A large outbreak of measles in the West Midlands, England, 2017-2018: descriptive epidemiology, control measures and lessons learnt.

In November 2017, eight confirmed measles cases were reported to Public Health England from a hospital in the West Midlands. A multidisciplinary Incident Management Team (IMT) was established to determine the extent of the problem and coordinate an outbreak response. Between 1 November 2017 and 4 June 2018, a total of 116 confirmed and 21 likely measles cases were linked to this outbreak; just under half (43%) were aged over 15 years of age. Fifty-five of the confirmed cases were hospitalised (48%) and no deaths were reported. At the start of the outbreak, cases were mostly individuals of Romanian origin; the outbreak subsequently spread to the wider population. Over the 8-month response, the IMT conducted the following control measures: extensive contact tracing, immediate provision of post-exposure prophylaxis, community engagement amongst specific high-risk groups, MMR awareness raising including catch-up campaigns and enhanced vaccination services at selected GP surgeries. Key challenges to the effective control measures included language difficulties limiting community engagement; delays in diagnosis, notification and appropriate isolation of cases; limited resources for contact tracing across multiple high-risk settings (including GPs and hospitals) and lack of timely data on vaccine coverage in sub-groups of the population to guide public health action.

Prospective use of whole genome sequencing (WGS) detected a multi-country outbreak of Salmonella Enteritidis.

Since April 2015, whole genome sequencing (WGS) has been the routine test for Salmonella identification, surveillance and outbreak investigation at the national reference laboratory in England and Wales. In May 2015, an outbreak of Salmonella Enteritidis cases was detected using WGS data and investigated. UK cases were interviewed to obtain a food history and links between suppliers were mapped to produce a food chain network for chicken eggs. The association between the food chain network and the phylogeny was explored using a network comparison approach. Food and environmental samples were taken from premises linked to cases and tested for Salmonella. Within the outbreak single nucleotide polymorphism defined cluster, 136 cases were identified in the UK and 18 in Spain. One isolate from a food containing chicken eggs was within the outbreak cluster. There was a significant association between the chicken egg food chain of UK cases and phylogeny of outbreak isolates. This is the first published Salmonella outbreak to be prospectively detected using WGS. This outbreak in the UK was linked with contemporaneous cases in Spain by WGS. We conclude that UK and Spanish cases were exposed to a common source of Salmonella-contaminated chicken eggs.

Isolation and characterisation of intestinal spirochaetes.

Faeces or rectal swabs from 1527 subjects were examined for the presence of intestinal spirochaetes by anaerobic culture on blood agar incorporating spectinomycin (400 mg/l). Twenty three specimens (1.5%) were positive, and only one of these came from a patient with diarrhoea. All positive specimens came from either Asians or known homosexuals. Comparative tests showed a close phenotypic similarity between the human isolates and non-pathogenic porcine intestinal spirochaetes. These organisms differ from Brachyspira aalborgi, a spirochaete isolated from subjects with histologically confirmed intestinal spirochaetosis.

"Agrobacterium yellow group" and Pseudomonas paucimobilis causing peritonitis in patients receiving continuous ambulatory peritoneal dialysis.

Five cases of peritonitis occurred during continuous ambulatory peritoneal dialysis in which unusual yellow pigmented Gram negative bacteria were isolated in pure culture. Four of these isolates were identified as the so called "Agrobacterium yellow group." The remaining isolate was identified as Pseudomonas paucimobilis, an organism closely related to the Agrobacterium yellow group.

Comparison of direct immunofluorescence and cell culture for detecting Chlamydia trachomatis.

Conventional cell culture methods were compared with a direct immunofluorescence test (MicroTrak, Syva UK, Maidenhead, Berkshire) to detect Chlamydia trachomatis in 137 patients (126 women, 11 men) attending a sexually transmitted diseases (STD) clinic. Results obtained by the two tests agreed in 87.6% of cases. Of 34 positive specimens, 17 were detected by culture and fluorescence, 15 by fluorescence only, and two by culture only. The excess of specimens that were negative on culture but positive on fluorescence might be accounted for by delays in culture (up to 18 hours). The MicroTrak test appears to be of value in peripheral hospitals that have to rely on transporting specimens to larger centres for culture.

Psicoterapia psicoanalítica de grupo

Los autores estudian en este libro la psicoterapia de grupo ilustrando sus hallazgos con material clínico de grupos de niños y adultos tratados. Se definen como psicoterapuetas de grupo, consideran el grupo como un todo sin adoptar un enfoque radical. No ven en el grupo un nuevo organismo sino un "todo social" que es más que la suma de sus partes. Sostienen que la transferencia no se desarrolla con la misma intensidad en el grupo que en el análisis individual, por lo cual para las neurosis de transferencia recomiendan el psicoanálisis