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CMO letters

This section contains professional letters and 'dear colleague' letters from the Chief Medical Officer to the NHS.

2008

PL CMO (2008)4, PL CNO (2008)3, PL CPHO (2008)2: Introduction of Human Papillomavirus Vaccine into the national immunisation programme

This letter provides information about the introduction of human papillomavirus (HPV) vaccine into the national immunisation programme.

PL CMO (2008)3, PL CNO (2008)2, PL CPHO (2008)1: The influenza immunisation programme 2008/09

This letter contains details of the annual influenza immunisation campaign, influenza immunisation for health and social care staff, and the poultry worker immunisation programme.

PL CMO (2008)2: Decontamination of surgical instruments: National Institute for Health and Clinical Excellence (NICE) guidance: Patient safety and reduction of risk of transmission of Creutzfeldt-Jakob Disease (CJD) via interventional procedures

This letter highlights the need for all centres offering neurological and posterior eye surgery to urgently review their implementation of the NICE guidance.

PL CMO (2008)1: Changes to the mandatory healthcare associated infection surveillance system for Clostridium difficile infection (CDI) from 1 January 2008

This letter sets out the new requirements for the reporting of C. difficile cases by acute trusts from 1 January 2008 and the need for trusts to review data entered on to the web-based system since its introduction by 10 March 2008.

2007

04/10/07: PL CMO (2007)8: Healthcare associated infections and death certification

Letter addressing concerns over the possible under-reporting of HCAI as a cause of death, and reinforcing the message that death certification is a significant responsibility for doctors and should reflect a careful consideration of all the events that led up to, and may have caused or contributed to, the person’s death.

30/08/07: Keep Warm Keep Well: Winter 2007/2008 - letter from the CMO

This letter from Sir Liam Donaldson, Chief Medical Officer, outlines the 'Keep Warm Keep Keep Well' campaign for winter 2007/08. The 'Keep Warm Keep Well' campaign aims to provide useful advice on how to stay healthy in the winter months, together with information about financial and practical help that is available. The campaign is particularly aimed at older people, and those who have chronic illness or who are vulnerable to illness due to disability.

25/07/07: PL CMO (2007)6: Additional £50 million for HCAIs and update on requirements for Clostridium difficile reporting

This Professional Letter provides information on the new funding for HCAIs announced on 4 July 2007, via SHA Directors of Nursing, and reminds staff of new reporting arrangements for Clostridium difficile infection.

23/07/07: PL CMO (2007)5: Haemophilus influenzae type B (Hib) vaccine for young children: catch-up programme

This letter explains a Haemophilus influenzae type b (Hib) vaccination catch-up programme, which will start on 10 September 2007 and continue until 3 March 2009.

19/04/07: Recommendations of the expert working group on the prevention of VTE hospitalised patients

This letter from Chief Medical Officer, Sir Liam Donaldson, gives recommendations of the expert working group on the prevention of venous VTE in hospitalised patients.

11/04/07: PL CMO (2007)4: Changes to the mandatory healthcare associated infection surveillance system for Clostridium difficile associated diarrhoea from April 2007

A web-based system for the surveillance of Clostridium difficile associated diarrhoea (CDAD) is being introduced in April 2007 and Trusts will have to enter all cases in individuals aged two years and over on to this new system (subject to Review of Central Returns (ROCR) approval).

02/04/07: PL CMO (2007)3: Influenza Immunisation Programme 2007/2008

This letter provides information on the influenza immunisation programme 2007/2008.

19/02/07: PL/CMO/2007/2: Decontamination of surgical instruments in light of National Institute for Health and Clinical Excellence (NICE) Guidance

This letter is a reminder that centres providing neurological and eye surgery should be developing arrangements to implement the NICE guidance and sets out the Department’s plans to issue further advice on decontamination in 2007.

19/02/07: PL/CMO/2007/1: CJD reporting and surveillance

The CMO is writing to remind neurologists to remain vigilant and to refer unusual neurological cases through the established national arrangements for referral and reporting of suspected cases of human prion disease (CJD).

2006

15/11/06: PL/CMO/2006/4: Screening for MRSA colonisation: a summary of best practice

MRSA colonisation is a risk factor present in a significant proportion of the patient population. For this reason trusts are advised to review their strategies for screening and decolonisation of patients with MRSA carriage immediately. In support of this the enclosed screening strategy has been devised to help with practical interventions.

03/08/06: Strengthening regional partnerships for health and well-being

This letter, sent to Government Office Regional Directors and Strategic Health Authority Chief Executives, describes the new national framework for the DH's regional presence. It also and seeks their help in developing a framework for the work of the DH's enhanced regional presence in 2007/8.

12/07/06: PL CMO (2006) 1: Important changes to the childhood immunisation programme

This CMO letter provides further information about changes to the routine childhood immunisation programme.

11/07/06: Changes to Public Health arrangements - Appointments of the Directors of Public Health

This letter from the Chief Medical Officer announces the appointments of the Directors of Public Health. They will have a key role in future public health leadership, and will be an asset to the Strategic Health Authority (SHA) and the Government Office Boards.

29/06/06: PL CMO (2006)3: The influenza immunisation programme 2006/2007

This letter reports on the coverage achieved by the 2005/2006 influenza vaccination programme, thanking health professionals for their hard work and commitment in achieving such a positive outcome, and informing them about the plans for the 2006/2007 programme.

26/05/06: Heatwave Plan 2006

This letter announces the re-issue of the updated Heatwave Plan for England, first launched July 2004. The Plan's purpose is to enhance resilience in the event of a heatwave. It is an important component of overall emergency planning.

30/03/06: PL CMO (2006)2: Reporting MRSA data: overview of arrangements

This letter sets out forthcoming changes to arrangements for the collection and checking of the MRSA data returns submitted by acute Trusts.

2005

21/12/05: PL CMO (2005)6: infection caused by Clostridium difficile

This letter reminds Trusts of (1) the requirements of the mandatory surveillance scheme operated on behalf of the Department of Health by the Health Protection Agency (HPA), (2) recommendations for microbiological investigation of outbreaks, and (3) the need for policies and procedures to be in place to minimise the risk of C. difficile infection and implement control policies when cases occur.

29/09/05: Outcome of consultation on a limited relaxation of restrictions on Hepatitis B infected health care workers and oral antiviral therapy

Following consultation in 2004, the Department of Health has decided not to ask the NHS to implement advice from the Advisory Group on Hepatitis (AGH) about a limited relaxation of restrictions on hepatitis B infected health care workers. This letter from Sir Liam Donaldson, on behalf of the UK Chief Medical Officers, provides further information on the outcome of the consultation.

21/09/05: Letter from the Chief Medical Officer to PCTs and SHA Chief Executives about his report on the British Pregnancy Advisory Trust (Bpas)

The Chief Medical Officer was asked, by the Secretary of State for Health, to investigate the handling of late abortion cases by the British Pregnancy Advisory Service (BPAS). His report makes a number of best practice recommendations for dealing with late gestation abortion cases and improving early access to services.

25/07/05: PL CMO (2005)2: The Influenza immunisation programme

This letter from the Chief Medical Officer, the Chief Nursing Officer and the Chief Pharmaceutical Officer describes the 2005 Influenza immunisation campaign.

21/07/05: Heath Select Committee's recommendation to give more prominence in undergraduate medical education to venous thromboembolism and its prevention

This letter from the CMO outlines the Government's response to the HSC's Report on the Prevention of Venous Thromboembolism in Hospitalised Patients, published earlier this year. It includes the HSC's recommendations on the implementation of, and adherence to, guidelines relating to thromboprophylaxis, counselling and risk assessment.

21/07/05: Guidelines on the Prevention and Treatment of Venous Thromboembolism in Hospitalised Patients

This letter from the CMO outlines the Government's response to the HSC's Report on the Prevention of Venous Thromboembolism in Hospitalised Patients, published earlier this year. It summarises the key findings; announces the establishment of a Working Group, and highlights a selection of key existing guidelines.

06/07/2005: PL CMO (2005)3: Changes to the BCG vaccination programme

This letter describes changes being introduced to the BCG vaccination programme. It outlines an improved targeted neonatal and other at-risk based programme which will replace the current schools' programme for older children.

28/06/05: PL CMO (2005)5: Exclusion of Femoral Heads from living donors - vCJD precautions

The UK Advisory Committee on the Microbiological Safety of Blood and Tissues and Organs (MSBTO; previously MSBT) has discussed the potential vCJD transmission risk arising from people who have received blood transfusions since 1 January 1980 and have recommended that living donors should be excluded from donating femoral heads. The Secretary of State for Health has now formally agreed this.

09/06/05: PL CMO (2005) 4: Mandatory surveillance of Methicillin Resistant Staphylococcus Aureus (MRSA) bacteraemias

The Chief Medical Officer and Chief Nursing Officer have issued a letter with new guidance on mandatory surveillance of MRSA bacteraemias, including monthly reporting to the HPA and an enhanced surveillance system for MRSA to be rolled out to all acute Trusts by October 2005.

31/03/05: PL CMO (2005) 1: The Pneumococcal Immunisation Programme for Older People and Risk Groups

This letter describes the pneumococcal immunisation campaign for 2005.

2004

18/11/2004: Patient safety and reduction of risk of transmission of Creutzfeldt-Jakob Disease (CJD) via surgical instruments

Letter from the Chief Medical Officer, Sir Liam Donaldson which, informs recipients that the guidance currently in force in England is that issued by the Department of Health in December 2001. together with the NICE (National Institute for Clinical Excellence) interim guidance of March 2004.

09/08/04: PL CMO (2004)4: Update on the influenza and pneumococcal immunisation programmes

This letter describes this year's influenza immunisation campaign and updates you on changes to the recommendations for pneumococcal immunisation.

09/08/04: PL CMO (2004)3 : New vaccinations for the childhood immunisation programme

This letter provides important information about forthcoming changes to the vaccines provided for the routine childhood immunisation programme in England. These changes are being made following the recommendation of the Joint Committee on Vaccination and Immunisation (JCVI).

09/07/2004: An integrated approach to human transmissible spongiform encephalopathies (prion diseases)

This letter gives guidance on patient referral to the first UK clinical trial of potential therapy for Creutzfeldt-Jakob Disease (CJD).

17/05/04: PL CMO (2004)2: Reducing the risk of exposure of patients to the agent of CJD through brain biopsy procedures

A brain biopsy can reveal a diagnosis of CJD that was not suspected prior to the biopsy because CJD can present in atypical ways with a differential diagnosis that includes conditions such as cerebral vasculitis. The biopsy could result in inadvertent exposure of subsequent patients to CJD agent via the instruments used. The Department of Health has taken expert advice on the need for additional guidance for the quarantine of surgical instruments following brain biopsies in such circumstances.

19/03/04: PL CMO (2004)1: Change in names of certain medicinal substances

This letter notifies recipients of a programme of action, in the interests of patient safety, to achieve consistency in the naming of medicinal substances.

2003

PL CMO (2003)8: Chickenpox (varicella) immunisation for health care workers

Varicella immunisation is now recommended for non-immune health care workers (HCWs), who work in primary care and in hospitals (both in the NHS and privately) and who have direct patient contact.

PL CMO (2003)7: Protecting women against rubella

From the beginning of October 2003, sero-negative women of child-bearing age and health care workers who need to be protected against rubella will be offered the combined measles-mumps-rubella (MMR) vaccine. This is because we are unable to secure supplies of licensed rubella vaccine.

PL CMO (2003)6: Adult immunisation update

Introduction of a pneumococcal immunisation programme for those aged 80 years and over; and influenza immunisation programme 2003/2004.

PL CMO (2003)5: Action on good practice following the Victoria Climbié report

This letter draws attention to the guide "What to do if you're worried a child is being abused". The guide sets out processes for safeguarding children.

PL CMO (2003)4: Surveillance of healthcare associated infections

This circular provides notification of the next tranche of the mandatory surveillance scheme for healthcare associated infections.

PL CMO (2003)3: Hospital Pharmacy initiative for promoting prudent use of antibiotics in hospitals

This letter provides information on new funding for promoting prudent antibiotic prescribing through enhanced clinical pharmacy activity.

PL CMO (2003)2: Planned HIB vaccination catch-up campaign: further information

This follows the professional letter of 17 February 2003 and provides detailed advice on how the campaign will be implemented.

PL CMO (2003)1: Planned HIB vaccination catch-up campaign

This letter provides advanced notice of the plans of the Department of Health to introduce a Haemophilus influenzae b (Hib) vaccine catch-up campaign.

2002

PL CMO (2002)4: Update on immunisation issues

This circular contains details of this year's influenza immunisation programme and also important information on other vaccines

PL CMO (2002)3: Annual appraisal of general practitioners in the NHS

This provides information on the appraisal programme for general practioners which will be launched in April 2002

PL CMO (2002)2: Carbon monoxide: The forgotten killer

Update of the CMO letter of September 1998 on CO poisoning: the main sources of CO in the home, signs and symptoms which should be looked for, investigations which may be necessary to establish whether a case of CO poisoning has occurred, guidance on how cases should be managed; and sources of further advice and information.

PL CMO (2002)1: Extending meningitis C vaccine to 20-24 year olds: pneumococcal vaccine for at-risk 2 year olds

Information on the extension of the availability of the meningitis C vaccine to people up to and including 24 years of age. Also included is revised advice on under the use of pneumococcal vaccine in at-risk groups aged 2 years.

2001

PL CMO (2001)5: Current vaccine and immunisation issues

Update on several important immunisation issues, namely: introduction of a pre-school acellular pertussis booster immunisation; thiomersal in vaccines; MMR vaccine update; current meningitis issues (prevention of meningococcal infection associated with the annual Hajj pilgrimage to Saudi Arabia, and winter rise in meningitis).

PL CMO (2001)4: Influenza immunisation programme 2001/2002

This letter contains further information and advice for everyone involved in the influenza immunisation programme.

PL CMO (2001)3: Diabetes - imminent phase out of insulin products by Lilly

Reminder of the withdrawal by 31 March 2001 of a number of human insulin formulations by Eli Lilly and Company Limited.

PL CMO (2001)2: Instalment prescribing of Buprenorphine for the treatment of drug addiction

This letter informs of the change from 1st April 2001 which will allow buprenorphine to be prescribed and dispensed by instalments for the treatment of drug addiction

PL CMO (2001)1: Current vaccine and immunization issues

Update on several important immunisation issues, namely: MMR; meningitis C; meningococcal immunization for asplenic patients and for pilgrims travelling to Saudi Arabia;influenza immunisation; anaphylaxis management.

2000

PL CMO (2000)3: Influenza immunisation

This letter provides further information and advice on this year's influenza immunisation campaign.

PL CMO (2000)2: Good practice in continence services

This guidance sets out a model of good practice to help achieve more responsive, equitable and effective continence services to benefit patients.

PL CMO (2000)1: Introduction of the Sure Start Maternity Grant

From 27 March 2000, the Sure Start Maternity Grant will replace the existing Maternity Paymentscheme and will offer extra help with maternity expenses for parents on low incomes.

1999

PL CMO (1999)5: Current vaccine issues - action update

Update on some specific issues in relation to vaccination programmes: maintaining continuity of vaccine supply for routine immunisation of infants and young children; encouraging further uptake of plain polysaccharide A + C meningococcal vaccine in first year higher education students; supplies of conjugate meningococcal C vaccine for infant immunisation.

PL CMO (1999)4: Start of the new meningococcal C conjugate vaccine immunisation programme

Includes replacement chapter for "Immunisation against infectious disease" 1996.

PL CMO (1999)3: Public information campaign on antibiotic resistance to be launched in October

This letter highlights the first phase of the Government's campaign on antibiotic resistance

PL CMO (1999)2: Introduction of immunisation against Group C meningococcal infections

A new vaccine will be implemented later this year. Group C meningococcal disease is responsible for 40% of cases of meningococcal disease in this country and is one of the foremost causes of death in children and young people.

PL CMO (1999)1: Meningococcal infection

A reminder about the importance of early recognition of meningococcal meningitis andsepticaemia, and prompt intervention, with important messages for doctors working in primary care and those providing front line hospital care.

1998

PL CMO (1998)6: Antimicrobial resistance

Draws attention to a new report from the Standing Medical Advisory Committee which has important implications for all health professionals who prescribe, dispense, supply and administer or advise on the use of antimicrobial agents.

PL CMO (1998)5: Carbon monoxide: The forgotten killer

This letter brings together the most up-to-date information on Carbon monoxide (CO) poisoning. It sets out the main CO sources in the home; describes the signs and symptoms which should be looked for; explains the investigations which may be necessary to establish whether a case of CO poisoning has occurred; describes how cases should be managed; and gives sources of further advice and information.

PL CMO (1998)4: Influenza immunisation: Extension of current policy to include all those aged 75 years and over

The Government has accepted a recommendation from the Joint Committee on Vaccination and Immunisation (JCVI) to extend the risk groups recommended to be offered annual influenza immunisation to include all those aged 75 years and older.

PL CMO (1998)3: Vitamin K for newborn babies

Updated guidance and advice on prevention of vitamin K deficiency bleeding in newborn babies.

PL CMO (1998)2: Measles, MMR vaccine, Crohn's disease and autism

Information that may help doctors in advising parents.

PL CMO (1998)1: Clinical examination of the breast

Further advice on the importance of teaching women to be breast aware and the lack of evidence to support the practice of breast palpation as a screening procedure in the well woman, with guidance on who should perform breast palpation in symptomatic women and as follow-up to breast cancer.

1997

PL CMO (1997)3: Avian (H5N1) influenza in Hong Kong

Significance and implications of the recent reports in the media and the medical press of cases of influenza in Hong Kong due to an avian (bird) influenza virus of the A (H5N1) subtype.

PL CMO (1997)2: Urgent communications

Urgent and immediate communications from the Chief Medical Officer (CMO) on public health are transmitted on average four times a year and are most likely to be connected with issues about drugs, infections, vaccines or other public health matters.

PL CMO (1997)1a: Unlinked anonymous HIV surveys

The summary report provides valuable information for all those involved in providing HIV/AIDS services and for those responsible for health promotion activities and includes a section on implications for purchasers. I would be grateful if you could ensure that these data are made available to all colleagues as appropriate.

PL CMO (1997)1: Meningococcal infection, meningitis & septicaemia

A reminder of the need to consider meningococcal infection in patients with certain symptoms, and guidelines on the management of outbreaks of meningococcal infections.

1996

PL CMO (1996)8 Unlinked anonymous HIV surveys summary report

Summary report from the Unlinked Anonymous Surveys Steering Group givingresults and analysis for samples tested for HIV between 1990 and 1995. It also highlights the key messages from the surveys.

PL CMO (1996)7: Influenza immunisation

List of influenza vaccines granted product licences for the 1996/7 season by the Medicines Control Agency (MCA).

PL CMO (1996)6: Change to the routine pre-school booster immunisation programme

With effect from October 1996, a second dose of Measles/Mumps/Rubella vaccine (MMR) is to be added to the routine immunisation programme. It is to be given at the same time as the pre-school Diphtheria/Tetanus and Polio vaccine boosters. In addition, a catch-up immunisation programme for MMR is also to commence from that date. These immunisations will, in the main, be delivered by General Practitioners.

PL CMO (1996)5: New variant of Creutzfeldt-Jakob disease (CJD)

Information about the new variant of CJD and with advice to help doctors respond to queries that patients may have following the announcements by the Secretary of State on 20 and 25 March.

PL CMO (1996)4: Report of the confidential enquiries into maternal deaths United Kingdom 1991-93

The Report shows the maternal mortality rate from conditions directly due to pregnancy (Direct deaths) has fallen for the first time in ten years to 5.5 deaths per 100,000 maternities from 6.0 per 100.000 for the preceding two triennia.

PL CMO (1996)3: Methicillin Resistant Staphylococcus Aureus in community settings

Information and advice about the care of people in the community who have the bacteria MRSA.

PL CMO (1996)2: Report of the confidential enquiries into maternal deaths United Kingdom 1991-93

The Report shows the maternal mortality rate from conditions directly due to pregnancy (Direct deaths) has fallen for the first time in ten years to 5.5 deaths per 100,000 maternities from 6.0 per 100,000 for the preceding two triennia.

PL CMO (1996)1: Implementing the reforms of specialist medical training - commissioning the specialist registrar grade

Information on the introduction of the new Specialist Registrar grade, replacing the existing registrar and senior registrar grades on 1 April 1996.

1995

PL CMO (1995)4: Carbaryl

The purpose of this letter is to alert health professionals to the contents of a Government statement about the use of the insecticide Carbaryl which is about to be issued. The point of relevance to health professionals is that Carbaryl is the active constituent in some preparations used for treatment of lice.

PL CMO (1995)3: Implementing the reforms to specialist medical training

Imminent changes to specialist medical training in the UK and to the GMC's registrationarrangements, implementing recommendations in the 1993 report 'Hospital Doctors: Training For The Future'.

PL CMO (1995)2: Influenza vaccine

List of influenza vaccines granted product licences for the 1995/96 season by theMedicines Control Agency (MCA).

PL CMO (1995)1: Hepatitis C and blood transfusion look back

Guidance and procedures for the look back exercise to trace, counsel and, if necessary, treat those people who may have been inadvertently infected with hepatitis C through blood transfusions.

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