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UK Health Protection Agency steps up efforts in public health
Newsdesk Streptococcus testing should be part of antibiotic prescribing Prescribing antibiotics without testing for Streptococcus spp is the least costeffective strategy primary care physicians use when treating adult sore throats. Mark Aronson and colleagues (Beth Israel Deaconess Medical Center, Boston, MA, USA) studied strategies for managing adult pharyngitis: observation without testing or treatment, empirical treatment with penicillin, throat culture, optical immunoassay (OIA) followed by culture, and OIA alone. Culture was the least expensive and most effective strategy when the prevalence of group A -haemolytic streptococci (GAS) pharyngitis was 10%. Empirical treatment was never the most effective or least expensive strategy, regardless of prevalence of GAS pharyngitis in adults. These results raise concerns about unnecessary prescribing of antibiotics and the potential for increasing bacterial resistance. According to Aronson, “Physicians prescribe broad-
spectrum antibiotics to 70–75% of adults with pharyngitis, despite only 10% having a strep throat, which is nearly the only reason to prescribe antibiotics”.
Childhood sore throats often caused by GAS
Aronson emphasised that their results only apply to adults. The situation is different for children, whose sore throats are much more likely to be caused by GAS. Itzhak Brook (Georgetown University School of Medicine, Washington DC, USA) says that before such studies, the assumption
was that it was more economical to treat sore throats with antibiotics. There are now clearly no grounds for making such an assumption. Both Aronson and Brook are firmly of the belief that indiscriminate prescribing of antibiotics contributes to development of bacterial resistance. “The reasons for treatment are complex and partly involve a desire by patients to receive antibiotics when they come to a doctor. It is important to get this message out to patients as well as doctors. I remain hopeful that the evidence that empiric treatment is the least cost-effective strategy will reduce the number of prescriptions of unnecessary antibiotics”, says Aronson. Brook draws attention to efforts already being made: “In some countries, such as Greenland, Finland, and Australia, public and medical community education has paid off in halting the increase in bacterial resistance.” Cathel Kerr
UK Health Protection Agency steps up efforts in public health Only 4 months after its formation, the UK’s Health Protection Agency (HPA) for England and Wales launched its corporate 5-year plan to tackle a broad range of health threats. The new goals include strategies to reduce the impact of infectious diseases, prepare for new and emerging diseases and threats to health, investigate childhood diseases associated with infection, chemical and radiation hazards, investigate illness associated with exposure to hazardous chemicals, improve health service preparedness for certain major emergencies, and provide the public with authoritative and science-based impartial information and advice. HPA Chairman Sir William Stewart said “the global threats to health have moved on and so must we—it’s time to step up our health defences”. Pat Troop, Chief Executive of the HPA said there will be an emphasis on horizon scanning—trying to understand the patterns of disease around the world, and being able to model and predict future scenarios.
Retrospective surveillance, will be replaced by real-time surveillance to keep one step ahead. There are also plans to establish a national panel for new and emerging infectious diseases with the Department of Health. “One of the things we are looking at is climate change, which is clearly bringing the potential of more insectborne diseases into the country. We have a programme at the moment trying to assess the current pattern of these vectors in the community and hope to have the first set of mapping data by the end of the year”. Continued emphasis will still remain on the more traditional infectious diseases. In the UK the number of cases of tuberculosis, HIV, and other sexually transmitted diseases are all up from last year. “We will be publishing an annual report on infectious diseases in an easily digestible form for the non-specialist. We will have what diseases are up, what are down, the number of cases, and demographics where known”, she added.
THE LANCET Infectious Diseases Vol 3 September 2003
Among other areas of focus will be developing new oral swab tests for key diseases, to replace invasive and timeconsuming blood tests. The HPA is working on a swab test for pertussis (whooping cough) in children and for syphilis. Given the ease of use, the swab test will provide a better picture of how common these diseases are nationwide, and for syphilis it means no risk of needle-stick injuries for healthcare staff testing HIV/AIDS patients and intravenous drug users. Shortly before the launch, the European Commission announced the creation of a European Centre for Disease Prevention and Control (ECDPC) to be approved by the end of 2003. Jean-Claude Desenclos from the Institut de Veille Sanitaire, France, a similar initative to the HPA says “both the UK and the EU initiatives are complementary: an ECDPC, will not be effective without strong national public health institutes like the HPA”. The corporate plan can be found at http://www.hpa.org.uk. Pam Das
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
529
spectrum antibiotics to 70–75% of adults with pharyngitis, despite only 10% having a strep throat, which is nearly the only reason to prescribe antibiotics”.
Childhood sore throats often caused by GAS
Aronson emphasised that their results only apply to adults. The situation is different for children, whose sore throats are much more likely to be caused by GAS. Itzhak Brook (Georgetown University School of Medicine, Washington DC, USA) says that before such studies, the assumption
was that it was more economical to treat sore throats with antibiotics. There are now clearly no grounds for making such an assumption. Both Aronson and Brook are firmly of the belief that indiscriminate prescribing of antibiotics contributes to development of bacterial resistance. “The reasons for treatment are complex and partly involve a desire by patients to receive antibiotics when they come to a doctor. It is important to get this message out to patients as well as doctors. I remain hopeful that the evidence that empiric treatment is the least cost-effective strategy will reduce the number of prescriptions of unnecessary antibiotics”, says Aronson. Brook draws attention to efforts already being made: “In some countries, such as Greenland, Finland, and Australia, public and medical community education has paid off in halting the increase in bacterial resistance.” Cathel Kerr
UK Health Protection Agency steps up efforts in public health Only 4 months after its formation, the UK’s Health Protection Agency (HPA) for England and Wales launched its corporate 5-year plan to tackle a broad range of health threats. The new goals include strategies to reduce the impact of infectious diseases, prepare for new and emerging diseases and threats to health, investigate childhood diseases associated with infection, chemical and radiation hazards, investigate illness associated with exposure to hazardous chemicals, improve health service preparedness for certain major emergencies, and provide the public with authoritative and science-based impartial information and advice. HPA Chairman Sir William Stewart said “the global threats to health have moved on and so must we—it’s time to step up our health defences”. Pat Troop, Chief Executive of the HPA said there will be an emphasis on horizon scanning—trying to understand the patterns of disease around the world, and being able to model and predict future scenarios.
Retrospective surveillance, will be replaced by real-time surveillance to keep one step ahead. There are also plans to establish a national panel for new and emerging infectious diseases with the Department of Health. “One of the things we are looking at is climate change, which is clearly bringing the potential of more insectborne diseases into the country. We have a programme at the moment trying to assess the current pattern of these vectors in the community and hope to have the first set of mapping data by the end of the year”. Continued emphasis will still remain on the more traditional infectious diseases. In the UK the number of cases of tuberculosis, HIV, and other sexually transmitted diseases are all up from last year. “We will be publishing an annual report on infectious diseases in an easily digestible form for the non-specialist. We will have what diseases are up, what are down, the number of cases, and demographics where known”, she added.
THE LANCET Infectious Diseases Vol 3 September 2003
Among other areas of focus will be developing new oral swab tests for key diseases, to replace invasive and timeconsuming blood tests. The HPA is working on a swab test for pertussis (whooping cough) in children and for syphilis. Given the ease of use, the swab test will provide a better picture of how common these diseases are nationwide, and for syphilis it means no risk of needle-stick injuries for healthcare staff testing HIV/AIDS patients and intravenous drug users. Shortly before the launch, the European Commission announced the creation of a European Centre for Disease Prevention and Control (ECDPC) to be approved by the end of 2003. Jean-Claude Desenclos from the Institut de Veille Sanitaire, France, a similar initative to the HPA says “both the UK and the EU initiatives are complementary: an ECDPC, will not be effective without strong national public health institutes like the HPA”. The corporate plan can be found at http://www.hpa.org.uk. Pam Das
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
529