Press Release

Minister for Health convenes the National Public Health Emergency Team as a public health response to the CPE superbug

The Minister for Health Simon Harris TD today announced that he is convening the National Public Health Emergency Team, as a public health response to the CPE/CRE superbug. Carbapenemase Producing Enterobacteriaceae (CPE) has been declared as a public health emergency, so that it is managed in line with the Public Health Plans which have been previously put in place for influenza.

CPE (also referred to as Carbapenem Resistant Enterobacteriaceae (CRE)) is the newest in a long line of ‘superbugs’ or bacteria that are hard to kill with antibiotics and are a particular problem in hospital settings.

Minister Simon Harris said “We have seen a rapid and worrying increase in the incidence of CPE in Ireland, with a significant increase in numbers of cases of CPE in recent years. Known outbreaks have occurred in eight healthcare facilities in Ireland resulting in high costs and bed closures. International experience indicates that CPE and Antimicrobial Resistance (AMR) need to be tackled at national level. That is why I am now convening the National Public Health Emergency Team and activating the National Public Health Emergency Plan. There is experience from other countries that a vigorous response in good time can contain CPE and so I am committed to tackling this with the urgency it requires.”

The Minister continued “We are now taking a number of important steps. A National Public Health Emergency Team (NPHET) will be convened next week. This group will provide advice, guidance, support and direction on the surveillance and management of CPE at national level; the development and implementation of a strategy to contain CPE and provide oversight. NPHET will conduct its work having regard to the broader healthcare associated infections (HCAI) and AMR issues in line with Ireland’s National Action on AMR 2017-2020 (iNAP),which I have launched today.”

The Chief Medical Officer, Dr Tony Holohan, stated: “I have examined this issue, in conjunction with the National Patient Safety Office, and concluded that the patient safety issues are so important that this CPE public health emergency requires a co-ordinated whole system response.”

ENDS

NOTE FOR EDITORS

The World Health Organization (WHO), Centre for Disease Control and the European Centre for Disease Prevention and Control (ECDC) all identify that infections with CPE are a serious threat to patient safety due to their resistance to multiple antimicrobials, meaning that there are very few therapeutic options which to treat infected patients. Human infections with CPE are associated with poorer patient outcomes, increased morbidity, mortality (rates exceeding 40-50%) and higher hospital costs.
Antimicrobial Resistance (AMR) is a growing problem for human health worldwide. The rise in antimicrobial resistance is recognised globally as one of the greatest potential threats to human and animal health with possible serious consequences for public health.

What is CPE?
Carbapenemase Producing Enterobacteriaceae CPE (also referred to as carbapenem resistant Enterobacteriaceae (CRE)) are an emerging threat to human health, particularly in hospital settings. CPE have developed the ability to become resistant to last-resort powerful antimicrobials known as carbapenems, which makes them more challenging to treat if they go on to cause infection. CPE are gram-negative bacteria that are carried in the gut and are resistant to most, and sometimes all, available antibiotics. CPE are an established threat to human health, particularly in hospital settings. They are shed in the faeces and transmitted by direct and indirect contact. A period of 4 weeks or more may elapse between that contact that results in acquisition of the organism and the time at which CPE becomes detectable in the faeces of the contact. More than half of all patients who develop blood stream infections with CPE die as a result of their infection.

What is the Public Health Emergency Plan?
The Department of Health’s National Health Emergency Plan is a plan to assist all health agencies in the State to respond to a public health emergency in an integrated and co-ordinated manner.

What is AMR?
Antimicrobial resistance (AMR) is resistance of a microorganism to a drug that was originally effective for treatment of infections caused by that microorganism. Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g., antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.
The evolution of resistant strains is a natural phenomenon that occurs when microorganisms replicate themselves erroneously or when resistant traits are exchanged between them. The use and misuse of antimicrobial drugs accelerates the emergence of drug-resistant strains. Poor infection control practices, inadequate sanitary conditions and inappropriate food handling encourage the further spread of AMR.

What is the effect of AMR?
A European Centre for Disease Control/European Medicines Agency (ECDC/EMEA) 2009 Report estimated that in 2007 drug-resistant bacteria were responsible for about 25,000 human deaths per annum in the EU alone, with associated healthcare costs and productivity losses of €1.5bn. The Report also stated that approx. 4 million patients are estimated to acquire a healthcare associated infection in the EU every year. (ECDC JOINT TECHNICAL REPORT ‘The Bacterial Challenge: time to react’ (2009)).

What is the National Action on AMR 2017-2020 (iNAP)?

Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 aims to implement policies and actions to prevent, monitor and combat AMR across the health, agricultural and environmental sectors. Reducing the inappropriate use of antimicrobial medicines, as well as preventing infections and disease, is vital to stop the development and spread of resistant microorganisms.

It provides an overview for the health, agricultural and environmental sectors. It presents key strategic interventions for tackling antibmicrobial resistance in line with World Health Organisation (WHO) requirements across the three sectors. These interventions represent Ireland’s commitment to the development and implementation of a holistic, cross-sectoral ‘One Health’ approach to the problem of antimicrobial resistance.

What are healthcare-associated infections (HCAIs)?

A healthcare-associated infection (HCAI) is an infection that is acquired after contact with the healthcare services. This is most frequently after treatment in a hospital, but can also happen after treatment in outpatient clinics, nursing homes and other healthcare settings. Healthcare-associated infections that are picked up in hospital are also known as “hospital-acquired infections”.

What is the National Patient Safety Office (NPSO)?

The National Patient Safety Office (NPSO) is located in the Department of Health. The NPSO provides the leadership with regard to patient safety policy, legislation and oversight. The NPSO has three key areas of work: clinical effectiveness, patient safety surveillance and patient advocacy and policy. http://health.gov.ie/national-patient-safety-office/