Reported cases of Ocular Toxocariasis within Wirral

Waiting for an internal review by Wirral Metropolitan Borough Council of their handling of this request.

Dear Wirral Metropolitan Borough Council,

In a Council meeting on 15 October 2018, Councillor Philip Davies spoke to the Chamber about the proposed PSPO's and said ‘we know that the evidence shows that in Wirral six children are known to have gone blind in one eye, in Wirral, through dog fouling’

In making that statement there was no evidence given to back it up and the only mention of Toxocariasis in the published Council Evidence Base and Supporting Documents states ‘The health hazard caused by dog fouling relates to Toxocariasis which is an infection caused by roundworm parasites (nematodes) of dogs. Eggs are shed in the faeces of infected dogs; the eggs require 1-3 weeks’ incubation to become infective, but the eggs can then pass into soil and sand, remaining alive and viable for many months. Humans may acquire Toxocariasis infection from handling soil or sand contaminated with eggs and directing ingesting them or from unwashed hands and contact with the dog fouling. Infection in humans with Toxocariasis is rare.’

Please supply the following information with regard to Councillor Philip Davies’ statement.

1. The origin of the statistic of six Wirral children having gone blind in one eye due to dog fouling, i.e. reported cases of ocular toxocariasis in Wirral.
2. The period of time over which the statistic is based, e.g. six incidents across one year, six incidents across five years, six incidents across twenty years etc.
3. Having defined the period of time over which the statistic applies please give me the relevant start and finish year for the period, e.g. 2010-2016

Yours faithfully,

Chris Fagan

InfoMgr, FinDMT, Wirral Metropolitan Borough Council

2 Attachments

Dear Mr Fagan

 

Further to the Freedom of Information request you submitted on 16^th
October, I must inform you that comments made at Council on 15^th October
regarding cases of Ocular Toxocariasis in Wirral were incorrect. This
occurred as a result of an administrative error leading to the Leader
being misinformed. The error will be corrected at the next Council meeting
(scheduled for 10^th December 2018) through a report of the Cabinet Member
for Environment.

 

The Council has prepared details of actual numbers of cases of
Toxocariasis and found that there were a total of 17 admissions where
Toxocariasis was either the main presenting condition (primary diagnosis)
or was a secondary diagnosis in Wirral patients between 2010 and 2018.
Please find attached details of incidents of Toxocariasis across Wirral
between 2010 and 2018.  

 

It is the Council’s intention to make a decision regarding the Dog Control
PSPO early next year and to undertake a prior to decision scrutiny
exercise on the proposed measures to be adopted as part of the PSPO.

 

Yours sincerely

 

 

Lynette Paterson

Principal Information Management Officer

Business Management

 

Treasury Building

Argyle Street
Birkenhead
Wirral
CH41 1AH

 

[1]Tel: 0151 691 8201

[2][Wirral Borough Council request email]

 

 

[3]LGC Awards15_Winner_MIP

 

 

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InfoMgr, FinDMT, Wirral Metropolitan Borough Council

2 Attachments

Dear Mr Fagan

 

Further to my earlier email, please find attached an amended document
which shows the total number of cases (all ages, primary and secondary
codes) as 20, not 17 as previously stated in error.

 

Yours sincerely

 

 

Lynette Paterson

Principal Information Management Officer

Business Management

 

Treasury Building

Argyle Street
Birkenhead
Wirral
CH41 1AH

 

[1]Tel: 0151 691 8201

[2][Wirral Borough Council request email]

 

 

[3]LGC Awards15_Winner_MIP

 

 

This information supplied to you is copyrighted and continues to be
protected by the Copyright, Designs and Patents Act 1988.   You are free
to use it for your own purposes, including any non commercial research you
are doing and for the purposes of news reporting. Any other reuse, for
example commercial publication, would require our specific permission, may
involve licensing and the application of a charge

 

 

 

This email and any files transmitted with it are confidential and intended
solely for the use of the individual or entity to whom they are addressed.
If you have received this email in error please notify the system manager.

References

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Dear InfoMgr, FinDMT,

Thank you for the response to FOI 1355549

There is a quote popularised by Mark Twain, who attributed it to British Prime Minister Benjamin Disraeli; it says ‘There are three kinds of lies: lies, damned lies, and statistics.’

Considering the fact that this report was made by Wirral Council Public Health Analysts it contains a lot of inaccurate information, although surprisingly enough, the inaccuracy does not, so much, revolve around the actual numerics of the statistics quoted rather than the information surrounding the definitions and subsequent interpretation of the figures for hospital admissions.

Firstly let me deal with Toxoplasmosis
The FOI 1355549 Response document states ‘B58: A further possibly relevant code is ICD code B58, which is used to code Toxoplasmosis, so we also queried HES using this code’

Toxoplasmosis is an infection caused by a single-celled parasite called Toxoplasma gondii. The only known definitive hosts for Toxoplasma gondii are members of family Felidae (domestic cats and their relatives).

A Toxoplasma infection occurs by one of the following:
1. Eating undercooked, contaminated meat (especially pork, lamb, and venison) or shellfish (for example, oysters, clams or mussels).
2. Accidental ingestion of undercooked, contaminated meat or shellfish after handling them and not washing hands thoroughly (Toxoplasma cannot be absorbed through intact skin).
3. Eating food that was contaminated by knives, utensils, cutting boards and other foods that have had contact with raw, contaminated meat or shellfish.
4. Drinking water contaminated with Toxoplasma gondii.
5. Accidentally swallowing the parasite through contact with cat faeces that contain Toxoplasma. This might happen by
a) Cleaning a cat’s litter box when the cat has shed Toxoplasma in its faeces;
b) Touching or ingesting anything that has come into contact with cat faeces that contain Toxoplasma; or
c) Accidentally ingesting contaminated soil (e.g., not washing hands after gardening or eating unwashed fruits or vegetables from a garden).
6. Mother-to-child (congenital) transmission.
7. Receiving an infected organ transplant or infected blood via transfusion, though this is rare.

Considering the above information relating to Toxoplasmosis it is clear that it is a completely separate entity to Toxocariasis and should be discounted and removed from your findings, as it has no relevance in this inquiry.

Now let me deal with Toxocariasis.

The FOI 1355549 Response document states ‘B83: The ICD-10 code used to code all cases of Toxocariasis is B83 (there are several sub-codes for different varieties of Toxocariasis, see table below, our search included all of these). These infections are also known as visceral larva migrans or helminthasis.’

That statement is totally incorrect. There is just one child code (sub-code) of B83 that is used to diagnose Visceral larva migrans (Toxocariasis) and the other child codes (sub-codes) ARE NOT for different varieties of Toxocariasis they are for different, unrelated parasitic worm infections (helminthiasis).

Here is a definition of helminthiasis from Mosby's Medical Dictionary, 9th edition.

Helminthiasis [hel′minthī′əsis]
Etymology: Gk, helmins, worm, osis, condition
a parasitic infestation of the body by helminths that may be cutaneous, visceral, or intestinal. Ascariasis, bilharziasis, filariasis, hookworm, and trichinosis are common forms of the disease.

ICD-10 Code B83 is a generic category for ‘Other helminthiases’ and covers a number of parasitic worm infestations not just Visceral larva migrans (Toxocariasis).

Visceral larva migrans (Toxocariasis) is only a child (sub-code) of ICD-10 code B83 and specific cases of Toxocariasis are diagnosed using the ICD-10 code B83.0

See source: https://icd.codes/icd10cm/B83
And: http://apps.who.int/classifications/icd1...

Here is the specification for ICD-10 Code B83 with relevant notes added in each section

PARENT GENERIC CATEGORY:
B83: OTHER HELMINTHIASES (B83 is Non-Billable i.e. it cannot be used to code a diagnosis)
Excludes:
capillariasis:
NOS (B81.1)
intestinal (B81.1)

Notes: ICD Code B83 is a generic code covering ‘Other helminthiases’; it is a non-billable code (i.e. it cannot be used to code a diagnosis). To code a diagnosis of this type, you must use one of the seven child codes (sub categories) of B83 that describe the diagnosis 'other helminthiases' in more detail. Those child codes are listed below)

THE CHILD CODES OF B83

B83.0 (Billable)
Visceral larva migrans
Toxocariasis

Notes: Toxocariasis is caused by two nematode parasites of animal, larvae of Toxocara canis (dog roundworm which is common to both dogs and foxes) and less frequently of Toxicara cati (cat roundworm)

B83.1 (Billable)
Gnathostomiasis (also known as larva migrans profundus:436)
Commonly called Wandering swelling

Notes: Caused by the nematode (roundworm) Gnathostoma spinigerum and Gnathostoma hispidum. Humans become infected by eating undercooked fish or poultry containing third-stage larvae, or reportedly by drinking water containing infective second-stage larvae in Cyclops

B83.2 (Billable)
Angiostrongyliasis due to Parastrongylus cantonensis
Angiostrongyliasis due to Angiostrongylus cantonensis
Eosinophilic meningoencephalitis† (G05.2*)
Excludes:
intestinal angiostrongyliasis (B81.3)

Notes: Primarily caused by the nematode (roundworm) Angiostrongylus cantonensis, the rat lungworm and it is the most common cause of human eosinophilic meningitis. In addition, Angiostrongylus (Parastrongylus) costaricensis is the causal agent of abdominal, or intestinal, angiostrongyliasis. Humans can acquire the infection by eating raw or undercooked snails or slugs infected with the parasite; they may also acquire the infection by eating raw produce that contains a small snail or slug, or part of one.

B83.3 (Billable)
Syngamiasis
Syngamosis

Notes: Caused by the nematode Mammomonogamus laryngeus (Syngamus laryngeus) which is found in tropical mammals

B83.4 (Billable)
Internal hirudiniasis
Excludes:
external hirudiniasis (B88.3)

Notes: A condition resulting from accidental ingestion of leeches in drinking water. They may attach themselves to the wall of the pharynx, nasal cavity, or larynx.

B83.8 (Billable)
Other specified helminthiases
This can include the following:

Acanthocephaliasis

Notes: The principle agents of acanthocephaliasis in humans are the thorny-headed worms, Macracanthorhynchus hirudinaceous and Moniliformis moniliformis. Bolbosoma species have also been known to infect humans.

Gongylonemiasis

Notes: Infection of the gastrointestinal tract with Gongylonema, a genus of nematode worms belonging to the suborder Spirurata species. Generally transmitted through various insects, especially beetles.

Hepatic capillariasis

Notes: Caused by the nematode (roundworm) Capillaria hepatica. Hosts are usually rodents, but may be pigs, carnivores and primates, including humans. Human infection. with Capillaria hepatica are extremely rare.

Metastrongyliasis

Notes: caused by nematodes of the family Metastrongylidae, usually found as lungworms in pigs.

Thelaziasis

Notes: Caused by Spirurid nematodes in the genus, Thelazia. Three species that have been implicated in human infection include Thelazia callipaeda (the Oriental eye worm), Thelazia. gulosa (the cattle eyeworm), and Thelazia californiensis (the California eye worm). Human infection occurs when flies feed on tears or other lacrimal secretions

B83.9 (Billable)
Helminthiasis, unspecified
Worms NOS (Not Otherwise Specified)
Excludes:
intestinal helminthiasis NOS (B82.0)

Notes: Helminthiasis is an infection with parasitic worms and the abbreviation NOS means ‘Not Otherwise Specified’. Anything in this category is a non-specific diagnosis for any macroparasitic disease of humans and other animals in which a part of the body is infected with parasitic worms, known as helminths. There are numerous species of these parasites, which are broadly classified into tapeworms, flukes, and roundworms. They often live in the gastrointestinal tract of their hosts, but they may also burrow into other organs, where they induce physiological damage.

So considering the specification of ICD-10 Generic Category B83, the only relevant child (sub code) to specifically diagnose Toxocariasis is ICD-10 code B83.0 all the other child (sub-codes) relate to other parasitic infections

Now looking at Table 1 from the FOI 1355549 Response document (please refer to your document to see Table 1)

This was what FOI 1355549 Response document said in analysis of Table 1

'As the table shows, there were 9 admissions between 2010-2018 in Wirral patients, where the primary diagnosis (main reason for admission) was Toxocariasis (B83 or sub-codes). All but one were for ‘Helminthiasis, unspecified’ (so the infection could be anywhere in the body) and 6 were in children or young people aged 19 or under, 3 were in adults. It is important to note that this is admissions, not patients. It is against GDPR regulations to link patient level, identifiable data, so for example, the same patient could have been admitted in 2015/16 (aged possibly 4) and then again in 2016/17 (aged possibly 5). We have no way of knowing if this is the case or not. So we cannot say for certain if it was 6 children, only that there were 6 admissions in children living in Wirral over this time period.'

Here are some bullet points regarding the information supplied above relating to Table 1 in the FOI 1355549 Response document

• The table shows there were 9 admissions between 2010-2018 in Wirral patients where the primary diagnosis (main reason for admission) was for child codes of the Generic parent ICD-10 B83 category – none of which were specifically B83.0 - Visceral larva migrans (Toxocariasis)
• The last item in Table 1 is an admission for ICD-10 Code B83.2 - Angiostrongyliasis due to Parastrongylus cantonens and that is a specific diagnosis of an infection caused by snails or slugs.
• The first 8 admissions listed are ICD-10 Code B83.9 - ‘Helminthiasis, unspecified’ i.e. Worms NOS (Not Otherwise Specified)
• ‘Helminthiasis, unspecified’ is worm infection ‘Not Otherwise Specified’ so it could be any of a number of parasitic worm infections as listed in the full B83 specification above – your document seems to suggest that ‘unspecified’ meant that the infection could be anywhere in the body and, in fact, in the first version of the document it even stated ‘so the infection could be anywhere in the body, eyes or ‘ocular’ are not specified’.
• The suggestion that the ICD-10 Code B83.9 are all cases of Visceral larva migrans (Toxocariasis) is merely conjecture and is not substantiated by fact in any way, and therefore, cannot be relied upon.
• While there were 8 admissions in Wirral for ICD-10 Code B83.9 ‘Helminthiasis, unspecified’ – there is no information as to where the patient contracted the infection and it may have been outside of the Wirral such as while holidaying abroad.
• The FOI response document also mentions a further 11 admissions where B83 sub codes were listed as a secondary diagnosis but there is no documentary evidence or statistics listed to support that.

In conclusion I would now like to request the following as part of this FOI inquiry (FOI 1355549)

1. Please review the information that you have supplied for FOI 1355549 and amend the document with the relevant corrections and send me a revised version.
2. Please include, in the revised document, the evidence and statistics to support the 11 admissions where B83 sub codes were listed as a secondary diagnosis, as it is relevant to this inquiry.
3. Please state the number of hospital admissions for the period 2010-2018 where the primary diagnosis was made with a specific B83.0 code for Visceral larva migrans (Toxocariasis).
4. Please state the number of hospital admissions for the period 2010-2018 where the secondary diagnosis was made with a specific B83.0 code for Visceral larva migrans (Toxocariasis).

I look forward to your prompt response.

Yours sincerely,

Chris Fagan

Dear InfoMgr, FinDMT,

Last week I requested further information regarding this FOI. Can you acknowledge that you are intending to respond to this request and please give me a date by which you will supply the information requested? Please can you respond with your intentions in this matter by Friday 30th November?

Here is the information requested:

1. Please review the information that you have supplied for FOI 1355549 and amend the document with the relevant corrections and send me a revised version. (please refer to my previous response for a synopsis of the incorrect information)
2. Please include, in the revised document, the evidence and statistics to support the 11 admissions where B83 sub codes were listed as a secondary diagnosis, as it is relevant to this inquiry.
3. Please state the number of hospital admissions for the period 2010-2018 where the primary diagnosis was made with a specific B83.0 code for Visceral larva migrans (Toxocariasis).
4. Please state the number of hospital admissions for the period 2010-2018 where the secondary diagnosis was made with a specific B83.0 code for Visceral larva migrans (Toxocariasis).

I look forward to your prompt response.

Yours sincerely,

Chris Fagan

InfoMgr, FinDMT, Wirral Metropolitan Borough Council

1 Attachment

Dear Mr Fagan

We write further to your emails of 19 and 26 November 2018.  Upon receipt
of your comments, we can advise as follows:

The analysis referred to in the email and undertaken in response to your
FOI request did not set out to, nor does it, determine how many children
have gone blind in one eye due to dog fouling. Instead it reports what
data is available for relevant parasitic infections. The report provides
this information based on Hospital Episode Statistics (HES) data. It shows
that whilst there were 9 admissions between 2010-2018 for Wirral patients,
where the primary diagnosis (main reason for admission) was Toxocariasis
(B83 or sub-codes), there were no admissions data specific to primary
diagnoses of Toxocariasis (B83.0 Visceral larva migrans (Toxocariasis)
during that period. Furthermore, the report does clarify that “Querying
national HES data does not however, allow us to determine the sequelae of
any infections diagnosed”. A review of medical records would be the only
way to determine the outcome of infection.

We trust this clarifies matters.  If you remain dissatisfied you may
request an internal review by emailing [1][Wirral Borough Council request email]
and you also have the right to complain to the Information Commissioner,
if you dispute the outcome of any review, by contacting
[2]https://ico.org.uk/global/contact-us/

Yours sincerely

 

Lynette Paterson

Principal Information Management Officer

Business Management

 

Treasury Building

Argyle Street
Birkenhead
Wirral
CH41 1AH

 

[3]Tel: 0151 691 8201

[4][Wirral Borough Council request email]

 

 

[5]LGC Awards15_Winner_MIP

 

 

This information supplied to you is copyrighted and continues to be
protected by the Copyright, Designs and Patents Act 1988.   You are free
to use it for your own purposes, including any non commercial research you
are doing and for the purposes of news reporting. Any other reuse, for
example commercial publication, would require our specific permission, may
involve licensing and the application of a charge

 

 

 

 

 

 

This email and any files transmitted with it are confidential and intended
solely for the use of the individual or entity to whom they are addressed.
If you have received this email in error please notify the system manager.

References

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2. https://ico.org.uk/global/contact-us/
3. file:///tmp/tel:0151
4. mailto:[Wirral Borough Council request email]

Dear Wirral Metropolitan Borough Council,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of Wirral Metropolitan Borough Council's handling of my FOI request 'Reported cases of Ocular Toxocariasis within Wirral' as I am totally dissatisfied with the responses to my FOI as you have not addressed all the points that I raised in my communications of 19 and 26 November regarding your FOI 1355549 document.

As a body in public governance you have a responsibility to ensure that information given is transparent, correct and unbiased and that includes any evidence or statistics supplied in support of that information.
My original FOI request was in regard to a statement made by Councillor Philip Davies in a council meeting discussing the proposed PSPO’s. Your first response while admitting the information quoted by Councillor Philip Davies was incorrect, it also included a three-page document prepared by Public Health analysts at Wirral Council that suggested that there had been 20 cases of Toxocariasis in Wirral between 2010-2018. The FOI 1355549 document supplied by the Public Health analysts was full of inaccurate information, incorrect definitions and summaries and the statistics were totally misrepresented to arrive at the figure of 20 cases of Toxocariasis.

Even in the last response from Lynette Paterson on 28th November it still says ‘there were 9 admissions between 2010-2018 for Wirral patients, where the primary diagnosis (main reason for admission) was Toxocariasis (B83 or sub-codes)’ - this implies that any admission under B83 or sub-codes) is Toxocariasis. That is totally incorrect.

In my last communications of 19 and 26 November this is what I requested from Wirral Council following the receipt of the document FOI 1355549:

1. Please review the information that you have supplied for FOI 1355549 and amend the document with the relevant corrections and send me a revised version. (please refer to my previous response for a synopsis of the incorrect information)

2. Please include, in the revised document, the evidence and statistics to support the 11 admissions where B83 sub codes were listed as a secondary diagnosis, as it is relevant to this inquiry.

3. Please state the number of hospital admissions for the period 2010-2018 where the primary diagnosis was made with a specific B83.0 code for Visceral larva migrans (Toxocariasis).

4. Please state the number of hospital admissions for the period 2010-2018 where the secondary diagnosis was made with a specific B83.0 code for Visceral larva migrans (Toxocariasis).

The only point covered in the last response from Lynette Paterson on 28th November was to agree that there were no admissions to Wirral Hospitals for a specific primary diagnosis of Toxocariasis (B83.0 – Visceral larva migrans). Once again I must reiterate that of those 9 admissions actually given in evidence, one was for B.83.2 Angiostrongyliasis due to Parastrongylus cantonensis) and is therefore not relevant as it is a specific diagnosis for another parasitic worm infection (lung worm) caused by ingesting snails or slugs. The other 8 admissions were under B83.9 (Heminthiasis, unspecified) and could be any number of different parasitic worm infections and any suggestions that they are all Toxocariasis is purely conjecture and IS NOT substantiated by fact in any way, and therefore, cannot be relied upon.

The FOI 1355549 document also suggests that there were 11 further admissions where there was a secondary diagnosis under B83 codes but it fails to supply any further evidence to back it up. I have requested that you supply that information.

In respect of your suggestion that there were 20 cases of Toxocariasis in Wirral between 2010 and 2018, the UK Government have published statistics for confirmed cases of Toxocariasis across the whole of England and Wales. This information can be found at

www.gov.uk/government/publications/zoono...

There were just 25 confirmed cases of Toxocariasis in the whole of England and Wales between 2007 and 2016.

And the Public Health England Common Animal Associated Infections Quarterly reports for the year of 2017 and 2018 show only two cases of Toxocariasis confirmed for that two-year period and they were in the second and third quarters of 2018. Both cases were adults (one female and one male) in the East Midlands.

www.gov.uk/government/publications/commo...

Considering that between 2010-2018, there were no specific primary diagnoses of B83.0 – Visceral larva migrans (Toxocariasis) in Wirral and the quoted secondary diagnoses have not been substantiated in fact as being B83.0, there appears to be very little substance to conjure up a magical figure of 20 cases of Toxocariasis, particularly alongside the published Government figures for England and Wales for the same period which, in comparison, suggest your quoted figure of 20 cases of Toxocariasis to be wholly unrealistic, and seemingly distorted to suit your agenda.

I, therefore, once again request that you:

1. Please review the information that you have supplied for FOI 1355549 and amend the document with the relevant corrections and send a revised version to me. You can refer to my previous correspondence for information regarding the incorrect information but here are some points of reference:
a) Remove the references to Toxoplasmosis as it does not have any relevance on an inquiry regarding dogs and Toxocariasis
b) Correctly define ICD-10 code B83 (on page 1 and in Appendix Table 2) and show clearly that only one child (sub-code i.e. B83.0) refers to a specific diagnosis for Toxocariasis.
c) Amend the information that examines Table 1, acknowledge that there are no specific diagnoses for Toxocariasis and also acknowledge that B83.9 ‘Helminthiaisis unspecified’ covers a wide range of parasitic worm infections and not just Visceral larva migrans (Toxocariasis) and that B83.2 is for an unrelated helminthiasis (parasitic worm infection).
d. Amend the document summary accordingly.

2. Please include, in the revised document, the evidence and statistics to support the 11 admissions where B83 sub codes were listed as a secondary diagnosis, as it is relevant to this inquiry.

3. Please state the number of hospital admissions for the period 2010-2018 where the primary diagnosis was made with a specific B83.0 code for Visceral larva migrans (Toxocariasis).

4. Please state the number of hospital admissions for the period 2010-2018 where the secondary diagnosis was made with a specific B83.0 code for Visceral larva migrans (Toxocariasis).

And finally may I remind you once again, that as a body in public governance you have a duty to ensure that information given is transparent, correct and unbiased and that includes any evidence or statistics supplied in support of that information.

A full history of my FOI request and all correspondence is available on the Internet at this address: https://www.whatdotheyknow.com/request/r...

Yours faithfully,

Chris Fagan

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