Research and analysis

HPR volume 14 issue 5: news (10 and 11 March)

Updated 23 December 2020

Coronavirus (COVID-19) information on GOV.UK: third update

The Coronavirus (COVID-19): UK government response continues to provide an overview of UK government and Public Health England (PHE) activity, including access to up-to-date NHS and PHE information and advice, and announcements by the Chief Medical Officer for England and the UK government.

On 3 March 2020, the Coronavirus Action Plan was published. It describes how the UK Pandemic Influenza Preparedness Strategy of 2011 has provided the foundation for contingency planning for the current epidemic.

The joint Department of Health and Social Care (DHSC) and PHE latest information and advice, updated daily, provides latest epidemiological data. A COVID-19: track coronavirus cases dashboard is available, showing reported cases in the UK, including new cases, cases by upper tier local authority in England, and number of deaths.

COVID-19 UK dashboard: total UK cases as at 9:00am on 10 March 2020.

Advice for travellers returning from affected areas outside the UK includes links to annotated maps (see below).

New guidance portal

Since 1 March 2020, the GOV.UK pages providing links to guidance related to COVID-19 have been rationalised so as to include a single guidance portal providing access to Guidance for health professionals and Guidance for non-clinical settings.

Guidance for health professionals includes:

• specified countries and areas with implications for returning travellers or visitors arriving in the UK
• background information about COVID-19 epidemiology, virology and clinical features
• guidance on investigation and initial clinical management of possible cases
• guidance on infection prevention and control
• guidance for primary care
• guidance for professionals advising the general public
• guidance for healthcare providers who have staff with relevant travel, healthcare or household contact history
• guidance for first responders
• guidance for ambulance trusts

Guidance for non-clinical settings covers:

• decontamination in non-healthcare settings
• educational settings
• employers and businesses
• social and community care and residential settings
• transport sector staff

Countries and specified areas with implications for returning travellers

Affected areas and countries outside the UK – for which there are implications for visitors and returning UK-resident travellers – continue to be divided into two categories: category 1, from which visitors and returning travellers should immediately self-isolate for 14 days, even if asymptomatic; and category 2, for which there is no need to self-isolate in the absence of symptoms.

For both these categories, links to up-to-date annotated maps have been added. As of 10 March, the whole of Italy was added to category 1.

Visitors and returning travellers to the UK from the following category 1 areas or countries, even if asymptomatic, should stay indoors, avoid contact with other people and call NHS 111 for further advice; these are:

• Wuhan or Hubei province (China)
• Iran
• Italy
• Daegu or Cheongdo in the Republic of Korea

Visitors and returning travellers from the category 2 areas or countries do not need to undertake any special measures so long as they do not develop symptoms; if they do have symptoms, even mild, they should self-isolate and call NHS 111.

Other guidance

The World Health Organization (WHO) has published a set of questions and answers about effective and ineffective methods of personal protection from infection.

Mumps outbreaks across England

Provisional data shows that in 2019 there were 5,042 laboratory-confirmed mumps cases in England compared to 1,066 in 2018 (see table below). This is the highest number of mumps cases seen since 2009. Activity was high in all regions of England and predominantly in young adults aged 15 to 34 years (4,133 in 5,042, 82%).

GP consultations for mumps, as reported through syndromic surveillance, have shown similar proportionate increases in 2019. The upward trend has persisted into 2020 with more than 1,000 confirmed cases in January 2020 compared to 191 during the same period in 2019.

About half (2,449 in 5,042, 49%) of the laboratory-confirmed cases reported in 2019 were unvaccinated, with the highest incidence rates seen in the so-called Wakefield cohorts – born in the late 1990s and early 2000s – who missed out on the measles, mumps and rubella (MMR) vaccine when they were younger. These cohorts are now old enough to attend college and university and are likely to continue fuelling the epidemic into 2020.

Many areas have reported outbreaks and, as with past epidemics, they are linked to schools, universities and colleges where prolonged close contact creates the ideal conditions for the infection to spread. Unvaccinated individuals can present with complications such as orchitis, meningitis and pancreatitis requiring hospitalisation.

While the mumps component of the MMR vaccine is highly effective at protecting young children, immunity can reduce over time. Therefore, older teenagers and adults who received 2 doses of MMR in childhood can still get mumps, although this is generally mild compared to those who are unvaccinated. High vaccination coverage helps limit the size, duration and spread of mumps outbreaks, and cases in vaccinated individuals tend to be milder and not suffer complications [1,2].

PHE is encouraging all students and young people who may have missed out on their MMR vaccine to contact their GP to get up to date as soon as possible.

Laboratory confirmed mumps cases, England 2019 (provisional data)

Region	<1	1 to 4	5 to 9	10 to 14	15 to 19	20 to 24	25+	N/k	Total
North East	–	2	2	8	84	138	91	–	325
North West	3	6	14	61	224	360	328	–	996
Yorkshire and Humber	–	3	6	15	102	167	123	–	416
East Midlands	–	4	3	17	142	322	140	–	628
West Midlands	1	5	5	24	141	170	144	–	490
East of England	–	1	4	10	65	115	106	–	301
London	1	8	8	16	90	166	308	–	597
South East	–	5	11	22	178	288	218	–	722
South West	–	1	7	10	143	239	167	–	567
TOTAL	5	35	60	183	1169	1965	1625	–	5042

References

1. Yung C, Andrews N, Bukasa A, Brown K, Ramsay M (2011). Mumps complications and effects of mumps vaccination, England and Wales, 2002 to 2006. Emerg Infect Dis. 7(4): 661-667.
2. Yung C, Ramsay M. (2016). Estimating true hospital morbidity of complications associated with mumps outbreak, England, 2004 to 2005. Euro Surveill. 21(33).

Infection reports in this issue of HPR

Common animal-associated infections (England and Wales): fourth quarter 2019

Routine reports of gastrointestinal infections in humans, England and Wales: January and February 2020