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
Cheers
Mark
Microbial Muzzzings
Comment on microbial happenings and developments
Tuesday, 17 June 2014
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
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.
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