Outbreak of Clostridium perfringens food poisoning linked to leeks in cheese sauce: an unusual source.

Between 11-13 December 2018, local public health authorities in the West Midlands, England were alerted to 34 reports of diarrhoea with abdominal cramps. Symptom onset was ~10 h after diners ate Christmas meals at a restaurant between 7-9 December 2018. A retrospective case-control study, environmental and microbiological investigations were undertaken to determine the source and control the outbreak. An analytical study was undertaken with odds ratios (OR) and 95% confidence intervals (CI). Forty persons were recruited to the analytical study (28/40 cases). Multivariable analysis found that leeks in cheese sauce was the only item associated with illness (aOR 51.1; 95% CI 4.13-2492.1). Environmental investigations identified significant lapses in food safety, including lapses in temperature control during cooking and hot holding, likely cross-contamination between raw and cooked foods and the reuse of leftover cheese sauce for the next day's service. No food samples were taken during the exposure period. Two faecal samples were positive for Clostridium perfringens with one confirming the enterotoxigenic gene. Cheese sauce is an unusual vehicle for the organism and the first time this has been reported in England.

Limiting worker exposure to highly pathogenic avian influenza a (H5N1): a repeat survey at a rendering plant processing infected poultry carcasses in the UK.

BACKGROUND: Current occupational and public health guidance does not distinguish between rendering plant workers and cullers/poultry workers in terms of infection risk in their respective roles during highly pathogenic avian influenza poultry outbreaks. We describe an operational approach to human health risk assessment decision making at a large rendering plant processing poultry carcasses stemming from two separate highly pathogenic avian influenza A (H5N1) outbreaks in England during 2007. METHODS: During the first incident a uniform approach assigned equal exposure risk to all rendering workers in or near the production line. A task based exposure assessment approach was adopted during the second incident based on a hierarchy of occupational activities and potential for infection exposure. Workers assessed as being at risk of infection were offered personal protective equipment; pre-exposure antiviral prophylaxis; seasonal influenza immunisation; hygiene advice; and health monitoring. A repeat survey design was employed to compare the two risk assessment approaches, with allocation of antiviral prophylaxis as the main outcome variable. RESULTS: Task based exposure assessment during the second incident reduced the number of workers assessed at risk of infection from 72 to 55 (24% reduction) when compared to the first incident. No cases of influenza like illness were reported in workers during both incidents. CONCLUSIONS: Task based exposure assessment informs a proportionate public health response in rendering plant workers during highly pathogenic avian influenza H5N1 outbreaks, and reduces reliance on extensive antiviral prophylaxis.

Rationalizing rationing in health care: experience of two primary care trusts.

BACKGROUND: Priority setting, or rationing, in healthcare is an unavoidable consequence of competing demands on the resources available. This is a description of the experience of the two Primary Care Trusts in using an explicit scoring tool to prioritize proposals submitted for new funding within the local health economy. METHODS: A Priorities Forum Panel was established, comprising representatives from the local NHS trusts. The Panel reviewed and scored new funding proposals and then ranked them for priority funding. RESULTS: Over 100 proposals were submitted (total cost: approximately 44 million pounds). Sixty-six proposals were scored (total cost: over 26 million pounds). Around 5 million pounds was available for funding, resulting in few of the top-scoring proposals being supported. The proposals which were linked to the implementation of National Institute for Health and Clinical Excellence (NICE) guidance were generally given a lower priority compared with those likely to relieve local pressures and facilitate the implementation of specific National Service Framework criteria. CONCLUSIONS: Funding of the locally driven priorities took precedence over some of the nationally driven priorities, such as funding of specific NICE guidance. The shortfall in resources did not allow for the funding of a significant number of high-scoring proposals.