Research and analysis

HPR volume 18 issue 11: news (10 and 20 December)

Updated 20 December 2024

New Health Protection (Notification) Regulations for England

The Department of Health and Social Care (DHSC) has published its response to a public consultation carried out in 2023 and indicated that the Government will make new regulations to amend the existing Health Protection (Notification) Regulations 2010, which apply to England only (1).

Subject to Parliamentary approval, the updated Regulations would come into force from April 2025, extending both Schedule 1 (notifiable diseases) and Schedule 2 (notifiable causative agents) of the 2010 Regulations, thus expanding the notification duties they place on registered medical practitioners and diagnostic laboratories respectively.

This means that from 6 April 2025, registered medical practitioners in England will have a statutory responsibility to report suspected or confirmed cases of these infectious diseases to the Proper Officer of the local authority (usually the UKHSA regional team).

Schedule 1 would be updated so as to include the following 8 infectious diseases: 

• Middle East respiratory syndrome (MERS)
• influenza of zoonotic origin
• chickenpox (varicella)
• congenital syphilis
• neonatal herpes
• acute flaccid paralysis or acute flaccid myelitis (AFP or AFM)
• disseminated gonococcal infection (DGI)
• Creutzfeldt-Jakob disease (CJD)

Schedule 2 would be updated so as to require laboratories that test human samples in England to report an additional 10 causative agents, not currently notifiable, to UKHSA. These are:

• Middle East respiratory syndrome coronavirus (MERS-CoV)
• non-human influenza A subtypes
• Norovirus
• Echinococcus spp
• Tick-borne encephalitis virus (TBEV)
• Toxoplasma (congenital toxoplasmosis)
• Trichinella spp
• Yersinia spp
• Respiratory syncytial virus (RSV)
• Candida auris

These changes aim to strengthen surveillance of, and public health responses to, these infectious diseases.

There will be updated guidance for registered medical practitioners and laboratories around the reporting of notifiable diseases and causative agents to UKHSA.

The plan to revise the 2010 Regulations follows an extensive public consultation, carried out in 2023. Prior to the consultation, UKHSA and the DHSC had reviewed the extent to which UK statutory requirements needed to be aligned with equivalent EU legislation. A summary of responses to the consultation has been published (2).

References

1. DHSC (2024). ‘Government response to the Health Protection (Notification) Regulations 2010: proposed amendments’.

2. DHSC (2024). ‘Summary of responses to the Health Protection (Notification) Regulations 2010: proposed amendments consultation’.

Poliovirus detected in routine sewage surveillance from Leeds, London and West Sussex in November

Routine environmental surveillance for poliovirus (PV) is undertaken by the UK Health Security Agency (UKHSA), working with the World Health Organization (WHO) Polio Global Specialised Laboratory at the Medical and Healthcare products Regulatory Agency (MHRA). The surveillance is undertaken at 26 sites, with monthly sampling, across England. It is part of the UK’s commitment to the Global Polio Eradication Initiative and provides an early warning system of PV importations which may then lead to community transmission.

Testing of the samples by the MHRA during November 2024 has identified a Vaccine Derived Poliovirus Type 2 (VDPV2) in 1 sample from East Worthing Sewage Treatment Works (which covers some of West Sussex local authority and adjacent areas), in 2 samples from Leeds Knostrop Sewage Treatment Works and 1 sample from the London Beckton Sewage Treatment Works.

The PV isolates found are genetically linked to a VDPV2 that has been widely circulating in several African countries in recent months, unrelated to any previous PV found in the UK. The same circulating VDPV2 strain has also been recently found in sewage samples from sites from three other European countries, as reported by WHO (1).

To date there is no evidence of community transmission and the risk to the public is low.

As part of routine surveillance, PVs are detected from time to time; these are normally one-off findings due to:

i) individuals being vaccinated overseas with the live attenuated oral polio vaccine (OPV), entering the UK and briefly ‘shedding’ traces of the ‘vaccine-like’ poliovirus in their faeces. Several countries offer OPV on exit as part of their response to polio outbreaks. Individuals who are immunosuppressed may shed virus for a long period of time.

ii) visitors entering the UK from a country where vaccine derived polio viruses have been circulating.

When there is community transmission the PV would be detected over a period of weeks and months. One-off or brief detections do not require any public health action.

Sampling at the sites where the VDPV2 has been detected has increased to fortnightly to inform a timely investigation and any necessary response.

Whilst there is currently no evidence of community transmission, vaccine-derived poliovirus, like the ones detected, have the potential to spread, particularly in communities where vaccine uptake is lower. On rare occasions it can cause paralysis in people who are not fully vaccinated. These latest findings are a timely reminder of the importance of local areas ensuring any children not fully up to date with their polio vaccinations are caught up.

The UK switched from using OPV to Inactivated Polio Vaccine (IPV) in 2004, the year after poliovirus was declared eradicated in the WHO European region. The primary course of polio containing vaccines is offered routinely to all babies at 8, 12 and 16 weeks of age (DTaP/IPV/Hib/HepB). Further doses of polio-containing vaccines are given at the age of 3 years and 4 months as part of the pre-school booster (dTaP/IPV) and at around 14 years old (Td/IPV) as part of the teenage booster.

Reference

1. WHO (November 2024). ‘Poliovirus detections in European Region underscore importance of vaccination and vigilance’.

Vaccine coverage reports in this issue

RSV vaccine coverage report in older adults for catch-up cohorts in England: November 2024

Prenatal pertussis vaccination coverage in England from July to September 2024

Infection reports

Laboratory confirmed cases of measles, rubella and mumps in England:  July to September 2024

Enterococcus spp. bacteraemia: voluntary surveillance 2023

Laboratory surveillance of streptococcal bacteraemia in England: 2023 update