Select Committee on Science and Technology Written Evidence

Memorandum by the Association of Clinical Microbiologists

  1.  Surveillance depends on timely collection of data to indicate any increases in infectious disease activity from baseline. Often this will involve an element of screening normal populations. Problems therefore arise when data is either not submitted or is not analysed efficiently. It may also be incomplete eg when a screening programme has insufficient coverage. Prevention of infection relies on targeting intervention measures effectively and this has to take into account the epidemiology of that infection. Therefore surveillance underpins effective prevention. Treatment of infection is usually based on a positive diagnostic result combined with clinical evidence. It will also take into account information on possible drug resistance. Diagnostic laboratories must therefore provide a rapid service so that treatment can be provided effectively. New technologies offer opportunities to reduce testing time and, although initially costly, should be utilised. Research and development in all these fields needs to be adequately funded. Finally there must be educational initiatives aimed at increasing public awareness of the problems of infectious diseases and how to avoid them.

  2.  The new strategy Getting Ahead of the Curve does, in theory, address these issues. The quality of reporting within the current system has been criticised although it does at least provide a basis for improvement. There is concern that the commitment to surveillance may be lost with the introduction of the new agency and that the situation will deteriorate. In particular the time-scale for the implementation of change is a major cause for concern since surveillance mechanisms may not be in place before the demise of the PHLS, ie April 2003. There also needs to be commitment to the continued development of diagnostic services since this is not a static field.

  3.  Continuing development and the introduction of new technologies for both diagnosis and surveillance have been crucial elements in a fast-moving field. It is essential that this continues and that the role, often historically fulfilled by PHLS, is recognised. Dedicated funding is needed which distinguishes between pure research and the development of microbiology services.

  4.  Obviously where effective vaccines are available they should be used to protect those at risk. Again, the use of epidemiology to identify these groups is essential and continuous monitoring is essential to determine uptake. Vaccine development is costly so that future candidates for investment should be assessed to be ultimately vaccine preventable, ie that efficient and effective use of the vaccine can be achieved. Unfortunately the public faith in vaccination has been damaged recently and this will require some effort to restore confidence.

  5.  In addition to the areas already mentioned, ie sexually transmitted infection, antimicrobial resistance, particularly multi-drug resistant TB and vancomycin resistant MRSA and hospital acquired infections, threats exist from re-emerging infectious problems, eg TB.

  Other areas for consideration should be:

    (i)  "New" agents which arise, eg the recognition of several major viral infections such as Human Immunodeficiency virus and Hepatitis C in the last 20 years. There are numerous other less global but equally severe infections, eg Hepatitis E virus, some of which may be zoonoses and these need to be investigated.

    (ii)  The continuing evolution of microbial agents which confers not only antimicrobial resistance but may alter host range.

    (iii)  The rapid spread of infection worldwide which is possible as a result of increased travel, eg influenza epidemics.

    (iv)  Bioterrorism organisms: anthrax, plague and tularaemia, clostridium botulinum, Q-fever and any bacterium engineered for virulence and transmissibility.

    (v)  vCJD. We have not seen all the implications of this yet as the total number of individuals infected is currently unknown and difficult to predict.

    (vi)  Endogenous retroviruses transmitted from animals (eg pigs) to humans. This is a theoretical possibility if xenotransplantation is approved. The global impact of the transmission of a retrovirus from chimpanzees to man, ie HIV, has been clearly evident

  6.  Statutory reporting may help to achieve this but needs to be enforced and is difficult to achieve. In addition suitable IT systems are required. As mentioned previously, developments in testing which provide early and quick diagnosis also need support to enable effective surveillance. Increased screening for certain infections, eg HCV, would provide better baseline epidemiological data and subsequently better targeted interventions.

October 2002

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