Tracking and responding to an outbreak of tuberculosis using MIRU-VNTR genotyping and whole genome sequencing as epidemiological tools.

Background: We describe an outbreak that contributed to a near doubling of the incidence of tuberculosis in Southampton, UK. We examine the importance of 24 locus mycobacterial interspersed repetitive unit variable number tandem repeat (MIRU-VNTR) genotyping in its identification and management and the role of whole genome sequencing (WGS) in tracing the spread of the strain. Methods: Outbreak cases were defined as those diagnosed between January and December 2011 with indistinguishable 24 locus-MIRU-VNTR genotypes or, cases linked epidemiologically. A cluster questionnaire was administered by TB nurses to identify contacts and social settings. Results: Overall, 25 patients fulfilled the case definition. No cases with this MIRU-VNTR genotype had been detected in the UK previously. Connections were found between all cases through household contacts or social venues including a football club, Internet cafe and barber's shop. Public health actions included extended contact tracing, venue screening and TB awareness-raising. The outbreak resulted in a high rate of transmission and high incidence of clinical disease among contacts. Conclusions: This outbreak illustrates the value of combining active case-finding with prospective MIRU-VNTR genotyping to identify settings to undertake public health action. In addition WGS revealed that the VNTR-defined cluster was a single outbreak and that active TB transmission not reactivation was responsible for this outbreak in non-UK born individuals.

Improving food provision in child care in England: a stakeholder analysis.

OBJECTIVE: To review national policy governing nutrition in child-care settings and explore policy translation at a regional and local level in the South East of England. DESIGN: Semi-structured interviews with regional experts. SETTING: Child-care settings in Southampton, England, registered by OFSTED (Office for Standards in Education Children's Services and Skills). SUBJECTS: Thirteen subjects including child-care professionals in Southampton and policy advisors from the Government Office of the South East. RESULTS: Policy regarding early years food provision varies across the country. Although there appears to be consensus between local stakeholders on the importance of improving early years nutrition in Southampton, intentions have yet to be translated into cohesive action, with differences in food and nutrition practice in child-care settings across the city. There are also areas of incoherence, inequalities in access to training and development, and duplication in local and regional support mechanisms. CONCLUSIONS: The importance of proper early nutrition to provide the building blocks for life-long health and well-being is grounded in a substantial evidence base. Outside the home, early years child-care settings are an ideal place for providing a strong foundation in nutritional health and dietary habits for young children. The long-term benefits of achieving optimum nutrition in the early years should be secured through the coherent efforts of national, regional and local policy makers, child-care practitioners and parents. Existing commitment and capacity to achieve this objective at a local and regional level must be supported and matched at a national level with the acceleration of policy development, including quality control and support mechanisms.