Infectious Diseases

This topic area covers statistics and information relating to infectious diseases in Hull including local strategic need and service provision. This section of the JSNA only includes statistics and information from a small number of infectious diseases where data is available on Office for Health Improvement & Disparities’ Fingertips. There are many more infectious diseases, but information is not necessarily available on these. Further information on some other infectious diseases within this JSNA can be found under Coronavirus (COVID-19), Respiratory Diseases and Sexually Transmitted Infectious under Health Factors within Adults. Information relating to vaccinations can be found within Vaccinations under Prevention for Adults, and within Screening and Vaccinations under Health Factors for Children and Young People.

This page includes information on the number of new laboratory confirmed cases of escherichia coli (e coli), methicillin-resistant staphylococcus aureus (MRSA), clostridium difficile (c difficile), klebsiella and pseudomonas aeruginosa (p aeruginosa) as well as information on tuberculosis (TB), mortality from communicable diseases, and antibiotic prescribing in primary care in order to reduce antimicrobial resistance.

If you need to report an infectious diseases, contact your local Health Protection Team.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page). This is particularly the case for this JSNA page, as the indicators relating to infections are updated more regularly on Fingertips than the update schedule for this page.

Headlines

• Some infectious diseases can cause high levels of mortality and disability whereas the effects from others can be relatively mild. However, there are available measures to reduce spread such as limiting contact with others, making occupied spaces well ventilated, maintaining good hygiene, taking up vaccinations, and reporting infectious diseases where appropriate so potential outbreaks can be managed. A communicable disease is a contagious infectious disease.
• In 2023/24, there were 269 laboratory confirmed cases of Escherichia coli (E. coli) in Hull which equates to a rate of 100 cases per 100,000 population. This was higher than England (74 cases per 100,000 population). The majority of the cases (208; 77%) were community-onset cases. There has been a relatively sharp increase in the number of infections in Hull in the last year.
• The number of laboratory confirmed cases of methicillin-resistant straphylococcus aureus (MRSA) are low in Hull as they are across England and the region. In 2023/24, there were three laboratory confirmed cases and the confirmed case rate slightly lower than England (1.1 versus 1.6 cases per 100,000 population). None of these cases were community-onset in Hull in 2023/24. The rate in Hull has generally been lower than England.
• During 2023/24, there were 43 laboratory confirmed cases of Clostridium difficile (C. difficle) in Hull, which was much lower than England (16.0 versus 29.5 cases per 100,000 population). Seven of these cases were community-onset healthcare associated cases and seven were community-onset cases community associated cases. The rate in Hull has been consistently lower than England.
• During 2023/24, there were 79 laboratory cases of Klebsiella Spp. and the rate was higher in Hull than England (29.3 versus 22.9 cases per 100,000 population. Overall, 52 (66%) of these cases were community-onset. There is year-on-year variability in the confirmed infection rate in Hull, but the rate has increased quite sharply in Hull in the last year.
• During 2023/24, there were 27 laboratory confirmed cases of pseudomonas aeurginosa (P. aeruginosa) in Hull. The infection rate was higher in Hull compared to England (10.0 versus 7.8 per 100,000 population). There has been some year-on-year variability, but on the whole, the rate in Hull has been higher than England. In 2023/24, 15 (56%) of these cases were community-onset.
• Over the three year period 2020 to 2022, there were 56 new cases of tuberculosis (TB) in Hull which gave an incidence rate of 7.1 per 100,000 population. In 2001-03, the incidence rate in Hull was more than half that of England (5.1 versus 13.1 per 100,000 population), but has increased over time in Hull as the make up of Hull’s population has changed. For the period 2001-03 to 2016-18, the rate in Hull was statistically significantly lower than England. Whilst the rate in Hull for 2020-22 is lower than England, it is no longer statistically significantly lower. The number of people in Hull with drug sensitive TB is relatively low, and there is considerable variability in the percentages who completed a full course of treatment within 12 months. For the latest year 2021, six of the 17 people with drug sensitive TB had completed a full course of treatment within 12 months which is the lowest it has been since 2001 at 35% and considerably lower than England at 84%. The rate was relatively low in Hull for 2020 at 58%, but in the three years prior to that it had been between 82% and 90%.
• There were 92 deaths among Hull residents from communicable diseases (certain infectious and parasitic diseases and influenza) that were registered during the three year period 2021-23 which gave a mortality rate of 14.2 deaths per 100,000 population. The mortality rate in Hull was higher than England at 13.0 deaths per 100,000 population. The rate in Hull over the last decade or so has been around 10-11 deaths per 100,000 population, so the latest rate of 14.2 deaths per 100,000 population represents an increase in Hull. The mortality rates illustrate year-on-year variability in Hull with a higher number of deaths from sepsis for some years. Whilst the number of deaths from communicable diseases reduced considerably for 2020 due to the COVID-19 pandemic, the total numbers have increased slightly since then with a higher number from flu, although the flu deaths have only made up around 18% of all communicable deaths in Hull in the last six years (2018 to 2023).
• Reduction in antibiotic consumption is a well-recognised target in antimicrobial resistance (AMR) policies both nationally and internationally. In Hull, for 2023, after adjusting for the population, there was a marginally higher rate of antibiotic prescribing in primary care within the NHS compared to England (0.90 versus 0.88 annual total items per STAR PU (Specific Therapeutic group Age sex weightings Related Prescribing Units – using these ‘weighted units’ is a way in which the measure takes into account the differences in the population). For 2015, the rate in Hull was 11% higher than England (1.22 versus 1.10 annual total items per STAR PU) and is currently only 2% higher than England. Thus the antibiotic prescribing rate has reduced in Hull and at a faster rate than the prescribing rate for England.

The Population Affected – Why Is It Important?

From Very Well Health, an infectious disease is an infection, when a microorganism enters the body. For bacteria or fungi, this means dividing and growing new cells at an exponential rate. Viruses have the added hurdle of entering human cells and taking over their control centres so they can make more of themselves. While all communicable diseases are infectious, not all infections are communicable, for example, tetanus can cause an infection, but a person with tetanus cannot spread it to other people. A communicable disease is a contagious one. If someone catches the illness, they can get ill and spread the pathogen onto the next person. This can be transmitted through respiratory droplets from coughing or sneezing, sexual activity, contact with blood, from mother to child during pregnancy, birth or breastfeeding, or ingestion of toxins usually from spoilt and contaminated food. Active illness where a person is coughing or sneezing a lot can give the microbe more opportunities to spread, but a person can still be contagious without symptoms. For instance, measles can be transmitted up to four days before the rash develops, and the virus can stay in the air for as long as two hours after an infected person leaves the room. Other microbes spread through an intermediatory, for instance, malaria is spread by mosquitoes who become infected after biting someone with the disease, and then they, in turn, pass the parasite onto the next person they bite. Some diseases can remain on surfaces such as door handles, and food poisoning in particular can be spread through the faecal-oral route when people don’t wash hands after using the toilet and touch surfaces, that others touch later.

From the World Health Organisation, infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another.  These diseases can be grouped in three categories: diseases which cause high levels of mortality; diseases which place on populations heavy burdens of disability; and diseases which owing to the rapid and unexpected nature of their spread can have serious global repercussions. Many of the key determinants of health and the causes of infectious diseases lie outside the direct control of the health sector. Other sectors involved are those dealing with sanitation and water supply, environmental and climate change, education, agriculture, trade, tourism, transport, industrial development and housing.

Therefore, it is important to prevent the spread of infectious diseases as much as possible, particularly those infections that have a higher likelihood of causing death and disability.

From the UK Health Security Agency, the general advice for managing outbreaks of infectious diseases in a particular setting or establishment is to encourage people who are unwell to not attend or remain separate from others, ensuring all eligible groups are enabled and supported to take up the offer of vaccinations, ensuring occupied spaces are well ventilated, reinforcing good hygiene practice, and requesting that infectious diseases are reported to the setting or establishment. There are recommendations on how long people should remain away from a setting such as work, school or nursery for specific diseases, and certain infections need to be reported to the Health Protection Teams. The UK Health Security Agency also has advice for Managing Specific Infectious Diseases.

This section of the JSNA only includes statistics and information from a small number of infectious diseases where data is available on Office for Health Improvement & Disparities’ Fingertips. There are many more infectious diseases, but information is not necessarily available on these. Further information on some other infectious diseases within this JSNA can be found under Coronavirus (COVID-19), Respiratory Diseases and Sexually Transmitted Infectious under Health Factors within Adults. Information relating to vaccinations can be found within Vaccinations under Prevention for Adults, and within Screening and Vaccinations under Health Factors for Children and Young People.

E. Coli (Escherichia Coli) Bacteraemia

Escherichia coli (abbreviated as E. coli) bacteria are frequently found in the intestines of humans and animals. There are many different types of E. coli, and while some live in the intestine quite harmlessly, others may cause a variety of diseases.

The bacterium is found in faeces and can survive in the environment. E. coli bacteria can cause a range of infections including urinary tract infection, cystitis (infection of the bladder), and intestinal infection. E. coli bacteraemia (blood stream infection) may be caused by primary infections spreading to the blood.

MRSA (Methicillin-Resistant Staphylococcus Aureus)

Staphylococcus aureus (S. aureus) is a bacterium that commonly colonises human skin and mucosa without causing any problems. It can also cause disease, particularly if there is an opportunity for the bacteria to enter the body, for example through broken skin or a medical procedure.

If the bacteria enter the body, illnesses which range from mild to life-threatening may then develop. These include skin and wound infections, infected eczema, abscesses or joint infections, infections of the heart valves (endocarditis), pneumonia and bacteraemia (blood stream infection).

Most strains of S. aureus are sensitive to the more commonly used antibiotics, and infections can be effectively treated. Some S. aureus bacteria are more resistant. Those resistant to the antibiotic meticillin are termed meticillin resistant Staphylococcus aureus (MRSA) and often require different types of antibiotic to treat them. Those that are sensitive to meticillin are termed meticillin susceptible Staphylococcus aureus (MSSA). MRSA and MSSA only differ in their degree of antibiotic resistance: other than that there is no real difference between them.

Clostridium Difficile (C. Difficile) Infection

Clostridioides difficile (C. difficile) is a bacterium that’s found in people’s intestines. It can be found in healthy people, where it causes no symptoms (up to 3% of adults and 66% of babies).

C. difficile causes disease when the normal bacteria in the gut are disadvantaged, usually by someone taking antibiotics. This allows C. difficile to grow to unusually high levels. It also allows the toxin that some strains of C. difficile produce to reach levels where it attacks the intestines and causes mild to severe diarrhoea.

C. difficile can lead to more serious infections of the intestines with severe inflammation of the bowel (pseudomembranous colitis). C. difficile is the biggest cause of infectious diarrhoea in hospitalised patients.

You can become infected with C. difficile if you ingest the bacterium (through contact with a contaminated environment or person). People who become infected with C. difficile are usually those who’ve taken antibiotics, particularly the elderly and people whose immune systems are compromised.

Klebsiella Spp. Bacteraemia

Klebsiella species are a Gram-negative rod shaped bacteria belonging to the Enterobacteriaceae family. They are commonly found in the environment and in the human intestinal tract (where they do not normally cause disease).

These species can cause a range of healthcare-associated infections, including pneumonia, bloodstream infections, wound or surgical site infections and meningitis. Acquired endogenously (from the patient’s own gut flora) or exogenously from the healthcare environment.

Patient to patient spread occurs through contaminated hands of healthcare workers or less commonly by contamination of the environment. Vulnerable patients, like the immune compromised, are most at risk. Infections can be associated with use of invasive devices or medical procedures.

Klebsiella spp. can become resistant to a wide range of antibiotics through a variety of mechanisms.

Pseudomonas Aeruginosa (P. Aeruginosa) Bacteraemia

Pseudomonas aeruginosa (P. aeruginosa) is a Gram-negative bacterium often found in soil and ground water. P. aeruginosa is an opportunistic pathogen and it rarely affects healthy individuals. It can cause a wide range of infections, particularly in those with a weakened immune system, for example cancer patients, newborns and people with severe burns, diabetes mellitus or cystic fibrosis.

P. aeruginosa infections are sometimes associated with contact with contaminated water. In hospitals, the organism can contaminate devices that are left inside the body, such as respiratory equipment and catheters. P. aeruginosa is resistant to many commonly-used antibiotics.

Tuberculosis (TB)

From the World Health Organisation, tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) and it most often affects the lungs. TB is spread through the air when people with lung TB cough, sneeze or spit. A person needs to inhale only a few germs to become infected. Every year, 10 million people fall ill with TB. Despite being a preventable and curable disease, 1.5 million people die from TB each year – making it the world’s top infectious killer. TB is the leading cause of death of people with HIV and also a major contributor to antimicrobial resistance. Most of the people who fall ill with TB live in low- and middle-income countries, but TB is present all over the world. About half of all people with TB can be found in eight countries: Bangladesh, China, India, Indonesia, Nigeria, Pakistan, Philippines and South Africa. About a quarter of the global population is estimated to have been infected with TB bacteria, but most people will not go on to develop TB disease and some will clear the infection. Those who are infected but not (yet) ill with the disease cannot transmit it. People infected with TB bacteria have a 5–10% lifetime risk of falling ill with TB. Those with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill.

From the NHS, the main treatment for TB is to take antibiotics for at least six months (or 3-6 months if the person does not have symptoms and has latent TB). If TB has spread to the brain, spinal cord or the area around the heart, then steroid medicine may also be necessary for a few weeks. If the person does not take the antibiotics correctly and complete the full course of treatment, TB can come back. There is a vaccination available for TB called the BCG (Bacillus Calmette-Guérin) vaccine and it is recommended for some people who are at a higher risk of catching TB or getting seriously ill from it.

Data Considerations

Data is available on the Office for Health Improvement & Disparities’ Fingertips for the rate of laboratory confirmed cases of various bacteraemia. For some specific bacteraemia, the numbers are small and in some cases very small with only a handful of cases each year. This means that there will be month-to-month and year-to-year variability in the trends over time, particularly for smaller geographical areas like Hull relative to larger geographical areas like the region or England. It can also mean that it is more tricky to interpret the trends over time as it is possible that a ‘blip’ of one or two fewer or additional cases can impact on the overall rate by a relatively large degree. See Small Numbers in the Glossary for more information.

The rates are given as laboratory confirmed cases, and will not include all cases of the infection. It is also possible that numbers increase over time if there is better detection, testing and/or recording of the specific infection over time. This appears to be the case for some bacteraemia where there were few cases in early 2017 and a more constant number of cases within a year or two (particularly for England where the trends in the infection rates are more stable over time).

On Fingertips, the number of reported cases of infections are given as as a total over a financial year and as a rolling 12-month rate of the number of cases by month for each sub-Integrated Care Board. Hull is within the Humber and North Yorkshire Integrated Care Board, and is coded as ’03F’. Both rates are given as the number of laboratory confirmed cases per 100,000 population.

The 12 month rolling rate is calculated as the total number of cases which occurred in the specified month and the preceding 11 months divided by population of the sub-ICB for the current month and the preceding 11 months. This rate is then multiplied by 100,000 to present as the number of laboratory confirmed cases per 100,000 population.

With the figures quoted as 12-month rolling count, it does mean that a new case will remain in the ‘count’ for a whole 12 month period. For instance, in the case of Methicillin-Resistant Staphylococcus aureus (MRSA), there were three cases in Hull for the year November 2017 to October 2018, and these occurred in November 2017, March 2018 and October 2018 (as the counts increased by one for each of these months). In the year prior to this covering the period, November 2016 to October 2017, there had been no cases in the previous 12 months in Hull. There were two cases in the year December 2017 to November 2018 and these occurred during November 2017 and March 2018 (the case in November 2017 was more than a year ago so dropped out of the 12-month rolling count). There was a new case in January 2019 which increased the annual count to three again. Therefore, the counts for each month should not be summed as this has already been done and this would result in ‘double counting’.

The Hull Picture

E. Coli (Escherichia Coli) Bacteraemia

Cases by Financial Year

The number of laboratory confirmed cases of E. coli is given below for Hull (03F) over a financial year compared to the others within the Humber and North Yorkshire Integrated Care Board, as well as the rate based on those that were community-onset. The rates are given as the number of cases over the year per 100,000 population.

The rate of cases of E. coli over the year for 2023/24 was 35% higher than England and 30% higher than England for community-onset cases.

The rate of E. coli cases in Hull had been increasing between 2014/15 and 2019/20 from 70 to 96 cases per 100,000 population, although this might have occurred by chance as there is some year-on-year variability and the rate in 2014/15 was particularly low (the rate in 2013/14 was nearly as high as the peak in 2018/19). The rate decreased to 76 per 100,000 population in 2020/21 due to the pandemic and presumably fewer hospital-onset cases due to the lower admission rates for non-COVID conditions. The rate has increased slightly between 2020/21 and 2022/23 from 76 to 80 cases per 100,000 population with a sharp increase between 2022/23 and 2023/24 to 100 cases. The rate in 2023/24 for Hull is the highest it has been since 2012/13.

Between 2012/13 and 2022/23, the rate of E. coli cases has followed a similar pattern in England, although there has been less variability and the rate in Hull has been consistently higher than England. However, in the last year, the rate of infection increased across England, but the rate of increase was markedly higher in Hull.

Over the year 2023/24, there were 269 cases of E. coli reported in Hull.

As around three-quarters of E. coli cases were community-onset, the trends over time for community-onset E. coli follow a similar pattern with an increase between 2014/15 and 2019/20 with a decrease in 2020/21 due to the pandemic and less population mixing, and an increase subsequently, with the latest rate around the same as the peak prior to the pandemic.

A reasonably similar pattern of change has occurred for England, but again the rate of variability has been much greater in Hull. The infection rate has increased since the low of 2020/21 for both Hull and England, but the rate of increase has been higher particularly in the last year.

Over the year 2023/24, there were 208 cases of E. coli reported in Hull which were community-onset, which is 77% of all cases reported.

Cases by Month (12-Month Rolling Total)

The 12-month rolling total count of the number of laboratory confirmed cases of E. coli is given below for Hull (03F) compared to the others within the Humber and North Yorkshire Integrated Care Board, as well as the rate based on those that were hospital-onset or community-onset.

For September 2024, the rates in Hull are considerably higher than England.

During early 2015, there were around 200 cases of E. coli per year when examining the rolling 12-monthly figures equating to around 17 cases on average per month. This gradually increased to reach a peak of around 260 cases per year (so around 22 per month) prior to the COVID-19 pandemic (lockdown commenced March 2020). The rates fell quite sharply during 2020 and early 2021 to reach a low of around 190 cases per year (around 16 per month). However, rates have gradually increased over time to reach to around 250-270 cases for October 2023 to September 2024 (around 21 cases per month).

The rates in Hull have been consistently higher than those across England, and consistently higher than the regional average since May 2023. The rates have increased for both England and the region since the low rates during the pandemic, but the rate of increase has been greater in Hull particularly since May 2023, although this appears to have levelled off in the last couple of months.

This has increased the inequalities gap between Hull and England. However, the infection rate for the most recent few months in 2024 at just under 100 cases per 100,000 population is only just below the peak prior to the pandemic for the period March 2019 to February 2020 at 102 cases per 100,000 population.

In the latest period, October 2023 to September 2024, there were 257 cases of E. coli bacteraemia in Hull.

There is more month-to-month variability in the rate of hospital-onset cases of E. coli bacteraemia as the total number of cases are smaller. However, there is an overall increasing trend in the hospital-onset infection rate between 2015 and 2024. The rate has consistently been higher than England, and since the pandemic the rate of increase has been greater in Hull than England which has increased the inequalities gap.

The number of hospital-onset cases of E. coli has tended to vary in Hull from around 15 to just over 20 cases per 100,000 population, although reached a peak of 25 cases per 100,000 population for the year January to December 2023. The number of cases has decreased in the last six months or so with a rate of 20 cases per 100,000 population for the latest period October 2023 to September 2024.

In the latest period, October 2023 to September 2024, there were 53 cases of E. coli bacteraemia in Hull that were hospital-onset. Thus just over one-fifth (21%) of E. coli cases that were laboratory confirmed were hospital-onset.

The rate of community-onset cases of E. coli has been consistently higher than the rate of hospital-onset cases, and with the majority of the cases having community-onset, the pattern over time in the community-onset rate of cases is similar to that observed above for all cases. The rate of infection during 2020 was relatively low presumably due to the COVID-19 pandemic falling from a high of just over 80 cases per 100,000 population occurring in the year prior to the COVID-19 pandemic lockdowns (which started in March 2020) to a low of 53 cases per 100,000 population a year later (for the period March 2020 to February 2021). The rate has increased since and has almost returned to the high pre-pandemic levels of around 76 cases per 100,000 population (for the latest period October 2023 to September 2024).

In the latest period, October 2023 to September 2024, there were 204 cases of E. coli bacteraemia in Hull that were community-onset. Over three-quarters (79%) of E. coli cases that were laboratory confirmed were community-onset.

MRSA (Methicillin-Resistant Staphylococcus Aureus)

The number of laboratory confirmed cases of MRSA are very low, and this impacts on trends over time and national comparisons as an increase of only one or two cases within the year can make a relatively large difference to the infection rate per 100,000 population. See Small Numbers within the Glossary for more information.

Cases by Financial Year

The number of laboratory confirmed cases of MRSA is given below for Hull (03F) over a financial year compared to the others within the Humber and North Yorkshire Integrated Care Board, as well as the rate based on those that were community-onset. The rates are given as the number of cases over the year per 100,000 population.

For 2023/24, the number of cases of MRSA was very low with 1.1 cases per 100,000 population over the year in Hull. There were no community-onset cases of MRSA.

The infection rate in Hull is lower than England.

In 2009/10 and 2010/11 there were 12 and 16 cases of MRSA in Hull respectively, but since then the numbers have been much smaller with most years having only one or two cases in total. The exceptions were 2011/12 when there were five cases, and recently in 2021/22 and 2022/23 when there have been four cases of MRSA in Hull.

In the latest year 2023/24, there have been only three cases in Hull.

Since 2012/13, there has been zero, one or two cases of community-onset MRSA each year in Hull with the exception being 2021/22 when there were four cases of community-onset MRSA in Hull. There were no cases of community-onset MRSA in Hull for the latest year 2023/24.

Cases by Month (12-Month Rolling Total)

The 12-month rolling total count of the number of laboratory confirmed cases of MRSA for September 2024 is lower in Hull (03F) compared to England. The hospital-onset rate is the same in Hull as England, but the community-onset rate is lower. However, the numbers are very small with fewer than two cases per 100,000 population. This means that there is likely considerable month-to-month variability.

The rates are also given separately for hospital-onset or community-onset infections.

The number of MRSA cases in Hull is very low. Examining the 12- monthly rolling figures, from 2015 to April 2024, there were between zero and six cases of of MRSA each year (as the figures are given as a 12-month rolling average). There were no cases of MRSA at all in Hull during the 16-month period July 2016 to October 2017.

With the figures quoted as 12-month rolling count and averages, it does mean that a new case will remain in the ‘count’ for a whole 12 month period. For instance, there were three cases in Hull for the year November 2017 to October 2018, and these occurred in November 2017, March 2018 and October 2018 (as the counts increased by one for each of these months). In the year prior to this covering the period, November 2016 to October 2017, there had been no cases in the previous 12 months in Hull. There were two cases in the year December 2017 to November 2018 and these occurred during November 2017 and March 2018 (the case in November 2017 was more than a year ago so dropped out of the 12-month rolling count). There was a new case in January 2019 which increased the annual count to three again.

There were no cases of hospital-onset MRSA cases between May 2016 and September 2018, with one case in October 2018 and another case in January 2019. A further case occurred in March 2020 with the next case occurring in April 2022 with a small number of new cases over the next few months so the annual count reached five in Spring 2023. As at December 2024, for the latest 12 month period October 2023 to September 2024, there had been three cases of hospital-onset MRSA.

The number of cases are very small in Hull so there is month-on-month variability (see Small Numbers), but the rate in Hull is currently more than 50% lower than England.

There were only three cases of hospital-onset MRSA cases between May 2016 and March 2022 with new cases in April 2022, August 2022, November 2022 and January 2023 with two new cases in May 2023, one further case in both January 2024 and April 2024, but no new cases since then. So the number of cases are very small in Hull so there is month-on-month variability (see Small Numbers). The latest rate in Hull is the same as England.

The number of community-onset cases of MRSA is also very small. There was one new case in each of months June 2016, November 2017, March 2018, November 2019, March 2021, October 2021, December 2021, January 2022, March 2022 and May 2024.

Clostridium Difficile (C. Difficile) Infection

The number of laboratory confirmed cases of C. difficile that are healthcare associated or community associated that were community-onset are small, and this impacts on trends over time and national comparisons as an increase of only one or two cases within the year can make a relatively large difference to the infection rate per 100,000 population. See Small Numbers within the Glossary for more information.

Cases by Financial Year

The infection rates for C. difficile in Hull (03F) are much lower than England for 2023/24 at 16.0 compared to 29.5 per 100,000 population (46% lower). The rates of community-onset healthcare associated C. difficile cases (48% lower) and rates of community-onset community associated C. difficile cases (68% lower) were also lower in Hull compared to England.

In 2009/10, there were 109 cases of C. difficile in Hull, although the infection rate in Hull was lower than England. However, since then there has been a general decreasing trend in Hull albeit with some year-on-year variability. There were 43 cases of C. difficile in Hull for the latest period 2023/24.

There has also been a decrease in England over the period 2009/10 to 2022/23, but the infection rate in Hull has been even lower than England since 2016/17.

The number of cases of C. difficile that were healthcare associated with community-onset were small in Hull with seven cases in 2023/24.

The number of cases of C. difficile that were community associated with community-onset were small in Hull with seven cases in 2023/24. The infection rate of community-onset community associated cases has been consistently lower in Hull than England for the period 2017/18 to 2023/24.

Cases by Month (12-Month Rolling Total)

The number of laboratory confirmed cases of C. difficile is given below for Hull (03F) compared to the other sub-ICBs within the Humber and North Yorkshire ICB.

The rates are also given separately for community-onset associated with healthcare and community-onset associated with community, so are slightly different to the infections given above which have rates separately for hospital-onset or community-onset infections.

For September 2024, the rates are considerably lower in Hull compared to England.

Between 2015 and mid-2016, the rates of C. difficile infections was higher in Hull compared to England, but since then the rates have been consistently lower than England except for Spring and Summer of 2019 when rates were similar in Hull as England. Between the year May 2020 to April 2021 and the year November 2022 to October 2023, the rates in Hull have been around 14-16 cases per year per 100,000 population compared to 22-28 cases per year per 100,000 population for England.

In the last few months, the rate in England has continued to increase to 31-32 cases per 100,000 population, and the rate in Hull has started to increase too, to 23 cases per 100,000 population for the latest period October 2023 to September 2024.

In the latest period, October 2023 to September 2024, there has been 61 cases of C. difficile in Hull.

The number of community-onset healthcare associated cases of C. difficile is relatively low in Hull (see Small Numbers within the Glossary for more information).

Except for the period September 2018 to December 2019 when rates in Hull were considerably higher and March to August 2021 where rates in Hull were marginally higher, the rates of community-onset healthcare associated cases of C. difficile has been lower in Hull compared to England, although there is some month-to-month variability in Hull.

The number of cases is very small in Hull, but has increased in the last few months. In the year March 2023 to February 2024, there had been six cases of C. difficile that were community-onset in Hull that were associated with healthcare, but for the latest year October 2023 to September 2024, there has been 12 such cases.

The rate of community onset-community associated infections of C. difficile has increased over time in Hull between the beginning of 2017 and the beginning of 2019, but then remained relatively consistent with 3-4 cases over the year per 100,000 population. The numbers dropped at the start of the COVID-19 pandemic from a high of 4.6 cases per year per 100,000 population in March 2020 to a low of 1.5 cases per year per 100,000 population for the year to July 2021. The numbers increased since then back to around 3-4 cases per year per 100,000 population in 2022, falling to just over two cases per year per 100,000 population towards the end of 2023.

From six cases (2.2 per 100,000 population) for the year January to December 2023, the number of cases has more than doubled to 14 (5.2 per 100,000 population) for the latest period October 2023 to September 2024. Despite the large increase in the number of cases, the absolute number of cases in the year are still relatively low at 14 infections of C. difficile in the community that were community-onset.

Despite the recent in increase in Hull, the infection rate in Hull has been consistently lower than England.

Klebsiella Spp. Bacteraemia

Cases by Financial Year

For 2023/24, the rate of cases of klebsiella spp. bacteraemia infection cases per 100,000 population was higher in Hull (03F) compared to England both overall and for community-onset cases.

There is year-on-year variability in the number of cases of klebsiella spp. infections in Hull, but the pattern of change between 2017/18 and 2022/23 in Hull is similar to that of England. However, in the last year there has been a much larger increase in the number of infections in Hull.

During the year 2023/24, there were 79 cases of klebsiella spp. infections in Hull.

There is year-on-year variability in the number of cases of klebsiella spp. infections taht are community-onset in Hull, but the pattern of change between 2017/18 and 2022/23 in Hull is similar to that of England with a very marginal increase over the period of time. However, again over the last year, the increase in Hull is greater.

The rate in Hull has generally been lower than England with the exception of 2021/22 and the latest year 2023/24.

During the year 2023/24, there were 52 cases of klebsiella spp. infections that were community-onset in Hull so almost two-thirds of cases of klebiella spp. infections in Hull are community-onset.

Cases by Month (12-Month Rolling Total)

For the year to September 2024, the rate of klebsiella spp. infections is the same in Hull (03F) as England being slightly lower for hospital-onset cases and slightly higher for community-onset cases.

There were four cases of klebsiella spp. infection in Hull for the year May 2016 to April 2017 giving a rate of 1.5 cases per 100,000 population, but this steadily increased to around 40 cases by February 2018 (for the year March 2017 to February 2018) giving a rate of around 15 cases per 100,000 population. The rate gradually increased over quite a long period of time between 20018 and mid-2023 to around 20 cases per 100,000 population although there was a slight decrease in 2020 and early 2021 due to the COVID-19 pandemic. Since mid-2023, the rate has increased in Hull to a high of 30 cases per 100,000 population for March 2024 (for the year April 2023 to March 2024) although there has been reduction to 23 per 100,000 population for September 2024 (for the year October 2023 to September 2024).

Over the period April 2017 to Autumn 2023, the infection rate in Hull has been reasonably similar to England, although since late 2023, the rate in Hull has increased at a faster rate than the increase for England, but has since decreased in Hull to the same level as England for the most recent period.

The increased rate could be due to increased testing, detection and/or recording of klebsiella spp. infections over time.

Over the period October 2023 to September 2024, there were 63 cases of klebsiella spp. infection in Hull.

The number of hospital-onset cases of klebsiella spp. infections has generally been higher in Hull compared to England when examining the 12-month rolling total number of infections.

In the year May 2016 to April 2017, there had been no hospital-onset klebsiella spp. infections in Hull but this has gradually increased in Hull. An increase has also been observed for England and the region, and it is possible that the increase is associated with better testing, detection and/or recording of klebsiella spp. infections over time.

The infection rate has shown considerably month-to-month variability over time, but since the end of 2017, the hospital-onset infection rate in Hull has generally been higher than England.

The rate in Hull reached a peak of 10 cases per 100,000 population for the year April 2023 to March 2024 with a total of 27 cases, but the rate has almost halved to just over five cases per 100,000 population for the latest period October 2023 to September 2024.

There have bee 14 hospital-onset cases of klebsiella spp. infections in Hull over the year October 2023 to September 2024.

The number of community-onset cases of klebsiella spp. infections as shown a similar pattern to that for hospital-onset cases, and it is again possible that the increase is due to better testing, detection and/or recording over time.

The community-onset klebsiella spp. infection rate has generally been lower in Hull compared to England, although the infection rate has increased in Hull since Autumn 2023. For September 2023 (year October 2022 to September 2023), the community-onset infection rates were similar in Hull as England at around 15 cases per 100,000 population. However, whilst the rate in England has increased slightly to 16 cases per 100,000 population for April 2024 (year May 2023 to April 2024) the rate in Hull has increased at a faster rate to almost 20 cases per 100,000 population. The rate in Hull has decreased in the last few months to 18 cases per 100,000 population for October 2023 to September 2024.

Over the year October 2023 to September 2024, there were 49 klebsiella spp. infections in Hull that were community-onset.

Pseudomonas Aeruginosa (P. Aeruginosa) Bacteraemia

Cases by Financial Year

The rate of P. aeruginosa bacteraemia infections in Hull (03F) was higher than England for 2023/24 both overall and for community-onset cases. The number of cases of infection are relatively small.

There has been year-on-year variability in the P. aeruginosa infection rate in Hull, but in general the rate has been higher in Hull than England.

During 2023/24, there were relatively few cases of P. aeruginosa in Hull with 27 in total over the year.

There has been year-on-year variability in the community-onset P. aeruginosa infection rate in Hull, but in general the rate has been higher in Hull than England.

During 2023/24, there were only 15 cases of P. aeruginosa in Hull that were community-onset so the number of cases is relatively small.

Cases by Month (12-Month Rolling Total)

For the year to September 2024, the number of cases of P. aeruginosa in Hull is higher than England overall and for community-onset cases, but the same as England for hospital-onset cases.

The number of cases of P. aeruginosa showed a steady increase from the year May 2016 to April 2017 to the year April 2018 to March 2019 for both Hull and England with the rate in Hull increasing from 0.8 to 8.8 per 100,000 population. The increased rate could be due to increased testing, detection and/or recording of P. aeruginosa infections over time.

The rate remained relatively constant for England at just under eight cases per 100,000 population, but for Hull the infection rate has been more variable ranging from 6.5 to 12.3 cases per 100,000 population. The rate was relatively high for the year May 2023 to April 2024 at 10.4 cases per 100,000 population and 28 infections, but has decreased in the last few months to 8.9 cases per 100,000 population for the year October 2023 to September 2024.

For the latest period October 2023 to September 2024, there were only 24 cases of P. aeruginosa in Hull so the number of cases is relatively small.

The rate of hospital-onset P. aeruginosa infections in Hull showed a similar pattern to England with no cases recorded until early to mid-2017 and then remaining relatively constant since then at around three cases per 100,000 population. Again, it is possible that this increase is due to better testing, detection and/or recording of P. aeruginosa infections over time. However, the rate in Hull has been much more variable compared to England ranging from 1.9 to 4.6 cases per 100,000 population.

The rate was relatively high in Hull for the year April 2023 to March 2024 with 4.5 cases per 100,000 population, but has decreased to 3.0 cases per 100,000 population for October 2023 to September 2024.

In the latest year period from October 2023 to September 2024, there has been eight cases of hospital-onset P. aeruginosa, so the numbers are small.

The community-onset cases of P. aeruginosa also increased substantially from April 2017 to February 2018 possibly due to better testing, detection and/or recording of P. aeruginosa infections over time. Since February 2018, the rate in England has remained relatively constant at just under five cases per 100,000 population, whereas there has been much greater variability in the number of cases in Hull.

Between the year to November 2018 to the year to November 2020, the rate in Hull was higher than England reaching a peak of 7.3 cases in Hull per 100,000 population for the year August 2018 to July 2019. Between December 2020 and November 2022, the rate in Hull was lower in England, but has increased to reach a peak of 7.8 cases per 100,000 population in Hull for the year October 2022 to September 2023. The rate has since decreased in Hull to 4.5 cases per 100,000 population for the year March 2023 to February 2024, but has increased in the last five months to 5.9 cases per 100,000 population for the year October 2023 to September 2024.

Over the year October 2023 to September 2024, there were 16 cases of P. aeruginosa in Hull that were community-onset cases. So the numbers are relatively small.

Tuberculosis (TB)

The incidence (new cases) of tuberculosis (TB) for the three years 2020-22 is slightly lower in Hull compared to England (7.1 versus 7.6 new cases per 100,000 population).

The number of new cases of TB in Hull was around five per 100,000 population for the three year period 2001-03, but gradually increased to a high of 8.8 new cases per 100,000 population for 2010-12. The rate subsequently decreased to 6.0 new cases per 100,000 population for 2015-17, but has increased slightly since then to 7.1 new cases per 100,000 population for 2020-22.

The incidence rate had been statistically significantly lower in Hull compared to England prior to 2018-20, but for the last three years 2018-20 to 2020-22, the incidence rate had been similar to England (only marginally lower).

There is a low percentage of drug sensitive TB notifications where the full treatment course had been completed in Hull with just over one-third of cases having completed their treatment during 2021. The percentage completing the full treatment course for England was much higher at 84% for 2021. However, the numbers of drug sensitive TB notifications are small which means that there is considerable year-on-year variability (see Small Numbers in the Glossary for more information.).

During 2021, six of the 17 people with drug sensitive TB had completed their full treatment within 12 months in Hull. However, with the relatively small number of drug sensitive TB notifications, there is considerable variability in the percentages completing full treatment. In general, the treatment completion rates have been comparable to England with no statistically significant differences, but there have been four years in the last 21 years where the percentages have been statistically significantly lower in Hull compared to England including the last two years of 2020 and 2021.

The percentage of people with drug sensitive TB had completed their full treatment within 12 months has ranged from 35% to 100% in Hull over the 21 year period with the percentage gradually increasing for England from 65% in 2001 to around 84-87% between 2008 and 2021.

Childhood Diseases

There is relatively limited information on the incidence of childhood diseases such as measles, mumps, rubella, etc, although some information relating to vaccinations of some conditions can be found within Vaccinations under Prevention for Adults, and within Screening and Vaccinations under Health Factors for Children and Young People.

COVID-19

Further information on Coronavirus (COVID-19) can be found under Health Factors within Adults.

Influenza

Further information on some other influenza can be found within Respiratory Diseases under Health Factors within Adults. Information relating to flu vaccinations can be found within Vaccinations under Prevention for Adults, and within Screening and Vaccinations under Health Factors for Children and Young People.

Sexually Transmitted Infections

Further information on Sexually Transmitted Infectious can be found under Health Factors within Adults.

Mortality from Communicable Diseases

For deaths registered during 2021-23, the direct standardised mortality rates for communicable diseases was slightly higher in Hull at 14.2 deaths per 100,000 population compared to 13.0 deaths per 100,000 population for England.

The measure includes deaths from certain infectious and parasitic diseases based on the International Classification of Diseases version 10 codes A00 to B99 as well as influenza (ICD10 codes J09-J11).

There were 92 deaths to Hull residents from communicable diseases that were registered within the three-year period 2021 to 2023. Between 2012-14 and 2020-22, there have been around 10-11 deaths per 100,000 population (slightly lower during the pandemic), so that latest rate represents an increase on trends observed over the last decade or so.

From local data, the deaths from communicable diseases were mainly from bacteria diseases including those which resulted in sepsis with 38 deaths in total. Additionally, there were 14 deaths from intestinal infectious diseases, seven deaths from flu, and five deaths from viral hepatitis. The remaining nine deaths were from tuberculosis, viral infections, HIV, mycoses, sequelae (or consequence) of infectious and parasitic diseases, and other infectious diseases. There were a similar number of deaths for men (35) and women (38). Almost seven in ten of the deaths were among those aged 70+ years with 7, 10, 14 and 19 deaths among those aged 70-74, 75-79, 80-84 and 85+ years respectively. There were nine deaths among people aged 40-49 years, four deaths among those aged 50-59 years and six deaths among those aged 60-69 years.

There were 92 deaths from communicable diseases which were registered during the period 2021-23, with a similar number of deaths from the different causes mentioned above except a higher number from bacteria diseases including those which resulted in sepsis (50) and from flu (15). There was also a similar number of deaths for males (47) and females (45), and just over two-thirds were among people aged 70+ years with 13, 12, 15 and 22 deaths among those aged 70-74, 75-79, 80-84 and 85+ years respectively. There were seven deaths among people aged 40-49 years, six deaths among those aged 50-59 years and 13 deaths among those aged 60-69 years.

The number of deaths registered each year from communicable disease has generally been around 22-27, but has been particularly high for some years such as 2007 when there was 45, 2011 when there was 57 and 2016 when there was 32. The higher numbers are generally due to a higher number of deaths from sepsis. There was only 16 deaths from communicable disease that were registered during 2020 which is associated with the COVID-19 pandemic as there was lower rates of social mixing, people wearing face masks and likely more people employing better hand hygiene habits. However, the number of deaths from communicable disease registered during 2022 and 2023 are relatively high with 33 and 35 deaths respectively.

There have been relatively few deaths from influenza with five registered during 2018, six during 2019 and very few registered during 2020 and 2021 due to the pandemic. The numbers increased to five and 10 for 2022 and 2023 respectively with seven already registered in 2024 (which includes most deaths which have been registered up to the end of July 2024).

Antibiotic Prescribing in Primary Care

Reductions in antibiotic consumption is a well-recognised target in antimicrobial resistance (AMR) policies both nationally and internationally. Fingertips includes information on adjusted antibiotic prescribing in primary are by the NHS. The rates of antibiotic prescribing are adjusted to take into account the demographics of the population as this influences the levels of prescribing. The annual total number of prescribing antibiotic items per STAR PU (Specific Therapeutic group Age sex weightings Related Prescribing Units) are given. The information is presented as indirectly standardised ratios (see Indirectly Standardised Ratios within the Glossary for more information although for the case of antibiotic prescribing the comparison groups is not England as the ratio is not one for England but the ‘standard’ is related to the population in terms of the STAR PU).

For 2023, after adjusting for the population, there is a marginally higher rate of antibiotic prescribing in Hull compared to England (0.90 versus 0.88 annual total items per STAR PU).

The annual total number of antibiotic items prescribed in primary care by the NHS has reduced in Hull from 1.22 to 0.93 units per STAR PU between 2015 and 2022. A reasonably similar rate of change has occurred for England. There was a decrease in 2020 and 2021, likely associated with the COVID-19 pandemic, but rates have increased in 2022, although are at a lower level than the rates observed prior to the pandemic.

In 2015, the rate of antibiotic prescribing in primary are by the NHS after taking into account Hull’s population was 11% higher than England (1.22 versus 1.10 annual total items per STAR PU). This has reduced over time to 2% higher in Hull compared to England for 2023 (0.90 versus 0.88 annual total items per STAR PU).

Vaccinations For Infectious Diseases

Information relating to vaccinations of some infectious conditions can be found within Vaccinations under Prevention for Adults, and within Screening and Vaccinations under Health Factors for Children and Young People.

Strategic Need and Service Provision

Whilst effects from some infectious diseases can be relatively mild, some infectious diseases can cause high levels of mortality and disability. Therefore, it is important to prevent the spread of infectious diseases as much as possible, particularly those infections that have a higher likelihood of causing death and disability.

From the UK Health Security Agency, the general advice for managing outbreaks of infectious diseases in a particular setting or establishment is to encourage people who are unwell to not attend or remain separate from others, ensuring all eligible groups are enabled and supported to take up the offer of vaccinations, ensuring occupied spaces are well ventilated, reinforcing good hygiene practice, and requesting that infectious diseases are reported to the setting or establishment. There are recommendations on how long people should remain away from a setting such as work, school or nursery for specific diseases, and certain infections need to be reported to the Health Protection Teams. The UK Health Security Agency also has advice for Managing Specific Infectious Diseases.

Resources

Very Well Health. https://www.verywellhealth.com/the-difference-between-communicable-and-infectious-diseases-4151985

World Health Organisation. Infectious Diseases. https://www.emro.who.int/health-topics/infectious-diseases/index.html

UK Health Security Agency. Guidance: Managing outbreak and incidents. https://www.gov.uk/government/publications/health-protection-in-schools-and-other-childcare-facilities/managing-outbreaks-and-incidents

UK Government. Escherichia coli (E. coli): guidance, data and analysis. https://www.gov.uk/government/collections/escherichia-coli-e-coli-guidance-data-and-analysis

UK Government. Staphylococcus aureus (MRSA): guidance, data and analysis. https://www.gov.uk/government/collections/staphylococcus-aureus-guidance-data-and-analysis

UK Government. Clostridioides difficile (C. difficile): guidance, data and analysis. https://www.gov.uk/government/collections/clostridium-difficile-guidance-data-and-analysis

UK Government. Klebsiella species: guidance, data and analysis. https://www.gov.uk/government/collections/klebsiella-species-guidance-data-and-analysis

UK Government. Pseudomonas aeruginosa (P. aeruginosa): guidance, data and analysis. https://www.gov.uk/government/collections/pseudomonas-aeruginosa-guidance-data-and-analysis

World Health Organisation. Tuberculosis. https://www.who.int/health-topics/tuberculosis

NHS. Tuberculosis (TB). https://www.nhs.uk/conditions/tuberculosis-tb/

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

Updates

This page was last updated / checked on 12 December 2024.

This page is due to be updated / checked in May 2025.