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1.
J Med Microbiol ; 69(3): 419-426, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31999240

RESUMEN

Introduction. Current testing practices for yersiniosis mean that its true incidence and epidemiology are not well understood. In mid-2016, the introduction of testing via a multiplex gastrointestinal PCR panel at Portsmouth hospital laboratory in Hampshire, UK, resulted in a marked increase in the number of Yersinia cases identified locally.Aim. Here we describe the epidemiology and microbiology of Yersinia cases identified at Portsmouth laboratory following the introduction of PCR testing.Methodology. A case was defined as a person with a stool specimen in which Yersinia was detected by PCR and/or culture at Portsmouth NHS Trust laboratory between 1 January 2014 and 31 December 2018. A case list was created from laboratory data submitted by Portsmouth laboratory to Public Health England (PHE), updated with speciation and serotyping data from the PHE reference laboratory. Descriptive analysis was performed.Results. Over 30 months following introduction of PCR testing, 199 cases were confirmed with Yersinia, compared to two cases in the preceding 30 months. This corresponds to a rate of 13.8 and 0.1 per 100 000 population per year respectively (P<0.0001). In total, 85% of tested isolates were Y. enterocolitica, belonging to multiple serotypes, and the rest belonged to a range of Y. enterocolitica-like species.Conclusions. Introduction of PCR testing led to the identification of a previously unrecognized burden of yersiniosis in Hampshire. The diversity of species and serotypes suggests heterogeneity in sources and transmission routes. Further research on exposures, risk factors and clinical sequalae is needed to improve our understanding of the clinical and public health impact.


Asunto(s)
Brotes de Enfermedades , Gastroenteritis/epidemiología , Yersiniosis/epidemiología , Yersinia enterocolitica/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Inglaterra/epidemiología , Femenino , Gastroenteritis/microbiología , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Salud Pública , Yersiniosis/microbiología , Yersinia enterocolitica/genética , Adulto Joven
2.
Vaccine ; 36(31): 4687-4692, 2018 07 25.
Artículo en Inglés | MEDLINE | ID: mdl-29945834

RESUMEN

INTRODUCTION: Due to regular vaccine preventable disease outbreaks and sub-optimal immunisation uptake in the London borough of Hackney, home to the largest Charedi Orthodox Jewish community in Europe, it was decided, in consultation with the community, to implement the WHO Tailoring Immunization Programmes approach (TIP). DESIGN: The WHO Tailoring Immunization Programmes (TIP) approach was used. TIP provides a framework based on behavioural insights methodology to identify populations susceptible to vaccine preventable diseases, diagnose supply and demand side barriers and enablers to vaccination and recommend evidence-informed responses to improve vaccination coverage. RESULTS: The results of the formative research and behavioural analysis challenged the assumption that a cultural or religious anti-vaccination sentiment existed within the community. Critical issues related to access to and convenience of immunisation services. Service providers in the area have challenges due to having to deliver immunisation services to the large numbers of children without additional resource. Where mothers were choosing to delay or refuse vaccinations their reasons were broadly similar to the wider population. The behavioural analysis identified potential categorisation of subgroups within the community enabling a more tailored approach to addressing concerns and meeting parents' needs. CONCLUSION: The TIP approach was an effective way of investigating factors linked to sub-optimal immunisation within the Charedi community. The use of behavioural insights enabled the categorisation of subgroups so that more targeted interventions could be developed. The comprehensive stakeholder engagement which is a key pillar of the TIP approach ensured a deeper understanding of the barriers and enablers to vaccination as well as increasing the level of ownership in the community. TIP should be considered as a useful approach to identify main facilitators and barriers to vaccination in communities with suboptimal immunisation uptake.


Asunto(s)
Esquemas de Inmunización , Aceptación de la Atención de Salud , Cobertura de Vacunación , Vacunación/psicología , Vacunas/administración & dosificación , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Judíos , Londres , Masculino , Padres , Encuestas y Cuestionarios
3.
Euro Surveill ; 22(29)2017 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-28749334

RESUMEN

In the United Kingdom, pertussis guidance recommends prophylaxis for household contacts within 21 days of case symptom onset if the household includes a vulnerable contact. The aim of our study was to identify characteristics associated with cases reported late for public health action. We reviewed the epidemiology of cases reported in London and South East England for the period 2010 to 2015. We characterised risk factors associated with late reporting of cases and described public health actions taken on timely reported cases. From 2010 to 2015, 9,163 cases of pertussis were reported to health protection teams. Only 11% of cases were reported within 21 days of onset, limiting opportunities for secondary prevention. Timely reporting was associated with younger age groups, pregnancy, being a healthcare worker and being reported by schools or hospital clinicians. Late reporting was associated with older age groups and general practitioner or laboratory reporting. Delays, such as those due to insidious onset and late presentation to healthcare, may be unavoidable; however, delay in reporting once a patient presents can be reduced since cases can be reported before laboratory confirmation. Thus we recommend working with clinicians and laboratories to determine causes and improve early reporting to public health.


Asunto(s)
Notificación de Enfermedades/estadística & datos numéricos , Salud Pública , Tos Ferina/diagnóstico , Niño , Preescolar , Inglaterra/epidemiología , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Londres , Masculino , Análisis Multivariante , Estudios Retrospectivos , Factores de Tiempo , Tos Ferina/epidemiología , Tos Ferina/prevención & control
4.
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
5.
Travel Med Infect Dis ; 17: 35-42, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28456684

RESUMEN

BACKGROUND: We describe trends of malaria in London (2000-2014) in order to identify preventive opportunities and we estimated the cost of malaria admissions (2009/2010-2014/2015). METHODS: We identified all cases of malaria, resident in London, reported to the reference laboratory and obtained hospital admissions from Hospital Episode Statistics. RESULTS: The rate of malaria decreased (19.4[2001]-9.1[2014] per 100,000). Males were over-represented (62%). Cases in older age groups increased overtime. The rate was highest amongst people of Black African ethnicity followed by Indian, Pakistani, Bangladeshi ethnicities combined (103.3 and 5.5 per 100,000, respectively). The primary reason for travel was visiting friends and relatives (VFR) in their country of origin (69%), mostly sub-Saharan Africa (92%). The proportion of cases in VFRs increased (32%[2000]-50%[2014]) and those taking chemoprophylaxis decreased (36%[2000]-14%[2014]). The overall case fatality rate was 0.3%. We estimated the average healthcare cost of malaria admissions to be just over £1 million per year. CONCLUSION: Our study highlighted that people of Black African ethnicity, travelling to sub-Saharan Africa to visit friends and relatives in their country of origin remain the most affected with also a decline in chemoprophylaxis use. Malaria awareness should focus on this group in order to have the biggest impact but may require new approaches.


Asunto(s)
Malaria , Viaje/estadística & datos numéricos , Adolescente , Adulto , África del Sur del Sahara/etnología , Antimaláricos/uso terapéutico , Quimioprevención/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Londres/epidemiología , Malaria/tratamiento farmacológico , Malaria/economía , Malaria/epidemiología , Malaria/etnología , Masculino , Persona de Mediana Edad , Adulto Joven
6.
Thorax ; 71(8): 742-8, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-25920328

RESUMEN

BACKGROUND: Information on geographical variation in localised transmission of TB can inform targeting of disease control activities. The aim of this study was to estimate the proportion of TB attributable to localised transmission for the period 2010-2012 in northern England and to identify case characteristics associated with spatiotemporal-genotypical clusters. METHODS: We combined genotyping data with spatiotemporal scan statistics to define an indicator of localised TB transmission and identified factors associated with localised TB transmission thus defined in a multivariable logistics regression model. RESULTS: The estimated proportion of TB cases in northern England attributable to localised transmission was 10% (95% CI 9% to 12%). Clustered cases (cases which were spatiotemporally clustered with others of identical genotype) were on average younger than non-clustered cases (mean age 34 years vs 43 years; p value <0.05). Being UK born (adjusted OR (aOR) 3.6, 95% CI 2.9 to 6.0), presenting with pulmonary disease (aOR 2.2, 95% CI 1.3 to 3.6) and history of homelessness (aOR 2.8, 95% CI 1.2 to 6.8) or incarceration (aOR 2.6, 95% CI 1.2 to 5.9) were independently associated with being part of a spatiotemporal-genotypical cluster in a multivariable model. Belonging to an ethnic group other than white or mixed/other was also significantly associated with localised transmission. We identified localised transmission in 103/1958 middle super output areas mostly in urban areas. CONCLUSIONS: Incorporating highly discriminatory genotyping data into spatiotemporal analysis of TB incidence is feasible as part of routine surveillance and can provide valuable information on groups at greater risk and areas with localised transmission of TB, which could be used to inform control measures, such as intensified contact tracing.


Asunto(s)
Mycobacterium tuberculosis/genética , Tuberculosis Pulmonar/transmisión , Adulto , Estudios Transversales , Inglaterra , Estudios de Factibilidad , Genotipo , Humanos , Incidencia , Mycobacterium tuberculosis/aislamiento & purificación , Factores de Riesgo , Análisis Espacio-Temporal , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/microbiología , Tuberculosis Pulmonar/prevención & control
7.
J Infect Dis ; 211(1): 80-90, 2015 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-25030060

RESUMEN

BACKGROUND: Administration of convalescent plasma, serum, or hyperimmune immunoglobulin may be of clinical benefit for treatment of severe acute respiratory infections (SARIs) of viral etiology. We conducted a systematic review and exploratory meta-analysis to assess the overall evidence. METHODS: Healthcare databases and sources of grey literature were searched in July 2013. All records were screened against the protocol eligibility criteria, using a 3-stage process. Data extraction and risk of bias assessments were undertaken. RESULTS: We identified 32 studies of SARS coronavirus infection and severe influenza. Narrative analyses revealed consistent evidence for a reduction in mortality, especially when convalescent plasma is administered early after symptom onset. Exploratory post hoc meta-analysis showed a statistically significant reduction in the pooled odds of mortality following treatment, compared with placebo or no therapy (odds ratio, 0.25; 95% confidence interval, .14-.45; I(2) = 0%). Studies were commonly of low or very low quality, lacked control groups, and at moderate or high risk of bias. Sources of clinical and methodological heterogeneity were identified. CONCLUSIONS: Convalescent plasma may reduce mortality and appears safe. This therapy should be studied within the context of a well-designed clinical trial or other formal evaluation, including for treatment of Middle East respiratory syndrome coronavirus CoV infection.


Asunto(s)
Inmunoglobulinas/administración & dosificación , Inmunoglobulinas/inmunología , Plasma/inmunología , Síndrome Respiratorio Agudo Grave/tratamiento farmacológico , Síndrome Respiratorio Agudo Grave/inmunología , Humanos , Gripe Humana/tratamiento farmacológico , Gripe Humana/inmunología , Estudios Prospectivos , Infecciones del Sistema Respiratorio/inmunología , Riesgo , Virus del SRAS/inmunología
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