pain of the testicle which may take up to a month to resolve.

Complications

Mastitis is rare but the cochlear infection can cause hearing impairment and deafness in affect all age groups. Meningitis and meningoencephalitis are common but often very mild. Pancreatitis occasionally with acute Diabetes. Myocarditis can occur and may cause fatality in adult cases of mumps. Severe inflammatory effects of mumps can be accompanied by neutrophilia.

Laboratory Tests

Saliva, urine or cerebrospinal fluid may be collected for culture.

Treatment

No specific treatment for mumps, treatment given to alleviate symptoms eg; Analgesics and bed rest . Severe inflammation antibiotics given to cover Staphylococcus aureus and Streptococcus pyogenes whilst waiting for laboratory results. A short course of corticosteroids may reduce pain and swelling in severe orchitis.

Prevention

Two doses of MMR vaccine are highly effective.

References

1. Health Protection Agency, Health Protection Report, Volume 3, Number 10, 13 March 2009.
2. Infectious Diseases 1996, Bannister, Begg and Gillespie. Blackwell Science.

Posted: 29 March 2009

This day commemorates the day in 1882 when Dr. Robert Koch announced that he had discovered the cause of tuberculosis, the aim is to raise public awareness that TB remains an epidemic in much of the third world causing two million deaths and nine million new cases each year.

The number of cases of TB in England is also increasing with approximately 8,000 new cases reported last year. Ensure that you recognise the symptoms and seek medical advice as TB is a curable disease.

Tuberculosis (TB)

Is an infectious disease caused by bacteria belonging to the Mycobacterium tuberculosis complex. It is the leading cause of death of curable infectious diseases, and the World Health Organisation (WHO) declared it a global emergency in 1993.

TB usually causes disease in the lungs (pulmonary), but it can also affect other parts of the body. Only the pulmonary form of TB is infectious. Once the infected person has taken 14 days of the prescription of specific combination antibiotics they no longer transmit the infection. TB is curable, but antibiotic treatment must be continued for at least 6 months. This is a notifiable disease and it is reported by the doctor to the Health Protection Agency.

If left untreated each person with active pulmonary TB will infect on average between 10 and 15 people every year. People infected with this disease may not become sick immediately as the disease may lie dormant for years and may only become activated when their immune system is weakened.

Transmission

Usually requires prolonged close contact with an infectious person and is caused by coughing infectious air droplets. Transmission risk is as follows;

Home 1 in 3

Dormitory 1 in 5

Nursing Home 1 in 20

School or Workplace 1 in 50

Casual social contact 1 in 100,000

Incubation

4 to 12 weeks

Infectivity

Pulmonary TB is infectious until 2 weeks of antibiotics have been completed.

Symptoms

Persistent cough

Severe night sweats

Weight loss

Severe tiredness

Blood streaked sputum

Swollen lymph nodes

Treatment

TB can be cured but it involves taking antibiotics for 6 to 9 months and treatment must be completed to prevent drug resistant TB from occurring.

Prevention

BCG vaccination is available to protect against TB, but it should never be administered to a person diagnosed with HIV.

Precautions

Follow Standard Principles use personal protective equipment, gloves, aprons and masks. Take care when handling tissues and dispose of immediately. Fold used bed linen and pillow cases when changing bedding, and wash on a hot wash. Wash Hands.

References

Health Act 2006, Code of Practice for the Prevention and Control of Healthcare Associated Infections.

Health Protection Agency Tuberculosis in the UK; Annual Report on Tuberculosis Surveillance in the UK October 2008.

Health Protection Agency Guidance on Vaccination Tuberculosis.

Infectious Diseases 1996 Bannister, Begg and Gillespie. Blackwell Science Ltd.

World Health Organisation, Tuberculosis Fact Sheet No 104 March 2007.

World Health Organisation, A World Free of TB, World TB Day.

27 February 2009

Meningitis is a serious infection caused by the meningococcal bacterium which can be found naturally at the back of the throat or nose in about 10% of the population. Many adults and children carry these germs without experiencing any ill effects and only rarely do they overcome the body’s defences and cause illness. This is also a notifiable disease (reported by the Doctor to the Health Protection Agency.

Meningitis means inflammation of the lining of the brain, (the meninges), and it can also cause septicaemia (blood poisoning) which can occur separately or together and the consequences of which can include permanent disability or death.

A vaccine was successfully introduced to prevent Meningitis C which has reduced the annual cases from 989 cases in 1999 to 22 cases in 2008.

Unfortunately there is no vaccine for the different strain of Meningitis B and although the number of cases in 2007 (1076) and 2008 (1070) were similar, there has been a significant rise in cases 252 reported in December 2008 and the first two weeks of January 2009.

Case figures for the UK December to January are as follows;

North West 52

Yorkshire and Humberside 35

West Midlands 32

South West 27

South East 26

Eastern 26

London 23

East Midlands 17

North East 14

An explanation for the rise in cases of meningitis could be associated with the increased number of cases of Influenza which peaked in December 2008 and influenza can cause a temporary impairment in immunity, but as the increase is greater than that usually associated with influenza this suggests other factors may also be involved this year.

Transmission

It is spread by airborne droplet and kissing.

Infectivity

It is not an efficient organism for spreading and requires prolonged and family close contact.

Symptoms

There is usually a combination of early symptoms;

Fever.

Vomiting.

Severe headache.

Stiff neck aching limbs and joints.

Dislike of bright lights.

Drowsiness and confusion.

Red - purple rash anywhere on the body that does not pale under pressure.

In small babies symptoms will also include;

Refusal to feed.

A high pitched cry.

Cold hands and feet.

Late symptoms in patients who are unrousable include;

Coma.

Shock - pale and clammy

Widespread red - purple rash

This disease can develop very quickly it can kill in hours, it is essential to stay vigilant and be able to recognise the signs and symptoms and seek medical help quickly if you have any concerns as this could save a life.

References

Health Protection Agency 23 January 2009 Increase in Meningococcal type B Infections in England.

Health Protection Report Volume 3 Number 3 23 January 2009 Meningococcal serigraph B infections in England.

Infectious Diseases 1996 Bannister, Begg and Gillepsie. Blackwell Science Ltd.

The Meningitis Trust, Meningitis information, signs and symptoms.

16 February 2009

Measles is an acute viral infectious illness caused by a morbillivirus and it is one of the most highly communicable infectious diseases and it is a notifiable disease, (reported by Doctor to the Health Protection Agency).

Before the introduction of measles vaccine in 1968 around 100 deaths a year occurred and up 800,000 cases annually. Following the introduction of the Measles, Mumps and Rubella (MMR) vaccine in 1998 the achievement of 90% plus of children being vaccinated substantially reduced the transmission of measles and notification fell to very low levels.

Due to controversy a few years ago regarding the MMR vaccine, (which has since been proven to be a safe vaccine), immunisation of children fell to below 80% and this has caused the re emergence of measles at level likely to cause outbreaks.

There have been 1,217 confirmed cases up to November 2008, and measles is spreading easily amongst unvaccinated children.

Case figures for the UK are as follows;

London 652

North West 152

South East 101

West Midlands 77

East of England 73

Yorkshire and Humberside 47

East Midlands 35

South West 31

North East 12

Wales 37

The latest figures for uptake of MMR is at 77.9% and this remains too low to prevent outbreaks.

The Department of Health issued guidance last year requiring all health care employers to check the MMR immunisation status of staff who work with immunosuppressed and oncology patients as their protection is dependant on avoiding exposure to the virus. Staff who work with this group of patients must provide evidence of having two doses of MMR vaccine. The Protection of healthcare workers particularly those in contact with immunosuppressed and oncology patients is essential and is required under the Health Act 2006, The Code of Practice for the Prevention and Control of Healthcare Associated Infections.

Transmission

It is spread by airborne droplet.

Incubation

10 to 18 days.

Infectivity

From when first symptoms occur infectious for up to four days before the rash appears and until four days after appearance of rash.

Symptoms

Fever.

Malaise.

Cold like symptoms.

Catarrh.

Cough.

Conjunctivitis.

Rash which is red and raised and starts on the head and spreads to the body and limbs. Koplik spots, (small red spots with blueish white centres) may appear on the mucous membrane in the mouth one or two days before the rash appears and may be seen for up to four days.

Complications

Otitis media in 8% percent of cases.

Pnuemonia in up to 6% of cases.

Diarrhoea in 8% of cases.

Convulsions in 1 in every 200 cases.

Encephalitis is rare.

Death 1 in 5,000 cases.

Prevention

MMR vaccination.

Precautions

Follow Standard Principles use personal protective equipment, gloves and aprons. Take care when handling tissues and dispose of immediately. Fold used bed linen and pillow cases when changing bedding. Wash Hands.

References

DH Measles (19.-5-08 Gateway ref no 9949)

Health Act 2006. Code of Practice for the Prevention and Control of Healthcare Associated Infections.

Health Protection Agency 9 January 2009, Continued Increase in Measles Cases.

Health Protection Agency Guidance on Vaccination Chapter 21 Measles.

Infectious Diseases 1996 Banister, Begg, and Gillepsie. Blackwell Science Ltd.

Dermatitis is a skin condition that affects 1 in 12 adults during their life.

It effects many healthcare and food industry workers who are frequently washing there hands or in contact with chemicals or food products..

What is Dermatitis ( also known as Eczema )         

It is condition where the skin becomes inflamed with extremely irritation.

Different types of Dermatitis

There are many different types of dermatitis but the four most common types are:

Atopic Dermatitis

This condition affects people with dry and rough skin. It often starts in babies and runs in families.

Contact Dermatitis

This usually occurs in adults and it occurs when the skin has been in contact with an irritant such as soap or disposable gloves.

Examples of the Occupations that are at risk from Contact Dermatitis

Cleaners                         Food Handlers 

Mechanics                      Hairdressers

Nurses

Examples of Contact Irritants

Hair Products               Leather                Rubber            Raw food                                                                            

Jewelry (metal)

 Irritant Contact Dermatitis

 This is a non allergic condition which occurs on the hands of people who are frequently exposing their hand to soap and water --- NURSES, CARE WORKERS, FOOD HANDLERS etc.

Constant use of soap and water removes the skin’s natural moisture and leaves it dry scaling cracks and very sore.

Contact Dermatitis

Is the allergic dermatitis where the person develops hypersensitivity usually against metals rubber, cosmetics and food exposure

Signs and Symptoms of Dermatitis

• Red skin
• Dry skin
• Itchy skin
• Small blisters on hands and feet
• Skin can become quite weepy and wet
• Scaly areas of skin that are frequently scratched

How to identify the Cause

You cannot catch dermatitis

It does not spread from person to person

People who work in a high risk industry of getting dermatitis and can usually identify themselves what is causing the problem.

Patch Testing

Is used to diagnose contact dermatitis various suspected allergens are placed on the skin in patches, and kept there for 2 days. The patches are then removed and the reactions are assessed. Reactions are graded 0 (no reaction) - 3 (blisters)

Treatment

Dermatitis cannot be cured but the signs and symptoms can be controlled

There are a number of over the counter creams available such as emollients (moisturising creams) and mild steroid creams.

If the above creams are not effective medical treatment must be sought.

Drug treatment should only used for the relief of symptoms. Dermatitis needs to be managed properly.

Identify the causes, such as soap or latex gloves, then avoid contact as much as possible.

Secondary staphylococcal infection is common.

Deep and painful fissures typically indicate such a infection.    

 If left untreated, multiple pustules may develop.

You may wish to discuss the management of your condition with your employer so you can continue to work safely.

Remember if you have cracked bleeding hands you are not only putting yourself at risk from infection but also your clients.

Consult a doctor if you are concerned about your health

For further information:

National Eczema Society www.eczema.org

.

Don’t forget keep looking on the notice boards as every month we have special offers on the distance learning courses. For less than £50.00 you could gain a national certificate in infection control related subjects.

Very soon we will be hearing about registering for a flu vaccination to protect the vulnerable adults and babies and key workers succumbing to this annual infection - so I am posting some information about it.