Surge of lower respiratory tract group A streptococcal infections in England in winter 2022: epidemiology and clinical profile.

BACKGROUND: Following low incidence of invasive group A streptococcal (iGAS) infections during the COVID-19 pandemic, marked increases were noted in many countries during 2022, particularly in children. In November 2022, severe presentations of lower respiratory tract infections (LRTIs), including empyema, were notified by clinicians across the UK. UKHSA investigated this rise with the aim of informing clinical management and public health response. METHODS: We undertook a case-series analysis using multiple routine data sources, exempted from ethics approval or patient consent. We identified iGAS cases in England in children younger than 15 years with an LRTI reported between Oct 1 and Dec 21, 2022, using UKHSA laboratory surveillance data (GAS detected in LRT specimens) and notifications by clinicians and Health Protection Teams (HPTs). Symptoms, diagnoses, health-care interactions, and outcome (death or recovery) data were obtained from HPT case management notes, the National Child Mortality Database, and the NHS Digital Emergency Care Dataset. FINDINGS: We identified 147 cases of LRTI iGAS in children across England (77 [52%] male, 70 [48%] female; median age 4 years [IQR 2-6]). Predominant ethnicities were White (74 [65%] of 113 with known ethnicity) and Asian (18 [16%] of 113). Most reported symptoms were fever (90 [75%] of 120 children with ≥1 symptom) and cough (60 [50%] of 120), and 71 (48%) of all 147 children had a diagnosed respiratory viral coinfection (most commonly hMPV and RSV). 127 (86%) of children attended an emergency department, 31% (n=36/114 with onset date) at least twice within 21 days after symptom onset. 37 (25%) of 147 children died, with a median time from symptom onset to death of 4 days (IQR 3-7). Of 32 children with sample dates, 16 (84%) were tested for GAS on or after the day they died. Over half of deaths (21 [57%] of 37 deaths) occurred in the community after rapid deterioration, of whom 18 had previous contact with health-care services documented. INTERPRETATION: The UK saw an unusual rise in iGAS LRTIs in children in late 2022. One in four cases died, over half in the community. Non-specific symptoms, viral symptoms, or positive virology might have lowered suspicion of bacterial infection. Although the use of multiple available data sources expedited the analysis, varying data completeness limited interpretation. Our study highlights the need for earlier detection and identification of effective measures to prevent death. FUNDING: None.

Case-Control Study of Risk Factors for Acquired Hepatitis E Virus Infections in Blood Donors, United Kingdom, 2018-2019.

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in England. Substantial yearly increases of autochthonous infections were observed during 2003-2016 and again during 2017-2019. Previous studies associated acute HEV cases with consumption of processed pork products, we investigated risk factors for autochthonous HEV infections in the blood donor population in England. Study participants were 117 HEV RNA-positive blood donors and 564 HEV RNA-negative blood donors. No persons with positive results were vegetarian; 97.4% of persons with positive results reported eating pork products. Consuming bacon (OR 3.0, 95% CI 1.7-5.5; p<0.0001), cured pork meats (OR 3.5, 95% CI 2.2-5.4; p<0.0001), and pigs' liver (OR 2.9, 95% CI 1.0-8.3; p = 0.04) were significantly associated with HEV infection. Our findings confirm previous links to pork products and suggest that appropriate animal husbandry is essential to reduce the risk for HEV infection.

" if I care about stuff, then other people care about me". Adolescents' experiences of helpful and unhelpful aspects of brief behavioural activation therapy for depression.

Brief Behavioural Activation (Brief BA) is a time limited psychological therapy for the treatment of depression symptoms in adolescents. Research on clients' experiences of the helpful and unhelpful aspects of psychological therapies is important for developing an understanding of the therapeutic process, and for helping to improve interventions and therapists' skills. The aim of this study was to explore 12-19 year old's experiences of the helpful and unhelpful aspects of Brief BA.Thematic analysis of one-to-one interviews with nine adolescents who had completed Brief BA at school was conducted.Three main themes relating to the helpful aspects were identified: "self-discovery"; "given the tools to cope and make progress"; "having someone to talk to." One main theme relating to the unhelpful aspects of Brief BA, "discontinuation and maintenance," was also identified.Findings indicated that the participants found behavioural activation strategies, identifying values and valued activities, and therapist support to be helpful. The duration of therapy and difficulties in maintaining improvements were identified as unhelpful aspects. Future research is needed to investigate the impact of the timing of the end of therapy and how improvements can be more easily maintained after the end of Brief BA.

COVID-19 cluster surveillance using exposure data collected from routine contact tracing: The genomic validation of a novel informatics-based approach to outbreak detection in England.

Contact tracing was used globally to prevent onwards transmission of COVID-19. Tracing contacts alone is unlikely to be sufficient in controlling community transmission, due to the pre-symptomatic, overdispersed and airborne nature of COVID-19 transmission. We describe and demonstrate the validity of a national enhanced contact tracing programme for COVID-19 cluster surveillance in England. Data on cases occurring between October 2020 and September 2021 were extracted from the national contact tracing system. Exposure clusters were identified algorithmically by matching ≥2 cases attending the same event, identified by matching postcode and event category within a 7-day rolling window. Genetic validity was defined as exposure clusters with ≥2 cases from different households with identical viral sequences. Exposure clusters were fuzzy matched to the national incident management system (HPZone) by postcode and setting description. Multivariable logistic regression modelling was used to determine cluster characteristics associated with genetic validity. Over a quarter of a million (269,470) exposure clusters were identified. Of the eligible clusters, 25% (3,306/13,008) were genetically valid. 81% (2684/3306) of these were not recorded on HPZone and were identified on average of one day earlier than incidents recorded on HPZone. Multivariable analysis demonstrated that exposure clusters occurring in workplaces (aOR = 5·10, 95% CI 4·23-6·17) and education (aOR = 3·72, 95% CI 3·08-4·49) settings were those most strongly associated with genetic validity. Cluster surveillance using enhanced contact tracing in England was a timely, comprehensive and systematic approach to the detection of transmission events occurring in community settings. Cluster surveillance can provide intelligence to stakeholders to support the assessment and management of clusters of COVID-19 at a local, regional, and national level. Future systems should include predictive modelling and network analysis to support risk assessment of exposure clusters to improve the effectiveness of enhanced contract tracing for outbreak detection.

How adolescents understand their values: A qualitative study.

An important component of some psychological therapies is the use of clients' values to motivate behaviour change. Values are understood to be developed during childhood and adolescence but there has been limited exploration of how young people experience values and their function across contexts. This study aimed to explore adolescents' understanding of the concept of 'values' and to elicit their experiences of values. Semi-structured, individual interviews were conducted with 11 adolescents aged 12-17 years. Thematic analysis was used to identify themes. Young people were readily able to discuss the meaning of 'values' and their own personal values. Three main themes were identified: (1) what values are (in general, and specific to themselves), (2) where values come from (relationships, education, growing up), and (3) why values are important (prioritising/decision making, reflecting on values is helpful). The adolescents in this study demonstrated an in-depth understanding of the meaning, origins and functions of values. The results suggest young people may welcome and benefit from opportunities to discuss their values, including in therapy.

Yoga in public school improves adolescent mood and affect.

The purpose of the present study was to directly compare the acute effects of participating in a single yoga class versus a single standard physical education (PE) class on student mood. Forty-seven high school students completed self-report questionnaires assessing mood and affect immediately before and after participating in a single yoga class and a single PE class one week later. Data were analyzed using paired-samples t tests and Wilcoxon-signed ranks tests and by comparing effect sizes between the two conditions. Participants reported significantly greater decreases in anger, depression, and fatigue from before to after participating in yoga compared to PE. Significant reductions in negative affect occurred after yoga but not after PE; however, the changes were not significantly different between conditions. In addition, after participating in both yoga and PE, participants reported significant decreases in confusion and tension, with no significant difference between groups. Results suggest that school-based yoga may provide unique benefits for students above and beyond participation in PE. Future research should continue to elucidate the distinct psychological and physiological effects of participating in yoga compared to PE activities.