Fighting infection : 4th report

58 Pages·2003·5.4 MB·English

by  Great Britain. Parliament. House of Lords. Science and Technology Committee

- Select Committee on
science and Technology
Fighting Infection
HL Paper 138
BY
FRONT COVER PHOTO
Kevin Beebe, Custom Medical Stock
Photo, Science and Photo Library
This report is based on evidence submitted
to and heard by the Committee throughout
the inquiry. That evidence has been
published in two volumes and _ is
reproduced on the CDRom _ that
accompanies the hard copy of this report
[HL Paper 23 and HL Paper138-l Session
2002-3]. In addition it is available on the
website www.parliament.uk/hlscience
Written evidence is published in volumes |
and II, and is referred to by the name of the
organisation or individual, volume number
and page number. For e.g.: Conway, | p15.
Oral evidence is published in volume II and
is referred to by name of the individual and
Question number. For e.g.: Conway, Q723.
Main acronyms
CAMR_ - Centre for Applied Microbial
Research
CCDC -Consultant in Communicable
Disease Control
CDC - Centers for Disease Control and
Prevention (US Federal Agency)
CDSC_ - Communicable Disease
Surveillance Centre
CICN -Community Infection Control
Nurse
vCJD - variant Creutzfeldt-Jakob
Disease
CPHL - Central Public Health Laboratory
Defra -Department of Environment,
Food and Rural Affairs
DfiID -Department for International
Development
EHO - Environmental Health Officer
FSA - Food Standards Agency
HPA - Health Protection Agency
IT - Information Technology
NPT - near patient test
PCT - Primary Care Trust
MRC - Medical Research Council
PHLS_— - Public Health Laboratory Service
SARS -Severe Acute Respiratory
Syndrome
SHA - Strategic Health Authority
VLA - Veterinary Laboratory
Association
WHO ~ - World Health Organization
HOUSE OF LORDS SESSION 2002-03
| 4th REPORT
SELECT COMMITTEE ON
SCIENCE AND TECHNOLOGY
FIGHTING INFECTION
Ordered to be printed 2 July 2003
PUBLISHED BY AUTHORITY OF THE HOUSE OF LORDS
LONDON — THE STATIONERY OFFICE LIMITED
£12.50 (inc VAT in UK)
HL Paper 138
a
HOUSE OF LORDS SESSION 2002-03
| 4th REPORT
SELECT COMMITTEE ON
SCIENCE AND TECHNOLOGY
FIGHTING INFECTION
2-8° AtUeG i2n0e 09
‘ ~rie ~,
g yy
|i * ‘ POU |j eea tLaibe i
4 1 q Pf i 5
gq q |a q m ad7
$ seas AERIALA NET SEEN ESR ET 8 SigtsPN REA H Op PAI oe
Ordered to be printed 2 July 2003
PUBLISHED BY AUTHORITY OF THE HOUSE OF LORDS
LONDON — THE STATIONERY OFFICE LIMITED
aL £12.50 (inc VAT in UK)
~ MIMO
PO oS00o AMASa eee, eee a es
, | Ss 5 at s, ~~ ee ae anat t on)
ee
“cy ee rogdde i
{ OOJOUNSS Ga ATA”
CONTENTS
Paragraph
PET ELAINAE Re t arate ececectereeecomposteoacls fa werorenclasiaacaemnteetiseRcEtLaAnnIaSt,i anBaOarE
PREFACE AND SUMMARY OF RECOMMENDATION G............cccccccesssseseceseeeseeeseceseeeaes
RCE TNR MOC TIRCT N Se oe crestn ertrlngnnlnicnionpitowriommscerieRnOeMn TnEdMnoiln cCnSaTiEs,a c1e0 7 1.6
Summary. of Recommendations MOLL AMIIROO AMA. VIM TAROSALIO2D2 1.9
CHAPTER 2: BACKGROUND AND REPORT STRUCTURE .........cccecceseceseceseeesseeeeeeeeee
Chapter SUMMALY. ..cnccsnasnsomanams MON MIORE Oa arntigeinngys wale hee lens. is
VY, Rew TE LCA LCS I Sga cc erate eats er a ohn tigncosdntlercudansesinacinunTnaMsTnn cTvOeT S ye |
Burden.of infection: extent of the!problenpas. bax .noilanicton.eawuil ieanoiaonal l Lies
FIGWEO TACKS SPECHT oo ocsenatancstartrr snbioreoaamndsndns cCnORcESn sMnOUmGMnOTiSn. eM9 18 2.9
CHARTER. 3: DIAGNOSIS.AND TREATMENT........... ontluagae. aninetask, bus. gnimaha
CHADICE. SUMIMALY iinco n ernncsurce saiecontinnanoremune ReRMED. (Rem. Das. atelanlonouding zsdiobl.....
Backsroundizeiss. bre .cieet noe ab .. nota ie. BOL VEL. RAL. MOLL Br
(GeTICRE LRT ACHTIOCNT S Aesc zsornsnaneseaoonnnenistanwanacasdeccincameneaerneni nesannsea: pLaAaAs eItI R 3.3
Basing diagnosis on symptoms or laboratory investigation .............cccccsscesseesseenees 35
iVS NL TA TS TESAB ayP AT Sal Tie see ene Se ee RR ERE. 3.11
Contacunutses giacine DeOple 1 CHE COMIMUNILY.....-<252 2c. sassococtetiscsangecscnceo Secsoutescedece» 3.14
Hospital loctorsernrecrr Sete te ne N ee ie eaten cea 3.18
TADOPALOPY SCION Sheen feces sack od Aeannds washes canaysanasecsessnareOaOsSa aDnEeM tSieMt Tc:e nALsB . 3.24
COLCUS IO NS ee rr et eye ee eee ree eee ces see at cav ddgorreante DUMB pb Pa ccas peaapp paw ah 3.26
GHAR PERS Shr DV i LOINtAIND CON TROD arc rreciiccareon tecstais taecsegcibearnasgsvedncaewopctvac es
MOE ast NINSL yM eta mem rE feo yicve ate eee Sonne es nelacevont Lote tontetecmsnvanaoesnvieas itonctensaded
PeVention icacctanecince eer ear teed eet nee: bonne aca sack enniosiad teal: 4.1
AC CANA ULOUN tee Naeem ere fg gee lle nate cca Baga niece eh ta a MNLat e 4.2
POC OCCEDIANCE Oley BCOIICS ct), neste tee Mee iy eer e ret an ipeln cay cass tetas inacincag ears 4.3
DCU CASI HOEY ACCUIN eget tier cceen emt et tees ncertscatarte tsar atas ete. Merge nics santercernereeteee 4.7
Social-conditions and beHaviourisAcAton, 0d MOM RII TRUS. IORI RA ID 4.14
COMETO! ACHIVIFY coc cneesecccxessarenncaineAaRnOSvEr)a RuOnEcDOcRn rSGa-nAeAs GsIaO nVDnDn Rees 2Aa 4.17
REC OUAITIUAIIN COMERO leg ei ey eit etas nah tes oe ears c die eck Sige tad otk ie Pata: 4.18
BESET STEN ONT ARO)b e cst RAG A Eo SADR Ea IRA an AIR AR 4.23
MOC ICLUSIONIS reese eaten tenn ee ener tne iene r crt eacktenenccerreresiteens eeeinsoitcesetne reese 4.26
CHARTER So OUR-VEILLANGE S ccccese VUE eedd, ACRES, IES Es ROTI, HOMER URI
Chapter summary .2..:..0....n.it.e .Ga.be. -t.6-G.ru.io.ks--s .-a.pshuliHud iitnoeeslsiilove s
WCE oN STIR Tae ome ies Cabra bitea oly ve urgeM aMa arn ts Ree, AE a ROU PRON Tee PEE Dad
Botett aAEyM erat ECSE A Cee eee Oe ee Ngee eet RN acct hel dadiedy uhcarecs say antuei aoa veiisdnuiensis >.2
Maintaining the information base: public health laboratories ...............ceeeeeeeeeees B24
DUAVELMANCE AS UNTEPreSENLALIN Cire eesee never nncencd oe varowy cusmroever errr ETSI LE, tad ERIE 5.16
Passive and active surveillance techmiques............ccccccscceseecsseeeeeccssecesseeessesees ay
PEC IOU LEM SUIT) 2 ee eee eee ate Eee cates ee ata clas cad cack 5.18
DT GI=7 COURUINC OR AERCECN O M eet ot tate eee ce gah Meee Gs oa. Joana -¢aaredunonden wali
Surveriiance in primary cake: SCMUINE? PLACtiCes 2... rere ecser terres eee Sey# 9
Innovative systems, sources and analysis of information................c:csssseeeeeeeneeees 5:25
Inte rating SUrVeMlAnCG eye. cee see ecole: oon tke on chen cance cen PRE A Pina ent 5.29
POEVIGCCE TC SPONDSUREI e ster ee eee soe het te os cord iup SO MEEME RCE dan seeds oookitsnacxbel ou
PATINA OD SOsO DOL KG ILOCOS yee cre nner renee, nn One oes taseletstavcaeenensaet Se
CHAPTER 6: INFORMATION SYSTEMS — NECESSARY SUPPORT ...c.cc e.ece.eee.see.eee e
CRAP TEE:SUMIINALY: co.s cast -catssseoh APIS naan AN SUES SP cece ae cea hint ree a va reed cee SE
SACRO CHING rite eee ec ee ee uae ogee PR Ra etc he Contac NER a pexass tonncenehevastass ses 6.1
Encouraging reporting: electronic submission of information ..............ceeeseeseeeeeeeees 6.6
Analysing information.............. farses. Peet Ste Peel Met te St ett 6.9
SSTEALHTO MTEIN LstM i emer te eee een ete hr. rate ee dk eng Maks Shucvsndavdendes> 6.12
Disseminating information to health care professionals..............:cssecsesesseeseceneeeseeesees 6.16
Warnine7iT 48 Nop suthiciented, 9M .PON MNRAS HN, RAD. RR. 6.20
CHAPTER 7: TRAINING AND EDUCATION ............:. 220 RUE TTA
Tasty ae eescat eee a dS oec raey endst setse dav atnecasss
Prats TeCHIONl SHCCEALTSIS ys eM tte voltae cee cp reatint sevens t tices tetast svar esoseunsoBbacnzees ie
Microbiologists, Infectious Disease Physicians and epidemiologists.................+++ lan
PCT RCTTITNC TIPA PNG ACER COLT SCO N ember ote tat csnccs ca tnse ania soavengescavecesesusestanapases 7.6
Education of health professionals other than infection specialists .............::csceseseeee 7.10
SCM nciON, COCA NOI ANG (Ne DUDICG 25... 2. cccacsntravnngusevasncensncenstovassshtaiacvncnees At
Pe WNL ee sae aes ea arr crete eae cates swxkins dune tals covends oxsilcncddeivenaanennaaasene 719
Confidence in Government atid Scientists..............cccccescssscssescsvoscnsssssscreeseseesessssoes 7.20
The media oi... sore. veveasossscoasucoh og, ea Ree RRM a Scie ien oe sees canes 120
CHABTERISSRESEARCH AND DEVELOPMEN Dxceic: kictocaqecesststercedtesesetrae reaesoeettereeena s
(Chapter SUA yiva wtere pactesrelsdancranaesoncrsioa qurrgelt aonilonids aeons eseti aa Decrees lactase ene, ee
Development of.vaccines and diagnostits S.A AO) Ve eA 8.1
Research in toliev er yee ancatge atiospesaroenanceredotieciessacepeetroendmet oeeea oeedeIecer acue 8.11
CHAPTER 9: COLLABORATION AND COORDINATION. .........ccccccsseceseseseesseceeseseneeseees
Chapter. summary. .1-ns.ccenrnoesneth tnd lvl Idee Dea LA, SITIO A OS ATS
Inter—departmental and inter—organisational collaboration ..............ccesccesscsereeeseeeeeees 9.1
KSOMETMIMEN joi a scercinecin celeste tiariiowien dares rcanacetane Celaa leeke astute ocean ne Osa
Clarifying lines of communication and accountability... ee ceeeeeeseeeeeeeees 9.6
Health Protectio ta Qe ncy icict ee -ooteeeeetestaoshintctaectc- ee eec eteato oesmu ee 9.8
Broadening. and deepening expertise....A.N.d .k.A. EN0CS: P.1e-aYsoI M,ce n 9.13
Mothers, anthropologists.and insect.experts....-.......0.-veessesaseronconseace HNEMLEUNR. 2 9.17
Infection centres: improving communication, developing teams and expertise.... 9.20
Intériiational collaboratin y sco sae cherie teeecit carcass etealiso neal O25
TEAC. vicconnsennsonseanasvonnownes AMMIAIRAVI MMII I), ANU C0 SEAT eT 9.34
Appendix 1: Members of Sub—Committee I and Declaration of Interests ..............cccccssceeeseeeenees
Appendixes Call for Exidence isaw ssjuueareauresaresitenAbnetsirowndsiadearesaavavrato oRgOaNve teannatas
Appendix Ss Acronyms sed in US Lepore eere ee eee
ADPCOGIX’ 45 LASUOL WITNESSES «fos. acer eames tt occ const paniicsnndety ease setae Stee cect eee eee ene
Box 1: Significant infections that have emerged over the last thirty years ...........cccceseceseeeeees
Box 2: gw ititecti ois COMUOLC Comer ter rr tens crt eon tne tac es mentee tee sree yer ent nee
Box 3: Lines of accountability and information flow, pre—Health Protection Agency................
Box 4: Lines of accountability and information flow, post—Health Protection Agency..............
Box 5: Problems in developing vaccines quickly wcicsicseccssesccvececesscosssecerecsLedAetLe cctenee
Box 67 pe Healtly Protection seteymmme ect ccce wai rtcs meteorie ee:steed atom maemcts
Box 7: Preventing and controllinoimrecuOn® six, saccsseosnte eents rnaenecd hoerrenst ainea ee eccere
Box 8: Investigating parrots—unclear lines of responsibility ...........ccccececcesseseteceeneeesseeeeaeenees
Box 9: Surveillance: building a picture of burden of infection ....c.cc c.eesc.ces.eces.ccce.seeceeee.eesa es
Box 10: Role of wildanimals i WileCiion wets wr. sacs epoch cee teen tienes here aennere
Box 11: Role of companion animals tn si fetCtO i ik oa bh ce ans eek poe eee Since art aertntesie A
Box 12: Strveillance, of MMUENZa.....:...accrecanevspoettrV AaNnSs aOuROn UeGn iInESe, cBFc erReen noenen e:i le
Box 13: Primary Research and: Development fundersitre. ester etteeret ees
Box'l4: Beliavigur and Man washi@crc) eerste csr entre ce Wa euees eens eee eee
Box 15: Main organisations in England with some responsibility for human infectious
AISCASE BELVICES ..-icisecLsOe tAnLetey eiadr. LOvL. Ire sVIGeI nDeIG.n ZaRc,i eATv enten eanvaeo
Note: References in the text of the Report are as follows:
(Q) refers to a question in Volume II (HL Paper 138-1)
(I, p) refers to a page in Volume I (HL Paper 23)
(II, p) refers to a page in Volume II (HL Paper 138-I)
The evidence is reproduced on a CD-Rom that accompanies the hard copy of this report and can be
accessed on www.parliament.uk/hlscience.
eer Sad
ae NEA ><)
ie oe ins a ; *
eet lapee cf iy
6 eer CO LINb idBe fiEa BR» , 4 Vee ata ea cma
naey = poping oD hes
5 alt . TaN inog e B 2 siacell avonosinl |
abiy [siooe oF estudtitnes bye amusinwob
hen HOU smote hedf is moi sib siqooq, noilticn
| i orn raat in Desi HAZ) smorbaye. ywtetiqesA
tana riats hase won & to aarition {evoly 6 tail) boast ylsbiw et tl sbau |
oy thie =o pple ga aetna 01 to sonsinaqxs t8eqo1 |
NTO cami mixneP ot) bastyn ni eoviviee szsoaib evoitostal |
enalOorey ‘th rider i bavot seor) madi 2stred reliriv (aireriognsirns .
Steck Vaiew ma aoieaiyace as tosinig 0) belssqx9 zooivise |
tr s wn trae of 2—19¥0 bar beotsees1—tsbau ss |
Syiwe dguod jon2 i tori :3q09 ot aide od ton yam esis ort nonosini as to
eee AND SUMMARY GF RECOMMENDATIONS veut T |
enti |
Nin PB Yi HF aah hsphiiosey yyy 2002 o
I RSSTy AP I Vet biel Mayotte” 1s
tie “BOO OF ASHE beS egiid" 2d PSY .
eee eaa riidinseda.nA o n dpcasmam ;
MEReIR MUON IgIYA 292 QIP HARI OD, '
wr 2s Nib: JO) Oea ges AB), |
Pees hg cial | : basl5 ip pt ine |
ROE Ay pein pie arenes i
ne Nad gitu it |
si sil. 99> ae
HAA ; ncaa bescraasn paid alte ray
ni aan woS ra a mee MPURIP ASOLO 4
ane — ot bused showM eany rth Suatt (oo baa bettie) |
sae Vii betvoryones nyt ts cudya egal tong |
iicguties aistoaepececeneecent i
nlnotdizeeryen 2mziian Senogqent
rtms plettion ye seh: aWe sane a » ey
bt ih : ated IG if ct
nae ee ae seg pathy - A wn
néte ti he
a qP oetign
ayn TOTS Smt ;
ean Se tes “hae nce “hg
4 ars “3 have
+t -3
" ‘-P a a
hall a:a reaj w (haoa
Sethe eds ae sapphire
vo hem nr faries
ik) aS nean
esh s
a tw >.
Executive Summary
Infectious disease is a significant cause of human illness and death. It leads to economic
downturns and contributes to social and political instability. Every year worldwide fifteen
million people die from an infection. The emergence of infections, such as Severe Acute
Respiratory Syndrome (SARS), create wide-spread anxiety and affects global travel and
trade. It is widely feared that a global outbreak of a new strain of influenza could result in a
repeat experience of 1918 when seventy million people died across the world.
Infectious disease services in England (the devolved administrations have separate
arrangements), whilst better than those found in many countries, suffer from problems. The
services expected to protect the population from both common and more unusual infection
are under—resourced and over-—stretched. If this country were to experience a major outbreak
of an infection the services may not be able to cope: there is not enough surge capacity.
Thus:
we recommend that the Government recognises and addresses the fact that,
although England has not experienced major epidemics of infection in recent
years, this owes as much to good fortune as to good management. Without
improvements we fear that this country will suffer from major epidemics and will
continue to see infectious disease take its toll in economic terms, in suffering and
in lives.
Arrangements for formal collaboration are poor and lines of accountability unclear.
Collaboration is difficult: many organisations and health professionals are involved in
fighting infection.
We call on the Minister for Public Health to improve cross—departmental working on
infection and to ensure that all relevant organisations understand their roles and
responsibilities. We also recommend that the Government create a number of “infection
centres”. These would develop collaborative working, create a critical mass of expertise and
provide a setting for high quality research and training in all aspects of infectious disease.
Committed and competent health professionals work hard to control and prevent infection,
yet they are insufficiently supported. We recognise that infectious disease cannot be
completely overcome, but improvements should be made in order to ensure that the
response as is as effective as possible. In particular there is a need to:
e Improve collaborative relationships across the services
e Ensure there are sufficient well-trained health professionals
e Develop ways of electronic capture, analysis and dissemination of information about
infection across relevant organisations
e Establish clear evidence—based priorities for, and facilitate development of vaccines
and diagnostic tests
e Fund research to provide an evidence base for improving diagnosis, treatment,
prevention and control of infection
e Secure supplies of vaccines in case of epidemics
e Provide clear advice and information to the public
International collaboration is an essential component of effective services. Global
partnerships provide early warning of possible epidemics. We believe that the Government
should further facilitate international collaboration by making available resources so that
infectious disease experts can be placed on short-term secondments with the WHO and
similar bodies.