Philip Veal (Public Health Agency)
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Infectious diseases: Campylobacter
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Philip Veal (Public Health Agency)
- 1. Dr Philip Veal Health Protection Consultant Gastrointestinal Disease Lead Public Health Agency
- 2. With thanks to the Health Protection Surveillance Centre, Dublin for supplying Ireland data. Note: all 2016 data is provisional.
- 3. Campylobacter in N. Ireland • Notifiable under food poisoning • General increasing trend until past two years • PCR testing phased in from 2014 • 3/5 labs now using PCR for campylobacter in addition to culture • No obvious effect on numbers • Risk factor questionnaire completed for clusters/outbreaks
- 4. 0 20 40 60 80 100 120 140 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Incidencerateper100,000population Crude incidence rate Campylobacter in Ireland and UK, 2006 - 2016 ROI NI E&W Scotland
- 5. Age specific rates of Campylobacter sp 0 50 100 150 200 0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+ Rateper100,000population Ireland NI 2015 0 50 100 150 200 0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+ Rateper100,000population Ireland NI 2016
- 6. Why? • Differing health system • Differing economic/demographic profile • Differences in water supplies • Other factors • All of the above?
- 7. E. coli - Introduction of PCR testing in N. Ireland • Gradually introduced since 2014 • 3/5 labs using PCR/Culture now • 2/5 labs still using culture/latex testing • 1/5 labs able to identify non-O157 serotypes • Large increase in reports of positive VTEC • Large number of PCR positive only specimens
- 8. 0 2 4 6 8 10 12 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Incidencerateper100,000population Incidence rate of E. coli O157, 2006 - 2015 ROI NI E&W Scotland
- 9. E. coli across island of Ireland • O 026 / O 157 make up the majority of serotyped cases in both areas • Generally very small numbers of each type of other serotypes in NI • Similar seasonality • Similar age profile
- 10. 2016 serotypes Serotype Ireland Belfast Lab Tests for non-0157 serotypes O 157 20% 19% O 026 32% 38% Other 32% 19% PCR Only 16% 19%
- 11. Challenges Faced in NI • No local reference laboratory • Interpretation of PCR only results • Differences between food and human typing (WGS versus phage typing / other typing) • Additional pressure on EHOs • Investigation of local/national clusters identified by WGS difficult due to time lag
- 12. Questions ? 2016 Annual Report for N. Ireland available at: www.publichealth.hscni.net/directorate-public- health/health-protection/gastrointestinal-infections
- 13. Thank you
Editor's Notes
- PCR introduced – had expected an increase
- Crude incidence rates in N. Ireland more similar to Ireland than rest of UK Seasonal pattern very similar Age specific profile show very different pattern between Ireland / N. Ireland Youngest age group much higher in Ireland No outbreaks reported in N. Ireland with exception of occasional family cluster
- Free GP consultations all age groups in NI, research shows again and again that high usage of GP services by non work age population – leading to more ascertainment (inverse association between deprivation and rates) – analysis data NI 2012-15 showed quartile 1 deprivation had lower rates however not analysed for confounders e.g. age profile rural/urban etc Much higher use of private water supply in Ireland. 99% of supply in NI on public supply from reservoirs; 1% private.
- Introduced in one lab in 2014 and another 2 labs over the next 18 months Working with labs to make case to comissioners for arrangements all specimens tested for recognised HUS causing serotypes
- Rates of O157 broadly similar between Ireland / N. Ireland over past 10 years. When including PCR only results and other serotypes overall rate of VTEC broadly similar in 2016 given lack of PCR testing in some NI areas. Increases in recent years in both north/south due to PCR only / serotypes other than O157 PCR testing introduced much earlier in Ireland Differing implementation / case definitions Much higher proportion of PCR only results in N. Ireland
- Much higher proportion of specimens serotyped /sent to reference lab in Ireland.
- Belfast Lab – covers approx 350,000 citizens approx 19% of NI population. Only lab non=0157 types. Picture very similar to ROI.
- No reference lab - Only some specimens referred to national reference lab – working on this - Cost/delays in sending specimens to reference lab Edited out: No whole genome sequencing for non-O157 Significant regional differences in testing