§ Mr. Anthony Grant
(by Private Notice) asked the Secretary of State for Social Services what steps he has taken to contain the outbreak of Lassa fever; and if he will make a statement.
§ The Minister of State, Department of Health and Social Security (Dr. David Owen)
My right hon. Friend the Secretary of State issued a statement yesterday. I will circulate this in the Official Report and copies are available in the Vote Office.
There is only one confirmed case. Three contacts of that case are in isolation and we shall not know the results of their tests for one to two weeks.
The possibility of Lassa fever cannot yet be ruled out in six other people who have recently returned from various parts of West Africa. It is expected that, with the current interest aroused in Lassa fever, further reports may arise. Another suspected case has already been shown to have malaria.
Regulations to make Lassa fever and rabies notifiable under public health legislation were laid before the House yesterday and come into force at midnight. I 1436 am sure the House will agree that in the circumstances it was right to take these special steps to bring the legislation into effect without the customary waiting period.
I will ensure that all possible measures are taken to safeguard public health and will arrange to inform the House of major developments which occur before the recess.
§ Mr. Grant
Is the Minister aware that I wish the known victim a speedy recovery and hope that the other cases turn out to be negative? Does he recall that, following the tragic death of two of my constituents during the smallpox outbreak in 1973, when they caught the disease from a laboratory technician in a public ward, a subsequent committee of inquiry strongly criticised the method of dealing with dangerous diseases? As Lassa fever is believed to be twice as dangerous as smallpox, can he satisfy us that all the recommendations of that inquiry and of the subsequent working party under Sir George Godber were carried out?
In particular, was it wise for the first case known to have come from Nigeria to spend four days in a public ward and for the laboratory technician who handled the blood and urine samples merely to be sent home when she became ill? Since a year or more has passed since the Godber working party reported, why did the Government have to act in such panic to make this a notifiable disease, since it was stated in that report to be a disease dangerous to human beings?
§ Dr. Owen
On the last point, the question of the use of a statutory instrument has been under consultation since March. It has been important to proceed with the normal consultative process. All that we have speeded up is the parliamentary process, which would normally have lasted for three weeks. As to the Cox inquiry, most of the lessons of that inquiry into smallpox have been learned. There are one or two recommendations—one in particular—which would require amending legislation which has not been introduced. That is something which we shall have to consider, but I stress that powers to compel in these cases are very rarely used because in themselves they raise serious problems about putting people into closer contact with a very infectious disease.
1437 As for the wisdom of the judgments in this case, my right hon. Friend has asked the Chief Medical Officer to reconvene the group of experts who advised him on Lassa fever in 1975 to investigate this case. They investigated the last case. I consider that an investigation by experts is the most productive form of inquiry in a case such as this. Lassa fever is extremely rare and knowledge of it is still being built up. As to wisdom and any criticisms which may be made, it is a common experience in medical practice that one often learns from the past. Retrospective wisdom is very easy and most doctors would recognise that we have all a good deal to learn about how we deal with Lassa fever.
§ Mr. Greville Janner
Is my right hon. Friend considering whether there are not other diseases which should be made notifiable so that we do not again run into this sort of situation, in which the Government have been forced to take this very proper but unfortunately necessary action?
§ Dr. Owen
I do not think there are. One has constantly to bear in mind that there are new diseases coming up and there are some other virus infections, but I stress that most of the powers which are necessary are already held. These are exceptional powers which are rarely used. In the case which caused some of the controversy, I am glad to see that the person concerned agreed to go voluntarily to hospital. That was much easier for everybody handling the case. Most experience is that when such a matter is explained to people, they agree voluntarily to go into isolation.
§ Mr. Carlisle
Since one of the suspects is in my constituency, may I ask whether the right hon. Gentleman is satisfied in the light of existing medical knowledge that there are adequate facilities in the various isolation hospitals to deal with any cases?
§ Dr. Owen
That is one thing that we have been keeping under review for improvement. I would not say that I am totally satisfied that all the best facilities are available, and we are looking into that. There is a question whether one should concentrate these facilities in one centre nationally and to what extent one 1438 should keep facilities available across the country. We have facilities which give broad cover for the nation as a whole. One needs to look at this matter in the light of all the experience of the cases, and I think that some improvements will probably need to be made.
§ Mrs. Wise
I thank my right hon. Friend for his prompt action in this situation. Will he give special consideration to the views which have been expressed by trade unionists working in the hospitals about whether hospital technicians, porters and other hospital workers are adequately protected in handling this and other dangerous diseases? Will he liaise with his right hon. Friend the Secretary of State for Employment in considering whether the Health and Safety at Work etc. Act is adequate in such situations?
§ Dr. Owen
The staff concerned have a legitimate view and it is open to them to put any of their views to the committee of experts under the chairmanship of the Chief Medical Officer. I am sure that any suggestions and criticisms will be gratefully received. As I have repeated several times, all of us have much to learn from these cases.
§ Dr. Vaughan
The whole House will wish to join the Minister in expressing concern over this illness and our deepest sympathy for the patients who may be affected. We fully support the steps that the right hon. Gentleman took yesterday. However, will he consider whether in cases of this kind it may be appropriate not to conceal the names of the suspected victims, since it may be of crucial importance to someone to know whether he has been in contact with a suspect?
§ Dr. Owen
That is a difficult question, which touches on the confidential relationship between doctor and patient, but I think that it needs to be looked at very carefully. In the light of what the hon. Gentleman has said, I undertake to do so. If one could get agreement from the patient, that would obviously be less objectionable than in another case. I undertake to look at it. I agree that when a general call is made to the public to volunteer if they develop any symptoms of the disease, it sometimes helps if they know the name of the patient. However, there are considerations to be borne in mind before we make a decision on that.
§ Following is the statement—
§ LASSA FEVER AND RABIES TO BE NOTIFIABLE
New Regulations come into force at midnight
Mr. David Ennals, Secretary of State for Social Services, and Mr. John Morris, Secretary of State for Wales, today made Regulations making Lassa fever and rabies notifiable diseases under the Public Health Acts.
The new Regulations, which come into operation at midnight tonight, give Medical Officers of Environmental Health dealing with cases or suspected cases of these diseases powers which they already have for the control of other serious infectious diseases such as smallpox. These include power to apply to a magistrate to order the removal to hospital of persons suffering from such diseases and the medical examination of suspects. In the case of Lassa fever adequate examination and the taking of test samples can safely be carried out only in a suitable hospital.
The present incident concerns an engineer who had been ill in Nigeria and returned to this country on 25th June for convalesence. On 12th July he was admitted to St. Mary's Hospital, London for investigation and in view of the possibility of Lassa fever was transferred on 16th July to the isolation unit at Coppetts Wood Isolation Hospital in North London. The complement fixation test for Lassa fever proved negative and he was discharged to his home in Sheffield on 19th July. On 26th July the Microbiological Research Establishment at Porton completed tests on specimens sent to them and isolated Lassa fever virus.
Arrangements were at once made for the man to be re-admitted to Coppetts Wood, and for contacts to be traced and placed under surveillance. Medical Officers for Environmental Health were alerted and a Press Notice issued on 27th July advising persons who had visited the George Bird Ward at St. Mary's during 12—16th July to report any feverish illness developing in the following 10 days. Currently, three persons who were in contact with the patient in the period in question have developed symptoms which could be relevant and have been moved into isolation, one in Manchester and two at Coppetts Wood, while tests are made. It is far from certain that they are suffering from Lassa fever but, because of the nature of the disease, it is necessary on public health grounds to take full precautions.
One of these three contacts, a laboratory technician, was at first unwilling to go into hospital despite medical advice that tests were necessary to establish whether or not she had contracted the disease. She is now in Coppetts Wood Isolation Hospital, Muswell Hill.
The process of control by tracing contacts and placing them under surveillance is continuing. A contact who was being sought while on holiday in Devon has now been traced and is under surveillance.
The Department of Health and Social Security has been informed today of three people recently returned from Nigeria who have developed feverish symptoms. They are under
surveillance but there is no apparent connection with the one identified case of Lassa fever.
There have hitherto been only two confirmed cases in this country of Lassa fever. In both these cases the disease was contracted in West Africa. Following the second of them, early in 1975, the Chief Medical Officer convened an expert group to consider what was needed for the care of persons suffering from, or suspected to be suffering from, Lassa fever and to protect public health. A memorandum based on their advice has been widely circulated in draft preparatory to early general issue to doctors. Mr. Ennals has asked the Chief Medical Officer to reconvene a group of experts to consider, in the light of the current incident, whether changes are needed in the advice received last year.