Select Committee on Science and Technology Written Evidence

Memorandum by Mark Kealy, Consultant for Communicable Disease Control, North and East Devon

1.   Problems affecting surveillance, treatment and prevention of human infectious disease in the UK

  Surveillance—good data is available from microbiology laboratories on infections where specimens have been submitted, which implies good coverage of the more severe, or more chronic diseases. However, the great bulk of acute infectious disease is either managed by patients and their families, or managed by general practitioners, and treated on an empirical basis with antibiotics. This means that there is little reliable data available on the circulating micro-organisms, particularly viruses. The only data there is comes from clinical diagnoses from sentinel practices in the RCGP scheme. The notification scheme is grossly under-used and has poor coverage of diseases/diagnoses anyway.

  The recent large community study of gastro-intestinal disease yielded much useful information about the incidence and prevalence of infectious gastro-intestinal disease. Similar and ongoing studies in respiratory disease would be most valuable.

  One other useful thing would be to link the surveillance databases for both human and animal diseases. There is quite a lot of animal testing done yielding information on diseases relevant to humans(such as Salmonella), but there is little published which allows trends to be seen between disease in animals and disease in humans.

  Treatment—there is some link with surveillance in that accurate, timely diagnosis is probably the biggest problem with treatment. Although antibiotic resistance is a factor at present. The difficulty is that even if appropriate specimens are taken, a bacteriological result may well take 3 days, and a virology result may take 2 weeks! Often not soon enough to be helpful in treatment.

  Prevention—there are broadly two aspects to prevention, one is immunisation, which is progressing well in many ways, but in others is a victim of its own success. The other is public, and professional education, which seems to have mixed success.

  The UK pursues a prudent policy in respect of immunisation, which means that the population benefit from vaccines with proven benefit at an early stage in development. A good example of the early use of a new vaccine was the meningococcal C campaign. On the other hand I think the UK has been wise to resist pressure for the routine use of Hepatitis B vaccine where the benefits outside the risk groups are less clear. The need for caution in the introduction of vaccines is clearly seen in the current MMR controversy, trying to introduce a new vaccine (such as Hep B or chickenpox) into the childhood schedule where people do not perceive a need would be likely to fail. Perversely, it is also the success of vaccines in virtually eliminating some diseases which causes some people to question the need for them, preferring to rely on herd immunity or alternative therapies.

  In terms of public education, there continue to be problems in getting people to practise good hand hygiene, let alone effective food safety and kitchen hygiene. It is probable that more needs to be done at primary school level, and this may include improving some school facilities.

  The current Public Health Law means that where compliance with public health requirements cannot be ensured voluntarily, compulsion is extremely difficult to achieve.

2.   Getting Ahead of the Curve—will it be effective?

  In my opinion GAC will improve systems for the laboratory surveillance of disease, it may also sponsor large community studies, it certainly has that potential. However, this is unlikely to be achieved without significant cost.

  However, in terms of the secondary prevention of disease, which is the focus of much of my work, I am concerned that the lack of clarity about the split of responsibilities proposed in GAC. At the local level this could lead to confusion about roles between the HPA and the Primary Care Trusts and gaps in coverage. Similarly the large number of PCTs needing to communicate with the new HPA and vice versa mean that there is a risk of breakdowns in communication. I would have preferred to have seen a stand-alone organisation dealing with communicable disease control and environmental hazards, but accountable to the PCT via a service level agreement. The inclusion of emergency planning within the new HPA seems a little incongruous, unless it is limited to providing advice on the response to chemical, radiological and biological hazards.

3.   Benefit from new diagnostic tests

  It will be seen from my earlier responses that I believe accurate and timely diagnosis a major prerequisite to the surveillance and treatment of infectious disease. I believe that more use should be made of near patient testing, which is adequately quality controlled. Tests already exist for streptococci, and I am sure more demand would increase the range of tests available. I think one of the obstacles is the resistance of laboratories to the use of this type of test.

4.   Vaccines

  I think it will be clear from the foregoing that I believe that the UK has a very good record in terms of its immunisation policies, and that a good balance is achieved between the early introduction of vaccines for which there is a clear need and resistance to those where the need is less clear.

5.   Threats for the future

  Another major pandemic of a new strain of influenza must be a major threat, as is the re-introduction of Smallpox. Patterns of migration, sexual behaviour and drug use mean that HIV still remains a major threat. Tuberculosis is not effectively controlled particularly through Port Health arrangements, and the incidence rate will continue to rise. Sexually transmitted infections such as chlamydia, gonorrhoea and syphilis are dangerously out of control. Global warming means that Malaria might make a reappearance in the UK.

6.   Policy

  One policy initiative which is unlikely to win wide support, but would reduce the incidence of food poisoning, would be the greater use of radiation treatment in food processing.

  The other major policy initiative would be a major reform of public health law, particularly port health, and the ability to restrain potentially infectious persons.

October 2002

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