November 2023 – Latest diphtheria briefing note from UKHSA
Please find attached the latest UKHSA briefing note on diphtheria.
Updated recommendations for the control of diphtheria amongst newly arriving asylum seekers arriving by small boat to England.
The level of risk of diphtheria for AS following this migrant journey is lower than previously estimated in 2022 but remains significant and greater than that for the wider UK population. This reduction is likely due to a combination of factors including reduced numbers of new arrivals, a reduction in infection in the AS population in Europe, a reduction in overcrowding in accommodation pathways and ongoing establishment of more robust health assessment, testing and early treatment of symptomatic individuals.
It is not possible to quantify the contribution of mass prophylaxis to diphtheria control since November 2022 but with the emergence of an increasing proportion of macrolide resistant cases and limited alternative antibiotic options available, this population level control strategy is not the preferred option in the long-term.
The following updated recommendations are therefore made with immediate effect, based on a reversion to individual level control measures:
• Early identification of cases; this requires continued provision of the basic health check on arrival to identify symptomatic individuals, allow early testing, treatment, and isolation of suspected cases
• Empirical treatment for respiratory symptoms (including sore throats), and skin lesions which includes cover for diphtheria
• Early offer of diphtheria vaccination; this requires continued delivery at reception to protect all new arrivals against severe infection. This is recommended in the reception facility for adults and families and in UASC hotel/accommodation settings as has been established. It is recommended that this provision is further strengthened to improve coverage. It is also imperative that work continues to ensure processes are in place to systematically record vaccination doses, with the information accessible to health partners.
• On arrival into initial accommodation (contingency hotel or large site), to ensure all asylum seekers are registered with a GP and have timely access to a baseline medical assessment (as set out in the Migrant Health Guide). This should include a review of all immunisations, as soon as possible, to allow timely catch-up to the UK schedule.
• On identification of a case, to follow national guidelines and implement a multiagency, multi-disciplinary response, which is particularly important for cases with macrolide resistant infection
• Suspected cases will require assessment for DAT treatment with appropriate clinical supervision and oversight (as per Supplementary guidance section 1.5.1 Supplementary guidance for cases and outbreaks in asylum seeker accommodation settings) UKHSA Briefing Note 2023/042 Issued 09/11/2023
• Contact tracing will be required with testing, prophylaxis and vaccination arranged for close contacts
• Local laboratories to monitor antibiotic susceptibilities and to ensure antibiotic treatment and prophylaxis schedules are amended for suspected macrolide resistance as per supplementary guidance. Linezolid treatment to be supervised by ID/ or alternative in community as required
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Updated recommendations for the control of diphtheria – 9 November 2023