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 2022/23, there were 214 laboratory confirmed cases of Escherichia coli (E. coli) in Hull which equates to a rate of 83 cases per 100,000 population. This was 20% higher than England (69 cases per 100,000 population). The majority of the cases (157; 73%) were community-onset cases. Between 2012/13 and 2022/23, there has been some year-on-year variability in the rate in Hull which has ranged from 53 to 79 cases per 100,000 population. The rate in Hull has been higher than England for all 11 of these years. From the monthly figures, the number of cases has increased since then, and the number of cases per 100,000 population for the year August 2023 to July 2024 is 30% higher in Hull compared to England (97 versus 75 cases per 100,000 population) with a total of 262 cases in Hull for the year August 2023 to July 2024.
• 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 2022/23, there were four laboratory confirmed cases and the confirmed case rate was similar to England (1.5 versus 1.4 cases per 100,000 population). None of these cases were community-onset in Hull. From the monthly figures, there were three cases in the year August 2023 to July 2024 in Hull (two hospital-onset and one community-onset).
• During 2022/23, there were 42 laboratory confirmed cases of Clostridium difficile (C. difficle) in Hull, which was much lower than England (16.2 versus 27.6 cases per 100,000 population). Nine of these cases were community-onset cases which were healthcare associated and 10 of these cases were community-onset cases which were community associated. Over the last seven years between 2016/17 and 2022/23, the rate in Hull has been lower than England, and there has been a slight reduction in the infection rate from 19 to 16 cases per 100,000 population (compared to the rate for England varying between 22 and 28 cases per 100,000 population). From the monthly figures, there were 58 cases over the year August 2023 to July 2024 and the rate in Hull was lower than England (21.5 versus 31.4 per 100,000 population).
• During 2022/23, there were 48 laboratory cases of Klebsiella Spp. and the rate was slightly lower in Hull than England (18.5 versus 20.9 cases per 100,000 population. Overall, 31 (65%) of these cases were community-onset. There is year-on-year variability in the confirmed infection rate in Hull which ranged from 16 to 24 cases per 100,000 population between 2017/18 and 2022/23. The rate has been gradually increasing in Hull at a similar rate to increases observed nationally, although the latest rate for 2022/23 is only just higher than the rate in 2017/18 (18.5 versus 16.1 per 100,000 population). However, examining the monthly figures, since late 2023, the number of cases in Hull has increased at a relatively fast rate compared previous trends and increases observed nationally, although the rate has fallen slightly in the last four months. Over the year August 2023 to July 2024, there were 66 laboratory confirmed cases of klebsiella spp., and the rate in Hull was only marginally higher than England (24.5 versus 23.2 per 100,000 population). Fewer than three in ten of these cases were hospital-onset.
• During 2022/23, there were 25 laboratory confirmed cases of pseudomonas aeurginosa (P. aeruginosa) in Hull. The infection rate was higher in Hull compared to England (9.6 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 between 2017/18 and 2022/23. In 2022/23, 17 (68%) of these cases were community-onset. Examining the monthly figures, there had been a sharp increase in the rate in Hull increasing from a low of 5.8 cases per 100,000 population for the year November 2021 to October 2022 (with 15 cases) to a high of 11.9 cases per 100,000 population for the year October 2022 to September 2023 (with 32 cases), although the rate has decreased to 8.9 cases per 100,000 population for the latest period August 2023 to July 2024 (24 cases). One-third of these cases were hospital-onset cases.
• 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 73 deaths among Hull residents from communicable diseases (certain infectious and parasitic diseases and influenza) that were registered during the three year period 2020-22 which gave a mortality rate of 11.5 deaths per 100,000 population. The mortality rate in Hull was marginally higher than England at 10.3 deaths per 100,000 population. 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 2022/23 was 20% higher than England and 10% higher than England for community-onset cases. Therefore, the rate of E. coli with that are not community-onset – presumably hospital-onset – is more than 20% higher than England.

The rate of E. coli cases in Hull had been increasing between 2014/15 and 2019/20 from 179 to 250 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 195 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 195 to 214 cases per 100,000 population.

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.

Over the year 2022/23, there were 214 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 lower than 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, and the infection rate has been consistently higher in Hull with a couple of years having similar rates for Hull and England.

Over the year 2022/23, there were 157 cases of E. coli reported in Hull which is 73% 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 July 2024, the rate in Hull is 30% higher than England (97.3 versus 75.0 per 100,000 population) with hospital rates 45% higher and community rates 26% higher. Just over three-quarters of the cases in Hull are community-onset.

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 January to July 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. 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, August 2023 to July 2024, there were 262 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 21 cases per 100,000 population for the latest period August 2023 to July 2024.

In the latest period, August 2023 to July 2024, there were 56 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.