Health Protection Agency Regional, London
Contact details
Dr Graham Fraser (or Dr Helen Maguire)Health Protection Agency London Regional
Epidemiology Unit
330 High Holborn
London WC1V 7PP
Regional Overview
London faces public health challenges of an intensity not experienced elsewhere in the country. Many infectious disease problems are exacerbated under circumstances unique to London. With a resident population of 7.5 million, augmented daily by an estimated million commuters and visitors, London is one of the largest, most densely populated, and ethnically diverse cities in Europe. Forty percent of the population live in the 10% most deprived districts of the country. Rates of TB, STIs, blood borne infections, malaria and measles are all much higher in the capital than elsewhere in the country.HPA London's main areas of work include
Surveillance of all communicable diseases of public health significance - analysis of trends, risk assessment, epidemic response, and production of regular electronic and hardcopy reports.Practical and active support in investigation and control of incidents and outbreaks of communicable disease: London is a busy location for public health authorities, and the Epidemiology Unit may be involved directly when an incident is particularly serious, large, crosses boundaries or is of national importance. The Unit also provides support to locally based public health physicians, hospital colleagues and NHS authorities in locally led incident investigations;
Expert technical advice and support: to the Regional Director of Public Health (also the Mayor of London's public health advisor), the Government Office for Health for London region, and the NHS London Strategic Health Authority, and the London Health Observatory; these particularlrly relate to assessment of emerging communicable disease public health risks, and contingency planning (eg measles, pandemic influenza, terrorist incidents);
Epidemiological applied research,and audit: The Unit has an active programme of continual applied research and audit into communicable disease problems in London, and we have also been involved in a number of research projects in association with academic departments and the national Centre for Infection, Colindale.
The region
London now has a single NHS Strategic Health Authority, with recently appointed Regional Director of Public Health. Across the city there are 35 NHS acute hospital trusts, including several tertiary hospitals, and 31 Primary Care Trusts, co-terminous with London boroughs. HPA London services the city through four Health Protection Units, each serving a population of 1.5 to 2.5 million.Staff
The Unit has two Consultant Regional Epidemiologists. Other members of the team include two senior and two junior epidemiological scientists, an information manager and computer programmer, and a team of six information officers and assistants, ,each with their specific areas of responsibility..A consultant epidemiologist and nurse epidemiologist will be appointed to the health care asoociated infection team in 2008. The Unit is usually supplemented by senior UK trainees in public health, and others working on secondment. There are good working relationships with other Regional staff, including health emergency planners, chemical hazards surveillance and management staff, and regional management staff.Main areas of activity in 2003
The focus of our work is in areas of particular public health importance, including tuberculosis, healthcare acquired infection, measles and other vaccine preventable diseases of childhood, meningococcal disease, HIV/STIs, and antenatal infection. TB surveillance and treatment outcome monitoring is conducted across all 33 London TB clinics using the web based London Tb Register (LTBR). We continue to implement the national mandatory surveillance system for staphylococcal bacteraemias and Clostridium difficile infection in hospital trusts and have an active programme of work in conjunction with HPU staff in supporting improvements in nosocomial infection control in London hospitals. Measles is a growing public health risk, and we are actively involved at both local and London-NHS level in addressing this problem. Meningococcal disease is over-represented among London’s more deprived communities and we are actively evaluating this.We continue to monitor and audit antenatal testing uptake and infection prevalence rates for hepatitis B, HIV, syphilis and rubella, the first region-wide scheme of its kind. We are working with HPU and haematology colleagues to address deficits in malaria surveillance and bring an increasing problem to the attention of policy makers. Outbreaks of gastro-intestinal infection continue to provide a major area of work, and we frewquently support HPU and localauthority colleagues, particularly with analytical epidemiological support. We continue to improve and support local laboratory diagnosed infection surveillance systems (CoSurv) as well as maintain enhanced systems for TB and meningitis surveillance. We maintain our regular surveillance outputs in the form of a quarterly report, ‘Londoni’, which provides feedback to stakeholders across the London health and public health system. We also produce a weekly electronic 'London Bulletin', providing healthcare professionals across London with timely information on local, national and international incidents and outbreaks.
Training opportunities
As a region in a busy metropolitan location, with many public health problems, we are well placed to facilitate Fellows’ exposure to practical management of communicable disease incidents and outbreaks, as well as connection with surveillance and policy issues at regional and national level. We do this in liason with colleagues in the Health Protection Units, other Regions of the Agency, and the Centre for Infection at Colindale (for regional and national outbreaks).The Unit regularly provides training placements of three to six months for senior trainees from the UK Public Health training programme, as well as ad hoc secondments to colleagues who wish to gain experience of regional public health work. We have also hosted ad hoc short-term placements to senior European FETP or public health trainees. All trainees provide an invaluable contribution to the work of this busy Unit, while in the process gaining field experience in communicable disease control and health protection issues. Trainees including EPIET fellows have opportunities to participate in all activities of the unit. Trainees provide a major impetus to applied research and audit activity of the Unit, and projects are agreed, taking into consideration previous experience and interest.
We have good links with several academic institutions across London, including the London School of Hygiene, Imperial College, University College London, and St George's Medical School, as well as with the National Centre for Infection, at Colindale, London , the London Health Observatory, and other Regions of the Agency.
Training supervision
One of the consultant epidemiologists will be the overall supervisor for the period of the Fellow’s training. For specific projects and tasks, the appropriate consultant for the area of work will act as trainer, so Fellows experience training from both consultants; on occasion consultants from CFi or academic departments contribute to specific training projects.Language requirements
EnglishTraining history
Number of EPIET fellows trained at institute: 3 (2004, 2006, 2007)Available as a training site for cohort 14: Yes