Research and analysis

HPR volume 13 issue 35: news (7 October)

Updated 20 December 2019

Gonococcal resistance to antimicrobials surveillance programme (GRASP) annual report in summary

PHE has published its annual Gonococcal resistance to antimicrobials surveillance programme (GRASP) report, presenting the latest data from surveillance of antimicrobial resistance in Neisseria gonorrhoeae [1].

New treatment guidelines for gonorrhoea in the UK were published in January 2019. Current first-line treatment for gonorrhoea is ceftriaxone monotherapy, but treatment effectiveness is threatened by antimicrobial resistance. Between 2017 and 2018, the percentage of isolates with reduced susceptibility to ceftriaxone rose from 16.6% in 2017 to 24.6% in 2018.

PHE’s national reference laboratory has confirmed 7 ceftriaxone resistant isolates between January 2015 and June 2019. Between 2017 and 2018, gonococcal isolates collected through PHE’s sentinel surveillance system also showed:

• an increase in resistance to azithromycin from 9.3% to 9.7%
• an increase in resistance to ciprofloxacin from 36.4% to 39.8%
• an increase in resistance to cefixime from 1.7% to 2.1%
• an increase in resistance to penicillin from 10.8% to 12.43%

In 2018, three cases of extensively drug-resistant Neisseria gonorrhoeae (XDR-Ng) were identified and confirmed by the national reference laboratory, all with epidemiological links to sexual networks in Southeast Asia or Spain. Details on these cases have been published separately [2,3,4].

Practitioners should ensure all patients with gonorrhoea are treated and managed according to national guidelines - and be alert to changes in antimicrobials recommended for front-line use [5]. Sexual health services should report possible cases of treatment failure to PHE. Contact the online HIV and STI web-portal at [email protected].

References

1. PHE (2019). Surveillance of antimicrobial resistance in Neisseria Gonorrhoeae. Key findings from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2018): data to June 2019.
2. Eyre and others. (2018). Gonorrhoea treatment failure caused by a Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance, England, February 2018. Euro Surveill. 23(27).
3. PHE (2018). Update on investigation of UK case of Neisseria gonorrhoeae with high-level resistance to azithromycin and resistance to ceftriaxone acquired abroad, HPR 12(14).
4. Eyre and others. (2018). Detection in the United Kingdom of the Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate resistance to azithromycin, October to December 2018. Euro Surveill. 24(10).
5. British Association for Sexual Health and HIV (BASHH). BASHH Guidelines.

EVD outbreak in eastern DRC: fourteenth update

The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) continues into its fifteenth month. As of 2 August 2019, 3,084 confirmed and 114 probable cases have been reported in North Kivu, Ituri and South Kivu provinces [1]. Of these, 2,137 have died but over 990 patients survived the infection. Between 1 and 30 September 2019, 157 newly confirmed cases were reported, the lowest monthly total since February 2019.

Data source WHO [1].

The apparent decrease in the number of cases should, however, be interpreted with caution, as operational and security issues in some health zones have significantly impeded the ability of response teams to undertake case detection and response activities. It is likely that a rebound in the number of reported cases will occur once these functions resume [2].

On September 10 2019, the World Health Organization (WHO) was made aware of unofficial reports of an unexplained death of a person in Dar es Salaam, United Republic of Tanzania [3]. It appears probable that this was an Ebola-related death. No further information is currently available, but WHO, their international partners and PHE continue to monitor the situation closely.

The risk to the UK public remains very low to negligible. The situation is being monitored closely and the risk assessment regularly reviewed.

Further information sources

• GOV.UK Ebola virus disease: clinical management and guidance
• NaTHNaC website travel advice Travel Health Pro website
• WHO website EVD homepage Ebola virus disease
• FCO travel advice DRC advice

References

1. WHO Dashboard (updated daily).
2. WHO (29 September 2019). External Situation Report 61.
3. WHO (21 September 2019). Disease Outbreak News .

Infection reports in this issue

This issue includes:

• Laboratory reports of respiratory infections made to PHE from PHE and NHS laboratories in England and Wales: weeks 36 to 39, 2019

• Laboratory reports of hepatitis A infections in England and Wales, January to March 2019

• Acute hepatitis B: national enhanced surveillance report January to March 2019