Communicable Diseases include infectious diseases which are usually spread from person to person and those diseases which are generally spread through contaminated food or water.

It was also required to implement the National Guidelines relating to bacterial meningitis and tuberculosis and to develop and implement local guidelines relating to other communicable diseases.

Working Groups of this committee have been very effective in developing and implementing national and local guidelines for the management of such diseases.

2. Vaccination and Vaccine Preventable Diseases

Vaccination against childhood infectious diseases is implemented by general practitioners with public health doctors in community care being responsible for school booster vaccinations. The success of the vaccination programme is reflected in part by the reduced level of notified infectious diseases in 1997 (Appendix 8).

The vaccination uptake for the first primary vaccination throughout the region at twelve months is 94%. The uptake of completed primary vaccinations is as follows: 86% at one year, 88% at fifteen months. Primary vaccination protects children against diphtheria, tetanus, whooping cough, polio and haemophilus influenza b (Hib disease). Analyses of more recent cohorts of children demonstrates that the receipt of first primary vaccinations is being maintained at a satisfactory level throughout the region, however improvement is needed in uptake of the completed course to achieve the target of 95%. Children are immunised against measles, mumps and rubella at fifteen months of age. The uptake for the MMR vaccination at twenty four months is 86% while the national target is 95%.

Just twelve cases of whooping cough were recorded in 1997 compared with twenty two in 1996. At the request of the Department of Health, data was collected on notified cases of whooping cough in the last quarter of 1997. Within the region only four cases were notified, three in children under the age of three and one in a young adult male. As part of this study the vaccination status of any case occurring was checked. None of the four cases had been vaccinated against whooping cough. One child had refused to accept vaccinations and the other three although fully vaccinated against other illnesses had refused to accept the whooping cough vaccination.

4. Rubella (German Measles)

Rubella is usually not a serious infection in children, however if contracted by a pregnant woman rubella can result in the birth of an extremely handicapped child with congenital rubella syndrome. At present in Ireland, Rubella Vaccine is provided to children as part of their measles, mumps and rubella (MMR) vaccine at 15 months and again at the age of 11 before leaving primary school.

Prior to the MMR vaccine becoming available, Rubella Vaccination was offered to girls prior to leaving primary school at the age of approximately 11 years old. This latter vaccination programme has been available in Ireland since the 1960s. Despite this however a significant percentage of women at antenatal care test as non-immune for rubella. This is likely to be due to a number of factors; including never previously vaccinated, failure to sero-convert and possibly a waning of immunity or at least of detectable antibodies.

In a retrospective review of 1,700 laboratory samples sent from antenatal clinics in the region, approximately 3% were non immune. These figures are in keeping with the number of rubella vaccines supplied to post natal women in two hospitals from hospital pharmacies and would be in keeping with other figures available in Ireland.

In 1997 information was received on 412 cases of gastro intestinal infection in the SEHB. This compares with 349 in 1996. Some of this increase was due to improved reporting and data capture. Over half (60%) of cases occurred in those under 5 years. Figure 6.1 shows the distribution by age group of gastro-intestinal infection in the SEHB.

Figure 6.1  Age Distribution: Gastro-Intestinal Infection, SEHB 1997

The most frequent causative organisms, as shown in figure 6.2, were Campylobacter (31%), Rotavirus (23%), Salmonella (21%), Cryptosporidium (10%) and Adenovirus (10%). These five accounted for almost 95% of cases.

Figure 6.2. Causative Organisms of Gastroenteritis, SEHB 1997

Others included Giardia Lamblia 1.7%, Gastro-enteritis unspecified 1.7%, Enterobius 0.5%, E Coli 157 0.5%, Enterovirus 0.2%, Shistosomiasis 0.2%, Shigella Flexneri 0.2% and Yersina 0.2%.

There has been an increase in the notification of cases of tuberculosis. However some of this increase may have been due to the increased surveillance which was carried out by public health doctors in the community and to the increased liaison between hospital based consultants and community doctors. A total of 50 cases were notified in 1997 as against 27 in 1996 and 37 cases in 1995. This gives a rate of 12.8 per 100,000 which is close to the national average.

Figure 6.3 Classifications of Tuberculosis by community care area SEHB 1997

Table 6. 1 Tuberculosis, by Age, Sex and Type, SEHB 1997

	Pulmonary		Non-Pulmonary
Age Years	Male	Female	Male	Female	Grand Total
0-14 years	1	0	0	1	2
15-44 years	4	3	1	3	11
45-64 years	7	3	2	2	14
65+ years	16	5	2	0	23
Total	28	11	5	6	50

Figure 6.5 Notified Cases of Sexually Transmitted Diseases in SEHB 1996-1997

Bacterial meningitis is an infectious disease which can have very serious consequences. One form of bacterial meningitis - haemophilus influenza b (Hib) has been virtually eliminated through immunisation included in the primary vaccination programme. No cases have been recorded in the SEHB in the past two years.

A total of 58 cases of bacterial meningitis were notified in 1997 of which 53 were cases of meningococcal disease (meningitis or septicaemia).

As meningococcal disease is seasonal, having a greater prevalence in the winter months, analysis by the twelve month period from July 1st to June 30th is more meaningful than by calendar year.

Analysis of the incidence of disease on this basis demonstrates that in the period July 1996 - June 1997, there were 53 cases of meningococcal disease with four deaths and from July 1997 - June 1998 there were 40 cases with no deaths.

There was a significant outbreak of meningococcal disease in the winter of '96 - '97 which is shown in the epidemic curve over the two year period (Figure 6.6).

9. Recommendations

The protection of the public from communicable diseases is a core public health function. As is evident form the preceding chapter, communicable diseases continue to impact on the health of the public and the work load of the health services.

It is recommended that:

South Eastern Health Board policies support, through regional and local policies, the attainment of national vaccination targets for the population as a whole and specific vulnerable subgroups.

For all communicable diseases including those where vaccination is not available or not appropriate, that the South Eastern Health Board at regional and local level continue to support and strengthen the development of protocols, based on best evidence, for surveillance, prevention, control and treatment.

Figure. 6.6 Meningococcal Epidemic Curve July '96 - June '98, SEHB

In this figure it is demonstrated that between October 1996 and April 1997 there were 41 cases of meningococcal disease. Of the thirty six for whom Grouping was obtained, 21 were Group C and 15 Group B. Most of the cases of Group C occurred in children and young adults in schools or other educational institutions.

As evident from Figure 6.7 most of the outbreak was located in Waterford CCA. The increase in cases was largely due to excess cases of Group C Meningococcal Disease.

References