Detection in the United Kingdom of the Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate resistance to azithromycin, October to December 2018.

We describe detection in the United Kingdom (UK) of the drug-resistant Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate azithromycin resistance. Two female patients developed infection following contact with UK-resident men from the same sexual network linked to travel to Ibiza, Spain. One case failed treatment with ceftriaxone, and azithromycin and gentamicin, before successful treatment with ertapenem. Both isolates had indistinguishable whole-genome sequences. Urgent action is essential to contain this drug-resistant strain.

Challenges of investigating a large food-borne norovirus outbreak across all branches of a restaurant group in the United Kingdom, October 2016.

During October and November 2016, over 1,000 customers and staff reported gastroenteritis after eating at all 23 branches of a restaurant group in the United Kingdom. The outbreak coincided with a new menu launch and norovirus was identified as the causative agent. We conducted four retrospective cohort studies; one among all restaurant staff and three in customers at four branches. We investigated the dishes consumed, reviewed recipes, interviewed chefs and inspected restaurants to identify common ingredients and preparation methods for implicated dishes. Investigations were complicated by three public health agencies concurrently conducting multiple analytical studies, the complex menu with many shared constituent ingredients and the high media attention. The likely source was a contaminated batch of a nationally distributed ingredient, but analytical studies were unable to implicate a single ingredient. The most likely vehicle was a new chipotle chilli product imported from outside the European Union, that was used uncooked in the implicated dishes. This outbreak exemplifies the possibility of rapid spread of infectious agents within a restaurant supply chain, following introduction of a contaminated ingredient. It underlines the importance of appropriate risk assessments and control measures being in place, particularly for new ingredients and ready-to-eat foods.

Lack of Secondary Transmission of Ebola Virus from Healthcare Worker to 238 Contacts, United Kingdom, December 2014.

In December 2014, Ebola virus disease (EVD) was diagnosed in a healthcare worker in the United Kingdom after the worker returned from an Ebola treatment center in Sierra Leone. The worker flew on 2 flights during the early stages of disease. Follow-up of 238 contacts showed no evidence of secondary transmission of Ebola virus.

London 2012 Olympic and Paralympic Games: public health surveillance and epidemiology.

Mass gatherings are regarded as potential risks for transmission of infectious diseases, and might compromise the health system of countries in which they are hosted. The evidence for increased transmission of infectious diseases at international sporting mass gatherings that attract many visitors from all over the world is not clear, and the evidence base for public health surveillance, epidemiology, and response at events such as the Olympics is small. However, infectious diseases are a recognised risk, and public health planning is, and should remain, a crucial part of the overall planning of sporting events. In this Series paper, we set out the planning and the surveillance systems that were used to monitor public health risks during the London 2012 Olympic and Paralympic Games in the summer of 2012, and draw attention to the public health issues-infectious diseases and chemical, radiation, and environmental hazards-that arose. Although the absolute risk of health-protection problems, including infectious diseases, at sporting mass gatherings is small, the need for reassurance of the absence of problems is higher than has previously been considered; this could challenge conventional public health surveillance systems. Recognition of the limitations of health-surveillance systems needs to be part of the planning for future sporting events.

Molecular typing of pneumococci for investigation of linked cases of invasive pneumococcal disease.

In winter 2007-2008, an outbreak of pediatric pneumonia caused by serotype 5 pneumococci was identified in a northeast London suburb. Variable number of tandem repeat analyses clustered these pneumococci from the other serotype 5 pneumococci in the United Kingdom, highlighting the importance of this discriminative typing method in supporting epidemiological investigations.

Ebola 2014: Setting up a port health screening programme at an international train station.

An outbreak of Ebola virus disease (EVD) began in Guinea in December 2013 and was declared a Public Health Emergency of International Concern by the World Health Organization in August 2014. In October, the UK government tasked Public Health England (PHE) to set up EVD screening at key ports. The key aim of port-of-entry screening was to identify passengers coming from areas with high risk of EVD, and give them advice to raise their awareness of symptoms and what actions to take. Direct flights from Sierra Leone, Guinea or Liberia had all been cancelled, so intelligence on passenger numbers and routes was used to identify the most commonly used routes from the affected countries into the UK. One of these was St Pancras International train station. Screening had never previously been implemented at a UK train station so had to be set up from scratch. Key to the success of this was excellent multi-agency working between PHE, the UK Border Force, Eurostar, Network Rail and the Cabinet Office. This paper gives an overview of the activation of EVD screening at St Pancras International and the subsequent decommissioning.

Patterns of early transmission of pandemic influenza in London - link with deprivation.

BACKGROUND: During the early containment phase in England from April to June 2009, the national strategy for H1N1 pandemic influenza involved case investigation and treatment, and tracing and prophylaxis of contacts. OBJECTIVE: To describe the relationship between early transmission of H1N1 pandemic influenza in London and age and socio-economic status. METHODS: Epidemiological data on cases of pandemic flu in London reported to the London Flu Response Centre were analysed to determine patterns of transmission. RESULTS: There were 3487 reported cases (2202 confirmed, 1272 presumed and 14 probable) from 20 April to 28 June 2009, during the 'containment' period. The highest report rate of 206 per 100 000 (95% CI 195-218) was seen in primary school-age children (5-11 years) followed by 129 (95% CI 119-139) in secondary school-age children (12-18 years). Reports of cases were initially concentrated in affluent areas but overall showed a clear trend with deprivation and risk ratio of 2·32 (95% CI 1·94-2·78) between the most deprived and the least deprived. CONCLUSION: Early transmissions were highest amongst school-aged children but linked with socio-economic deprivation across all age groups.

Pandemic (H1N1) 2009: setting up a multi-agency regional response centre--a toolkit for other public health emergencies.

The H1N1 pandemic emerged from Mexico in April 2009. In the UK, local Health Protection Units were quickly overwhelmed with calls from health professionals seeking public health advice on this novel virus. The Health Protection Agency (HPA) led the initial response and established regional flu response centres (FRCs). In London, the HPA's flu response moved swiftly from four in-house emergency operations centres to a fully functional multiagency response centre in rented office space, working with a new database, IT and telephone systems to provide a regional response. Surge capacity was sought from the National Health Service (NHS) and other agencies. The London FRC transferred to NHS leadership supported by the existing management team to assist the NHS in London prior to the opening of the National Pandemic Flu Service. Structured debriefs were undertaken, identifying lessons for future evolving incidents. This paper gives an overview of the activation, resilience and decommissioning of the London FRC, incorporating the lessons identified and key recommendations into a toolkit for future emergency evolving incidents that adopt a regional response centre model.

Pragmatic management of programmatic vaccination errors--lessons learnt from incidents in London.

Correct storage, handling and administration of vaccines are vital components of a successful immunisation programme. However, with the large number of different healthcare professionals now involved in delivering the vaccine programme on a daily basis, it is inevitable that programmatic errors will occur. Decisions as to how best to rectify these errors can be difficult however, as often they are unprecedented and there may be no hard evidence on which to base their management. These decisions must therefore be based on what is known and any available previous experience. They also often take place in an environment of concern about litigation and liability which puts pressure on health care workers to take a defensive or conservative approach. Management decisions may ultimately also have to be a pragmatic choice based on the individual situation and what is deemed to be the best way to minimise adverse reactions, ensure patients are adequately protected and maintain public confidence in the immunisation programme. Here, we describe our experiences of managing vaccine programmatic errors and some of the many factors that we had to consider.

Passage from India: an outbreak of hepatitis B linked to a patient who acquired infection from health care overseas.

OBJECTIVES: To investigate a nosocomial and community outbreak of hepatitis B to establish how the infections might have occurred. STUDY DESIGN: Descriptive study. METHODS: Four cases of hepatitis B who had stayed in hospital during their incubation periods, a case in one of their household contacts, and three further cases in the community were all linked to a patient who had been infected during a renal transplant in India. Medical records from cases were reviewed to extract information about risk factors for infection. Working practices were reviewed to determine how nosocomial transmissions might have occurred. 'Look-back' exercises were conducted to identify and follow-up other patients and staff who might also be at-risk of infection. Hepatitis B viral sequences from all cases were examined to determine whether they were related. RESULTS: Viral DNA sequences from all nine cases were identical. The primary case had an extremely high viral load due to underlying immunosuppression. Three of the nosocomial transmissions occurred whilst the primary and secondary cases shared general medical wards; two whilst the primary case was in standard isolation. No clear routes of infection were identified. The fourth was associated with a failure of infection control in operating theatres. CONCLUSIONS: Invasive medical procedures in high-prevalence countries carry a clear risk of blood borne viral infections. There is a need for much better awareness of this risk, both among patients who are considering travelling for treatment, and the health professionals who will be caring for them on their return. Infections may be preventable through hepatitis B vaccination. Patients admitted to hospital following invasive medical procedures in high-prevalence countries should be nursed with stringent infection control measures until blood borne viral infections can be excluded. However, patients with hepatitis B who are highly infectious may transmit the virus despite high standards of infection control.