Attendance at London workplaces after symptom onset: a retrospective cohort study of staff members with confirmed COVID-19.

BACKGROUND: Coronavirus disease (COVID)-secure workplace guidance, including the prompt self-isolation of those with COVID-19 symptoms, is fundamental to disease control in workplaces. Despite guidance, a large number of workplace outbreaks have been observed. This study aimed to identify the proportion of symptomatic staff members attending workplaces after symptom onset or testing, and associated factors. METHODS: This study of symptomatic COVID-19 cases associated with London workplaces used London Coronavirus Response Centre (LCRC) records from routine telephone calls with cases and employers, from 17th July to 10th September. For each case, symptoms, date of onset, date of testing and the last attendance at work were extracted. Univariable logistic regression was performed to investigate whether age, gender or occupation was associated with workplace attendance after the onset of symptoms. RESULTS: Out of 130 symptomatic COVID-19 cases, 42 (32.3%) attended the workplace after their reported date of symptom onset, including 16 (12.3%) with recorded COVID-19 symptoms. Five staff members attended after COVID-19 testing. Males were 66% less likely to attend the workplace after the onset of COVID-19 symptoms compared to females (odds ratio 0.34, P = 0.05). Age and occupation were not predictive for workplace attendance after the onset of symptoms. CONCLUSION: A minority of symptomatic cases attended the workplace after the onset of COVID-19 symptoms, with a smaller proportion attending after testing. Males appeared less likely to attend the workplace after the onset of COVID-19 symptoms. This study highlights the need for ongoing COVID-19 secure workplace practices and prompt self-isolation after COVID-19 symptom onset or testing.

Multiple needle-stick injuries with risk of human immunodeficiency virus exposure in a primary school.

Twenty children received needle-stick injuries with a risk of exposure to human immunodeficiency virus type 1 during an incident in a primary school playground. All were counseled and offered human immunodeficiency virus postexposure prophylaxis. All 20 children started postexposure prophylaxis, and 19 attended for follow-up testing 3 months later. More than one-half of the children completed the full 4-week course of treatment. None of the 19 children tested seroconverted after the incident.

Is preparedness for CBRN incidents important to general practitioners in East London?

General practitioners (GPs) have an important role in public health response to CBRN incidents, including disseminating information to worried patients and undertaking risk assessments of patients. The authors undertook the first known UK survey of GPs' CBRN preparedness to assess knowledge and attitudes towards CBRN preparedness among GPs in East London, in the area of the Olympic Park. A questionnaire was developed, focusing on GPs' self-preparedness for, and perceived roles in CBRN incidents, and GPs' access to resources and policies for dealing with such incidents. Of 157 GPs, 56 responded, although some responded collectively for their practice. The majority of respondents recognised roles for themselves in CBRN incidents, including recognition of illness, supporting decontamination, and appropriate reporting. However, 79 per cent of GPs also felt unprepared for such incidents. The most popular topic for training to address this was clinical presentation of CBRN exposures. Most practices had no policy for dealing with suspect packages and white powder incidents. Since this survey, guidance and training has been made available to local GPs. As the UK will host more events like the 2012 Olympics, preparedness for GPs will continue to be an important consideration in the UK.

Epidemiology, antibiotic resistance trends and the cost of enteric fever in East London, 2005-2010.

INTRODUCTION: Enteric fever seen in the UK has usually been acquired abroad. The cost to the NHS of treating enteric fever cases is not known. Data on the epidemiology of enteric fever, inpatient treatment costs and the public health management is needed to make decisions regarding the cost benefit considerations of introducing targeted prevention strategies. METHODS: A retrospective study of laboratory confirmed enteric fever cases was conducted to estimate the cost of inpatient treatment and to determine antimicrobial resistance patterns at two hospitals in East London between January 2005 and the end of August 2010. RESULTS: 138 cases of enteric fever were identified during the study period (90 S.ser.Typhi and 48 S. ser. Paratyphi). 92% had a recent history of foreign travel, 57% had travelled to visit friends and relatives (VFRs), 26% sought pre-travel health advice and 26% of patients had received typhoid vaccination. The inpatient treatment cost of 138 cases to the NHS was £272,747. The proportion of isolates with high level ciprofloxacin resistance (MICs>1 mg/L) has increased from 10% in 2006 to 30% in 2010. Our data also shows the emergence of isolates with high azithromycin MICs (>32 mg/L); 60% (six out of ten) isolates tested in July-August 2010. CONCLUSIONS: There is a significant direct cost of treating enteric fever cases on the NHS. Cost reduction measures are confined due to the lack of effective oral antibiotics following the emergence of high level resistance to ciprofloxacin and azithromycin. Outpatient parenteral antibiotic therapy service and improved preventative public health measures aimed at VFR travellers in particular may be helpful in reducing costs.