LETTER: Brent councillors & officers should have training on disease danger from raw human sewage

 Dear Editor,

Reading all the latest from Neil Nerva and UKHSA (see Notes below) plus other local commentary you can imagine that I am just appalled at the previous lack of action given that indications are that the polio virus is spreading and mutating. Why Brent Council has not declared a ‘Major Incident’ is totally and utterly beyond my comprehension. 

 

Once again, Brent Council is trying to shut the gate after the horses have bolted. The total combined lack of understanding and action is just appalling.

 

Perhaps some in-service training for Councillors and Council Officers on the connection between the presence of untreated raw human sewage in waterways and the spread of diseases might be in order?

 

John Poole

 

Notes:

 

Cllr Neil Nerva (Cabinet Member for Public Health and Adult Social Care) wrote to all Brent councillors on August 10th attaching the UK Health Security Agency on the health dangers after detection of the pokio virus in waste water in the borough. He stated:

Councillors have a key role to promote vaccination for children aged one to nine.

 UK Health Security Agency Press Release

JCVI has advised all children aged one to nine in London are offered a polio booster vaccine, prioritising the areas where the virus is present. The NHS in London will contact parents when it's their child’s turn to come forward for a booster or catch-up polio dose. Vaccine-derived poliovirus has been detected in sewage in Barnet, Brent, Camden, Enfield, Hackney, Haringey, Islington and Waltham Forest. There have been no confirmed cases of polio and the risk to the wider population is low. Across London, childhood vaccination uptake is lower than the rest of the country.

Following the discovery of type 2 vaccine-derived poliovirus in sewage in north and east London, the Joint Committee on Vaccination and Immunisation (JCVI) has advised that a targeted inactivated polio vaccine (IPV) booster dose should be offered to all children between the ages of one and nine in all London boroughs. This will ensure a high level of protection from paralysis and help reduce further spread of the virus. Nationally the overall risk of paralytic polio is considered low because most people are protected from this by vaccination. Many countries globally, including the USA and EU countries like Belgium, provide an additional dose of polio-containing vaccine as part of their childhood vaccination schedule. The NHS in London will contact parents when it's their child’s turn to come forward for a booster or catch-up polio dose - parents should take up the offer as soon as possible. The programme will start with the areas affected, where the poliovirus has been detected and vaccination rates are low. This will be followed by rapid rollout across all boroughs. This booster dose will be in addition to the NHS childhood vaccination catch up campaign across London. It’s important all children aged 1-9, even if up-to-date with their vaccinations, accept this vaccine when offered to further strengthen their protection against the poliovirus. Following the findings earlier this year of type 2 poliovirus (PV2) collected from the Beckton sewage treatment works, further upstream sampling undertaken by the UK Health Security Agency (UKHSA) and the Medicines and Healthcare products Regulatory Agency (MHRA) has now identified at least one positive sample of the poliovirus currently present in parts of several boroughs: Barnet, Brent, Camden, Enfield, Hackney, Haringey, Islington and Waltham Forest. The sampling has also detected the virus in lower concentrations and frequency in areas adjacent to the Beckton catchment area to the South (immediately below the Thames) and to the east of Beckton. However, it is not clear whether the virus has established itself in these areas or if the detections are due to people from the affected area visiting these neighbouring areas. The level of poliovirus found and the high genetic diversity among the PV2 isolates suggests that there is some level of virus transmission in these boroughs which may extend to the adjacent areas. This suggests that transmission has gone beyond a close network of a few individuals. A total of 116 PV2 isolates have been identified in 19 sewage samples collected in London between 8 February and 5 July this year, but most are vaccine-like virus and only a few have sufficient mutations to be classified as vaccine derived poliovirus (VDPV2). VDPV2 is of greater concern as it behaves more like naturally occurring ‘wild’ polio and may, on rare occasions, lead to cases of paralysis in unvaccinated individuals. UKHSA is working closely with health agencies in New York and Israel alongside the World Health Organisation (WHO) to investigate the links between the poliovirus detected in London and recent polio incidents in these two other countries. Dr Vanessa Saliba, Consultant Epidemiologist at UKHSA said: No cases of polio have been reported and for the majority of the population, who are fully vaccinated, the risk is low. But we know the areas in London where the poliovirus is being transmitted have some of the lowest vaccination rates. This is why the virus is spreading in these communities and puts those residents not fully vaccinated at greater risk. Polio is a serious infection that can cause paralysis but nationally the overall risk is considered low because most people are protected by vaccination. The last case of polio in the UK was in 1984, but decades ago before we introduced the polio vaccination programme around 8000 people would develop paralysis every year. It is vital parents ensure their children are fully vaccinated for their age. Following JCVI advice all children aged one to nine years in London need to have a dose of polio vaccine now – whether it’s an extra booster dose or just to catch up with their routine vaccinations. It will ensure a high level of protection from paralysis. This may also help stop the virus spreading further. Jane Clegg, Chief Nurse for the NHS in London said: While the majority of Londoners are protected from polio, the NHS will shortly be contacting parents of eligible children aged one to nine years old to offer them a top-up dose to ensure they have maximum protection from the virus. We are already reaching out to parents and carers of children who aren’t up to date with their routine vaccinations, who can book a catch-up appointment with their GP surgery now and for anyone not sure of their child’s vaccination status, they can check their Red Book. The UKHSA, working with the MHRA, has already increased sewage surveillance to assess the extent of spread of the virus and are currently sampling eight further sites across London. A further 15 sites in London will start sewage sampling in mid-August, and 10 -15 sites will be stood up nationally to determine if poliovirus is spreading outside of London.

Editor's Note:  With primary schools closed for the summer holiday the usual method of communication  with parents of young children is unavailable. Brent Council should be seeking imaginative ways of communicating the urgent information about the need for parents  to take advantage of the vaccination offerfor their children (aged 1-9. Councillors could be doing that for their wards via social media, Facebook sites and Next Door as well as personal contact.

Poliovirus detected in sewage from North and East London

Brent and Harrow residents who campaigned over the recent raw sewage pollution in the Wealdstone Brook and who warned of the danger to young people will be very concerned to see this press release from the UK  Health Security Agency.

Investigation underway to protect public, who are urged to ensure polio vaccines are up to date, especially parents of young children who may have missed an immunisation opportunity.

The UK Heath Security Agency (UKHSA), working with the Medicines and Healthcare products Regulatory Agency (MHRA), has found poliovirus in sewage samples collected from the London Beckton Sewage Treatment Works.

As part of routine surveillance, it is normal for 1 to 3 ‘vaccine-like’ polioviruses to be detected each year in UK sewage samples but these have always been one-off findings that were not detected again. These previous detections occurred when an individual vaccinated overseas with the live oral polio vaccine (OPV) returned or travelled to the UK and briefly ‘shed’ traces of the vaccine-like poliovirus in their faeces.

Investigations are underway after several closely-related viruses were found in sewage samples taken between February and May. The virus has continued to evolve and is now classified as a ‘vaccine-derived’ poliovirus type 2 (VDPV2), which on rare occasions can cause serious illness, such as paralysis, in people who are not fully vaccinated.

The detection of a VDPV2 suggests it is likely there has been some spread between closely-linked individuals in North and East London and that they are now shedding the type 2 poliovirus strain in their faeces. The virus has only been detected in sewage samples and no associated cases of paralysis have been reported – but investigations will aim to establish if any community transmission is occurring.

The last case of wild polio contracted in the UK was confirmed in 1984. The UK was declared polio-free in 2003.

Dr Vanessa Saliba, Consultant Epidemiologist at UKHSA said:

Vaccine-derived poliovirus is rare and the risk to the public overall is extremely low.

Vaccine-derived poliovirus has 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 so if you or your child are not up to date with your polio vaccinations it’s important you contact your GP to catch up or if unsure check your Red Book. Most of the UK population will be protected from vaccination in childhood, but in some communities with low vaccine coverage, individuals may remain at risk.

We are urgently investigating to better understand the extent of this transmission and the NHS has been asked to swiftly report any suspected cases to the UKHSA, though no cases have been reported or confirmed so far.

Jane Clegg, Chief nurse for the NHS in London said:

The majority of Londoners are fully protected against Polio and won’t need to take any further action, but the NHS will begin reaching out to parents of children aged under 5 in London who are not up to date with their Polio vaccinations to invite them to get protected.

Meanwhile, parents can also check their child’s vaccination status in their Red Book and people should contact their GP surgery to book a vaccination, should they or their child not be fully up to date.

The UK is considered by the World Health Organization to be polio-free, with low-risk for polio transmission due to the high level of vaccine coverage across the population. However, vaccine coverage for childhood vaccines has decreased nationally and especially in parts of London over the past few years, so UKHSA is urging people to check they are up to date with their vaccines.

Wastewater surveillance is being expanded to assess the extent of transmission and identify local areas for targeted action. Healthcare professionals have been alerted to these findings so they can promptly investigate and report anyone presenting with symptoms that could be polio, such as paralysis.