A large outbreak of the Kappa mutation of COVID-19 in Cork, Ireland, April-May 2021.

BACKGROUND: In May 2021, the B.1.617 variant of SARS-CoV-2 emerged in Ireland, and both Delta and Kappa sub-lineages were initially deemed variants of concern (VOCs) on a precautionary basis. We describe a large outbreak of SARS-CoV-2 B.1.617.1 (Kappa mutation) linked to a private gathering among third level students in Cork, Ireland. METHODS: Surveillance data were available from the Health Service Executive COVID Care Tracker. The epidemiological sequence of infection for each new case in this outbreak was tracked and whole genome sequencing was requested on all linked cases. Enhanced public health control measures were implemented by the Department of Public Health HSE-South to contain onward spread of VOCs, including retrospective contact tracing, lengthy isolation and quarantine periods for cases and close contacts. Extensive surveillance efforts were used to describe and control onward transmission. RESULTS: There were 146 confirmed SARS-CoV-2 cases linked to the outbreak. All sequenced cases (53/146; 36%) confirmed Kappa mutation. The median age was 21 years (range 17-65). The majority (88%) had symptoms of SARS-CoV-2 infection. There were 407 close contacts; the median was 3 per case (range 0-14). There were no known hospitalisations, ICU admissions or deaths. Vaccination data was unavailable, but the outbreak pre-dated routine availability of COVID-19 vaccines among younger adults in Ireland. CONCLUSION: Enhanced public health control measures for new and emerging variants of SARS-CoV-2 may be burdensome for cases and close contacts. The overall public health benefit of enhanced controls may only become apparent when evidence on disease transmissibility and severity becomes more complete.

Children are safe in schools: a review of the Irish experience of reopening schools during the COVID-19 pandemic.

OBJECTIVES: Schools in the Republic of Ireland reopened to students and staff in late August 2020. We sought to determine the test positivity rate of close contacts of cases of coronavirus disease 2019 (COVID-19) in schools during the first half-term of the 2020/2021 academic year. METHODS: National-level data from the schools' testing pathway were interrogated to determine the positivity rate of close contacts of cases of COVID-19 in Irish primary, postprimary and special schools during the first half-term of 2020/2021 academic year. The positivity rates among adult and child close contacts were compared and the proportion of national cases of COVID-19 who were aged 4-18 years during the observation period was calculated to assess whether this proportion increased after schools reopened. RESULTS: Of all, 15,533 adult and child close contacts were tested for COVID-19 through the schools' testing pathway during the first half-term of the 2020/2021 academic year. Three hundred and ninety-nine close contacts tested positive, indicating a positivity rate of 2.6% (95% confidence interval: 2.3-2.8%). The positivity rates of child and adult close contacts were similarly low (2.6% vs 2.7%, P = 0.7). The proportion of all national cases of COVID-19 who were aged 4-18 years did not increase during the first half-term of the 2020/2021 school year. CONCLUSIONS: The low positivity rate of close contacts of cases of COVID-19 in schools indicate that transmission of COVID-19 in Irish schools during the first half-term of the 2020/2021 academic year was low. These findings support policies to keep schools open during the pandemic.

Investigation of a foodborne outbreak of Shigella sonnei in Ireland and Northern Ireland, December 2016: the benefits of cross-border collaboration and commercial sales data.

OBJECTIVES: To describe a cross-border foodborne outbreak of Shigella sonnei that occurred in Ireland and Northern Ireland (NI) in December 2016 whilst also highlighting the valuable roles of sales data and international collaboration in the investigation and control of this outbreak. STUDY DESIGN: A cross-border outbreak control team was established to investigate the outbreak. METHODS: Epidemiological, microbiological, and environmental investigations were undertaken. Traditional analytical epidemiological studies were not feasible in this investigation. The restaurant chain provided sales data, which allowed assessment of a possible increased risk of illness associated with exposure to a particular type of heated food product (product A). RESULTS: Confirmed cases demonstrated sole trimethoprim resistance: an atypical antibiogram for Shigella isolates in Ireland. Early communication and the sharing of information within the outbreak control team facilitated the early detection of the international dimension of this outbreak. A joint international alert using the European Centre for Disease Control's confidential Epidemic Intelligence Information System for Food- and Waterborne Diseases and Zoonoses (EPIS-FWD) did not reveal further cases outside of the island of Ireland. The outbreak investigation identified that nine of thirteen primary case individuals had consumed product A from one of multiple branches of a restaurant chain located throughout the island of Ireland. Product A was made specifically for this chain in a food production facility in NI. S. sonnei was not detected in food samples from the food production facility. Strong statistical associations were observed between visiting a branch of this restaurant chain between 5 and 9 December 2016 and eating product A and developing shigellosis. CONCLUSIONS: This outbreak investigation highlights the importance of international collaboration in the efficient identification of cross-border foodborne outbreaks and the value of using sales data as the analytical component of such studies.

A Cluster of Hepatitis A Viral Infection in HSE South.

Hepatitis A is an acute viral infection of the liver that produces clinical features ranging from asymptomatic infection to fulminant hepatitis1. The authors report a cluster of 5 serologically-confirmed cases of acute Hepatitis A Virus (HAV), all serum IgM positive for HAV Genotype 1A. This is on a background of only 2 other cases notified to HSE-South in 2016 to date, both travel related. There was a considerable delay in notification in two out of 5 cases. This case report highlights the importance of prompt notification of Hepatitis A, as timely notification would have facilitated prompt contact vaccination and might well have prevented illness in two subsequent household contacts.

Investigation and management of an outbreak of Salmonella Typhimurium DT8 associated with duck eggs, Ireland 2009 to 2011.

Salmonella Typhimurium DT8 was a very rare cause of human illness in Ireland between 2000 and 2008, with only four human isolates from three patients being identified. Over a 19-month period between August 2009 and February 2011, 34 confirmed cases and one probable case of Salmonella Typhimurium DT8 were detected, all of which had an MLVA pattern 2-10-NA-12-212 or a closely related pattern. The epidemiological investigations strongly supported a linkbetween illness and exposure to duck eggs. Moreover, S. Typhimurium with an MLVA pattern indistinguishable (or closely related) to the isolates from human cases, was identified in 22 commercial and backyard duck flocks, twelve of which were linked with known human cases. A range of control measures were taken at farm level, and advice was provided to consumers on the hygienic handling and cooking of duck eggs. Although no definitive link was established with a concurrent duck egg-related outbreak of S. Typhimurium DT8 in the United Kingdom, it seems likely that the two events were related. It may be appropriate for other countries with a tradition of consuming duck eggs to consider the need for measures to reduce the risk of similar outbreaks.

Continued raw milk consumption on farms: why?

The potential dangers associated with drinking unpasteurized milk have been highlighted over recent years. Nevertheless, the vast majority of Irish farming families persist in the practice. This qualitative study was undertaken to ascertain the reasons why. It was found that farmers generally believe their milk to be risk free on the basis of 'routine' test results. They also believe it to be of better quality than pasteurised milk, in addition to being the cheaper option. Adherence to tradition is another factor. The targeting of a more informed, credible public health message which takes account of commonly held, and understandable, views among the farming community is proposed.

Self-perceived health status of Irish breast cancer survivors.

BACKGROUND: There is a paucity of data on the health status of breast cancer survivors. AIMS: To measure the self-perceived health status of a cohort of breast cancer survivors by means of the SF-36 questionnaire. METHODS: The questionnaire was administered to 120 survey participants. Findings were compared with those of an external comparison group. RESULTS: The health status of the survey participants was found to be significantly better than that of the comparison group on four of the eight SF-36 dimensions--social functioning, mental health, vitality and general health perceptions. CONCLUSIONS: The self-perceived health status of breast cancer survivors merits further research in the Irish context. Inclusion of the SF-36 questionnaire as an outcome measure is recommended.

Quality control of multichannel haematology analysers: critique of current methods and the need for performance goals.

Performance goals for internal quality control of multichannel haematology analysers have been developed by consensus in the Subcommittee on Quantitative Cellular Haematology of the National Committee of Clinical Laboratory Standards (NCCLS). Conventional methods of quality control (i.e. use of standards for machine calibration and control samples to detect drift) are not feasible for the automated complete blood-cell count because standards and generally accepted reference methods for cell enumeration are not currently available. In the absence of an ideal system, a host of different quality control strategies are utilized with fresh whole blood, stabilized blood preparations, commercial surrogate materials, and statistical functions of measurements on patient specimens. All have their theoretical strengths and weaknesses which, up to now, have been difficult to quantify and to compare experimentally between methods and between laboratories. Performance goals, or what have been judged by a consensus of experts to be achievable tolerance limits for the various sources of analytical variations, were determined for the following measurements: haemoglobin concentration, erythrocyte count, leukocyte count, platelet count, and mean cell volume. These performance goals can be used to compare the effectiveness of the various quality control strategies now used and to determine which strategy would perform best and be most cost-effective in a particular laboratory situation.

Changing technologies in the reference laboratory.

Changes in technology will have a profound impact on specialized reference laboratories. In their research and development efforts, reference laboratories will have to pursue the incorporation of the technologies of molecular and cell biology into clinical practice. Computers can be applied to the management of clinical laboratory data bases and to the organization of scientific and clinical knowledge for medical consultation. Because of the distance between the site of acquisition of referred specimens and the laboratory, research on analyte stability is needed. Computer networking will help to solve problems of inadequacy of clinical information, and bar code technology will address the problems of specimen identification. Finally, improved telecommunication will permit reference laboratories of the future to be true medical consultation centers rather than just technical analysis operations.

Investigation of statistical decision rules for sequential hematologic laboratory tests.

A statistical data processing program for identifying patients who are likely to have abnormalities on various hematologic laboratory tests is described. The prediction of abnormal levels of serum vitamin B12, serum folate, transferrin saturation, and reticulocyte counts is based on a statistical analysis of the patient's age, sex, and routine blood cell measurements. The program was developed using data from normal-value studies and data from patients who had these laboratory abnormalities. The sensitivity and specificity of the program were evaluated in a controlled prospective study of about 5,000 ambulatory adult patients. The program's predictions also were compared with the laboratory tests requested by the patients' attending physicians. The program was most sensitive for predicting low serum vitamin B12 (74%) and low transferrin saturation (78%). In the prospective evaluation, the predictive values varied from 11% for predicting low serum folate to 65% for predicting low transferrin saturation.

The prediction of prothrombin time system performance using secondary standards.

A method for the comparison of prothrombin time systems using single large lots of lyophilized plasma in the College of American Pathologists Surveys is presented. Systematic biases for prothrombin time methods as well as for thromboplastins have been measured, and their use allows a very accurate (within 2.25%) prediction of the prothrombin time for the great number of prothrombin time systems presently being used in the United States.

Routine erythrocyte measurements in diagnosis of iron-deficiency anemia and thalassemia minor.

A study was made of the routine electronic measurements of erythrocyte size and hemoglobin concentration in blood samples from 122 patients with decreased transferrin saturation and 66 patients with elevated levels of hemoglobin A2 or F. The medical histories of these patients were reviewed to identify 52 cases of uncomplicated iron-deficiency anemia and 39 cases of uncomplicated thalassemia minor. Four decision functions were compared for separating these two disorders. The functions evaluated were: D.F'. = MCV--[5 X Hb]-RBC; ratio MCV/RBC; ratio MCH/RBC, and RBC. The rules performed better in the uncomplicated cases than in the routine laboratory defined cases. Only minor differences in the performances of the various decision functions were observed. None was sufficiently accurate for final diagnosis, but they should have value in screening patients and in determining which additional test should be considered.