Risk factors for outbreaks of COVID-19 in care homes following hospital discharge: A national cohort analysis.

BACKGROUND: The population of adult residential care homes has been shown to have high morbidity and mortality in relation to COVID-19. METHODS: We examined 3115 hospital discharges to a national cohort of 1068 adult care homes and subsequent outbreaks of COVID-19 occurring between 22 February and 27 June 2020. A Cox proportional hazards regression model was used to assess the impact of time-dependent exposure to hospital discharge on incidence of the first known outbreak, over a window of 7-21 days after discharge, and adjusted for care home characteristics, including size and type of provision. RESULTS: A total of 330 homes experienced an outbreak, and 544 homes received a discharge over the study period. Exposure to hospital discharge was not associated with a significant increase in the risk of a new outbreak (hazard ratio 1.15, 95% CI 0.89, 1.47, P = .29) after adjusting for care home characteristics. Care home size was the most significant predictor. Hazard ratios (95% CI) in comparison with homes of <10 residents were as follows: 3.40 (1.99, 5.80) for 10-24 residents; 8.25 (4.93, 13.81) for 25-49 residents; and 17.35 (9.65, 31.19) for 50+ residents. When stratified for care home size, the outbreak rates were similar for periods when homes were exposed to a hospital discharge, in comparison with periods when homes were unexposed. CONCLUSION: Our analyses showed that large homes were at considerably greater risk of outbreaks throughout the epidemic, and after adjusting for care home size, a discharge from hospital was not associated with a significant increase in risk.

Long-term health effects after resolution of acute Cryptosporidium parvum infection: a 1-year follow-up of outbreak-associated cases.

We describe a longitudinal study carried out in an adult outbreak-associated cohort to investigate health effects, including post-infectious irritable bowel syndrome, occurring after resolution of acute Cryptosporidium parvum infection. New symptoms self-reported up to 12 months included: weight loss (31 %), abdominal pain (38 %), diarrhoea (33 %), eye pain (9 %), joint pain (33 %), fatigue (22 %) and symptoms consistent with irritable bowel syndrome (IBS) (28 %). Two people were medically diagnosed with IBS. This study describes for the first time sequelae reported by patients up to 12 months after infection with C. parvum, which appear to be similar to those described with C. hominis.

Cluster of atypical adult Guillain-Barré syndrome temporally associated with neurological illness due to EV-D68 in children, South Wales, United Kingdom, October 2015 to January 2016.

We report a cluster of atypical Guillain-Barré syndrome in 10 adults temporally related to a cluster of four children with acute flaccid paralysis, over a 3-month period in South Wales, United Kingdom. All adult cases were male, aged between 24 and 77 years. Seven had prominent facial diplegia at onset. Available electrophysiological studies showed axonal involvement in five adults. Seven reported various forms of respiratory disease before onset of neurological symptoms. The ages of children ranged from one to 13 years, three of the four were two years old or younger. Enterovirus testing is available for three children; two had evidence of enterovirus D68 infection in stool or respiratory samples. We describe the clinical features, epidemiology and state of current investigations for these unusual clusters of illness.

Evaluation of recruitment and selection for specialty training in public health: interim results of a prospective cohort study to measure the predictive validity of the selection process.

BACKGROUND: The recruitment process for public health specialty training includes an assessment centre (AC) with three components, Rust Advanced Numerical Reasoning Appraisal (RANRA), Watson-Glaser Critical Thinking Appraisal (WGCT) and a Situation Judgement Test (SJT), which determines invitation to a selection centre (SC). The scores are combined into a total recruitment (TR) score that determines the offers of appointment. METHODS: A prospective cohort study using anonymous record linkage to investigate the association between applicant's scores in the recruitment process and registrar's progress through training measured by results of Membership Faculty Public Health (MFPH) examinations and outcomes of the Annual Review of Competence Progression (ARCP). RESULTS: Higher scores in RANRA, WGCT, AC, SC and TR were all significantly associated with higher adjusted odds of passing Part A MFPH exam at the first attempt. Higher scores in AC, SC and TR were significantly associated with passing Part B exam at the first attempt. Higher scores in SJT, AC and SC were significantly associated with satisfactory ARCP outcomes. CONCLUSIONS: The current UK national recruitment and selection process for public health specialty training has good predictive validity. The individual components of the process are testing different skills and abilities and together they are providing additive value.

The transmission of tuberculosis in schools involving children 3 to 11 years of age.

Little is known about the risk of tuberculosis transmission from children. We reviewed the published literature on the transmission of tuberculosis during outbreaks involving children 3 to 11 years of age and report that transmission rates among close contacts in school outbreaks are on average higher (weighted average 69.8% vs. 39.3%) if the index case is a child than an adult.

Preventing household transmission of Shiga toxin-producing Escherichia coli O157 infection: promptly separating siblings might be the key.

BACKGROUND: Preventing household transmission of Shiga toxin-producing Escherichia coli O157 (STEC O157) infection is important because of the ease of interpersonal transmission and the potential disease severity. METHODS: We conducted a retrospective cohort study of households associated with an outbreak of STEC O157 infection in South Wales, United Kingdom, in autumn 2005. We investigated whether characteristics of the primary case patient or the household were predictors for secondary household transmission of STEC O157 infection. Furthermore, we estimated the proportion of cases that might be prevented by isolation (e.g., hospitalization) of the primary case patient immediately after the microbiological diagnosis and the number of patients with STEC O157 who would need to be isolated to prevent 1 case of hemolytic uremic syndrome. Based on dates of symptom onset, case patients in households were classified as having primary, coprimary, or secondary infection. Secondary cases were considered to be preventable if the secondary case patient's symptoms started >1 incubation period (4 days) after the date of microbiological diagnosis of the primary case. RESULTS: Eighty-nine (91%) of 98 eligible households were enrolled. Among 20 households (22%), 25 secondary cases were ascertained. Thirteen secondary cases (56%) occurred in siblings of the primary case patients; hemolytic uremic syndrome developed in 4 of these siblings. Presence of a sibling (risk ratio, 3.8; 95% confidence interval, 0.99-14.6) and young age (<5 years) of the primary case patient (risk ratio, 2.03; 95% confidence interval, 0.99-41.6) were independent predictors for households in which secondary cases occurred. Of the 15 secondary cases for which complete information was available, 7 (46%) might have been prevented. When restricting isolation to primary case patients who were aged <10 years and who had a sibling, we estimated the number of patients who would need to be isolated to prevent 1 case of hemolytic uremic syndrome to be 47 patients (95% confidence interval, 16-78 patients). CONCLUSIONS: Promptly separating pediatric patients with STEC O157 infection from their young siblings should be considered.

Selection into specialty training in public health: performance of the Medical Training Application Service shortlisting.

OBJECTIVE: To assess the performance of shortlisting against appointability to public health specialty training under the Medical Training Application Service (MTAS) selection methodology using multiple modality in person assessment. METHODS: Candidates who had applied to public health specialty training programme in Wales and East of England and shortlisted were assessed in the first assessment round. Further to MTAS review, candidates not previously short listed were offered assessment in the second round. Receiver operating characteristic (ROC) analysis was done. RESULTS: In both the programmes, the shortlisting scores of candidates considered appointable were substantially higher than those considered not appointable, a score difference of 13.0 (95% confidence interval (CI) 3.0-23.0) and 13.5 (95% CI 3.4-23.5) respectively. The area under the ROC curve (ROCAUC) was 0.88 (95% CI 0.63-1.00) in Wales and 0.77 (95% CI 0.57-0.97) in East of England. The shortlisting scores of the two programmes that gave an optimum performance (maximum sum of the sensitivity and specificity) were comparable (scores of 62 and 63 respectively). CONCLUSION: MTAS shortlisting undertaken in two independent public health specialty training programmes discriminated well between appointable and not appointable candidates.

Surveillance of influenza immunisation uptake in people aged under 65 years with chronic disease.

Historically, it has been difficult to obtain population based data on the uptake of influenza immunisation in people aged under 65 years who are at risk of serious illness or death from influenza and its complications. Data obtained electronically from 96% of all practices in Wales demonstrated that uptake in this group is low, with only a quarter of eligible patients immunised. Uptake varies considerably between patient groups and between geographical areas. This suggests an opportunity for significant health gain from targeted interventions to improve uptake.

Q fever outbreak in industrial setting.

An outbreak of Q fever occurred in South Wales, United Kingdom, from July 15 through September 30, 2002. To investigate the outbreak a cohort and nested case-control study of persons who had worked at a cardboard manufacturing plant was conducted. The cohort included 282 employees and subcontractors, of whom 253 (90%) provided blood samples and 214 (76%) completed questionnaires. Ninety-five cases of acute Q fever were identified. The epidemic curve and other data suggested an outbreak source likely occurred August 5-9, 2002. Employees in the factory's offices were at greatest risk for infection (odds ratio 3.46; 95% confidence interval 1.38-9.06). The offices were undergoing renovation work around the time of likely exposure and contained straw board that had repeatedly been drilled. The outbreak may have been caused by aerosolization of Coxiella burnetii spore-like forms during drilling into contaminated straw board.

Fusidic acid resistance in community isolates of methicillin susceptible Staphylococcus aureus and the use of topical fusidic acid: a retrospective case-control study.

Resistance to fusidic acid among community methicillin susceptible Staphylococcus aureus (MSSA) isolates in the United Kingdom and prescriptions for fusidic acid have both doubled over the past 6 years. A retrospective case-control study was undertaken to test the hypothesis that the use of topical fusidic acid is associated with the isolation of resistant organisms. A statistically significant association was found between fusidic acid resistance in MSSA isolates and exposure to topical fusidic acid (odds ratio: 2.77, 95% CI 1.01-7.93, P = 0.027). This study demonstrates for the first time an association between the use of topical fusidic acid and resistance at the individual patient level and supports the hypothesis that the observed increase in resistance is causally associated with the increased use of topical fusidic acid.

Fusidic acid resistance in community isolates of methicillin-susceptible Staphylococcus aureus and fusidic acid prescribing.

The level of resistance to fusidic acid among community methicillin-susceptible Staphylococcus aureus (MSSA) isolates in the UK and prescriptions for fusidic acid have both doubled over the past 6 years. It is hypothesized that selective pressure arising from topical use of fusidic acid in the community accounts for this increase. A significant correlation was found between prescribing of fusidic acid and resistance at the practice level (Spearman's rho = 0.46, 95% confidence interval 0.11-0.71, P = 0.01). Further controlled studies are required to determine whether this association is causal.

Enhanced surveillance of primary measles mumps and rubella (MMR) immunisation in Wales.

In England and Wales routinely available data measure uptake of the measles mumps and rubella (MMR) vaccine at 2 years. This results in a delay in detecting change in uptake of the vaccine, which is scheduled at 12 months of age. The predictive value of uptake at 15-17 months is limited by the greater variability in uptake between quarters at the younger age. This can be overcome by presenting the data as a four-quarter annual rolling average. Uptake of the MMR vaccine at 2 years of age in Wales is predicted to stabilise at around 84% in the first three quarters of 2002.