Pregnancy-associated listeriosis in England and Wales.

Listeriosis is a rare but severe foodborne disease with low morbidity and high case-fatality rates. Pregnant women, unborn and newborn babies are among the high-risk groups for listeriosis. We examined listeriosis cases reported to the enhanced surveillance system in England and Wales from 1990 to 2010 to identify risk factors influencing outcome. Cases were defined as pregnancy-associated if Listeria monocytogenes was isolated from a pregnant woman or newborn infants aged <28 days. Of the 3088 cases reported, pregnancy-associated listeriosis accounted for 462 (15%) cases and 315 cases resulted in a live birth. Several factors were identified as affecting the severity and outcome of listeriosis in pregnancy in both mother and child including: presence or absence of maternal symptoms, gestational age at onset of symptoms, and clinical presentation in the infant (meningitis or septicaemia). Deprivation, ethnicity and molecular serotype had no effect on outcome.

Measuring the effect of influenza A(H1N1)pdm09: the epidemiological experience in the West Midlands, England during the 'containment' phase.

The West Midlands was the first English region to report sustained community transmission during the 'containment' phase of the influenza A(H1N1)pdm09 pandemic in England. To describe the epidemiological experience in the region, West Midlands and national datasets containing laboratory-confirmed A(H1N1)pdm09 virus cases in the region during the 'containment' phase were analysed. The region accounts for about 10·5% of England's population, but reported about 42% of all laboratory-confirmed cases. Altogether 3063 cases were reported, with an incidence rate of 56/100 000 population. School-associated cases accounted for 25% of cases. Those aged <20 years, South Asian ethnic groups, and residents of urban and socioeconomically deprived areas were disproportionately affected. Imported cases accounted for 1% of known exposures. Regional R 0 central estimates between 1·41 and 1·43 were obtained. The West Midlands experience suggests that interpretation of transmission rates may be affected by complex interactions within and between sub-populations in the region.

Challenges and lessons learned from implementing a risk-based approach to school advice and closure during the containment phase of the 2009 influenza pandemic in the West Midlands, England.

OBJECTIVE: School closure as a social distancing measure was used in some countries during the initial phases of the influenza A(H1N1)pdm09 pandemic. The objective of this paper is to describe the use of a risk-based approach to public health interventions for schools during the 'containment phase' of the pandemic and to describe lessons learnt. METHODS: The development of a framework for risk assessment and decision-making to determine school closures in the West Midlands, England, during the 'containment phase' of influenza A(H1N1)pdm09 pandemic is described. RESULTS: Using the framework developed during the 'containment phase', assessments were conducted for 344 educational institutions who reported confirmed cases or 'particularly high absenteeism'. Of these, 209 (60%) had confirmed cases and 65 were closed, mainly for public health or operational reasons. Schools were closed on an individual basis, during the most intense period of the pandemic and for an average period of six days (maximum 11 days). The risk-based approach evolved as experience and knowledge of influenza A(H1N1)pdm09 pandemic virus increased, however some decisions were difficult to communicate to parents, schools and stakeholders particularly when the number of schools affected escalated and the pandemic response phases changed. CONCLUSION: The management of school closures is an 'uncertain art'. Numerous challenges and lessons were identified in attempting, during the containment phase of the influenza A(H1N1)pdm09 pandemic, to ensure consistency and transparency in an increasingly complex process. The overall approach described could be further developed to improve decision-making for infectious diseases in schools.

Hospital-acquired listeriosis associated with sandwiches in the UK: a cause for concern.

BACKGROUND: Hospital-acquired outbreaks of listeriosis are not commonly reported but remain a significant public health problem. AIM: To raise awareness of listeriosis outbreaks that have occurred in hospitals and describe actions that can be taken to minimize the risk of foodborne listeriosis to vulnerable patients. METHODS: Foodborne outbreaks and incidents of Listeria monocytogenes reported to the Health Protection Agency national surveillance systems were investigated and those linked to hospitals were extracted. The data were analysed to identify the outbreak/incident setting, the food vehicle, outbreak contributory factors and origin of problem. FINDINGS: Most (8/11, 73%) foodborne outbreaks of listeriosis that occurred in the UK between 1999 and 2011 were associated with sandwiches purchased from or provided in hospitals. Recurrently in the outbreaks the infecting subtype of L. monocytogenes was detected in supplied prepacked sandwiches and sandwich manufacturing environments. In five of the outbreaks breaches in cold chain controls of food also occurred at hospital level. CONCLUSIONS: The outbreaks highlight the potential for sandwiches contaminated with L. monocytogenes to cause severe infection in vulnerable people. Control of L. monocytogenes in sandwich manufacturing and within hospitals is essential to minimize the potential for consumption of this bacterium at levels hazardous to health. Manufacturers supplying sandwiches to hospitals should aim to ensure absence of L. monocytogenes in sandwiches at the point of production and hospital-documented food safety management systems should ensure the integrity of the food cold chain.

Volume of print media coverage and diagnostic testing for influenza A(H1N1)pdm09 virus during the early phase of the 2009 pandemic.

BACKGROUND: Impact of an infectious disease on public health diagnostic health services may be affected by the volume of media coverage which can amplify risk perception and increase demand for services. OBJECTIVES: To examine the association between volume of newspaper reports and laboratory testing for influenza A(H1N1)pdm09 in one English health region during the early phase of the pandemic. STUDY DESIGN: Cross-sectional retrospective review identifying newspaper articles on A(H1N1)pdm09 in major regional (sub-national) newspapers from 27 April 2009 through 5 July 2009, and comparing the weekly frequency of articles with the weekly number, and positivity rate, of laboratory-confirmed cases of A(H1N1)pdm09 during the same time period. RESULTS: A positive correlation (r=0.67; p=0.02) was seen between the volume of school-related articles and the number of laboratory-confirmed cases. Increased testing during the most intense period of the pandemic was mainly seen in school-aged children (5-15 years) and adults (≥16 years). Adults accounted for the highest number of tests, but had the lowest positivity rates, which were highest among school-aged children. As the volume of media coverage decreased this was followed one week later by a fall in the number of tests and positivity rates in each age-group. CONCLUSION: The results presented suggest a temporal association between volume of media reporting and number of laboratory tests. The increased volume of media reporting, in particular the intense school-related coverage, may have raised population concern leading to an increased demand for diagnostic testing. These results have potential implications for future pandemic preparedness planning.

Relapse precipitants in Nigerian drug abusers.

OBJECTIVE: To determine the precipitants of relapse among patients admitted to a Psychiatric Hospital in Nigeria for substance abuse. PATIENTS AND METHODS: A cross-sectional survey of consecutive admitted drug abuse patients was carried out at the Psychiatric Hospital, Yaba, Lagos, using Marlatt's categories to measure high risk situations for relapse. RESULTS: Eighty-two subjects who were mostly male (87.9%), never married (53.7%), privately employed (58.5%), professionals (32%) with mean age 31.2 (+/- 6.56) years were evaluated. Most had used two or three different drugs. Coping with negative emotional states or enhancement of positive emotions were the main reasons for relapse determinants given by the subjects. Substance abuse management in Nigeria should embrace inquiries into these emotional states during both the admission and the post-discharge periods. CONCLUSION: Routine use of Marlatt' relapse precipitant categories may be helpful in designing intervention strategies to sustain abstinence in Nigerian drug abuser.