Tuesday, 17 June 2014

Well, we appear to be back almost by popular demand!!

Hello Folks - it has been a fair while but we are back! several people have asked where they can see the public engagement work I do and the comments to media. Well if you come to this blog you will see the comments and work I do. It is not all there yet but I have made a start. Hope you find it useful



Alert after Legionnaires’ disease case in baby

Following the determination of a case of neonatal Legionnaires Disease Public Health England have issued a press release explaining the situation. I have commented for the Science Media Centre and that appears at the bottom of the piece.
For immediate release:
Tuesday 17 June, 2014

 PHE advises temporary suspension of heated home birthing pools filled in advance of labour in home settings
 Public Health England (PHE) and NHS England have temporarily advised against the home use of birthing pools with built-in heaters and recirculation pumps, potentially filled up to two weeks in advance of the birth. This follows a single case of Legionnaires’ disease identified in a baby born in this specific type of birthing pool at home. The baby is currently receiving intensive care treatment in hospital. Samples taken from the heated birthing pool used have confirmed the presence of Legionella bacteria, which cause Legionnaires’ disease. Tests are ongoing to establish if it is the same strain which infected the baby. This is the first reported case of Legionnaires’ disease linked to a birthing pool in England, although there have been two cases reported internationally some years ago.
 NHS England has today issued a Patient Safety Alert rapidly notifying the healthcare system – and specifically midwives – to the possible risks associated with the use of these heated birthing pools at home. The alert recommends that heated birthing pools, filled in advance of labour and where the temperature is maintained by use of a heater and pump, are not used for labour or birth. In the meantime, a full risk assessment into their use is being carried out.
 The majority of birthing pools used at home are filled from domestic hot water systems at the time of labour – these birthing pools do not pose the same risk and are excluded from this alert. There are no concerns about these types of pools as long as pumps are used solely to empty the pool and not for recirculation of warm water.
 Professor Nick Phin, PHE’s head of Legionnaires’ disease, said: “This is an extremely unusual situation, which we are taking very seriously. As a precaution, we advise that heated birthing pools, filled in advance of labour and where the temperature is then maintained by use of a heater and pump, are not used in the home setting, while we investigate further and until definitive advice on disinfection and safety is available. “We do not have concerns about purchased or hired pools that are filled from domestic hot water supplies at the onset of labour, provided that any pumps are used solely for pool emptying. “PHE and relevant local authorities are investigating the infection control measures required for this type of birthing pool and local authorities will be working with the small number of companies who supply these heated birthing pools for use at home.”
 Louise Silverton, director for midwifery at the Royal College of Midwives, said: “Women planning birth at home using a traditional pool that is filled when the woman is in labour or using a fixed pool in an NHS unit are not affected by this alert and should not be concerned. Birthing pools in hospitals are subject to stringent infection control procedures and monitoring. Home birthing pools filled during labour come with disposable liners and are only in place for a relatively short time period, reducing opportunity for bacterial growth.
 “Any women with concerns about using home birthing pools should contact their midwife or local maternity unit.”
 Legionnaires’ disease is extremely rare in childhood, with only one case in children aged 0-9 years reported in England between1990-2011.The infection does not spread from person-to-person – people become infected with the bacteria through inhalation of contaminated water droplets.

Prof Mark Fielder, Professor of Medical Microbiology at Kingston University and Hon General Secretary of the Society for Applied Microbiology.
The recent report of a baby being treated in intensive care following the diagnosis of Legionnaries Disease is an unfortunate and very rare occurrence. The case has been reported by Public Health England they have already advised against a specific type of birthing pool with built in heaters and recirculation pumps. The specific type of pool implicated can be filled in advance of labour and the temperature is maintained by the heater and pump. Birthing pools that are filled from domestic hot water systems at the time of labour do not appear to possess the same risk factors and are not included under the current exclusion. This single case does represent a rare occurrence indeed this is the first case reported in England, there were two other cases reported internationally in past years. The infection is caused by a bacteria called Legionella pneumophilia which can be found commonly in water sources and at low levels it is harmless. The organism can be controlled effectively if the water is cooled to below 20oC or heated to above 60oC. This type of treatment coupled with general good hygiene in terms of keeping water free of impurities will help to keep the organism under control.

Wednesday 4 June 2014

Following the emergence of the outbreak of what transpired to be Bacillus cereus in parenteral feed, Public Health England released the following press release.
For immediate release
Wednesday 4 June, 2014
Investigation into Bacillus cereus infections
Public Health England (PHE) and the Medicines and Healthcare products Regulatory Agency (MHRA) can confirm they are investigating 15 cases of blood poisoning (septicaemia) caused by a bacteria known as Bacillus cereus. The affected babies were in neonatal intensive care units at a small number of hospitals in England.
Many of the babies were premature and very vulnerable and one baby has sadly died but the others are responding to antibiotic treatment.
Investigations are ongoing but so far indications show that the cases have been strongly linked with a number of batches of a particular form of intravenous liquid called parenteral nutrition which was given to the babies. This contains a variety of nutrients that are delivered directly into the babies’ bloodstream when they have problems ingesting food via their mouth. This batch of product is manufactured by ITH Pharma Limited.  
Because this type of nutrition is given into the bloodstream of vulnerable babies and adults it is manufactured under strictly controlled aseptic conditions. Investigations with the company have identified an incident that might have caused the contamination. Investigations into this by the MHRA are ongoing and inspectors from the MHRA are visiting the manufacturing plant.
The product has a short shelf life and although it is unlikely that any stock from the day of contamination incident remains (it expired on 02/06/14). The MHRA has issued a Class 1 drug alert to support the manufacturer’s recall of the product this afternoon.
Although the affected product was only issued to a limited number of neonatal units an alert has been issued to all neonatology units across the UK to make them aware of the incident.  Doctors have been given advice on what steps they need to take to identify any potential cases of infection and how to dispose of affected stock.
Bacillus cereus is a bacteria found widely in the environment in dust, soil and vegetation. Most surfaces would be likely to test positive for the presence of the bacteria. Bacillus cereus produces very hardy spores and in the right conditions these will grow. The spores can produce a toxin which causes illness.
Professor Mike Catchpole, PHE incident director, said: “This is a very unfortunate incident and PHE have been working closely with the MHRA to investigate how these babies could have become infected. Given that the bacteria is widely spread in the environment we are continuing to investigate any other potential sources of infection. However all our investigations to date indicate that the likely source of the infection has been identified. We have acted quickly to investigate this issue alongside the MHRA and we have taken action to ensure that the affected batches and any remaining stock of this medicine is not being used in hospitals.”

Adam Burgess, the MHRA’s manager of the Defective Medicines Reporting Centre, said:
“Patient safety is our top priority and we are working alongside PHE to establish what has happened. We have sent inspectors to the manufacturer’s facility to carry out a detailed and rigorous inspection and we have ensured that the potentially affected medicine is recalled.”

I was called upon by the BBC news channel to undertake a live news interview where I explained the origins of the organism. Essentially we are dealing with an environmental spore forming Gram positive rod that apparently got into the feed being given to these very unwell premature babies. The feed was being given straight into the blood stream as they children were apparently not able to ingest or digest in the normal manner. The actions of the MHRA, PHE and the company involved limited the outbreak and protected many more patients. One should not comment too much more whilst the investigation is being carried out as speculation is not helpful at this time. We must of course recognise the tragedy of the situation where a child has lost their life – our thoughts go out to the childs family and loved ones. One does also have to remember that we are dealing with very unwell children and indeed only modern medical technology was sustaining their lives. It is good to see that the surviving children are responding well to the antibiotics being administered.

I was also interviewed on several radio stations re-iterating the points above getting out to LBC radio, BBC Radio Asia  and across the BBC regional radio news network, where interviews were carried on BBC Radio Humberside, BBC Radio York, BBC Radio Devon, BBC Radio Somerset, BBC Radio Wiltshire, BBC Radio Norfolk, BBC Three Counties Radio (covering Bedfordshire, Hertfordshire and Buckinghamshire) and BBC Radio Kent.
The following comment was then released by the Science Media Centre :
Prof Mark Fielder, Professor of Medical Microbiology, Kingston University, said:
“The recent Bacillus cereus outbreak linked to parenteral feed has left 14 premature babies with septicaemia and sadly one other has lost their life. There is an ongoing investigation to establish exactly how this feed might have become contaminated and in the meantime there has been a product recall to prevent any further infection. Public Health England and the MHRA have acted quickly to both identify the organism responsible and to put measures in place to protect the public. The occurrence of a further three cases, whilst distressing, was to some extent expected as patients who might have earlier received contaminated material develop symptoms. It remains the case that the outbreak is likely to have been contained and very few (if any) further cases will be seen.”

Since this comment went out we have seen three more babies become infected, which is not completely unexpected but nonetheless sad. Why not completely unexpected? Well although the infected material was withdrawn some feed may have been still in the ‘system’ or small amounts delivered to patients so it may have a taken a while for infections to become apparent. Sadly one more baby died but as I understand it this child had other unrelated complications. It would appear that to date no further loss of life has occurred and that this outbreak is now controlled.

 28th March 2013
Cases of TB in domestic cats and cat-to-human transmission – risk to public very low
   Following news reports about the potential for pet cats to be able to transmit TB to patients a comment was called for to put some perspective on the stories. Below are the links to the stories : http://www.bbc.co.uk/news/health-26766006 and http://www.dailymail.co.uk/health/article-2590699/Two-British-people-contract-tuberculosis-contact-cat-recorded-cases-cat-human-transmission.html)

Here is my comment given to the media:
Prof Mark Fielder, medical microbiologist Kingston University, Hon Gen Sec Society for applied Microbiology.

 The recent report of Mycobacterium bovis infection in cats is a highly unusual situation and we currently have no evidence that this occurrence has spread. With this is mind the risk to the public and pet owners remains very low. Having said that we should, as a precautionary measure, take the advice of the PHE in that people who have been in contact with an animal with a known infection should see their doctor just to ensure they have not been exposed.