Communicable disease

Introduction

Communicable diseases are those that can be transmitted from one person, or animal, to another. The disease may spread directly, via another species (vector) or via the environment.

The spread of a disease in the community is determined by environmental and social conditions which make it easier for a disease to pass from one person to another. At an individual level, some people can be more easily affected or infected and some people can be protected against an infectious disease because they are born immune, develop immunity or acquire immunity.

Ensuring people start and complete programmes of immunisation and vaccination can control the spread of disease.  Council public health teams will also have plans to respond to outbreaks of communicable diseases.

Key inequalities and risk factors

Overall, the number of people either “at risk” or suffering from communicable diseases in Bracknell Forest is low.  Numbers of Tuberculosis (TB) cases are very low, and TB services are good as evidenced by high TB completion rate at 12 months.  HIV prevalence is low and late diagnosis of HIV is still an issue.

• wide variation in BBV screening and Hepatitis B vaccination uptake among high-risk groups
• HIV testing offer/uptake among high-risk groups is variable
• late diagnosis of HIV is showing an increasing trend
• no standard protocol or screening for TB in primary care
• certain groups are at an increased risk of Hepatitis B: people originally from high-risk countries, people who inject drugs, and people who have unprotected sex with multiple sexual partners
• persons who inject drugs are at higher risk of contracting hepatitis B and C infections.
• older people aged 75+ are more vulnerable to healthcare-associated infections (HCAI)

Communicable disease

Mortality from infectious and parasitic diseases shows the total number of deaths in a population from those diseases during a given time period. As the number of deaths in an area will be heavily influenced by the age and gender of the population, these factors are controlled by standardisation and presented as a rate per 100,000 to allow more direct comparison between areas that have different population structures.

The following graph created from data on the Health and Social Care Information Centre – NHS Indicator Portal shows that mortality from infectious and parasitic disease in Bracknell Forest was generally comparable with regional and national averages for most years between 1995 and 2014 except during 2001-04 and 2006.

Source: Health and Social Care Information Centre – NHS Indicator Portal (Create new graph from data on server)

The number of communicable, vaccine preventable and gastrointestinal diseases in Bracknell Forest by type of infection between 2008 and 2014 is set out in the table below:

Communicable diseases	2008	2009	2010	2011	2012	2013	2014
Tuberculosis	7	10	12	12	10	8	14
Hepatitis B (acute & chronic)	12	14	16	13	13	–	0
Hepatitis C case	<5	6	6	8	6	–	0
HIV prevalence (total under treatment)					96	–	114
Legionella	<5	<5	<5	0	0	0	0
Vaccine Preventable Diseases
Measles	7	6	0	6	<5	9	3
Mumps	<5	11	7	6	<5	24	18
Rubella	0	0	0	0	0	3	1
Pertussis (whooping cough)	5	5	<5	<5	14	14	27
Meningococcal Disease	<5	<5	0	0	0	0	0
Gastrointestinal Diseases
Campylobacter	141	125	103	154	171	–	0
Cryptosporidiosis	9	7	10	9	6	–	0
E Coli 0157	<5	0	0	<5	<5	–	0
Giardia lamblia	<5	<5	7	5	6	–	1
Hepatitis A	<5	0	0	0	0	–	–
Salmonella (typhi &paratyphi)	<5	<5	0	0	<5	–	1
Salmonella (excl enteric)	30	27	16	17	19	–	–
Shigella	<5	7	6	<5	<5	–	–

Source: NOIDS database, TVHPU, 2013. Source: SOPHID – Survey of prevalent HIV infections diagnosed 2012, PHE Source: Notifiable diseases annual reports, Public Health England. Source: HIV: surveillance, data and management, Public Health England

Tuberculosis (TB)

Two measures of tuberculosis (TB) treatment are included in the Public Health Outcomes Framework. The first, TB incidence, shows the rate of reported new cases of TB per year per 100,000 population.  The data is reported as a three year average because the numbers per year are small.  The graph below shows that since 2009-11, the TB incidence rate is around 9 per 100,000 per year.  The figures for Bracknell Forest have been significantly below the national figures consistently since 2000-02.

The second, TB treatment completion shows the number of people completing treatment for TB with in 12 months of diagnosis. The treatment completion rate is not available for Bracknell Forest because of the small number of TB cases (i.e. <20 TB cases).

HIV (Human Immunodeficiency Virus)

Nationally, key strategic priorities are to (i) reduce the proportion of late HIV diagnoses and, (ii) increase the proportion of HIV infections diagnosed.

The 2014 HIV data tables report that there were 144 residents (aged 15-59) accessing HIV related care in Bracknell Forest. The 2014 HIV prevalence rate is 1.56 per 1,000 population (aged 15-59). This is greater than the 2012 figure of 1.33 per 1,000 population.  It is, however, nearer the two per 1,000 (15-59 years) population threshold which is considered a proxy for an undiagnosed prevalence and a cost effective level to implement routine HIV testing at local authority level.

New HIV diagnosis is a measure of targeted efforts to reduce transmission and wider availability of HIV testing in a variety of different medical services and non-medical settings, including the expansion of self-sampling/self-testing.  Public Health England data shows the rate of adults (aged 15 or above) newly diagnosed with HIV per 100,000 population in Bracknell Forest is falling. However, the percentage of late diagnosis of people with HIV in Bracknell Forest is increasing. Late diagnosis is the most important predictor of morbidity and mortality among those with HIV infection and is essential to evaluate the success of expanded HIV testing.

Gastrointestinal infections

There were 26 cases of food poisoning in Bracknell Forest reported in 2014. Campylobacter is the most common cause of food poisoning and continues to be the most common cause of reported gastroenteritis.

Blood-borne viruses (BBVs)

Blood-borne viruses (BBVs) are viruses that some people carry in their blood and can be spread from one person to another. The most prevalent BBVs are HIV, hepatitis B (HBV) and hepatitis C.

Hepatitis B virus (HBV) is a preventable viral infection carried in the blood causing inflammation of the liver and potentially long term damage. The hepatitis C virus (HCV) causes hepatitis (inflammation of the liver) and can lead to chronic liver disease.

Healthcare associated infections

Healthcare associated infections (HCAI) are infections that are acquired as a result of health care. Most infections occur in primary care settings.

Large declines of around 75−80% have been seen in the incidence of MRSA bacteraemia and CDI between financial year (FY) 2007/2008 and 2013/14. In contrast, MSSA and E. coli bacteraemia have shown year-on-year increases in incidence. Older people are particularly susceptible to HCAI with fatality rates highest in the 75+ age group.

Rates at Frimley Park NHS Foundation Trust are similar to the national figure whilst rates at the Royal Berkshire NHS Foundation Trust are slightly higher.

Detailed guidance on meticillin-resistant Staphylococcus aureus (MRSA), meticillin-susceptible Staphylococcus aureus (MSSA) and, Escherichia coli bacteraemia (ie bloodstream infection) and Clostridium difficile infection (CDI) and other HCAI are available from the Public Health England website.

Want to know more?

Infectious diseases (Public Health England) – the Public Health England website is a resource for local health protection services and leads which sets out the public health response to all communicable disease outbreaks and emergencies that need specialist expertise.

Health Knowledge –  learning resource is for anyone working in health, social care and well-being wherever they work or study. The resource allows you to access a broad range of learning materials for personal use or for teaching purposes in order to help everyone expand their public health knowledge.

Stopping Tuberculosis in England: An action plan from the Chief Medical Officer (Department of Health, 2004) – steps which the Government, health services and local communities need to take to reverse any  rise in TB.

Tuberculosis (NICE, 2016) – covers preventing, identifying and managing latent and active tuberculosis (TB) in children, young people and adults. It aims to improve ways of finding people who have TB in the community and recommends that everyone under 65 with latent TB should be treated. It describes how TB services should be organised, including the role of the TB control board.

Tuberculosis prevention and treatment: a toolkit for planning, commissioning and delivering high-quality services in England (Department of Health, 2007) – a toolkit to enable commissioners plan and commission high-quality TB services for their local population, and monitor their delivery. It sets out a framework for assessing local needs, and identifying how services can be best provided to meet those needs. It also contains models of best practice aimed at TB service providers, including laboratories and public health teams.

Tuberculosis (TB) and other mycobacterial diseases: diagnosis, screening, management and data (Public Health England, 2014 updated 2016) – Tuberculosis (TB) diagnosis, screening, epidemiology and strategy.

UK National Guidelines for HIV Testing 2008 (British HIV Association) – to facilitate an increase in HIV testing in all healthcare settings to reduce the proportion of individuals with undiagnosed HIV infection.  Part of a wider suite of HIV guidance.

NICE HIV testing and prevention pathways – recommendations for the NHS, local authorities and the wider public, voluntary, community and private sectors on how to prevent the spread of HIV by increasing the uptake of HIV testing services. In particular, the recommendations aim to increase the uptake of HIV testing among men who have sex with men and black Africans living in England who are, or who have been, sexually active.

Hepatitis B and C – ways to promote and offer testing (NICE, 2012 updated 2013) – pathways and standards for commissioners and providers of public health services, hepatitis testing and treatment services and laboratory services for hepatitis B and C testing. It is also for local organisations providing services for children and adults at increased risk of hepatitis B and C infection, including those in the NHS, local authorities, prisons, immigration removal centres and drugs services, and for voluntary sector and community organisations working with people at increased risk.

NHS Choices – information on hepatitis A, hepatitis B and other forms of hepatitis.

Healthcare associated infection (HCAI): operational guidance and standards (Public Health England, 2012) – steps health protection teams will need to take to make sure they meet healthcare associated infections (HCAIs) standards.

Thames Valley Public Health Prospectus 2014 – key contacts and leads for public health priorities in the Thames Valley

Public Health (Control of Disease) Act 1984 (HM Government) – and accompanying Regulations

This page was created in February 2014 and last updated on 25 May 2016.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Communicable Disease. Available at: http://jsna.bracknell-forest.gov.uk/living-working-well/health-protection/communicable-diseases (Accessed: dd Mmmm yyyy.)

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