Typhoid and paratyphoid

Typhoid and paratyphoid (also known as enteric fever) are diseases caused by Salmonella enterica serovar Typhi (typhoid) or Paratyphi A, B and C (paratyphoid). Classic typhoid fever is a serious disease which can be life-threatening unless treated promptly with antibiotics. Paratyphoid is typically milder than typhoid and of shorter duration. Typhoid and paratyphoid are almost exclusively acquired abroad through the ingestion of heavily contaminated food and water. Typhoid and paratyphoid are spread from person-to-person by the faecal-oral route. Therefore, their prevention and control is dependent on good sanitation, clean water and scrupulous personal hygiene. The typhoid vaccine offers limited protection against typhoid and no protection at all against paratyphoid. Variation in rates of typhoid and paratyphoid may reflect variation in underlying populations e.g. by ethnicity, but are also indicative of the need for a public health focus on pre-travel advice and vaccination.

In 2019, the number of East Sussex residents who were diagnosed with typhoid or paratyphoid was 1 (the number in 2018 was 1). The typhoid/paratyphoid rate per 100,000 residents was 0.2 in 2019, similar to 0.7 per 100,000 in England. The rank of East Sussex for this was 104th highest (out of 150 upper tier local authorities and unitary authorities (UTLAs/UAs)).

Salmonella (non-typhoidal)

Salmonella is a bacteria that lives in the guts of domestic and wild animals including poultry, cattle, pigs, hedgehogs, snakes and lizards. Salmonella infection can cause gastrointestinal illness and in rare cases lead to complications such as sepsis. This section relates to the Salmonella causing food poisoning i.e. non-typhoidal Salmonella (not those causing typhoid or paratyphoid fever).

In 2017, the number of East Sussex residents who were diagnosed with Salmonella was 71 (the number in 2016 was 32). The Salmonella diagnoses rate per 100,000 residents was 13.0 in 2017, similar to 15.7 per 100,000 in England. The rank of East Sussex was 109th highest (out of 147 UTLAs/UAs). Since 2016, the increase in the rate of Salmonella in East Sussex was 122%.

Campylobacter

Campylobacter causes food poisoning and is the most commonly reported bacterial gastrointestinal pathogen in England. The majority of infections result in self-limiting diarrhoea, however, infection has also been associated with chronic sequelae such as Guillain-Barré syndrome. Campylobacter causes a substantial community and healthcare burden in the UK. The bacteria lives in the gastrointestinal tract of a wide range of livestock (especially poultry) and wildlife species and in pets such as dogs and cats. People can get Campylobacter from raw or undercooked meat, especially chicken meat, unpasteurised milk or untreated water. Bacteria can spread easily through poor hygiene in food preparation, for example if you do not wash your hands, you can spread bacteria from chicken to salads.

In 2017, the number of East Sussex residents who were diagnosed with Campylobacter was 576 (the number in 2016 was 579). The Campylobacter diagnoses rate per 100,000 residents was 105 in 2017, worse than 96.6 per 100,000 in England. The rank of East Sussex for this was 66th highest (out of 146 UTLAs/UAs). Since 2016, the decrease in East Sussex was 1%.

STEC O157

Shiga toxin-producing Escherichia coli serogroup O157 (STEC) is a zoonotic gastrointestinal infection for which animals (particularly ruminants such as cattle and sheep) are the main reservoir. Transmission occurs either due to direct contact with infected animal faeces, ingestion of food contaminated with infected animal or human faeces or via contact with the infected faeces of another person. STEC causes moderate to severe disease in humans. Most cases will present with mild (diarrhoea) to moderate (bloody diarrhoea) gastrointestinal symptoms but a proportion (~ 5%) will go on to develop more severe complications such as haemolytic uraemic syndrome (HUS). Some complications may require long-term care or result in permanent disability (e.g. kidney failure). Infants, young children and the elderly are particularly vulnerable to such complications.

In 2018, the number of East Sussex residents who were diagnosed with STEC O157 was 8 (the number in 2017 was 6). The 5 year mean STEC O157 diagnoses rate per 100,000 residents was 1.1 in 2014 - 18, similar to 1.2 per 100,000 in England. The rank of East Sussex for this was 64th highest (out of 148 UTLAs/UAs).

Listeria

Listeria monocytogenes causes listeriosis, a rare but potentially life-threatening disease. Healthy adults are unlikely to experience infection, however, Listeria infection (listeriosis) is dangerous to pregnant women, the elderly and people with weakened immune systems. Listeria is typically spread by contaminated foods. Listeria is an unusual bacterium because it can grow at low temperatures, including refrigeration temperatures of below 5 degrees. It is, however, killed by cooking food thoroughly and by pasteurisation. Local variation in numbers may reflect poor food management, variation in the numbers of people with weakened immune systems or different uptake of food safety messages in pregnant women. Areas with persistent significantly high rates in the absence of known outbreaks should investigate the cause and should enhance prevention advice as appropriate.

In 2018, the number of East Sussex residents who were diagnosed with Listeria was 0 (the number in 2017 was 1). The 5 year mean Listeria diagnoses rate per 100,000 residents was 0.4 in 2014 - 18, similar to 0.3 per 100,000 in England. The 5 year rank of East Sussex was 43rd highest (out of 148 UTLAs/UAs).

Shigella

Shigellosis, also known as bacillary dysentery, is caused by four species. Shigella flexneri and Shigella sonnei are endemic in the UK while infections with Shigella dysenteriae and Shigella boydii are usually imported. Shigella generally causes a relatively mild illness, however 1 in 5 cases may progress to more severe disease, including hospitalisation due to bloody diarrhoea, persistent gastroenteritis or more severe complications such as bacteraemia. Patients with Shigella dysenteriae can also develop a very severe condition known as haemolytic uremic syndrome (HUS). Infection is readily transmitted from person to person, via the oro faecal route. In the past, shigellosis has primarily been associated with travel to countries with poor sanitation or transmission between young children and their care-givers in household, nursery or school settings. More recently, outbreaks of Shigella sonnei and Shigella flexneri have been linked to person-to-person spread among gay, bisexual and other men who have sex with men (GBMSM).

In 2017, the number of East Sussex residents who were diagnosed with Shigella was 15 (the number in 2016 was 14). The Shigella diagnoses rate per 100,000 residents was 2.7 in 2017, similar to 3.5 per 100,000 in England. The rank of East Sussex was 58th highest (out of 147 UTLAs/UAs).

Giardia

Giardia can be transmitted by direct contact with infected animals or humans, or by consumption of water, food or drinks contaminated by the faeces of infected animals or humans. People may also be infected by swimming in contaminated water e.g. lakes or rivers. Many cases are associated with foreign travel. Persistently significantly high rates of Giardia in the absence of known outbreaks would indicate the need to investigate the underlying reasons and reinforce prevention activity as appropriate e.g. advice regarding contact with animals.

In 2017, the number of East Sussex residents who were diagnosed with Giardia was 47 (the number in 2016 was 55). The Giardia diagnoses rate per 100,000 residents was 8.6 in 2017, similar to 8.5 per 100,000 in England. The rank of East Sussex was 49th highest (out of 147 UTLAs/UAs). Since 2016, the decrease in the rate of Giardia in East Sussex was 15%.

Crytposporidium

Cryptosporidiosis is a disease usually caused by the parasites Cryptosporidium hominis and C. parvum. It is most commonly seen in children aged between 1 and 5 years. People with weak immune systems are likely to be more seriously affected. The most common symptom is mild to severe watery diarrhoea. The parasites are resistant to chlorine. Outbreaks of cryptosporidiosis have been linked to drinking or swimming in contaminated water and contact with infected lambs and calves during visits to open farms. Persistently significantly high rates of Cryptosporidium in the absence of known outbreaks would indicate the need to investigate the underlying reasons and reinforce prevention activity as appropriate e.g. advice regarding contact with animals.

In 2017, the number of East Sussex residents who were diagnosed with Cryptosporidium was 31 (the number in 2016 was 49). The Cryptosporidium diagnoses rate per 100,000 residents was 5.7 in 2017, similar to 7.3 per 100,000 in England. The rank of East Sussex was 85th highest (out of 147 UTLAs/UAs). Since 2016, the decrease in the rate of Cryptosporidium in East Sussex was 37%.

Meningococcal disease

Invasive meningococcal disease (IMD), caused by the bacteria Neisseria meningitidis, is an important cause of severe illness and death. Incidence is highest in children under five years of age, with a secondary peak in young people aged 15 to 19 years of age. Vaccination against the most common meningococcal groups are offered to children and adolescents as part of the UK immunisation schedule. High rates of invasive meningococcal disease should prompt review of the causes, for example, an outbreak or poor uptake of vaccination among risk groups.

In the period Jul 2020 - Jun 2021, the number of East Sussex residents who were diagnosed with confirmed invasive meningococcal disease was 1. The invasive meningococcal disease diagnoses rate per 100,000 residents was 0.2 in Jul 2020 - Jun 2021, similar to 0.1 per 100,000 in England. The rank of East Sussex for this was 48th highest (out of 150 UTLAs/UAs).

Measles

Measles is the most infectious of all diseases transmitted through the respiratory route. It can lead to severe complications, particularly in immunosuppressed individuals and young infants. Measles infection during pregnancy increases the risk of miscarriage, stillbirth or preterm delivery. The most effective way to control measles is by achieving high uptake of two doses of measles, mumps, rubella (MMR) vaccine.

In 2021, the number of East Sussex residents who were diagnosed with measles was 0 (the number in 2020 was 0). The 5 year mean measles diagnoses rate per 100,000 residents was 0.2 in 2017 - 21, better than 0.8 per 100,000 in England. The rank of East Sussex for this was 81st highest (out of 150 UTLAs/UAs).

Mumps

Mumps is a vaccine preventable viral infection which can occasionally cause severe complications, including swelling of the ovaries (oophoritis), swelling of the testes (orchitis), aspetic meningitis and deafness.

In 2018, the number of East Sussex residents who were diagnosed with mumps was 0 (the number in 2017 was 1). Since 2017, the decrease in the rate of mumps in East Sussex was 100%. The 5 year mean mumps diagnoses rate per 100,000 residents was 1.9 in 2012 - 16, better than 3.6 per 100,000 in England. The rank of East Sussex for this was 99th highest (out of 150 UTLAs/UAs).

Pertussis

Pertussis (whooping cough) is a vaccine preventable bacterial infection and causes a prolonged cough illness, with the majority of cases occurring in individuals aged 15 years and over. However, it result in life threatening complications in infants under 6 months of age and immunosuppressed individuals.

In 2021, the number of East Sussex residents who were diagnosed with pertussis was 1 (the number in 2020 was 16). The pertussis diagnoses rate per 100,000 residents was 0.2 in 2021, similar to 0.1 per 100,000 in England. The rank of East Sussex for this was 25th highest (out of 150 UTLAs/UAs).

Immunisation

The World Health Organization (WHO) says that the 2 public health interventions that have had the greatest impact on the world's health are clean water and vaccines. ‘Immunisation against infectious disease’, also known as the Green Book, has the latest information on vaccines and vaccination procedures in the UK. Vaccination coverage is the best indicator of the level of protection a population will have against vaccine preventable communicable diseases. Coverage is closely correlated with levels of disease. Monitoring coverage identifies possible drops in immunity before levels of disease rise. Previous evidence shows that highlighting vaccination programmes encourages improvements in uptake levels. NICE guidance PH21: Reducing differences in the uptake of immunisations aims to increase immunisation uptake among those aged under 19 years from groups where uptake is low.

Figure 29. Chart showing immunisation uptake for selected childhood and adult vaccines in East Sussex compared to the rest of England

The local result for each indicator is shown as a circle, against the range of results for England shown as a grey bar. The line at the centre of the chart shows the England average, the diamond shows the average for the South East region.

Compared to England:

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Key for spine bars

In 2022/23, the percentage vaccine coverage of Dtap/IPV/Hib at 1 year old for East Sussex residents was 92.4 (in 2021/22 it was 93.4). This was similar to 91.8 for England. The rank of East Sussex was 75th highest (out of 150 UTLAs/UAs).

In 2022/23, the percentage vaccine coverage of one dose of MMR at 2 years old for East Sussex residents was 90.7 (in 2021/22 it was 91.7). This was better than 89.3 for England. The rank of East Sussex was 74th highest (out of 150 UTLAs/UAs).

Tuberculosis

Tuberculosis (TB) is an infectious disease that usually affects the lungs, although it can affect almost any part of the body. People at higher risk of TB include those who have medical conditions that weaken the immune system (including HIV), homeless persons, people who inject drugs, those who have lived in areas of the world with high rates of TB, and close contacts of a person who has infectious TB. More local information on TB can be found on the online TB profiles and UKHSA Region reports.

In the 3 years from 2019 - 21, the number of East Sussex residents who were diagnosed with TB was 39 (the number in 2018 - 20 was 42). The 3 year mean TB diagnoses rate per 100,000 residents was 2.4, better than 7.8 per 100,000 in England. The rank of East Sussex was 118th highest (out of 150 UTLAs/UAs). Since 2018 - 20, the decrease in East Sussex was 6%; in the 5 years since 2014 - 16, the decrease was 44%.

The percentage of TB cases in East Sussex in 2021 who had been offered a test for HIV was 100%, similar to 98.4% in England. The percentage of TB cases in East Sussex in 2021 starting treatment within 4 months was suppressed, and not compared to 68.4% in England.

Legionella

Legionnaires’ disease is caused by Legionella bacteria. It is an important health protection issue as infection can result in pneumonia and has a high mortality rate, especially in the elderly and immunosuppressed individuals. The organism is ubiquitous and can colonise poorly designed and/or poorly maintained wet cooling systems, which have the potential to cause large outbreaks.

In 2020, the number of East Sussex residents who were diagnosed with legionella was 0 (the number in 2019 was 5). The legionella diagnoses rate per 100,000 residents was 0.0 in 2020, similar to 0.6 per 100,000 in England. The rank of East Sussex was 149th highest (out of 150 UTLAs/UAs).

Hepatitis B

Hepatitis B is vaccine preventable and an important health protection issue that can cause serious disease. Variation in the incidence rate may reflect outbreaks, differences in the number of people in risk groups (such as migrants from countries with a high prevalence of hepatitis B, gay, bisexual and other men who have sex with men (GBMSM), people who inject drugs), in addition to variation in uptake of vaccination of risk groups. High rates of acute hepatitis B should prompt a review of cases to determine underlying reasons and to identify appropriate interventions.

In 2021, the number of East Sussex residents who were newly diagnosed with acute hepatitis B was 1 (the number in 2020 was 1). The rate of new diagnoses per 100,000 residents was 0.2, similar to the rate of 0.3 per 100,000 in England. The rank of East Sussex for the rate of new acute hepatitis B diagnoses was 71st highest (out of 150 UTLAs/UAs).

In 2017 - 19 the under 75 mortality rate from hepatitis B related end-stage liver disease/hepatocellular carcinoma per 100,000 residents was 0.1, similar to the rate of 0.1 per 100,000 in England. The rank of East Sussex was 86th highest (out of 149 UTLAs/UAs).

Hepatitis C

Hepatitis C is an important health protection issue. The infection increases people's risk of developing serious long term disease. About a third of people infected with hepatitis C virus will eventually develop liver cirrhosis accompanied with an increased risk of developing liver cancer. Hepatitis C is difficult to diagnose. Variation in detection rates may reflect differences in local testing activity as well as differences in the number of people in risk groups (such as people who inject drugs).

In 2017 the rate of hepatitis C detection in per 100,000 residents was 21.2, similar to the rate of 18.4 per 100,000 in England. The rank of East Sussex for the rate of hepatitis C detections was 52nd highest (out of 146 UTLAs/UAs).

In 2017 - 19 the under 75 mortality rate from hepatitis C related end-stage liver disease/hepatocellular carcinoma per 100,000 residents was 1.1, worse than the rate of 0.5 per 100,000 in England. The rank of East Sussex was 15th highest (out of 149 UTLAs/UAs).

Sexually transmitted infections

As STIs are often asymptomatic, frequent screening of risk groups is important. Early detection and treatment can reduce important long-term consequences, such as infertility and ectopic pregnancy. While vaccination is a measure that can be used to control genital warts, hepatitis A and hepatitis B, control of other STIs relies on consistent and correct condom use, behaviour change to decrease overlapping and multiple partners, ensuring prompt access to testing and treatment, and ensuring partners of cases are notified and tested.

The burden of STIs in England continues to be greatest in young people, gay, bisexual and other men who have sex with men (GBMSM) and black ethnic minorities. Of all age-groups, the highest STI diagnosis rates in England are in young people aged 15-24 years. High levels of gonorrhoea transmission are of particular concern due to the emergence of extensively drug resistant gonorrhoea (XDR-NG) in England.

For more information on local sexual health access the sexual and reproductive health profiles which include downloadable summary profiles, and UKHSA Region reports.

It should be noted that if high rates of gonorrhoea and syphilis are observed in a population, this reflects high levels of risky sexual behaviour. When interpreting trends, please note that recent decreases in genital warts diagnoses may be due to the protective effect of HPV vaccination, and are particularly evident in the younger age groups, offered the vaccine since the national programme began. An increase in genital herpes diagnoses may be due to the use of more sensitive tests.

Figure 41. Chart showing key STI indicators in East Sussex local authority compared to the rest of England

The local result for each indicator is shown as a circle, against the range of results for England shown as a grey bar. The line at the centre of the chart shows the England average, the diamond shows the average for the South East region.

Compared to England:

• Better
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• Not compared

Key for spine bars

Other infections transmitted sexually

Other infections can be spread through sexual intercourse in addition to other routes, e.g. hepatitis B, hepatitis C and some infections are spread faecal-orally during sexual activity - termed sexually transmissible enteric infections (STEI) e.g. hepatitis A and Shigella.

HIV

Free and effective antiretroviral therapy (ART) in the UK has transformed HIV from a fatal infection into a chronic but manageable condition. People living with HIV in the UK can now expect to have a near normal life expectancy if diagnosed promptly and they adhere to treatment. The population groups who have been most at risk of HIV in the UK have been GBMSM and black African people. With progressive strengthening of combination prevention (including condom use, expanded HIV testing, prompt antiretroviral therapy and availability of pre-exposure prophylaxis), HIV transmission, AIDS and HIV-related deaths could be eliminated in the UK. For more local information on HIV please access the UKHSA Region Reports.

Figure 49. Chart showing key HIV indicators in East Sussex local authority compared to the rest of England

The local result for each indicator is shown as a circle, against the range of results for England shown as a grey bar. The line at the centre of the chart shows the England average, the diamond shows the average for the South East region.

Compared to England:

• Better
• Similar
• Worse
• or
• Lower
• Similar
• Higher
• or
• Not compared

Key for spine bars

Antibiotic prescribing in primary care

Reducing antibiotic consumption is a well-recognised target in anti-microbial policies and can be used as an overall metric for benchmarking across local authorities. In order to fully appreciate antimicrobial prescribing, it is necessary to take into consideration demographic characteristics of the population as it may influence levels of prescribing and therefore this data is adjusted for both age and sex.

In 2022, the number of antibiotic items prescribed in primary care in East Sussex was 306,161, a 13% increase since 2021 (n = 271527). The adjusted primary care prescribing rate was 0.9 in 2022, worse than 0.9 per 100,000 in England. The rank of East Sussex for this was 77th highest (out of 150 UTLAs/UAs).

Air pollution

Poor air quality is a significant public health issue. The burden of air pollution in the UK in 2013 was estimated to be equivalent to approximately 28,000-36,000 deaths at typical ages and an associated loss of population life of 328,000-416,000 life years lost ¹. This indicator displays the fraction of mortality attributable to particular air pollution and will enable local authorities to prioritise action on air quality in their local area to help reduce the health burden from air pollution.

The fraction of mortality attributable to particulate air pollution was 4.7% in 2021, and not compared to 5.5% in England. The rank of East Sussex for this was 138th highest (out of 150 UTLAs/UAs).