The epidemiology and management of clusters of invasive meningococcal disease in England, 2010-15.

BACKGROUND: Guidance for public health management of invasive meningococcal disease (IMD) in in England recommends the use of antibiotic chemoprophylaxis and vaccination. We summarized clinical and epidemiological data collected during routine management of IMD clusters in England. METHODS: Data on epidemiology and operational decisions for public health management were reviewed for clusters between April 2010 and December 2015. RESULTS: Clusters were generally 2-3 cases (53/58; 91%) within a single age band <18-years. Nurseries (n = 20, 34%), households/social networks (n = 14, 24%) and schools (n = 10, 17%) were the commonest settings. Chemoprophylaxis alone was used in 36 (58%) clusters, including most serogroup B clusters (31/41; 76%). Chemoprophylaxis and vaccination was used in a further 20 (32%) clusters. Vaccine was delivered promptly (<7 days). Four clusters had cases with onset post-chemoprophylaxis; no clusters recorded cases with onset post-vaccination. No pattern was observed between interventions and setting/population at risk, and interventions were consistent with national guidance. Challenges to management included logistical issues related to intervention delivery. CONCLUSIONS: Public health management of IMD clusters presents challenges in decision-making and implementation of interventions. Nonetheless, few cases were observed following intervention. Responses were consistent with national guidance. A systematic data collection tool should be developed to support future evaluation.

Guidelines for prevention and control of group A streptococcal infection in acute healthcare and maternity settings in the UK.

Hospital outbreaks of group A streptococcal (GAS) infection can be devastating and occasionally result in the death of previously well patients. Approximately one in ten cases of severe GAS infection is healthcare-associated. This guidance, produced by a multidisciplinary working group, provides an evidence-based systematic approach to the investigation of single cases or outbreaks of healthcare-associated GAS infection in acute care or maternity settings. The guideline recommends that all cases of GAS infection potentially acquired in hospital or through contact with healthcare or maternity services should be investigated. Healthcare workers, the environment, and other patients are possible sources of transmission. Screening of epidemiologically linked healthcare workers should be considered for healthcare-associated cases of GAS infection where no alternative source is readily identified. Communal facilities, such as baths, bidets and showers, should be cleaned and decontaminated between all patients especially on delivery suites, post-natal wards and other high risk areas. Continuous surveillance is required to identify outbreaks which arise over long periods of time. GAS isolates from in-patients, peri-partum patients, neonates, and post-operative wounds should be saved for six months to facilitate outbreak investigation. These guidelines do not cover diagnosis and treatment of GAS infection which should be discussed with an infection specialist.

The risk to infants from nosocomial exposure to tuberculosis.

We undertook a systematic literature and database review for reports of nosocomial exposures of infants less than 24 months of age to tuberculosis. We found 7 instances of transmission among 4867 babies in 26 reports (19 published, 7 from a national database for reporting such events).

Identification of tuberculosis cases by port health screening in Essex 1997-2003.

Between 1997 and 2003 an annual average of 1867 new entrants seen at the port of arrival were notified to the communicable disease teams who now form the Essex Health Protection Unit. We examined the number of individuals who made contact with health services by linking port health and tuberculosis databases with combinations of surname, forename and date of birth the number of new entrants developing tuberculosis. We also searched paper records for all incidents of active tuberculosis in health and residential care workers. Eighteen individuals were in both port health and tuberculosis data sets; only one was identified by new entrant screening. In the same period there were 35 cases of active tuberculosis in health care workers, only one of whom had been screened on arrival in the United Kingdom, resulting in follow-up of 371 contacts. The new entrant screening programme in Essex should be stopped and resources diverted to improve followup of new entrants, especially those who are health care workers.