Preliminary investigation of a significant national Cryptosporidium exceedance in the United Kingdom, August 2023 and ongoing.

Routine laboratory surveillance has identified an unprecedented and ongoing exceedance of Cryptosporidium spp. across the United Kingdom, notably driven by C. hominis transmission, since 14 August 2023. Information from 477 reported cases in England and Wales, followed up with a standardised exposure questionnaire as of 25 September 2023, identified foreign travel in 250 (54%) of 463 respondents and swimming in 234 (66%) of 353 cases. A significant, common exposure has not yet been identified in first analyses.

The effect of community water fluoridation on dental caries in children and young people in England: an ecological study.

BACKGROUND: The protective effect of community water fluoridation (CWF) against dental caries may be modified by secular changes in health behaviour. We aimed to determine the contemporary association between fluoride in public water supplies (PWS) and dental caries indicators and inequalities in England. METHODS: We estimated exposure to CWF and PWS fluoride concentrations from national monitoring data, using Geographic Information Systems and water supply boundaries, categorizing mean period exposure into <0.1, 0.1-<0.2, 0.2-<0.4, 0.4-<0.7 and ≥0.7 mg/l. We used area-level health outcome and confounder data in multivariable regression models to determine the association between fluoride and caries outcomes and calculated preventive fractions using these coefficients. RESULTS: The odds of caries and of severe caries in 5-year-olds fell with increasing fluoride concentration in all SES quintiles (P < 0.001 to P = 0.003). There was a negative trend between increasing fluoride concentration and dental extractions (P < 0.001). Compared to PWS with <0.2 mg/l, CWF prevented 17% (95% confidence interval (CI): 5-27%) to 28% (95% CI: 24-32%) of caries (high-low SES) and 56% (95% CI: 25-74%) of dental extractions. The association between fluoride concentration and caries prevalence/severity varied by socioeconomic status (SES) (P < 0.001). CONCLUSIONS: Exposure to fluoride in PWS appears highly protective against dental caries and reduces oral health inequalities.

An outbreak of Cryptosporidium parvum linked to pasteurised milk from a vending machine in England: a descriptive study, March 2021.

We describe the investigations and management of a Cryptosporidium parvum outbreak of linked to consumption of pasteurised milk from a vending machine. Multiple locus variable number of tandem repeats analysis was newly used, confirming that C. parvum detected in human cases was indistinguishable from that in a calf on the farm. This strengthened the evidence for milk from an on-farm vending machine as the source of the outbreak because of post-pasteurisation contamination. Bacteriological indicators of post-pasteurisation contamination persisted after the initial hygiene improvement notice. We propose that on-farm milk vending machines may represent an emerging public health risk.

Marine harmful algal blooms and human health: A systematic scoping review.

Exposure to harmful algal blooms (HABs) can lead to well recognised acute patterns of illness in humans. The objective of this scoping review was to use an established methodology and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting framework to map the evidence for associations between marine HABs and observed both acute and chronic human health effects. A systematic and reproducible search of publications from 1985 until May 2019 was conducted using diverse electronic databases. Following de-duplication, 5301 records were identified, of which 380 were included in the final qualitative synthesis. The majority of studies (220; 57.9%) related to Ciguatera Poisoning. Anecdotal and case reports made up the vast majority of study types (242; 63.7%), whereas there were fewer formal epidemiological studies (35; 9.2%). Only four studies related to chronic exposure to HABs. A low proportion of studies reported the use of human specimens for confirmation of the cause of illness (32; 8.4%). This study highlighted gaps in the evidence base including a lack of formal surveillance and epidemiological studies, limited use of toxin measurements in human samples, and a scarcity of studies of chronic exposure. Future research and policy should provide a baseline understanding of the burden of human disease to inform the evaluation of the current and future impacts of climate change and HABs on human health.

Outbreak of diarrhetic shellfish poisoning associated with consumption of mussels, United Kingdom, May to June 2019.

We report on six cases of diarrhetic shellfish poisoning following consumption of mussels harvested in the United Kingdom. Dinophysis spp. in the water column was found to have increased rapidly at the production site resulting in high levels of okadaic acid-group lipophilic toxins in the flesh of consumed mussels. Clinicians and public health professionals should remain aware of algal-derived toxins being a potential cause of illness following seafood consumption.

Qualitative study of Ebola screening at ports of entry to the UK.

INTRODUCTION: In response to the 2013-2016 West African outbreak of the Ebola virus disease (EVD), Public Health England introduced enhanced screening at major UK ports of entry. Our aim was to explore screeners' and screened travellers' perceptions of screening as part of an evaluation of the screening programme. METHODS: We undertook qualitative focus groups and semistructured interviews with screeners and travellers who had returned from affected countries before and after the introduction of screening in England. The study was conducted in two airports: one international rail terminal and one military airport. Research topic guides explored perceptions of the purpose and implementation of the process, potential improvements and reactions to screening. The data were analysed using the framework method. RESULTS: Twenty-four screeners participated in 4 focus groups (one for each port of entry) and 23 travellers participated in interviews. Three themes are presented: 'Context', 'Screeners' experience of the programme' and 'Screening purpose and experiences'. The programme was implemented rapidly, refined over time and adapted to individual ports. Screeners reported diverse experiences of screening including negative impacts on their normal roles, difficult interactions with passengers and pressure to identify positive EVD cases. Screening was considered unlikely to identify individuals with symptoms of EVD, and some participants suggested it was driven by political concerns rather than empirical evidence. The screening process was valued for its provision of information and reassurance. CONCLUSION: This qualitative study found that the UK EVD screening process was perceived to be acceptable to assess individual risk and provide information and advice to travellers. Future programmes should have clear objectives and streamlined processes to minimise disruption, tailored to the nature of the threat and developed with the needs of humanitarian workers as well as general travellers in mind.

Modelling the cost differential between healthy and current diets: the New Zealand case study.

BACKGROUND: Evidence on whether healthy diets are more expensive than current diets is mixed due to lack of robust methodology. The aim of this study was to develop a novel methodology to model the cost differential between healthy and current diets and apply it in New Zealand. METHODS: Prices of common foods were collected from 15 supermarkets, 15 fruit/vegetable stores and from the Food Price Index. The distribution of the cost of two-weekly healthy and current household diets was modelled using a list of commonly consumed foods, a set of min and max quantity/serves constraints for each, and food group and nutrient intakes based on dietary guidelines (healthy diets) or nutrition survey data (current diets). The cost differential between healthy and current diets was modelled for several diet, prices and policy scenarios. Acceptability of resulting meal plans was validated. RESULTS: The average cost of healthy household diets was $27 more expensive than the average cost of current diets, but 25.8% of healthy diets were cheaper than the average cost of current diets. This cost differential could be reduced if fruits and vegetables became exempt from Goods and Services Tax. Healthy diets were cheaper with an allowance for discretionary foods and more expensive when including takeaway meals. For Maori and Pacific households, healthy diets were on average $40 and $60 cheaper than current diets due to large energy intakes. Discretionary foods and takeaway meals contributed 30-40% to the average cost of current diets. CONCLUSION: Healthy New Zealand diets were on average more expensive than current diets, but one-quarter of healthy diets were cheaper than the average cost of current diets. The impact of diet composition, types of prices and policies on the cost differential was substantial. The methodology can be used in other countries to monitor the cost differential between healthy and current household diets.

Summer music and arts festivals as hot spots for measles transmission: experience from England and Wales, June to October 2016.

We report 52 cases of measles linked to music and arts festivals in England and Wales, between mid-June and mid-October 2016. Nearly half were aged 15 to 19 years. Several individuals who acquired measles at one festival subsequently attended another festival while infectious, resulting in multiple interlinked outbreaks. Transmission within festivals resulted in a geographical spread of cases nationally as well as internationally, which presents particular challenges for measles control.

Low hepatitis B testing among migrants: a cross-sectional study in a UK city.

BACKGROUND: In 2012, hepatitis B virus (HBV) testing of people born in a country with a prevalence of ≥2% was recommended in the UK. Implementation of this recommendation requires an understanding of prior HBV testing practice and coverage, for which there are limited data. AIM: To estimate the proportion of migrants tested for HBV and explore GP testing practices and barriers to testing. DESIGN AND SETTING: A cross-sectional study of (a) migrants for whom testing was recommended under English national guidance, living in Bristol, and registered with a GP in 2006-2013, and (b) GPs practising in Bristol. METHOD: NHS patient demographic data and HBV laboratory surveillance data were linked. A person was defined as 'HBV-tested' if a laboratory result was available. An online GP survey was undertaken, using a structured questionnaire. RESULTS: Among 82 561 migrants for whom HBV testing was recommended, 9627 (12%) were 'HBV-tested'. The HBV testing coverage was: Eastern Africa 20%; Western Africa 15%; South Eastern Asia 9%; Eastern Asia 5%. Of 19 GPs, the majority did not use guidelines to inform HBV testing in migrants and did not believe routine testing of migrants was indicated; 12/17 GPs stated that workload and lack of human, and financial resources were the most significant barriers to increased testing. CONCLUSION: The majority of migrants to a multicultural UK city from medium-/high-prevalence regions have no evidence of HBV testing. Much greater support for primary care in the UK and increased GP awareness of national guidance are required to achieve adherence to current testing guidance.

The hyper-envelope modeling interface (HEMI): a novel approach illustrated through predicting tamarisk (Tamarix spp.) habitat in the Western USA.

Habitat suitability maps are commonly created by modeling a species' environmental niche from occurrences and environmental characteristics. Here, we introduce the hyper-envelope modeling interface (HEMI), providing a new method for creating habitat suitability models using Bezier surfaces to model a species niche in environmental space. HEMI allows modeled surfaces to be visualized and edited in environmental space based on expert knowledge and does not require absence points for model development. The modeled surfaces require relatively few parameters compared to similar modeling approaches and may produce models that better match ecological niche theory. As a case study, we modeled the invasive species tamarisk (Tamarix spp.) in the western USA. We compare results from HEMI with those from existing similar modeling approaches (including BioClim, BioMapper, and Maxent). We used synthetic surfaces to create visualizations of the various models in environmental space and used modified area under the curve (AUC) statistic and akaike information criterion (AIC) as measures of model performance. We show that HEMI produced slightly better AUC values, except for Maxent and better AIC values overall. HEMI created a model with only ten parameters while Maxent produced a model with over 100 and BioClim used only eight. Additionally, HEMI allowed visualization and editing of the model in environmental space to develop alternative potential habitat scenarios. The use of Bezier surfaces can provide simple models that match our expectations of biological niche models and, at least in some cases, out-perform more complex approaches.

Using habitat suitability models to target invasive plant species surveys.

Managers need new tools for detecting the movement and spread of nonnative, invasive species. Habitat suitability models are a popular tool for mapping the potential distribution of current invaders, but the ability of these models to prioritize monitoring efforts has not been tested in the field. We tested the utility of an iterative sampling design (i.e., models based on field observations used to guide subsequent field data collection to improve the model), hypothesizing that model performance would increase when new data were gathered from targeted sampling using criteria based on the initial model results. We also tested the ability of habitat suitability models to predict the spread of invasive species, hypothesizing that models would accurately predict occurrences in the field, and that the use of targeted sampling would detect more species with less sampling effort than a nontargeted approach. We tested these hypotheses on two species at the state scale (Centaurea stoebe and Pastinaca sativa) in Wisconsin (USA), and one genus at the regional scale (Tamarix) in the western United States. These initial data were merged with environmental data at 30-m2 resolution for Wisconsin and 1-km2 resolution for the western United States to produce our first iteration models. We stratified these initial models to target field sampling and compared our models and success at detecting our species of interest to other surveys being conducted during the same field season (i.e., nontargeted sampling). Although more data did not always improve our models based on correct classification rate (CCR), sensitivity, specificity, kappa, or area under the curve (AUC), our models generated from targeted sampling data always performed better than models generated from nontargeted data. For Wisconsin species, the model described actual locations in the field fairly well (kappa = 0.51, 0.19, P < 0.01), and targeted sampling did detect more species than nontargeted sampling with less sampling effort (chi2 = 47.42, P < 0.01). From these findings, we conclude that habitat suitability models can be highly useful tools for guiding invasive species monitoring, and we support the use of an iterative sampling design for guiding such efforts.

Chinese scholars call for AIDS rules based on respect for individual rights.

In June 2002, the UN Theme Group on HIV/AIDS in China published a comprehensive situation analysis and needs assessment of the HIV/AIDS epidemic in the People's Republic of China (PRC). The report, entitled "HIV/AIDS: China's Titanic Peril", also describes and analyzes current HIV/AIDS legislation and policies. It notes that "laws and regulations that are based on fear and prejudice have contributed to fuelling the epidemic instead of curbing it." The report observes that the targets and goals established in China's five-year Plan of Action (2001-2005) are not consistent with the commitments endorsed in June 2001 at the United Nations General Assembly Special Session on HIV/AIDS. It states that the Plan "continues to present HIV/AIDS as a medical problem, and fails to understand the epidemic as a broader development issue." Even where laws could assist, enforcement remains a huge challenge. For example, in 1998 the National People's Congress passed a law prohibiting commercial blood donations for medical purposes. Nonetheless, the illicit and unregulated blood trade, which has rapidly accelerated the spread of HIV infection in China, has continued. When the alarm was sounded by Dr. Wan Yanhai, coordinator of the AIZHI (AIDS) Action Project, the government response was to arrest him. In the following article, Nick Young, editor of China Development Brief, reviews the findings of three studies commissioned by the United Nations Development Programme (UNDP) on the role of the law in response to HIV/AIDS.

Duty to warn about likely adverse effects - news

A 48-year-old West Indian woman with hypertension sued the district health authority and doctors at the district hospital for negligence in not warning her about adverse effects of minoxidil. The drug had led to excessive hair growth and darkening of the face, causing great distress and limiting her social life.(AU)