Chamber and committees

The Health and Safety Executive has produced guidance entitled Managing health and safety in swimming pools. The guidance provides details on filtration, disinfection and hygiene standards which should be observed in order to reduce cryptosporidiosis incidence in pools.

In addition to the Health and Safety Executive guidance, the Pool Water Treatment Advisory Group (PWTAG) is an independent group with membership from various statutory, voluntary and professional organisations with an interest in pool water treatment and pool users. PWTAG have also published guidance entitled Swimming Pool Water, treatment and quality standards for pools and spas. This document is a good practice guide used by pool operators and others and contains information on the reduction of cryptosporidiosis.

The following table shows incidence of cryptosporidiosis by board area. In Tayside in 2005 there was an outbreak of cryptosporidiosis linked to Auchingarrich Wildlife Centre in Perthshire which increased the figures. Greater Glasgow and Argyll and Clyde health boards merged in 2006 and therefore 2005 and 2006 figures have been amalgamated from both health boards.

	2005	2006	2007	2008	2009
Ayrshire and Arran	8	25	29	34	50
Borders	28	23	16	24	27
Dumfries and Galloway	32	22	39	51	47
Fife	37	41	18	20	20
Forth Valley	34	25	29	17	21
Grampian	102	60	77	96	102
Greater Glasgow and Clyde	99*	141*	82	81	94
Highland	48	29	38	29	30
Lanarkshire	53	53	56	52	76
Lothian	135	91	60	110	109
Orkney	2	5	6	5	6
Shetland	0	0	2	0	0
Tayside	130**	97	59	84	74
Western Isles	1	0	0	0	0
Total	709	612	511	610	656

Notes:

*Denotes amalgamated figures for both Argyll and Clyde/Greater Glasgow Health Boards

**Denotes preponderance of cases from Auchengarrich outbreak.

Table 1 shows the number of pulmonary and non-pulmonary tuberculosis (TB) cases reported to ESMI (enhanced surveillance of mycobacterial infection) from 2004-08.

Table 1: Number of Pulmonary and Non-Pulmonary Tuberculosis Cases Reported to ESMI, 2004-08

Year	Pulmonary TB	Non-Pulmonary TB
2004	277	115
2005	230	134
2006	232	150
2007	270	138
2008	265	187

 

Figures released on world TB day (24 March) 2010 indicate a provisional total of 275 pulmonary and 193 non-pulmonary tuberculosis cases in 2009.

Table two shows the number of respiratory and non-respiratory cases of tuberculosis as reported by Health Protection Scotland in the 2009 surveillance report

Table 2: Notifications of Respiratory and Non-Respiratory Tuberculosis in Scotland as Reported by Health Protection Scotland

Year	Respiratory	Non-Respiratory
2004	351	112
2005	244	145
2006	260	154
2007	268	141
2008	302	200

 

Enhanced Surveillance of Mycobacterial Infection (ESMI) collects information on the suspected source of infection. As it is often very difficult to determine how a patient has contracted tuberculosis this information is often not provided. Where a healthcare setting is recorded as the suspected source of infection, it may be a healthcare setting in another NHS board area, another part of the UK or the person''s country of origin. The following table shows the number of cases where suspected source is recorded as a healthcare setting by NHS board from 2004-08.

Number of Tuberculosis Cases where Suspected Source of Infection is a Healthcare Setting by NHS Board, 2004-08

NHS Board Area	2004	2005	2006	2007	2008	Total
Argyll and Clyde*	0	0	0	0	0	0
Ayrshire and Arran	0	0	0	0	0	0
Borders	0	0	0	0	0	0
Dumfries and Galloway	0	0	0	0	0	0
Fife	0	0	0	0	0	0
Forth Valley	0	0	0	0	0	0
Grampian	0	1	0	0	1	2
Greater Glasgow*	0	0	1	1	1	3
Greater Glasgow and Clyde*	0	0	0	0	0	0
Highland	0	0	0	0	0	0
Lanarkshire	0	0	0	1	1	2
Lothian	7	2	0	0	1	10
Tayside	0	0	0	0	0	0
Western Isles	0	0	0	0	0	0
Total	7	3	1	2	4	17

Note: *1 April 2006 saw the dissolution of NHS Argyle and Clyde.

The following table shows the number of cases of tuberculosis by age group reported to Enhanced Surveillance of Mycobacterial Infection (ESMI) from 2004-08.

Number of Cases of Tuberculosis by Age Group as Reported to ESMI, 2004-08

Age Group (Years)	2004	2005	2006	2007	2008
0-4	8	7	4	8	10
05-14	15	5	4	6	9
15-24	43	36	32	49	53
25-34	72	79	86	97	118
35-44	76	70	44	72	81
45-54	49	44	50	45	49
55-64	39	36	52	44	45
65-74	37	43	53	45	37
75-84	39	40	44	32	38
85+	14	5	12	10	12
Total	392	365	381	408	452

 

Enhanced Surveillance of Mycobacterial Infection (ESMI) collects information on the outcome of cases of tuberculosis one year after initial diagnosis and notification. The most recent complete year of validated and published data on outcome is 2007. The following table shows the total number of deaths among cases of tuberculosis by suspected relationship between TB and death (as reported to ESMI) from 2003-07. This data has not been not validated against official GRO data on deaths due to tuberculosis.

Number of Deaths and Suspected Relationship to Death as Reported to ESMI, 2003-08

Year	Caused Death	Contributed to Death	Incidental to Death	Unknown Relationship	Total
2003	8	10	5	10	33
2004	11	8	15	3	37
2005	10	12	13	3	38
2006	8	12	11	10	41
2007	9	7	13	9	38

 

The standard recommended drug regimen for tuberculosis is four drugs for two months followed by two drugs for four months. Information on the length of treatment is not collected through the Enhanced Surveillance of Mycobacterial Infection (ESMI) scheme therefore this information is not held centrally.

Enhanced Surveillance of Mycobacterial Infection (ESMI) captures the number of people identified as close contacts requiring screening for each case of tuberculosis. This does not necessarily reflect the actual numbers that ultimately attend for screening. ESMI does not collect information on people screened for any other reason, for example new entrant screening, occupational health and pre-BCG vaccination. No information is collected on the age of any contacts identified. The table shows the number of contacts identified through contact tracing exercises by NHS board area from 2004-08.

The NHS board area should be viewed with caution as some people may have been identified as a contact requiring screening by one NHS board area but may actually be screened in another NHS board area, another part of the UK or in another country. In addition, in any given year an incident in an educational/residential/NHS setting may result in an increased number of contacts being identified for follow-up.

Number of Contacts Identified through Contact Tracing Exercises by NHS Board, 2004-08

NHS Board Area	2004	2005	2006	2007	2008	Total
Argyll and Clyde	0	48	11	0	0	59
Ayrshire and Arran	0	0	67	101	27	195
Borders	2	2	49	11	15	79
Dumfries and Galloway	0	0	62	610	13	685
Fife	0	40	73	47	49	209
Forth Valley	0	3	5	32	54	94
Grampian	764	602	74	215	198	1853
Greater Glasgow	848	633	139	0	0	1620
Greater Glasgow and Clyde	0	0	495	578	1,375	2,448
Highland	42	25	112	69	49	297
Lanarkshire	153	202	565	110	157	1187
Lothian	451	352	166	237	432	1638
Tayside	60	11	65	109	272	517
Western Isles	0	2	0	21	459	482
Total	2,333	1,920	1,883	2,140	3,100	11,376

Note: *1 April 2006 saw the dissolution of NHS Argyle and Clyde.

The information is not held centrally.

The current maximum waiting time standard from 31 March 2010 for a first outpatient consultation following a GP referral, including in the speciality of ENT, is 12 weeks. This standard has effectively been delivered by NHSScotland since 31 March 2009, a year ahead of schedule.