Cork 2008

The 2008 Five Nations Conference took place on April 29-30 at the Sheraton Hotel, Fota Island, Cork. The conference takes place annually at a different venue in one of the five host nations (England, Scotland, Wales, Northern Ireland and the Republic of Ireland). The aim of the conference is to provide a focus for CPD for CCDCs, Consultants and Specialists in PH and their colleagues in the epidemiology, and control of infectious, non infectious and environmental hazards.


This year there were four main themes:

  • Making Surveillance Work: What’s the best way to count what counts?
  • Environmental issues: New challenges for health protection;
  • Health protection in vulnerable people and
  • Outbreaks and Incidents: Evidence or intuition?

There was also a Late Breakers and Hot Topics session to round off the conference.
The Conference Booklet for Cork 2008 is available here.

Dr Jim Keily, Chief Medical Officer for the Republic of Ireland warmly welcomed all delegates to the conference in his introduction and also expressed the hope that some practical outcomes in operations and procedures in health protection
would result from this symposium.


An interesting and thought provoking keynote address was delivered by Dr Denis Coulombier, Head of the Unit for Preparedness and Response at the European Centre for Disease Protection and Control (ECDC), Stockholm. Dr Coulombier started his address by outlining how the role of the ECDC integrates with the health protection services of European member states and then elaborated on the benefits of both ‘classic’ indicator-based surveillance and event-based surveillance which is unstructured but provides timely data on emerging threats.


The first session on ‘Making Surveillance Work’ provided opportunity to hear about different methods that had been adopted by health protection professionals to collect, collate and report surveillance data, ranging from web-based automated systems to paper-form completion by attending clinicians, each tailored for the particular surveillance scheme in question. Dr Andrew Grant from HPA CfI also gave a very interesting presentation on how linking datasets can add value to surveillance data and how probabilistic record linkage can work even when data and patient identifiers are incomplete or error-prone.


Session two focused on the new health protection challenges faced with regard to environmental issues. Dr Shantini Paranjothy, in her presentation about assessing the public health impact of the floods in Doncaster in 2007, discussed how the mental health impact of such events can be much greater than the physical health impact on the affected populations.


These findings highlight the importance of identifying risk factors for psychological morbidity that can be targeted in future interventions. Dr Rachel Chalmers, head of the Cryptosporidium Reference Unit at NPHS Microbiology Swansea, also gave a very interesting presentation assessing the value of boil water notices (BWN) in outbreak management with the conclusion that BWN is a valuable and an immediate control measure and poor compliance should be addressed through more proactive and constructive communication.


The specific challenges faced in delivering health protection services to vulnerable populations, such as prisoners, sex workers, travelling communities and disadvantaged communities, was the theme for session three. Dr Caron Walker, of North East HPU, gave a presentation on the management of an on-going cluster of TB in a large disadvantaged family which showed how communicating and involving the family has been key in managing this complex outbreak. All presentations highlighted how important suitable and specific communication with the target group is in facilitating effective health protection services to vulnerable people.


Day two of the conference started with session 4 which examined the relationship between evidence and the intuition of health protection professionals when investigating outbreaks and incidents. Presentations were given on several high profile incidents including the investigation in Scotland and the North West of England in 2006 of a fatal case of inhalational anthrax, a large TB outbreak involving two crèches in Cork and two H5N1 avian influenza outbreaks in Suffolk. A particular highlight was a presentation by Josie Smith from NPHS on the role that intuition had in the investigating of a large outbreak of HIV in Cardiff and the use of mapping to facilitate contact tracing of at risk individuals in highly interconnected sexual networks.
Perhaps most worryingly though is the fact that this outbreak indicates that well-informed and HIV-educated individuals continue to transmit HIV and other STIs in highly active, high risk casual sex networks.


The conference finished with a late-breakers and hot topics session which covered a wide range of health protection issues. Dr Marian McAvoy from Bedfordshire and Hertfordshire HPU gave a fascinating presentation on the management of the local media coverage of a TB outbreak in a primary school and how initially hostile and inaccurate reporting was turned into balanced, informative and accurate coverage through dialogue between the media and the HPU. Dr Sue O’Connell, Head of the Lyme Borreliosis Unit, HPA Microbiology Southampton, gave an overview of Lyme disease in the five nations and the ‘hot spots’ where ticks are particularly prevalent (tip: where there’s deer, there are ticks!). However, of particular concern is the amount of misinformation available about the condition, particularly on the Internet, and the misdiagnosis of Lyme disease in people with other conditions.

Mistreatments have been documented as causing numerous serious harms and even some deaths. The last presentation of the conference was about PVL –Staphylococcus aureus infections in Olympic wrestlers (not to be confused with the ‘showman’ WWE wrestlers in tight Lycra shorts). Diane Fiefield from Greater Manchester HPU gave an excellent and humourous talk on the investigation and measures implemented following an increase in skin infections in members of a local wrestling club where personal hygiene was not top of the agenda! To raise awareness of this infection risk, which can affect individuals participating in any contact sport, a leaflet was produced by Salford PCT with a snappy title selected by members from the target audience –‘Keep your tackle clean’

In between sessions there was also time to view the poster display, and enjoy the social activities-a highly entertaining and competitive quiz with all questions having a connection to health protection, an excellent conference dinner with a highly amusing after-dinner speech given by Mr Martin Higgins, the Chief Executive of safefood Ireland followed by a traditional Irish Celidh.


Finally, a big thank you must go to the conference organizing committee who did a sterling job in ensuring that the programme was varied, pertinent and interesting and that all ran smoothly and efficiently. Also many congratulations to our hosts, Health Service Executive (HSE), Republic of Ireland, for choosing such a superb venue.


See you next year in Newcastle!

Author – Dr Clare Coombes
National Public Health Service for Wales