Epidemiology of two decades of invasive meningococcal disease in the Republic of Ireland: an analysis of national surveillance data on laboratory-confirmed cases from 1996 to 2016.

We examined the epidemiology of invasive meningococcal disease (IMD) in the Republic of Ireland (ROI) between epidemiological year (EY) 1996/1997 and EY2015/2016. Over the 20 EYs, 3707 cases were reported with annual incidence rates per 100 000 peaking at 11.6 in EY1999/2000, decreasing significantly to 1.5 in EY2015/2016. The highest disease burden was in infants and children <5, whereas adults aged ⩾65 years experienced the highest case fatality ratio (CFR) of 15.7% but over the study period the median annual CFR remained low (4.4%). Meningococcal serogroup B (menB) dominated (78%), followed by menC (17%), menW (1%) and menY (1%). The incidence of menC IMD declined significantly in all age groups after menC vaccine introduction in 2000. MenB incidence also declined over the 20 EYs with decreasing trends in all age groups under 65, including an almost 50% decrease in infants over the final four EYs. IMD incidence in the ROI has declined, partly attributable to menC vaccination success, coupled with a spontaneous decline in menB. However, recent gradual increases in non-menB IMD and the introduction of vaccines targeting menB demand continued detailed surveillance to accurately monitor trends and to assess vaccine impact.

A retrospective assessment of the completeness and timeliness of meningococcal disease notifications in the Republic of Ireland over a 16-year period, 1999-2015.

OBJECTIVES: To assess how invasive meningococcal disease (IMD) records held by the Irish Meningitis & Sepsis Reference Laboratory (IMSRL) compare to records of IMD notifications reported on the national integrated electronic Computerised Infectious Disease Reporting (CIDR) system. STUDY DESIGN: We assessed the completeness, data quality and timeliness of IMD notifications and reference laboratory records for the period between 01 July 1999 and 30 June 2015 by identifying discrepant and/or missing data items in a matched case data set and by measuring the timeliness of case reporting. METHODS: We matched anonymised cases notified to CIDR to records based at the IMSRL using birth, reporting and onset dates with gender and laboratory parameters of meningococcal strain characteristics and method of confirmation. Completeness, data quality and the timeliness of notifications were assessed by a stratified sensitivity-based technique and by calculating the average difference between IMSRL and CIDR reporting dates. RESULTS: CIDR recorded a total of 3163 notifications, of which 2759 (87.2%) were matched to IMSRL records. Completeness of IMD case classification as confirmed was estimated to be >99%. Examining the levels of discrepant or missing data in both matched CIDR and IMSRL records as a measure of data quality, recording of demographic items and meningococcal group showed least differences, recording of laboratory case confirmation method and meningococcal strain characteristics were less well recorded, with detail on clinical presentation/diagnosis least well recorded. Overall average annual difference between CIDR and IMSRL recording dates was 3.2 days (95% confidence interval 2.6-3.8). CONCLUSIONS: A high quality of IMD surveillance in Ireland was demonstrated, but scope for improvements in timeliness and capture of enhanced surveillance data regarding date of onset and strain-specific characteristics were identified.

Reporting of Acute Flaccid Paralysis in Children under 15 years of age: Improving Surveillance, January 2009 - December 2014.

Acute Flaccid Paralysis (AFP) surveillance, including case investigation and specimen collection is a gold standard method for poliomyelitis surveillance. The expected annual non-polio AFP rate <15 years of age in Ireland is = 1/100 000 population. This study reviewed all cases of AFP reported to the Irish Paediatric Surveillance Unit and the Health Protection Surveillance Centre between January 2009 and December 2014 and compared reporting rates with the expected incidence rate annually. We assessed quality of surveillance data in terms of completeness of investigation for each case reported. Forty-three AFP cases in children <15 years were notified; 35 of which were confirmed. Guillain-Barre Syndrome (GBS) accounted for 48.6% (n=17) of AFP notifications. In 2014, the expected annual AFP target rate was reached. This study identified possible under-reporting of AFP paediatric cases in Ireland between 2009-2013. Completeness of investigations has improved over time, but requires further work.

A prolonged outbreak of invasive meningococcal disease in an extended Irish Traveller family across three Health Service Executive (HSE) areas in Ireland, 2010 to 2013.

Between March 2010 and November 2013 eight laboratory-confirmed cases of serogroup B, invasive meningococcal disease (IMD) were identified in an extended Irish Traveller family across three Health Service Executive (HSE) areas of Ireland. Cases were aged between 5 and 46 months, and were either a cousin or sibling of another case. All eight cases survived. Chemoprophylaxis was given to relevant nuclear family members and close contacts on each occasion, but failed to prevent further cases. Neisseria meningitidis isolates from six cases were highly related, belonging to the ST-41/44 clonal complex, and shared the porA designation 7­2,4. In November 2013, the outbreak control team recommended that directly observed ciprofloxacin chemoprophylaxis be administered simultaneously to the extended family, and that the four component meningococcal B (4CMenB) vaccine be administered to family members aged 2 months to 23 years inclusive and relevant close contacts of the eighth case. Subsequently these recommendations were implemented at three regional clinics. Additionally pharyngeal swabs (n=112) were collected to assess carriage rates of N. meningitidis in this extended family. Pharyngeal carriage of N. meningitidis was detected in 15 (13%) family members. From the epidemiological investigation and carriage study overcrowding was the most likely risk factor identified in this outbreak. To date, the combination of directly observed ciprofloxacin chemoprophylaxis and use of 4CMenB vaccine have controlled the outbreak with no further cases diagnosed.

Seasonal influenza vaccine uptake in HSE-funded hospitals and nursing homes during the 2011/2012 influenza season.

Annual seasonal influenza vaccine is recommended for all health care workers (HCWs) in Ireland. For the 2011/2012 influenza season, information was collected on influenza vaccination uptake among HCWs employed in Health Service Executive (HSE)-funded hospitals (primarily acute) and of nursing homes (NHs) and also among NH long-term and short-term respite care residents. Forty-five hospitals (80%) and 120 NHs (75%) provided uptake data. Nationally, influenza vaccine uptake among hospital employed HCWs was estimated to be 18% and 14% among HCWs in NHs; in NHs vaccine uptake among long-term care residents was estimated to 88%. These findings highlight the continued low uptake among HCWs of all categories and demonstrate the need for sustained measures to improve uptake rates.

Transmission of endemic ST22-MRSA-IV on four acute hospital wards investigated using a combination of spa, dru and pulsed-field gel electrophoresis typing.

The transmission of meticillin-resistant Staphylococcus aureus (MRSA) between individual patients is difficult to track in institutions where MRSA is endemic. We investigated the transmission of MRSA where ST22-MRSA-IV is endemic on four wards using demographic data, patient and environmental screening, and molecular typing of isolates. A total of 939 patients were screened, 636 within 72 h of admission (on admission) and 303 >72 h after admission, and 1,252 environmental samples were obtained. Isolates were typed by spa, dru and pulsed-field gel electrophoresis (PFGE) typing. A composite dendrogram generated from the three sets of typing data was used to divide isolates into 'dendrogram groups' (DGs). Ten percent of patients (92/939) were MRSA-positive; 7 % (44/636) on admission and 16 % (48/303) >72 h after admission (p = 0.0007). MRSA was recovered from 5 % of environmental specimens (65/1,252). Most isolates from patients (97 %, 85/88) and the environment (97 %, 63/65) exhibited the ST22-MRSA-IV genotype. Four DGs (DG1, DG4, DG16 and DG17) accounted for 58 % of ST22-MRSA-IV isolates from patients. Epidemiological evidence suggested cross-transmission among 44/92 patients (48 %) but molecular typing confirmed probable cross-transmission in only 11 instances (13 %, 11/88), with the majority of cross-transmission (64 %; 7/11) occurring on one ward. In the setting of highly clonal endemic MRSA, the combination of local epidemiology, PFGE, spa and dru typing provided valuable insights into MRSA transmission.

Childhood cancer in Ireland: a population-based study.

BACKGROUND: Population-based studies of childhood cancer incidence, survival and mortality make an important contribution to monitoring the successful implementation of new treatment guidelines and to understanding the epidemiology of these diseases. METHODS: We analysed incidence and survival data for cancers diagnosed in children under 15 years of age in the Republic of Ireland during 1994-2000 (the first 7 years of National Cancer Registry coverage), and longer term mortality trends. RESULTS: World age-standardised incidence rates in Ireland averaged 142 cases per million children per year, slightly higher than the European average and slightly lower than the US average, although differences varied by diagnostic group. Observed 5-year survival in Ireland (79% overall) was slightly higher than European and US averages, and was significantly higher for acute non-lymphocytic leukaemia (67%) and (compared with the USA) significantly lower for Hodgkin lymphoma (83%). No significant increases in incidence rates were evident from the available 7 years' data, either overall or for particular diagnostic groups. Rates of childhood cancer mortality have declined markedly since the 1950s. CONCLUSIONS: Data presented here are in line with other developed countries and suggest major improvements in treatment and consequent survival.

Mortality predictions for colon and anorectal cancer for Ireland, 2003-17.

OBJECTIVE: Colorectal cancer mortality predictions for Ireland are presented for all ages and for the age group 0-64 years. METHODS: Log and log-linear Poisson regression modelling was fitted to colorectal cancer mortality data for each year between 1950 and 2002 to predict average European age standardized mortality rates (EASMRs) per 100,000 person years (100,000 PY(-1)) and average numbers of deaths. RESULTS: EASMRs for colon cancer are predicted to fall to 17.3 100,000 PY(-1) (95%PI 14.4, 20.2) in men and to 8.4 100,000 PY(-1) (95%PI 6.9, 10.2) in women by 2013-17. EASMRs for anorectal cancer are also predicted to fall to 8.0 100,000 PY(-1) (95%PI 6.6, 9.5) in men and to 3.0 100,000 PY(-1) (95%PI 2.3, 3.8) in women by this time. Truncated EASMRs for colon cancer for those aged between 0 and 64 years are predicted over the next 15 years to fall from their current levels to 4.4 100,000 PY(-1) (95%PI 3.0, 5.8) in men and to 2.3 100,000 PY(-1) (95%PI 1.5, 3.2) in women. For anorectal cancer, truncated EASMRs for those aged between 0 and 64 years are also predicted over the next 15 years to fall from their current levels to 2.9 100,000 PY(-1) (95%PI 2.0, 3.8) in men and to 0.9 100,000 PY(-1) (95%PI 0.4, 1.3) in women. CONCLUSIONS: Ireland currently has one of the highest colorectal mortality rates in the developed world but recent downward trends, the advent of new screening tests and well targeted public health promotion programmes may lead to further reductions.

Mortality predictions for Ireland, 2001-2015: cancers of the breast, ovary, and cervix and Corpus uteri.

Linear and log-linear Poisson regression models of Irish breast, ovarian, and cervical and corpus uterine cancer mortality data for the years 1953-2000 were used to predict European age standardized mortality rates (EASMRs) per 100,000 person years and numbers of deaths for the period 2001-2015. Rates for the whole population and for those under 65 are expected to fall from their current levels for breast and corpus uterine cancers but not for ovarian and cervical uterine cancers. EASMRs for postmenopausal women aged between 55 and 69 years are predicted to fall for breast, ovarian, and cervical and corpus uterine cancers. The continuing expansion of the Irish female population is the primary reason why the numbers of deaths arising from breast, ovarian, and cervical uterine cancer are predicted to increase in all of the above age groups. It is not exactly clear why the numbers of corpus uterine cancer deaths are expected to continue to decline, but it may be a matter of improvement in overall death-certificate coding or their diagnoses as cervical cancer deaths.

A population-based study of skin cancer incidence and prevalence in renal transplant recipients.

BACKGROUND: Cancers occurring following solid organ transplantation are a rapidly growing public health concern. Defining the extent of the problem has been limited by surveillance systems with incomplete registration of cases and the paucity of reliable national incidence data. OBJECTIVES: To determine the incidence of all cancers following renal transplantation and to make a detailed examination of trends and patterns associated with postrenal transplant skin cancers. METHODS: Integration of data from the national renal transplant database and the national cancer registry in Ireland enabled accurate determination of the number of renal transplant recipients (RTRs) with skin cancers and other malignancies in the time period 1 January 1994 to 31 December 2001. RESULTS: We demonstrated a biphasic increase in skin cancer incidence following renal transplantation, determined by the age at transplantation. There was a steady increase in risk for older RTRs (age 50+ years) from year 2 post-transplant, whereas the increased risk in younger RTRs (age < 50 years) occurred later but much more significantly, reaching 200 times the risk for an age-matched nontransplanted population by year 6 post-transplant. The number of nonmelanoma skin cancers (NMSCs) registered in RTRs accounted for 1% of all NMSCs registered nationally over the study period. The standardized incidence rates for invasive NMSC (33-fold increase) and in situ carcinoma of the skin (65-fold increase) were significantly increased (P < 0.05). The risk for invasive squamous cell carcinoma (SCC) was increased 82-fold compared with the nontransplanted population. Male RTRs were at particular risk of invasive SCC at sun-exposed sites such as the scalp and the external ear. Risk of malignant melanoma and Kaposi sarcoma were also increased relative to the nontransplanted population. CONCLUSIONS: This comprehensive national study illustrates how rates of skin cancer in Irish RTRs have influenced the national incidence of skin cancer. The high incidence of SCC, basal cell carcinoma and Bowen's disease in the early post-transplant period for older patients and the cumulative risk in younger patients with increased duration of transplantation highlight the importance of implementing early and continued cancer surveillance regimens post-transplant.

Mortality predictions for esophageal, stomach, and pancreatic cancer, Ireland, up to 2015.

BACKGROUND AND AIM OF THE STUDY: An analysis was undertaken to predict numbers of esophageal, stomach, and pancreatic cancer deaths and their World age standardized mortality rates (WASMRs) per 100,000 person years (100,000 PY-1) in Ireland for the years 2005, 2010 and 2015. METHODS: Linear and log-linear Poisson regression models were applied to 1950-2002 Irish cancer mortality data. RESULTS: By 2015, esophageal cancer WASMR for males is expected to rise to 9.1 100,000 PY-1, but for females to fall to 2.3 100,000 PY-1. In women under 65 yr, the WASMR is expected to decline to 0.8 100,000 PY-1 but to increase to 3.6 100,000 PY-1 in men. The stomach cancer WASMR for males is predicted to decrease to 5.3 100,000 PY-1 and for females to 2.9 100,000 PY-1. In males under 65 yr, the WASMR is predicted to fall to 1.7 100,000 PY-1 and to 1.0 100,000 PY-1 in women. The male WASMR for pancreatic cancer is predicted to decrease to 5.9 100,000 PY-1 and to 4.7 100,000 PY-1 in women. In men under 65 yr, the WASMR is predicted to drop to 1.7 100,000 PY-1 and to fall in women to 1.2 100,000 PY-1. CONCLUSIONS: Apart from male esophageal cancer, the findings would indicate that declines in Irish WASMRs for these three cancer types are expected to occur by 2015.

The epidemiology of infectious syphilis in the Republic of Ireland.

In response to the increasing numbers of syphilis cases reported among men having sex with men (MSM) in Dublin, an Outbreak Control Team (OCT) was set up in late 2000. The outbreak peaked in 2001 and had largely ceased by late 2003. An enhanced syphilis surveillance system was introduced to capture data from January 2000. Between January 2000 and December 2003, 547 cases of infectious syphilis were notified in Ireland (415 were MSM). Four per cent of cases were diagnosed with HIV and 15.4% of cases were diagnosed with at least one other STI (excluding HIV) within the previous 3 months. The mean number of contacts reported by male cases in the 3 months prior to diagnosis was 4 (range 0-8) for bisexual contacts and 6 for homosexual contacts (range 1-90). Thirty one per cent of MSM reported having had recent unprotected oral sex and 15.9% of MSM reported having had recent unprotected anal sex. Sixteen per cent of cases reported having had sex abroad in the three months prior to diagnosis. The results suggest that risky sexual behaviour contributed to the onward transmission of infection in Dublin. The outbreak in Dublin could be seen as part of a European-wide outbreak of syphilis. The rates of co-infection with HIV and syphilis in Ireland are comparable with rates reported from other centres. There is a need to improve surveillance systems in order to allow real time evaluation of interventions and ongoing monitoring of infection trends.

The epidemiology of infectious syphilis in the Republic of Ireland.

In response to the increasing numbers of syphilis cases reported among men having sex with men (MSM) in Dublin, an Outbreak Control Team (OCT) was set up in late 2000. The outbreak peaked in 2001 and had largely ceased by late 2003. An enhanced syphilis surveillance system was introduced to capture data from January 2000. Between January 2000 and December 2003, 547 cases of infectious syphilis were notified in Ireland (415 were MSM). Four per cent of cases were diagnosed with HIV and 15.4% of cases were diagnosed with at least one other STI (excluding HIV) within the previous 3 months. The mean number of contacts reported by male cases in the 3 months prior to diagnosis was 4 (range 0-8) for bisexual contacts and 6 for homosexual contacts (range 1-90). Thirty one per cent of MSM reported having had recent unprotected oral sex and 15.9% of MSM reported having had recent unprotected anal sex. Sixteen per cent of cases reported having had sex abroad in the three months prior to diagnosis. The results suggest that risky sexual behaviour contributed to the onward transmission of infection in Dublin. The outbreak in Dublin could be seen as part of a European-wide outbreak of syphilis. The rates of co-infection with HIV and syphilis in Ireland are comparable with rates reported from other centres. There is a need to improve surveillance systems in order to allow real time evaluation of interventions and ongoing monitoring of infection trends.

The public health importance of Ascaris lumbricoides.

Numerous studies have shown that anthelminthic treatment can be effective in improving growth rates when given to malnourished children with ascariasis. Recent investigations have also indicated that Ascaris infections can affect mental processing in some school children. Poor socio-economic conditions are among the key factors linked with higher prevalences of ascariasis, as are defaecation practices, geophagia, cultural differences relating to personal and food hygiene, occupational necessity, agricultural factors, housing style, social class and gender. Chemotherapy is currently the major tool used for the strategic control of ascariasis as a short-term goal. In the long term, improvements in hygiene and sanitation are thought to aid long-term control considerably. Targeted treatment, especially when aimed at schoolchildren, has been a major focus of recent control efforts in some areas. Universal treatment reaches more people and thus decreases further aggregate morbidity, especially in nutritionally vulnerable preschool-age children. Selective treatment requires technical effort to identify heavily infected individuals; acceptance by the community may vary in less educated populations when some individuals receive treatment and others do not. Child-targeted treatment may be more cost-effective than population treatment in reducing the number of disease cases and, in high transmission areas, expanding coverage of a population can be a more cost-effective strategy than increasing the frequency of treatment.

Eczema and hay fever in schoolchildren.

In a questionnaire survey of 2,813 children aged 4 to 19 years, eczema prevalence was 7.8% but rose to 21.3% in those with asthma. The prevalence was 5.9% in non-asthmatics. The hay fever prevalence was 12.3% but rose to 36% in those with asthma. The prevalence was 8.9% in non-asthmatics. Hay fever was more common in urban than rural children, but there was no town/country difference for eczema.

B-cell epitope mapping within the MA16 antigenic sequence found in Eimeria acervulina merozoites and sporozoites.

Overlapping heptapeptides derived from the MA16 Eimeria acervulina antigenic sequence (Castle et al., 1991) were synthesised on polypropylene pins ('pepskan' technique, Cambridge Research Biochemicals, UK). Binding of antibodies from chickens and rabbits infected and immunised respectively with various species of Eimeria oocysts (E. acervulina, E. tenella, E praecox, E. necatrix and E. maxima), was examined using the coated pins as the solid phase of an enzyme immunoassay (EIA). Antigenicity of the overlapping synthetic heptapeptides was then analysed using a number of algorithms based on the amino acid sequence to predict secondary protein structure, hydrophilicity, acrophilicity and chain flexibility profiles. The antigenicity of this sequence appears to be quite different from that found for the E. tenella GX3264 antigenic sequence (Bhogal et al., 1992) whose profile was similarly examined (Talebi and Mulcahy, 1994) using the same rabbit and chicken anti-Eimeria oocyst sera.

Mapping for B-cell epitopes in the GX3262 antigenic sequence derived from Eimeria tenella sporulated oocysts.

Polypropylene pins were impregnated with synthetic overlapping heptapeptides based on the GX3262 Eimeria tenella antigenic sequence (Miller et al., 1989). Using these coated pins as the solid phase of an enzyme immunoassay (EIA), binding of sera from chickens and rabbits infected and immunised respectively with five different species of Eimeria were examined. Antibody reactions to the individual heptapeptides were then analysed by a number of criteria based on the amino acid sequence including hydropathy, chain flexibility and secondary structure.

Asthma and wheeze in schoolchildren.

In a questionnaire survey of 2813 children aged 4 to 19 years 11.9% reported asthma compared to 4.4% in 1983-4: a rise of 170% over 9 years. The asthma prevalence was 8.35% in girls and 14.8% in boys. The prevalence of wheeze in the past 12 months was 12% in girls and 18.9% in boys. The wheeze prevalence values for 9 year olds were similar to those found in a recent study in Galway. 40.8% of those reporting wheeze in the previous 12 months did not report asthma. This suggests under diagnosis, ineffective communication of the diagnosis to the parents or denial of the diagnosis. 79% of those with asthma reported wheeze and 10.7% reported cough but no wheeze ('cough variant asthma'), emphasising the importance of cough as an indicator of asthma in these children.

Sero-epidemiology of toxocariasis in school children.

The seroprevalence of toxocariasis was investigated in 2129 school children ranging in age from 4 to 19 years. Infection, as measured by titre, was found to be high compared to values obtained from children in other countries, with 31% having a titre of > or = 1:50 and 3.1% having titres of > or = 1:800. Relationships between seroprevalence and host factors including age, sex and location, and risk factors including geophagia, thumbsucking and pet ownership were explored. Age was found to be a significant factor in relation to infection with Toxocara. Males were significantly more infected than females, as were the inhabitants of rural schools versus urban schools. The percentage of seropositive children varied widely from school to school. Geophagia and pet ownership were found to be significantly associated with toxocariasis. Logistic regression analysis was used to model the relative contribution of these factors to infection with Toxocara. While this analysis identified factors which were highly significantly associated with Toxocara titre, the odds ratios were generally low indicating the low specificity of the model.