Risk exposures for human ornithosis in a poultry processing plant modified by use of personal protective equipment: an analytical outbreak study.

Ornithosis outbreaks in poultry processing plants are well-described, but evidence for preventive measures is currently lacking. This study describes a case-control study into an outbreak of ornithosis at a poultry processing plant in the East of England, identified following three employees being admitted to hospital. Workers at the affected plant were recruited via their employer, with exposures assessed using a self-completed questionnaire. Cases were ascertained using serological methods or direct antigen detection in sputum. 63/225 (28%) staff participated, with 10% of participants showing evidence of recent infection. Exposure to the killing/defeathering and automated evisceration areas, and contact with viscera or blood were the main risk factors for infection. Personal protective equipment (goggles and FFP3 masks) reduced the effect of exposure to risk areas and to self-contamination with potentially infectious material. Our study provides some evidence of effectiveness for respiratory protective equipment in poultry processing plants where there is a known and current risk of ornithosis. Further studies are required to confirm this tentative finding, but in the meantime respiratory protective equipment is recommended as a precautionary measure in plants where outbreaks of ornithosis occur.

A human metapneumovirus outbreak at a community hospital in England, July to September 2010.

We describe an outbreak of human metapneumovirus (hMPV) which occurred in July-September 2010 at a community hospital in the East of England. Based on the medical and nursing records, cases were retrospectively defined as suspected if they had had an influenza-like illness (ILI), and probable if they had had an ILI and an epidemiological link to a laboratory-confirmed case. Of a total of 17 symptomatic inpatients, five were classified as probable cases, five were laboratory confirmed and seven were suspected. The attack rate was 29.4% for confirmed and probable cases combined. The median age of symptomatic inpatients was 85 years-old (range 68-96) and the majority (16/17) of symptomatic inpatients had an underlying medical condition. Control measures introduced appeared to restrict further exposure of susceptible patients to infection although modelling suggested that up to four of 10 confirmed and probable cases (40%) could have been prevented through more timely diagnosis and recognition of an outbreak. These findings suggest that there should be increased awareness of hMPV infection within healthcare settings, particularly when the population at risk has a high prevalence of underlying co-morbidities.

Surveillance of community genital Chlamydia trachomatis testing in the East of England, 2008-2010.

BACKGROUND: Widespread testing for chlamydia is expected to result in a reduction in prevalence. In 2008, coverage indicators introduced by the Department of Health (DH) required collection and submission of all tests performed outside of genitourinary medicine clinics. No mechanism existed to collect community-based tests conducted outside of the National Chlamydia Screening Programme. The Health Protection Agency Regional Epidemiology Unit in the East of England (EoE) set up a new system to routinely collect and submit these tests on behalf of the regional Primary Care Organizations (PCOs). METHODS: Testing data were requested from all laboratories commissioned to undertake chlamydia testing by EoE PCOs. Data were imported into a bespoke Structured Query Language server database and automated data processing routines were run. Data fulfilling national criteria were submitted for inclusion in the DH indicators. RESULTS: High-quality data were submitted to set deadlines with minimum impact on laboratories. Completeness of data variables varied by laboratory and by variable type. After complex data processing, 96% of laboratory reported tests in the 15-24 year age range were eligible for submission. CONCLUSIONS: This centralized method of data collection provides high-quality data, allowing for further analysis, which can be used to inform improvements in health care. These methods could be transferred to any of the hundreds of organisms for which similar laboratory data exist.

Pandemic (H1N1) 2009 influenza in the UK: clinical and epidemiological findings from the first few hundred (FF100) cases.

The UK was one of few European countries to document a substantial wave of pandemic (H1N1) 2009 influenza in summer 2009. The First Few Hundred (FF100) project ran from April-June 2009 gathering information on early laboratory-confirmed cases across the UK. In total, 392 confirmed cases were followed up. Children were predominantly affected (median age 15 years, IQR 10-27). Symptoms were mild and similar to seasonal influenza, with the exception of diarrhoea, which was reported by 27%. Eleven per cent of all cases had an underlying medical condition, similar to the general population. The majority (92%) were treated with antiviral drugs with 12% reporting adverse effects, mainly nausea and other gastrointestinal complaints. Duration of illness was significantly shorter when antivirals were given within 48 h of onset (median 5 vs. 9 days, P=0.01). No patients died, although 14 were hospitalized, of whom three required mechanical ventilation. The FF100 identified key clinical and epidemiological characteristics of infection with this novel virus in near real-time.

Pandemic Influenza A (H1N1) 2009 and mortality in the United Kingdom: risk factors for death, April 2009 to March 2010.

This paper describes the epidemiology of fatal pandemic influenza A(H1N1) cases in the United Kingdom (UK) since April 2009 and in particular risk factors associated with death. A fatal case was defined as a UK resident who died between 27 April 2009 and 12 March 2010, in whom pandemic influenza A(H1N1) infection was confirmed by laboratory or recorded on death certificate. Case fatality ratios (CFR) were calculated using the estimated cumulative number of clinical cases as the denominator. The relative risk of death was estimated by comparing the population mortality rate in each risk group, with those not in a risk group. Across the UK, 440 fatal cases were identified. In England, fatal cases were mainly seen in young adults (median age 43 years, 85% under 65 years), unlike for seasonal influenza. The majority (77%) of cases for whom data were available (n=308) had underlying risk factors for severe disease. The CFR in those aged 65 years or over was nine per 1,000 (range 3 - 26) compared to 0.4 (range 0.2 to 0.9) for those aged six months to 64 years. In the age group between six month and 64 years, the relative risk for fatal illness for those in a risk group was 18. The population attributable fractions in this age group were highest for chronic neurological disease (24%), immunosuppression (16%) and respiratory disease (15%). The results highlight the importance of early targeted effective intervention programmes.

Health impact of the Buncefield oil depot fire, December 2005: study of accident and emergency case records.

BACKGROUND: On Sunday 11th of December 2005, an explosion occurred at the Buncefield oil depot, Hertfordshire, resulting in a large fire that blazed for several days. Two Accident and Emergency (A&E) departments were placed on stand-by to receive casualties. A simple surveillance system was put in place during the acute phase of the incident, but this was not adequate to fully examine the health impact of the fire. METHODS: Retrospective study of A&E records at Hemel Hempstead and Watford A&E departments for the period that the fire burnt. RESULTS: Two hundred and forty-four people attended A&E as a result of the fire: 187 were members of the emergency services; 17 were oil depot workers; and 40 were members of the public. The most common presenting complaints were respiratory symptoms (n = 66) and injuries (n = 38). Twenty-five (21%) individuals were referred for medical follow-up. There were no fatalities. CONCLUSION: There was a significant impact on local health services, with many emergency service personnel attending A&E asymptomatically. Alternative health service provision for these individuals, possibly near to the scene of the incident, should be considered. This incident has also highlighted an urgent need to develop surveillance systems that enable real-time monitoring of the acute public health impact of major incidents.

What happens to people diagnosed with tuberculosis? A population-based cohort.

We examined different patient outcomes following diagnosis of tuberculosis (TB). Incident cases were reported to the enhanced surveillance system in the East of England, between 2000 and 2003. For the 575 cases reported in 2001 and 2002, outcomes were assessed 1 year after initiating treatment. The crude clinical incidence rate of TB was 6.0 cases/100,000 person-years (pyr) [95% confidence interval (CI) 5.7-6.4], highest in the 25-29 years age group (14.9, 95% CI 12.9-17.1 cases/100,000 pyr) and among Black Africans (328.6, 95% CI 286.9-374.6 cases/100,000 pyr). Patients born abroad were 2.35 (95% CI 1.03-5.32) times more likely to be lost to follow-up than those born in the United Kingdom. Age at diagnosis (OR 1.05, 95% CI 1.04-1.07) and pulmonary disease (OR 2.73, 95% CI 1.21-6.15) were independently associated with mortality. Elderly patients and those with pulmonary TB appear to have worse outcomes despite treatment. Foreign-born patients may need closer follow-up to ensure favourable outcomes.

Legionnaires' disease: when an 'outbreak' is not an outbreak.

During August 2006, there was a large increase in non-travel related legionella cases throughout England and in the Netherlands.

Monitoring the uptake of HIV testing among first attendees at GUM clinics in the East of England region.

This study was conducted to determine the extent to which genitourinary medicine clinics in the East of England region are monitoring the uptake of HIV testing. Ninety-four per cent of GUM clinics in the region offer HIV testing to all new patients. The uptake varied around the region, but all clinics are able to monitor uptake and the majority of clinics can audit uptake. The overall regional uptake has already exceeded the target for 2004.

Prevention of perinatal hepatitis B transmission in a health authority area: an audit.

The aim of this audit was to provide baseline measurement of antenatal hepatitis B virus (HBV) screening uptake, coverage of HBV vaccination in infants born to high- and low-risk HBsAg carrier mothers, completion of post-vaccination serological testing, outcome for vaccinated infants, and an assessment of the factors that influenced the effectiveness of the whole programme. Methods included identifying HBV positive pregnancies by laboratory results, and follow up of at-risk infants by a GP survey. Uptake of antenatal HBV screening was 99.9%. Thirty-one HBV positive pregnancies were identified, and twenty-nine infants were followed up. The overall HBV vaccination completion rate was 93%. Fifty per cent of eligible infants were tested for hepatitis carriage, the majority of whom were high-risk infants. None had acquired HBV infection and all had gained adequate immunity. We conclude that, although the local screening programme has been implemented effectively, there is inconsistency in the follow up of infants at high and low risk of acquiring HBV.

Tetanus immunisation policy in England and Wales--an overview of the literature.

Current UK policy on immunisation for tetanus has changed in the light of evidence that five doses of vaccine probably provides sufficient protection as long as high-risk wounds are managed with tetanus immunoglobulin. This paper reviews the evidence base for tetanus immunisation policy in England and Wales: the epidemiology of tetanus, vaccination coverage and response to tetanus toxoid, and population immunity to tetanus. The paper highlights gaps in our current knowledge of tetanus vaccination and policy implementation, and makes recommendations for further investigations.

Use of ivermectin, given orally, to control scabies in homes for the elderly mentally ill.

Outbreaks of scabies in two homes for the elderly mentally ill in the UK and the use of an oral agent, ivermectin, as a control measure are described. The difficulties of diagnosis and control in this setting are discussed.