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1.
Euro Surveill ; 22(36)2017 Sep 07.
Artículo en Inglés | MEDLINE | ID: mdl-28920571

RESUMEN

The first documented British outbreak of Shiga toxin-producing Escherichia coli (STEC) O55:H7 began in the county of Dorset, England, in July 2014. Since then, there have been a total of 31 cases of which 13 presented with haemolytic uraemic syndrome (HUS). The outbreak strain had Shiga toxin (Stx) subtype 2a associated with an elevated risk of HUS. This strain had not previously been isolated from humans or animals in England. The only epidemiological link was living in or having close links to two areas in Dorset. Extensive investigations included testing of animals and household pets. Control measures included extended screening, iterative interviewing and exclusion of cases and high risk contacts. Whole genome sequencing (WGS) confirmed that all the cases were infected with similar strains. A specific source could not be identified. The combination of epidemiological investigation and WGS indicated, however, that this outbreak was possibly caused by recurrent introductions from a local endemic zoonotic source, that a highly similar endemic reservoir appears to exist in the Republic of Ireland but has not been identified elsewhere, and that a subset of cases was associated with human-to-human transmission in a nursery.


Asunto(s)
Brotes de Enfermedades , Infecciones por Escherichia coli/epidemiología , Síndrome Hemolítico-Urémico/epidemiología , Escherichia coli Shiga-Toxigénica/genética , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Enfermedades Transmisibles Emergentes , ADN Bacteriano/genética , Inglaterra/epidemiología , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/microbiología , Proteínas de Escherichia coli/genética , Síndrome Hemolítico-Urémico/diagnóstico , Síndrome Hemolítico-Urémico/microbiología , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Recurrencia , Análisis de Secuencia de ADN , Serogrupo , Toxina Shiga II/genética
2.
Euro Surveill ; 22(19)2017 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-28537550

RESUMEN

Invasive group A streptococcal infection has a 15% case fatality rate and a risk of secondary transmission. This retrospective study used two national data sources from England; enhanced surveillance (2009) and a case management system (2011-2013) to identify clusters of severe group A streptococcal disease. Twenty-four household pairs were identified. The median onset interval between cases was 2 days (range 0-28) with simultaneous onset in eight pairs. The attack rate during the 30 days after first exposure to a primary case was 4,520 per 100,000 person-years at risk (95% confidence interval (CI): 2,900-6,730) a 1,940 (95% CI: 1,240-2,880) fold elevation over the background incidence. The theoretical number needed to treat to prevent one secondary case using antibiotic prophylaxis was 271 overall (95% CI: 194-454), 50 for mother-neonate pairs (95% CI: 27-393) and 82 for couples aged 75 years and over (95% CI: 46-417). While a dramatically increased risk of infection was noted in all household contacts, increased risk was greatest for mother-neonate pairs and couples aged 75 and over, suggesting targeted prophylaxis could be considered. Offering prophylaxis is challenging due to the short time interval between cases emphasising the importance of immediate notification and assessment of contacts.


Asunto(s)
Profilaxis Antibiótica/métodos , Vigilancia de la Población/métodos , Infecciones Estreptocócicas/prevención & control , Infecciones Estreptocócicas/transmisión , Streptococcus pyogenes/aislamiento & purificación , Adolescente , Transmisión de Enfermedad Infecciosa/prevención & control , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Inglaterra/epidemiología , Composición Familiar , Femenino , Humanos , Incidencia , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/fisiología , Virulencia
3.
Vaccine ; 32(36): 4681-8, 2014 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-24996125

RESUMEN

In January-March 2013 in England, confirmed measles cases increased in children aged 10-16 years. In April-September 2013, the National Health System and Public Health England launched a national measles-mumps-rubella (MMR) campaign based on data from Child Health Information Systems (CHIS) estimating that approximately 8% in this age group were unvaccinated. We estimated coverage at baseline, and, of those unvaccinated (target), the proportion vaccinated up to 20/08/2013 (mid-point) to inform further public health action. We selected a sample of 6644 children aged 10-16 years using multistage sampling from those reported unvaccinated in CHIS at baseline and validated their records against GP records. We adjusted the CHIS MMR vaccine coverage estimates correcting by the proportion of vaccinated children obtained through sample validation. We validated 5179/6644 (78%) of the sample records. Coverage at baseline was estimated as 94.7% (95% confidence intervals, CI: 93.5-96.0%), lower in London (86.9%, 95%CI: 83.0-90.9%) than outside (96.1%, 95%CI 95.5-96.8%). The campaign reached 10.8% (95%CI: 7.0-14.6%) of the target population, lower in London (7.1%, 95%CI: 4.9-9.3) than in the rest of England (11.4%, 95%CI: 7.0-15.9%). Coverage increased by 0.5% up to 95.3% (95% CI: 94.1-96.4%) but an estimated 210,000 10-16 year old children remained unvaccinated nationally. Baseline MMR coverage was higher than previously reported and was estimated to have reached the 95% campaign objective at midpoint. Eleven per cent of the target population were vaccinated during the campaign, and may be underestimated, especially in London. No further national campaigns are needed but targeted local vaccination activities should be considered.


Asunto(s)
Programas de Inmunización/estadística & datos numéricos , Vacuna contra el Sarampión-Parotiditis-Rubéola/uso terapéutico , Sarampión/prevención & control , Paperas/prevención & control , Rubéola (Sarampión Alemán)/prevención & control , Adolescente , Niño , Inglaterra , Encuestas Epidemiológicas , Humanos , Salud Pública
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