Zoonotic infections in UK and Irish veterinary students: a cross-sectional survey.

BACKGROUND: Zoonotic infections are a recognised risk for the veterinary community. Veterinary students are at risk, due to the range of activities they participate with on training coupled with their inexperience; yet the prevalence and severity of infections in veterinary students has been little studied. In this study, a survey explored zoonotic infections in UK and Irish veterinary students. METHODS: A survey containing both open and closed questions, was distributed to undergraduate veterinary students at all veterinary schools in the UK and Republic of Ireland. Descriptive statistics, and univariable logistic regression were used to explore quantitative data; thematic analysis was used to explore qualitative data. RESULTS: There were 467 responses, 31.5% (95% CI 27.3-35.9, n = 147) of those students reported having contracted at least one zoonotic infection during their studies. The most prevalent self-reported infections were cryptosporidiosis (15.2% of all respondents), dermatophytosis (5.6%), and other gastrointestinal infections assumed to be of zoonotic origin (4.5%). 7% of respondents reported having acquired a zoonosis within the last 12 months, 91% of these infections were acquired during farm placements. Thematic analysis (n = 34) showed that infection was an accepted risk, particularly on farm, and students were often reluctant to take time off their studies or placements as a result of infection. Reporting was very low, meaning universities would not have accurate figures on infection risk or particularly risky placement providers. CONCLUSIONS: Based on these survey results, veterinary students appear to be at increased risk of contracting zoonotic diseases, particularly on farm placements. Attitude and behaviour change at multiple levels is required to reduce the risk of infection to students and normalise reporting of illness.

Enhanced lateral flow testing strategies in care homes are associated with poor adherence and were insufficient to prevent COVID-19 outbreaks: results from a mixed methods implementation study.

INTRODUCTION: Care homes have been severely affected by the SARS-CoV-2 pandemic. Rapid antigen testing could identify most SARS-CoV-2 infected staff and visitors before they enter homes. We explored implementation of staff and visitor testing protocols using lateral flow devices (LFDs). METHODS: An evaluation of a SARS-CoV-2 LFD-based testing protocol in 11 care homes in Liverpool, UK, including staff and visitor testing, plus a qualitative exploratory study in nine of these homes. The proportion of pilot homes with outbreaks, and outbreak size, were compared to non-pilot homes in Liverpool. Adherence to testing protocols was evaluated. Fifteen staff were interviewed, and transcript data were thematically coded using an iterative analysis to identify and categorize factors influencing testing implementation. RESULTS: In total, 1,638 LFD rapid tests were performed on 407 staff. Protocol adherence was poor with 8.6% of staff achieving >75% protocol adherence, and 25.3% achieving $\ge$50%. Six care homes had outbreaks during the study. Compared to non-pilot care homes, there was no evidence of significant difference in the proportion of homes with outbreaks, or the size of outbreaks. Qualitative data showed difficulty implementing testing strategies due to excessive work burden. Factors influencing adherence related to test integration and procedural factors, socio-economic factors, cognitive overload and the emotional value of testing. CONCLUSION: Implementation of staff and visitor care home LFD testing protocols was poorly adhered to and consequently did not reduce the number or scale of COVID-19 outbreaks. More focus is needed on the contextual and behavioural factors that influence protocol adherence.

Implementing lateral flow devices in long-term care facilities: experiences from the Liverpool COVID-19 community testing pilot in care homes- a qualitative study.

INTRODUCTION: Antigen-based lateral flow devices (LFDs) offer the potential of widespread rapid testing. The scientific literature has primarily focused on mathematical modelling of their use and test performance characteristics. For these tests to be implemented successfully, an understanding of the real-world contextual factors that allow them to be integrated into the workplace is vital. To address this gap in knowledge, we aimed to explore staff's experiences of integrating LFDs into routine practice for visitors and staff testing with a view to understand implementation facilitators and barriers. METHODS: Semi-structured interviews and thematic analysis. RESULTS: We identified two main themes and five subthemes. The main themes included: visitor-related testing factors and staff-related testing factors. Subthemes included: restoring a sense of normality, visitor-related testing challenges, staff-related testing challenges, and pre-pilot antecedent factors. CONCLUSION: Our study demonstrates that the real-world implementation of LFDs to test visitors and staff faces significant challenges as a result of several contextual factors negatively affecting the work practice and environment. More comprehensive studies are needed to identify and inform effective implementation strategies to ensure that LFDs can be adopted in an agile way that better supports an already exhausted and morally depleted workforce.

A descriptive epidemiological study of the incidence of newly diagnosed Lyme disease cases in a UK primary care cohort, 1998-2016.

BACKGROUND: Primary care is likely to see the highest number of Lyme disease patients. Despite this, there is limited published data regarding Lyme disease patients accessing primary care in the UK. We aim to describe trends in the incidence of a new diagnosis, and demographics of patients identified in a primary care electronic health database. METHODS: A descriptive epidemiological study of Lyme disease coded patients in UK primary care. 3725 patients coded for Lyme disease during 1998-2016 were identified within The Health Improvement Network (THIN). Incidence rates and the demographics of cases identified were described. Poisson regression was used to analyse socio-demographic characteristics of the cases. RESULTS: There was an increase in annual crude incidence rates, peaking in 2015 at 5.47 (95% CI 4.85-6.14) cases per 100,000 population per year. Multivariable analysis showed there were significant differences in the ages of those affected, incidence of a new diagnosis rose as deprivation levels improved, and that there was a higher incidence of cases living in rural areas compared to urban areas. There was no significant difference between sexes for the UK. Cases were significantly more likely to identify with being white compared to the national population. CONCLUSIONS: An increasing incidence of patients newly coded with Lyme disease related Read codes was identified using data from a UK national primary care database. By comparing these incidence figures with national laboratory-confirmed surveillance data, a multiplication factor of 2.35 (95%CI 1.81-2.88) can be calculated in order to estimate the annual number of cases seen in primary care. The significant socio-demographic variables associated with a Lyme disease diagnosis likely reflect a complex interplay of socio-economic issues, which needs to be further explored. Future work is needed to examine the treatment and management of patients within this database.

Mapping tweets to a known disease epidemiology; a case study of Lyme disease in the United Kingdom and Republic of Ireland.

BACKGROUND: Analysis of social media is an emerging method with potential as a tool for disease surveillance. Twitter may offer a route for surveillance by using tweeting habits as a proxy for disease incidence. Previous work has focused on temporal patterns and have proven to be successful. However, the identification of geographical patterns has been limited by a combination of Twitter's data collection policies and by exploring diseases that have a high prevalence and high levels of awareness with the public. We propose that, by performing a restricted geographical search strategy on a disease with a relatively low incidence, one may be able to explore spatial patterns. Here, Lyme disease in the United Kingdom and the Republic of Ireland is used as a case example. OBJECTIVE: To explore whether the tweeting habits of British and Irish Twitter users matched the known spatio-temporal epidemiology of Lyme disease in these respective countries. METHODS: All Tweets containing the word 'Lyme' were collected between the 1st of July 2017 and the 30th June 2018, restricted by geography (a 375-mile radius around the geographical centre of Great Britain) and by language (English-only tweets). Tweets were removed which referred to locations that included 'Lyme' within their name (e.g. Lyme Regis). Only original tweets were analysed. Daily and monthly time series were created and compared to national Lyme disease surveillance figures. A map of the number of Twitter users tweeting about Lyme disease per 100,000 population per local authority was created. This was formerly compared to national surveillance data for England and Wales using an exploratory spatial data analysis approach. RESULTS: During the study period, 13,757 original tweets containing the word 'Lyme', and excluding place names relating to Lyme, were collected. The mean number of daily tweets was 38 (range: 12-276). There was strong seasonality with the highest number of tweets in the summer, this matched the known epidemiology of Lyme disease. Of the 5212 of users who tweeted about Lyme disease, 51.8% had a user profile location that could be matched to a local authority in the United Kingdom or Republic of Ireland. The mean number of Twitter users tweeting about Lyme disease per 100,000 population per local authority was 3.7. The areas with the highest incidence were south-west England and the Highlands of Scotland. When comparing these figures to English and Welsh Lyme disease surveillance figures they showed a significant positive spatial correlation (p = 0.002). CONCLUSIONS: The tempo-spatial pattern of Twitter users tweeting about Lyme disease matches the known disease epidemiology. The degree of geographical concordance between Twitter users' locations and national surveillance reports, indicate that Twitter has the potential to be used in to identify potential disease hotspots based on the levels of social media 'noise'. There is scope for further work to test the robustness of Twitter as an adjunct 'measure of concern' disease surveillance tool. However, caution must be taken as national media stories can skew data and Twitter users may not provide reliable facts in the data that they share on the platform.

Characteristics and patient pathways of Lyme disease patients: a retrospective analysis of hospital episode data in England and Wales (1998-2015).

BACKGROUND: Lyme disease is a tick-borne disease of increasing global importance. There is scant information on Lyme disease patient demographics in England and Wales, and how they interact with the National Health Service (NHS). Our aims were to explore the demographic characteristics of Lyme disease patients within the Hospital Episode Statistics (HES) and Patient Episode Database for Wales (PEDW), and to describe patient pathways. METHODS: Data from 1st January 1998 to 31st December 2015 was retrieved from the two administrative hospital datasets (HES and PEDW), based on patients coded with Lyme disease. Information was collected on demographic characteristics, home address and case management. Incidence rates were calculated, and demographics compared to the national population. RESULTS: Within HES and PEDW, 2361 patients were coded with Lyme disease. There was a significant increase (p < 0.01) in incidence from 0.08 cases/100,000 in 1998, to 0.53 cases/100,000 in 2015. There was a bimodal age distribution, patients were predominantly female, white and from areas of low deprivation. New cases peaked annually in August, with higher incidence rates in southern central and western England. Within hospital admission data (n = 2066), most cases were either referred from primary care (28.8%, n = 596) or admitted via accident and emergency (A&E) (29.5%, n = 610). This population entering secondary care through A&E suggest a poor understanding of the recommended care pathways for symptoms related to Lyme disease by the general population. CONCLUSIONS: These data can be used to inform future investigations into Lyme disease burden, and patient management within the NHS. They provide demographic information for clinicians to target public health messaging or interventions.

Perceptions of the impact of the RCVS Certificate in Advanced Veterinary Practice on the careers of its graduates.

BACKGROUND: This study aimed to investigate the perceived effect of the RCVS Certificate in Advanced Veterinary Practice (CertAVP) on its graduates, with respect to career advancement, professional practice and contentment with work in the veterinary industry. METHODS: A cross-sectional online survey of CertAVP graduates was performed, utilising descriptive analysis of Likert scales, logistic regression of demographic variable associations with key outcomes and free-text analysis. RESULTS: The majority (89%) of the 103 respondents felt that the CertAVP led to improvements in professional practice, 56% felt it had helped advance their career and 55% stated it had improved their contentment with work in the veterinary industry. The CertAVP was perceived to improve evidence-based practice, clinical governance, intellectual satisfaction and encourage lifelong learning, but was not perceived to improve work-life balance. LIMITATION: Due to potential response bias, this study may not represent the wider population. CONCLUSION: Despite respondents reporting career advancement, this was only reflected in mentorship and managing more complex cases; respondents neither felt that the CertAVP resulted in promotion, a pay rise or new leadership roles, nor did it afford greater flexibility in their working schedule.

Audit of animal-related injuries at UK veterinary schools between 2009 and 2018.

BACKGROUND: Animal-related injuries pose a significant risk to the veterinary profession. This study aimed to describe the incidence, demographics, context and consequences of animal-related injuries at UK veterinary schools. METHODS: A multicentre audit of accident records (2009-2018) across five UK veterinary schools was performed. Injury rates were stratified by school, demographics and species. The context and cause of the injury were described. Multivariable logistic models explored factors associated with medical treatment, hospital visits and time off work. RESULTS: An annual rate of 2.60 (95% confidence interval 2.48-2.72) injuries per 100 graduating students was calculated, varying between veterinary schools. Injuries were more frequently recorded in staff than students, and there were significant differences between staff and students in the activities performed preceding injury. Cats and dogs were associated with the highest number of reported injuries. However, injuries associated with cattle and horses were the most severe, with significantly higher hospital attendances and more time off work taken. LIMITATIONS: Data were based on reported injuries and likely underestimate the true injury rate. The population at risk was hard to quantify as population size and exposure were variable. CONCLUSION: Further research is recommended to explore the clinical and workplace management, including recording culture, of animal-related injuries among veterinary professionals.

COVID-19 vaccine hesitancy in care home staff: A survey of Liverpool care homes.

Uptake of COVID-19 vaccine first doses in UK care homes has been higher among residents compared to staff. We aimed to identify causes of lower COVID-19 vaccine uptake amongst care home staff within Liverpool. An anonymised online survey was distributed to all care home managers, between the 21st and the 29th January 2021. 53 % of 87 care homes responded. The overall COVID-19 vaccination rate was 52.6 % (n = 1119). Reasons, identified by care home managers for staff being unvaccinated included: concerns about lack of vaccine research (37.0 %), staff being off-site during vaccination sessions (36.5 %), pregnancy and fertility concerns (5.6 %), and allergic reactions concerns (3.2 %). Care home managers wanted to tackle vaccine hesitancy through conversations with health professionals, and provision of evidence dispelling vaccine misinformation. Vaccine hesitancy and logistical issues were the main causes for reduced vaccine uptake among care home staff. The former could be addressed by targeted training, and public health communication campaigns to build confidence and acceptance of COVID-19 vaccines.

Evaluating the impact of using mobile vaccination units to increase COVID-19 vaccination uptake in Cheshire and Merseyside, UK: a synthetic control analysis.

OBJECTIVE: To evaluate the impact of mobile vaccination units on COVID-19 vaccine uptake of the first dose, the percentage of vaccinated people among the total eligible population. We further investigate whether such an effect differed by deprivation, ethnicity and age. DESIGN: Synthetic control analysis. SETTING: The population registered with general practices (GPs) in nine local authority areas in Cheshire and Merseyside in Northwest England, UK. INTERVENTION: Mobile vaccination units that visited 37 sites on 54 occasions between 12 April 2021 and 28 June 2021. We defined intervention neighbourhoods as having their population weighted centroid located within 1 km of mobile vaccination sites (338 006 individuals). A weighted combination of neighbourhoods that had not received the intervention (1 495 582 individuals) was used to construct a synthetic control group. OUTCOME: The weekly number of first-dose vaccines received among people aged 18 years and over as a proportion of the population. RESULTS: The introduction of a mobile vaccination unit into a neighbourhood increased the number of first vaccinations conducted in the neighbourhood by 25% (95% CI 21% to 28%) within 3 weeks after the first visit to a neighbourhood, compared with the synthetic control group. Interaction analyses showed smaller or no effect among older age groups, Asian and black ethnic groups, and the most socioeconomically deprived populations. CONCLUSIONS: Mobile vaccination units are effective interventions for increasing vaccination uptake, at least in the short term. While mobile units can be geographically targeted to reduce inequalities, we found evidence that they may increase inequalities in vaccine uptake within targeted areas, as the intervention was less effective among groups that tended to have lower vaccination uptake. Mobile vaccination units should be used in combination with activities to maximise outreach with black and Asian communities and socioeconomically disadvantaged groups.

English hospital episode data analysis (1998-2018) reveal that the rise in dog bite hospital admissions is driven by adult cases.

Dog bites are a global health issue that can lead to severe health outcomes. This study aims to describe the incidence and sociodemographics of patients admitted to English National Health Service (NHS) hospitals for dog bites (1998-2018), and to estimate their annual direct health care costs. An analysis of patient level data utilising hospital episode statistics for NHS England, including: temporal trends in annual incidence of admission, Poisson models of the sociodemographic characteristics of admitted patients, and direct health care cost estimates. The incidence of dog bite admissions rose from 6.34 (95%CI 6.12-6.56) in 1998 to 14.99 (95%CI 14.67-15.31) admissions per 100,000 population in 2018, with large geographic variation. The increase was driven by a tripling of incidence in adults. Males had the highest rates of admission in childhood. Females had two peaks in admission, childhood and 35-64 years old. Two percent (2.05%, 95%CI 0.93-3.17) of emergency department attendances resulted in admission. Direct health care costs increased and peaked in the financial year 2017/2018 (admission costs: £25.1 million, emergency attendance costs: £45.7million). Dog bite related hospital admissions have increased solely in adults. Further work exploring human-dog interactions, stratified by demographic factors, is urgently needed to enable the development of appropriate risk reduction intervention strategies.

Paediatric emergency department dog bite attendance during the COVID-19 pandemic: an audit at a tertiary children's hospital.

Background: Responses to the COVID-19 pandemic include strict public health measures, such as national lockdowns. During these measures, paediatric emergency department attendances have declined and the prevalence of presenting complaints has changed. This study sought to identify whether dog bite attendance and victim demographics changed during COVID-19 public health measures. Methods: An audit was conducted of emergency department attendance data from a UK tertiary paediatric hospital between January 2016 and September 2020. Dog bite attendance and victim demographics were explored using χ2 tests and multivariable Poisson regression. The mean monthly percentage of attendance due to dog bites in 2020 was compared against predicted percentages based on previous years' data. Results: Dog bite attendance rose in conjunction with the introduction of COVID-19 public health measures and reached a peak in July 2020 (44 dog bites, 1.3% of all attendances were due to dog bites). This was a threefold increase in dog bite attendance. By September 2020, attendance had returned to normal. The demographic profile of child dog bite victims remained the same. Boys had the highest attendance rates in 7-12 year-olds, girls in 4-6 year-olds. Girls showed higher attendance rates in the summer, while boys' attendance rates were constant throughout the year. COVID-19 public health measures were associated with a 78% increase in attendance for boys and a 66% increase in girls. Conclusions: COVID-19 national public health measures were associated with an increase in paediatric emergency department dog bite attendance, and may be due to increased child exposure to dogs via 'stay at home' orders and school closures. National lockdowns are likely to continue globally throughout the COVID-19 pandemic; this is likely to result in more dog bites. Urgent public health communication and injury prevention strategies are needed to help prevent these avoidable injuries.

Backyard poultry cases in UK small animal practices: Demographics, health conditions and pharmaceutical prescriptions.

BACKGROUND: Backyard poultry ownership is of keen interest in the United Kingdom. However, despite this, little is known about veterinary care engagement and outcomes of visits in this group of species. METHODS: This study described and characterised veterinary practice-visiting backyard poultry, utilising electronic health record data supplied by veterinary practices voluntarily participating in the Small Animal Veterinary Surveillance Network between 1st April 2014 and 31st March 2019. RESULTS: In total, 4424 recorded poultry consultations originating from 197 veterinary practices (352 sites) were summarised. Chicken consultation (n = 3740) peak incidence was in early summer (April-June), relative to all recorded species. More chickens resided in rural (incident rate ratio = 2.5, confidence interval [CI] 2.3-2.6, p <0.001) or less deprived areas. Non-specific clinical signs were commonly recorded (17.6% of chicken consultations, CI 15.9-19.2), as were those indicative of advanced disease. This latter finding was reflected in prescribed management strategies, with euthanasia comprising 29.8% (CI 27.0-32.6) of consultations. Antimicrobials were commonly prescribed (33.0% of consultations, CI 29.8-36.2), 43.8% of which included antimicrobials considered 'highest priority critically important' by the World Health Organisation. CONCLUSION: Our findings indicate a need to tailor antimicrobial prescription guidance to the backyard poultry setting. In addition, late presentation of disease, vague clinical descriptions in clinical narratives and high euthanasia rates show that disease identification, management and knowledge of poultry health and welfare among owners and veterinary surgeons can be improved.

The demographics and geographic distribution of laboratory-confirmed Lyme disease cases in England and Wales (2013-2016): an ecological study.

OBJECTIVE: Lyme disease is a tick-borne disease of increasing incidence and public concern across the Northern Hemisphere. However, the socio-demographics and geographic distribution of the population affected in England and Wales are poorly understood. Therefore, the proposed study was designed to describe the demographics and distribution of laboratory-confirmed cases of Lyme disease from a national testing laboratory. DESIGN: An ecological study of routinely collected laboratory surveillance data. SETTING: Public Health England's national Lyme disease testing laboratory. PARTICIPANTS: 3986 laboratory-confirmed cases of Lyme disease between 2013 and 2016. RESULTS: In England and Wales, the incidence of laboratory-confirmed Lyme disease rose significantly over the study period from 1.62 cases per 100 000 in 2013 to 1.95 cases per 100 000 in 2016. There was a bimodal age distribution (with peaks at 6-10 and 61-65 years age bands) with a predominance of male patients. A significant clustering of areas with high Lyme disease incidence was located in southern England. An association was found between disease incidence and socioeconomic status, based on the patient's resident postcode, with more cases found in less deprived areas. Cases were disproportionately found in rural areas compared with the national population distribution. CONCLUSIONS: These results suggest that Lyme disease patients originate from areas with higher socioeconomic status and disproportionately in rural areas. Identification of the Lyme disease hotspots in southern England, alongside the socio-demographics described, will enable a targeted approach to public health interventions and messages.