ABSTRACT
BackgroundThe newborn hearing screening programme (NHSP) in England was impacted by the COVID-19 pandemic as screening and audiology services initially stopped outpatients, some parents declined or delayed screening and services struggled to manage capacity with reduced staffing.To monitor the impact Public Health England (PHE) produced weekly data reports. A modelling tool was developed for providers to identify babies still awaiting screening or audiological assessment using the national IT system, SMaRT4Hearing (S4H) and audiology data. This information was used to track screening completion and to support restoration of hearing screening prioritising babies with the greatest chance of permanent childhood hearing impairment (PCHI).ObjectivesDevelopment of a modelling tool toprovide assurance of screening pathway completion,map additional audiology capacity required for babies deferred from screening andprioritise babies that need to be seen first on the basis of risk to minimise delays in the diagnosis of PCHIMethodsWeekly data reports extracted from S4H highlighting services with less than 90% coverage and more than 40% of screen referrals awaiting audiology to support commissioner assurance of screening and audiological capacity.Development of a modelling tool for use by screening providers and audiology servicesResultsThe programme saw a significant reduction in the number of babies with a completed screen outcome, a slight rise in the number referred to audiology and an increasing number of babies awaiting diagnostic assessment.1. CoverageWeek on week coverage for April 2020 – end of March 2021 compared to April 2019 – March 2020 These data describe an initial drop in coverage at the start of the pandemic from 98.8% to 76.1% with return to near expected levels of coverage over time. There remain more babies that did not have hearing screening compared to the year before.2. Providers with <90% coverage, >40% screening referrals awaiting audiologyTracking of progress by highlighting services meeting these criteria in a national summary report for screening commissioners supported by detailed metrics for each provider.3. Comparison of diagnosis of permanent childhood hearing impairmentThe number of unilateral and bilateral cases of permanent childhood hearing impairment diagnosed within the screening programme in 2020/21 is compared to 2019/20 tracking babies deferred for behavioural testing in audiology at the age 7–9 months.ConclusionsThe COVID-19 pandemic initially impacted the coverage for the newborn screening programme. Coverage has improved over time but there remains a proportion of babies that were not offered initial screening or deferred screening until audiological assessment at 7–9 months of age. These babies are now reaching the age to be seen in audiology. Weekly reporting and use of the modelling tool to support screening and audiology capacity mapping has provided assurance to screening commissioners that the babies at greatest risk have been prioritised. Final full year figures will estimate the potential number of delayed diagnoses of permanent childhood hearing impairment in 2020/21. Paediatric services need to be aware of the impact of COVID-19 on newborn hearing screening and should check if screening has been completed or that babies are referred for audiological assessment.
ABSTRACT
OBJECTIVES: Our objective was to systematically investigate false-negative histidine-rich protein 2 rapid diagnostic tests (HRP2-RDT) in imported Plasmodium falciparum malaria cases from travelers to the UK and the Republic of Ireland (RoI). METHODS: Five imported malaria cases in travellers returning to the UK and RoI from East Africa were reported to the PHE Malaria Reference Laboratory as negative according to histidine-rich protein (HRP2)-RDT. The cases were systematically investigated using microscopic, RDT, molecular, genomic, and in in vitro approaches. RESULTS: In each case, HRP2-RDT was negative, whereas microscopy confirmed the presence of P. falciparum. Further analysis revealed that the genes encoding HRP2 and HRP3 were deleted in three of the five cases. Whole-genome sequencing in one of these isolates confirmed deletions in P. falciparum chromosomes 8 and 13. Our study produced evidence that the fourth case, which had high parasitemia at clinical presentation, was a rare example of antigen saturation ('prozone-like effect'), leading to a false negative in the HRP2-RDT, while the fifth case was due to low parasitemia. CONCLUSIONS: False-negative HRP2-RDT results with P. falciparum are concerning. Our findings emphasise the necessity of supporting the interpretation of RDT results with microscopy, in conjunction with clinical observations, and sets out a systematic approach to identifying parasites carrying pfhrp2 and pfhrp3 deletions.