Seroepidemiology and phylogenetic characterisation of measles virus in Ireland, 2004-2013.

BACKGROUND: Ireland is classified as an area of high measles incidence. A World Health Organisation-European Region strategic plan exists for measles elimination by 2015. OBJECTIVES: To retrospectively investigate measles outbreaks using all patient samples (sera and oral fluid) received for measles laboratory diagnosis and characterise the genetic diversity of circulating measles genotypes in Ireland. STUDY DESIGN: 704 cases of acute measles infection as determined by the presence of measles specific IgM in sera and oral fluids were confirmed at the National Virus Reference Laboratory. Measles positive samples (n=116) were examined by genotyping, sequence analysis and phylogenetic characterisation. RESULTS: Three measles outbreaks occurred over the study period: 2004, 2009/2010 and 2011. Measles IgM positivity ranged from 22-29% in outbreak years to 5-10% in the intervening years. Age profile analysis revealed that whereas individuals >10 years accounted for only 8% of cases in the 2004 outbreak, this increased to 33% and 29% in the 2009/2010 and 2011 outbreaks, respectively. The <1 year cohort accounted for 18-20% of cases in all outbreaks. Phylogenetic analysis demonstrated both indigenous transmission and also importation events. Clade D viruses were exclusively found circulating in Ireland, with autochthonous transmission of diverse genotype D4 strains associated with large outbreaks across Europe. More recently, genotype D8 was identified and these were associated with importation events. CONCLUSIONS: This study provides a comprehensive genetic analysis of circulating measles genotypes in Ireland and discriminated between indigenous and imported viral strains. Notably, an increase in laboratory-confirmed measles cases in the greater than 10 years of age group was seen over the study period. This information is valuable to inform vaccination strategies with a focus on those populations who remain susceptible to measles infection.

The perception of ward-based nurses seconded into an Outreach Service.

A group of ward nurses were seconded into an Outreach Service for a 2-week period. Following this, the group took part in an evaluation of the placement using a focus group methodology. The aim of this project was to explore the perceptions of a ward-based nurse recruited into the Outreach Service so that they could function effectively and efficiently in that role. The intended outcomes of the project were: --to explore the needs of the new Outreach nurse who was recruited from the ward environment --to enable the participants of the project to have a better understanding of the role of the Outreach team --to enable the participants to develop their skills in assessing critically ill patients --to make recommendations to the Kent Critical Care Network regarding the recruitment of ward staff to Outreach.

Implementing a critical care course for ward nurses.

This article describes the setting up and evaluation of a course for ward-based nurses, which is designed to improve their skills in caring for highly dependent patients. The authors suggest such courses can increase nurses' confidence and competence and, as well as enhancing care, can improve communication with senior staff about issues of concern.

Why nurses choose not to undertake clinical supervision--the findings from one ICU.

A two-year action research study explored the implementation of clinical supervision in an intensive care unit (ICU). This paper focuses on one aspect of that study--the lack of uptake of clinical supervision. The themes that emerged from interview data focused on: resources, the purpose of clinical supervision, having good enough support elsewhere and personal issues. Some similarities were found to the blocks to clinical supervision which Hawkins and Shohet previously reported (1989).