Select Committee on Health Appendices to the Minutes of Evidence

Attachment 11



  On 6 March 2000, an aid worker returned to the UK from Sierra Leone with suspected Lassa Fever, a rodent virus that is endemic in Eastern Sierra Leone. It causes a serious illness that in some cases results in extensive haemorrhaging and death. He was initially admitted to the Hospital for Tropical Diseases in London and after three days was transferred to Coppetts Wood Hospital where he died on 23 March. This is the fifth case of Lassa Fever to be imported into the UK since 1976.

  Events of this nature may occur at any time without warning. The occurrence of a single incident or of an outbreak of a serious life-threatening infection, requires a rapid response from a number of agencies acting in concert. Co-ordination and public health leadership combined with expert microbiology is therefore key in effectively controlling the incident and preventing transmission and adverse outcomes. The most recent case of Lassa Fever came to the notice of the Public Health Laboratory Service (PHLS) through the PHLS Communicable Disease Surveillance Centre (CDSC) on-call system on a Thursday evening, and the diagnosis was made late on the Friday evening at the PHLS Central Public Health Laboratory. The Incident Control Team had to convene rapidly over the weekend. Further confirmatory testing was undertaken, potential contacts of the patient were identified and interviewed, all relevant national, local and international agencies were informed; plans were formulated for patient care, and for prevention and control of the infection; roles of responsibility were delegated, with clear lines of accountability; press officers from the main health agencies were involved and consulted on media briefing. By Monday the plans were operational with smooth co-operation between the various agencies and an established forum, the Incident Control Team, for decision making.


  With these kinds of infection, without rapid co-ordinated action there is the danger that the infection will be transmitted to health care workers, and to the public. The clinical diagnosis of Lassa Fever is rarely obvious (it was not in this case) and so rapid laboratory diagnosis is essential for early recognition. This is a hazardous infection requiring P4 containment which needs to be undertaken at a national reference laboratory. There is also the potential to provoke excessive and inappropriate public anxiety, thus emphasising the need to work proactively and responsibly with the press and other media to convey a balanced and honest level of risk to the public. Both these contingencies require senior experienced people to establish lines of communication and accountability among the many agencies involved.

  There may be potential international implications. In cases of Viral Haemorrhagic Fevers or other highly infectious diseases, it is important to alert the country of origin as the case may signal an outbreak and/or contacts of the case may need to be traced. Transport agencies may need to be informed as an infected person may have returned to the UK on public transport exposing other passengers to risk of infection. This would necessitate public health agencies tracing contacts at risk. (This did not apply in the recent case of Lassa Fever where the patient was flown back by air ambulance so that the risk was known to staff who took the necessary precautions.)


  A wide range of agencies are involved in every incident. However, for every incident the players will vary. In the Lassa Fever incident there was extensive involvement of UK national and local organisations, as well as overseas organisations. The PHLS took the lead in this incident. Other agencies involved included the Department of Health, the Department for International Development, two acute NHS Trusts, the Chief Medical Officer, the Regional Director of Public Health, the Health and Safety Executive, a number of District Health Authorities, authorities at Heathrow airport, a number of GPs, the Intercounty and London Ambulance Services, several agencies in Sierra Leone including the Ministry of Health, the World Health Organization, the European Commission, Centers for Disease Control and Prevention USA, the air ambulance in Switzerland and the Swiss Ministry of Health.

  Whatever the nature of the incident, it is important to have an extant plan which can be adapted. The PHLS is well placed to offer the expertise and skills to take the co-ordinating role, having both public health skills, corporate knowledge and expert microbiology.


  In the event of a major infectious disease/health incident there is a surge in the need for experienced professional staff at senior and more junior levels and a need for secretarial and other administrative support. The increased support may need to be sustained for substantial periods of time and may apply to a number of the organisations involved. In the Lassa Fever incident over 90 contacts were spread over three hospital sites. The largest resource input from PHLS was the public health component requiring input from six consultants and three senior registrars, with additional public health support from the host district health authority. However it was also necessary to immediately provide expert virology in a secure laboratory and the provision of daily virological investigation to support patient management. The surge capacity of public health was stretched to its limit. Most public health input was located on one site; optimally there should have been support on all three sites as clinicians were not able to give the public health advice and support needed.

  It is important that key senior people are accessible in all the relevant agencies at all times and that contact details for the persons on duty are available. Difficulty was experienced in contacting senior officers at the European Commission out of hours though communications were good with WHO in Geneva.


  PHLS has the strength of combining public health, laboratory and clinical virological skills. It has a tried planning strategy and good corporate knowledge to achieve a rapid co-ordinated reaction where multiple organisations and agencies are involved. It is important in the future that there is sufficient surge capacity and resource management capacity to deal effectively with major incidents. The PHLS would also be able to make a significant contribution to incidents involving suspected or actual deliberate release of biological and chemical agents where the need for rapid action, mobilisation of resources and expert combination of laboratory and public health skills would be similar to those in this incident.


  It is important to have centres with corporate knowledge, that will be well placed to respond to other future incidents, be they natural or deliberate.

  Prepared by Drs Margie Meltzer, Natasha Crowcroft and David Brown, Public Health Laboratory Service.

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Prepared 28 March 2001