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Health: PVL

Volume 710: debated on Wednesday 13 May 2009


Asked By

To ask Her Majesty’s Government how many cases of Panton-Valentine Leukocidin (PVL) Staphylococcus aureus positive there were in the last year for which figures are available and what is the incidence of PVL in all Staphylococcus infections.

My Lords, in 2007, 1,206 Panton-Valentine Leukocidin positive cases were reported to the Health Protection Agency. On the second point raised by the noble Baroness, although data are not available to calculate the incidence of PVL infections, it is estimated that less than 2 per cent of Staphylococcus aureus infections are PVL positive.

My Lords, I thank the noble Baroness for her Answer. Is she aware that this is a particularly nasty toxin that mixes with MRSA and causes the white cells to be killed? Therefore it is exceedingly dangerous. People are dying because they are not diagnosed; often they are young children or students. Will the noble Baroness make this a notifiable condition and send guidelines to primary care staff and also to schools and clubs?

My Lords, the noble Baroness is quite correct that this is an extremely unpleasant infection; but fortunately it is extremely rare. Very few infections are notifiable diseases—generally they are those where a public health action is required. Available data do not suggest that this is required for PVL, but we are keeping this under constant review. For example, notification regulations are currently being updated, and there will be provision to add new infections as necessary.

The noble Baroness is also correct that our priority is to ensure that doctors and other clinicians are aware of how to diagnose and manage this infection, because it does need to be managed very quickly. We are also making sure that information is available to healthcare workers in primary care and to GPs. Information is also being made available through the HPA to other workers who are dealing particularly with young people.

My Lords, because this is a very serious—if very rare—illness, we are sponsoring two major projects on the prevalence of PVL in different populations. The first is to determine the proportion of skin and soft-tissue infections when people come into emergency departments. The second is a study of nasal carriage from a random sample of people in the south-west. We are asking GPs to provide us with samples where there are no clinical symptoms, so we can see how prevalent it is among the general population. In addition, we have commissioned PVL testing of stored samples of Staphylococcus aureus in a Birmingham hospital.

My Lords, although it is an uncommon condition, it is serious so why does not the Minister consider making it a notifiable disease for a trial period of, say, a few months? It is a very serious infection indeed.

My Lords, the noble Lord is right: it is very serious, as I said, but, as I also said, most notifiable diseases are ones where there is a health protection issue. We are keeping the condition under review and we are collecting data. I am not ruling out making it a notifiable disease; I am just saying that at the moment, we do not think that it is necessary.

My Lords, it is indeed a very serious infection, as is swine flu. Does the Minister not agree that all infections can be prevented by good personal and household hygiene, efficient community services, clean water and good nursing techniques, all promoted by Florence Nightingale 150 years ago? Will she undertake to visit the museum across the road as soon as possible, buy a copy of Notes on Nursing and make sure that everyone in the Department of Health reads it?

My Lords, I absolutely agree with the noble Baroness. She is not the first person today to suggest that I should visit the Florence Nightingale exhibition, and I will do so.

My Lords, I do not know the answer to that, but I undertake to find out for the noble Lord. At the moment, we are surveying it, identifying it and making sure that information is out there so that doctors and clinicians recognise it and treat it as quickly as it needs to be.

My Lords, although extremely rare, this infection is very dangerous because of the speed with which it kills. There is usually little or no time to wait for the relevant tests to come back from the laboratory. What is desperately needed is a rapid bedside diagnostic test. Is my noble friend aware of any research going on to provide a test such as the one that is becoming available for haemolytic Streptococcus?

My Lords, I am indeed aware of that. My noble friend is completely correct to say that bedside identification is necessary. It takes 24 hours to get absolute confirmation, and my noble friend is right: that is not quick enough. However, the disease can be treated by normal antibiotics, so we just need to get on and treat it.

My Lords, in view of the similarity of the early stages of PVL infection and swine flu, and, as has been mentioned, the tremendous urgency of having an accurate diagnosis, because if PVL is not treated, it can rapidly be fatal, what guidance is the Ministry giving to the medical profession on the issue?

My Lords, there are two forms of guidance: one provided by the Health Protection Agency and the other provided by the British Society of Antimicrobial Chemotherapy. I have given the noble Baroness, Lady Masham, part of the guidance that has been issued; I will be very happy to make that available in the Library.