An outbreak of Salmonella Saintpaul in a Scottish childcare facility: the influence of parental under-reporting.

BACKGROUND: Salmonella outbreaks in childcare facilities are relatively rare, most often occurring secondary to contaminated food products or poor infection control practices. We report an outbreak of Salmonella Saintpaul at a pre-school facility in Ayrshire, Scotland with atypical clinical and epidemiological features. METHODS: Following notification of the initial two cases, the multi-disciplinary Incident Management Team initiated enhanced active case finding and two environmental inspections of the site, including food preparation areas. Parent and staff interviews were conducted by the Public Health department covering attendance, symptomatology and risk factors for all probable and confirmed cases. Microbiological testing of stool samples and the facility water tank was conducted. Whole Genome Sequencing (WGS) was performed for positive stool samples at the national reference laboratory. Infection control measures were introduced iteratively due to the atypical progression of the outbreak. RESULTS: There were 15 confirmed cases and 3 children admitted to hospital during the outbreak. However, 35.7% of cases reported extremely mild symptoms. The attack rate was 15.2%, and age of affected children ranged from 18 to 58 months (mean 35 months). All cases were the same Multilocus Sequence Type (MLST50). Epidemiological investigation strongly suggested person-to-person spread within the facility. Existing infection control practices were found to be of a high standard, but introduction of additional evidence-based control measures was inadequate in halting transmission. Facility staff reported concerns about lack of parental disclosure of gastrointestinal symptoms, particularly where these were mild, with 50.0% of cases having attended while symptomatic against public health advice. Voluntary two-week closure of the facility was implemented to halt transmission, following which there were no new cases. WGS results were unavailable until after the decision was taken to close the facility. CONCLUSIONS: This is the first reported instance of a Salmonella Saintpaul outbreak at a childcare facility, or where person-to-person transmission is indicated. Clinicians should consider the influence of parental under-reporting on gastrointestinal outbreaks in childcare settings, particularly where perceived severity is low and financial or social pressures to attend work may reduce compliance. WGS cannot yet replace conventional microbiological techniques during short, localised outbreaks due to delays receiving results.

Cluster of exertional rhabdomyolysis in three young women.

Three young women, aged 18-24 years, presented to general practice with signs and symptoms of exertional rhabdomyolysis in 2016. All attended the same gym and had undertaken an intensive physical workout. Presenting symptoms were severe muscle pain and swelling, significantly reduced range of motion in affected muscles and, in two cases, dark-coloured urine. One case had presented to the out-of-hours service 4 months previously with similar symptoms but rhabdomyolysis was not considered, although retrospective history taking suggests that was the likely diagnosis. All three women were admitted to hospital, treated with intravenous fluids and discharged between 1 and 6 days later. All made a full recovery with no renal sequelae. The cases were questioned about potential risk factors, and the only commonality was unaccustomed strenuous exercise.

How is diarrhoea managed in UK care homes? A survey with implications for recognition and control of Clostridium difficile infection.

BACKGROUND: Policy and regulatory efforts to reduce Clostridium difficile infection (CDI) rates now focus increasingly on the community setting, especially residential and nursing homes for the elderly. We aimed to describe how potentially infectious diarrhoea is managed in care homes, and to explore related infection control and human waste management practices. METHODS: A questionnaire was sent to all care homes in Sussex, asking about management of diarrhoea and related infection control practices. RESULTS: Response rate was 41%. Residents with diarrhoea were reported to be isolated promptly in 36% of homes, and 78.2% of homes reported always wearing appropriate personal protective equipment. Most homes waited over 24 h before sending stool samples for testing. Human waste was disposed of by automated sluice in only 26% of care homes. Bedpans were washed in residents' sinks in 20.7% of residential homes, and in communal baths in 9.6%. CONCLUSION: This study shows that most care homes are not fully compliant with current infection prevention and control guidance, and that some unacceptable practices are occurring. In order to reduce potential for transmission of CDI and other diarrhoeal infection in care homes, infection prevention and control practices must be improved, with early diagnosis and control.

Why lesbians should be encouraged to have regular cervical screening.

INTRODUCTION: The UK National Health Service Cervical Screening Programme (NHSCSP) advice on cervical cytology screening states that women who have never had sex with men are at very low risk of developing cervical cancer, and advice regarding need for screening in lesbians is inconsistent. METHODS: Literature review searching PubMed, Web of Science and the Internet for articles on lesbians, cervical cancer and cervical cancer risk factors focusing on human papillomavirus (HPV) and screening behaviours. RESULTS: Case reports and prevalence studies show that HPV can be transmitted sexually between women. It is not known whether prevalence of HPV or cervical cancer differs between lesbians and heterosexual women. The evidence consistently shows that prevalence of non-attendance for cervical screening is much higher in lesbian than heterosexual women, which is linked to a belief that lesbians are less susceptible to cervical cancer and have less need for screening. Despite sharing most of the same risk factors as heterosexual women, lesbians are much less likely to undergo regular screening. CONCLUSIONS: The NHSCSP should take a clear and consistent stance on the need for cervical screening in lesbians. Both the health care and the lesbian communities must be made aware of the fact that regular cervical screening is as important in this group as it is in the heterosexual female population.