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1.
Epidemics ; 44: 100709, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37579587

RESUMO

Relaxing social distancing measures and reduced level of influenza over the last two seasons may lead to a winter 2022 influenza wave in England. We used an established model for influenza transmission and vaccination to evaluate the rolled out influenza immunisation programme over October to December 2022. Specifically, we explored how the interplay between pre-season population susceptibility and influenza vaccine efficacy control the timing and the size of a possible winter influenza wave. Our findings suggest that susceptibility affects the timing and the height of a potential influenza wave, with higher susceptibility leading to an earlier and larger influenza wave while vaccine efficacy controls the size of the peak of the influenza wave. With pre-season susceptibility higher than pre-COVID-19 levels, under the planned vaccine programme an early influenza epidemic wave is possible, its size dependent on vaccine effectiveness against the circulating strain. If pre-season susceptibility is low and similar to pre-COVID levels, the planned influenza vaccine programme with an effective vaccine could largely suppress a winter 2022 influenza outbreak in England.


Assuntos
COVID-19 , Vacinas contra Influenza , Influenza Humana , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Vacinas contra Influenza/uso terapêutico , Estações do Ano , Eficácia de Vacinas , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinação , Inglaterra/epidemiologia
2.
J Public Health (Oxf) ; 43(3): e446-e452, 2021 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-33782705

RESUMO

BACKGROUND: UK asymptomatic contacts of confirmed COVID-19 cases are not routinely tested for SARS-CoV-2. Testing contacts may improve case ascertainment and reduce onward transmission. This study investigated the acceptability of SARS-CoV-2 testing among contacts of confirmed cases as an integral part of the contact-tracing process. METHODS: A cross-sectional descriptive survey of case contacts was conducted in the UK. All contacts who completed a telephone call with the NHS Test and Trace Agile Lighthouse team were eligible for inclusion and were offered a molecular test. Consenting participants were sent a self-swab kit. RESULTS: Of the 1523 individuals contacted, 602 (39.5%) accepted the test offer. Of the 240 (39.9%) samples returned for testing, 16.3% tested polymerase chain reaction-positive for SARS-CoV-2.Most individuals who declined with a reason (638/905; 70.5%) reported they had already taken or booked a SARS-CoV-2 test, or were part of a testing programme. Matched laboratory records confirmed 73.1% of those who declined were tested by another route. CONCLUSIONS: Most case contacts were tested, either through arranging a test by themselves or by accepting the study offer. Results demonstrate high acceptability, with substantial test positivity, indicating that there is public health benefit in offering tests to contacts as a routine part of the contact-tracing process.


Assuntos
COVID-19 , Teste para COVID-19 , Busca de Comunicante , Estudos Transversais , Humanos , SARS-CoV-2
3.
BMC Infect Dis ; 21(1): 90, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33478428

RESUMO

BACKGROUND: Ending the global tuberculosis (TB) epidemic requires a focus on treating individuals with latent TB infection (LTBI) to prevent future cases. Promising trials of shorter regimens have shown them to be effective as preventative TB treatment, however there is a paucity of data on self-administered treatment completion rates. This pilot trial assessed treatment completion, adherence, safety and the feasibility of treating LTBI in the UK using a weekly rifapentine and isoniazid regimen versus daily rifampicin and isoniazid, both self-administered for 12 weeks. METHODS: An open label, randomised, multi-site pilot trial was conducted in London, UK, between March 2015 and January 2017. Adults between 16 and 65 years with LTBI at two TB clinics who were eligible for and agreed to preventative therapy were consented and randomised 1:1 to receive either a weekly combination of rifapentine/isoniazid ('intervention') or a daily combination of rifampicin/isoniazid ('standard'), with both regimens taken for twelve weeks; treatment was self-administered in both arms. The primary outcome, completion of treatment, was self-reported, defined as taking more than 90% of prescribed doses and corroborated by pill counts and urine testing. Adverse events were recorded. RESULTS: Fifty-two patients were successfully enrolled. In the intervention arm 21 of 27 patients completed treatment (77.8, 95% confidence interval [CI] 57.7-91.4), compared with 19 of 25 (76.0%, CI 54.9-90.6) in the standard of care arm. There was a similar adverse effect profile between the two arms. CONCLUSION: In this pilot trial, treatment completion was comparable between the weekly rifapentine/isoniazid and the daily rifampicin/isoniazid regimens. Additionally, the adverse event profile was similar between the two arms. We conclude that it is safe and feasible to undertake a fully powered trial to determine whether self-administered weekly treatment is superior/non-inferior compared to current treatment. TRIAL REGISTRATION: The trial was funded by the NIHR, UK and registered with ISRCTN ( 26/02/2013-No.04379941 ).


Assuntos
Antituberculosos/uso terapêutico , Tuberculose Latente/tratamento farmacológico , Rifampina/análogos & derivados , Rifampina/uso terapêutico , Adolescente , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/efeitos adversos , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Isoniazida/administração & dosagem , Isoniazida/efeitos adversos , Isoniazida/uso terapêutico , Londres , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Rifampina/administração & dosagem , Rifampina/efeitos adversos , Autoadministração , Resultado do Tratamento , Adulto Jovem
4.
Epidemiol Infect ; 148: e60, 2020 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-32079547

RESUMO

For outbreaks of gastrointestinal disease, rapid identification of the source is crucial to enable public health intervention and prevent further cases. Outbreak investigation comprises analyses of exposure information from cases and, if required, undertaking analytical epidemiological studies. Hypothesis generation has been reliant on empirical knowledge of exposures historically associated with a given pathogen. Epidemiology studies are resource-intensive and prone to bias, one of the reasons being the difficulties in recruiting appropriate controls. For this paper, the information from cases was compared against pre-defined background exposure information. As exemplars, three past outbreaks were used, one of common and two of rare exposures. Information from historical case trawling questionnaires was used to define background exposure having removed any exposures implicated with the outbreak. The case-background approach showed good sensitivity and specificity, identifying correctly all outbreak-related exposures. One additional exposure related to a retailer was identified and four food items where all cases had been exposed. In conclusion, the case-background method, a development of the case-case design, can be used to assist with hypothesis generation or when a case-control study may not be possible to carry out.


Assuntos
Surtos de Doenças , Exposição Ambiental/estatística & dados numéricos , Projetos de Pesquisa Epidemiológica , Gastroenteropatias/epidemiologia , Adulto , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública , Estudos Retrospectivos , Infecções por Salmonella/epidemiologia , Infecções por Salmonella/transmissão , Adulto Jovem
5.
Epidemiol Infect ; 147: e215, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-31364538

RESUMO

Shiga toxin-producing Escherichia coli (STEC) infection can cause serious illness including haemolytic uraemic syndrome. The role of socio-economic status (SES) in differential clinical presentation and exposure to potential risk factors amongst STEC cases has not previously been reported in England. We conducted an observational study using a dataset of all STEC cases identified in England, 2010-2015. Odds ratios for clinical characteristics of cases and foodborne, waterborne and environmental risk factors were estimated using logistic regression, stratified by SES, adjusting for baseline demographic factors. Incidence was higher in the highest SES group compared to the lowest (RR 1.54, 95% CI 1.19-2.00). Odds of Accident and Emergency attendance (OR 1.35, 95% CI 1.10-1.75) and hospitalisation (OR 1.71, 95% CI 1.36-2.15) because of illness were higher in the most disadvantaged compared to the least, suggesting potential lower ascertainment of milder cases or delayed care-seeking behaviour in disadvantaged groups. Advantaged individuals were significantly more likely to report salad/fruit/vegetable/herb consumption (OR 1.59, 95% CI 1.16-2.17), non-UK or UK travel (OR 1.76, 95% CI 1.40-2.27; OR 1.85, 95% CI 1.35-2.56) and environmental exposures (walking in a paddock, OR 1.82, 95% CI 1.22-2.70; soil contact, OR 1.52, 95% CI 2.13-1.09) suggesting other unmeasured risks, such as person-to-person transmission, could be more important in the most disadvantaged group.


Assuntos
Infecções por Escherichia coli/epidemiologia , Disparidades nos Níveis de Saúde , Síndrome Hemolítico-Urêmica/epidemiologia , Toxina Shiga/efeitos adversos , Escherichia coli Shiga Toxigênica/isolamento & purificação , Adulto , Análise de Variância , Bases de Dados Factuais , Diarreia/epidemiologia , Diarreia/microbiologia , Escherichia coli Êntero-Hemorrágica/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Feminino , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Incidência , Masculino , Análise Multivariada , Avaliação das Necessidades , Prevalência , Estudos Retrospectivos , Medição de Risco , Classe Social , Reino Unido/epidemiologia
6.
Epidemiol Infect ; 147: e226, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-31364583

RESUMO

To control hepatitis A spread by vaccination, accurate estimation of transmissibility is vital. Regan et al. (2016) proposed a model of hepatitis A virus (HAV) transmission and used least squares to calibrate model to the 1991/1992 HAV outbreak in men who have sex with men (MSM) in Sydney, Australia. Based on the estimate of R0, they obtained the critical immunity of 70% and showed that when the proportion immune <70%, there is a definite chance for outbreaks to take place. The immunity level from previous surveys ranges from 32% to 64% after 1996 while no outbreaks in Australian MSMs have been reported since 1996. Further noticing the ill-distributed parameters, we argue that their estimate of R0 is not accurate. In this study, we revisited their model by Bayesian inference, which has privilege over least squares. We obtained the appropriate posterior distributions of parameters and the estimate of R0 ranges from 1.38 to 2.89, indicating a critical immunity of 65%. The reduction in critical immunity and outbreak probabilities predicts the absence of outbreaks in Australian MSMs since 1996. Our study shows the importance of using appropriate methods to provide reliable and accurate estimates of the model parameters especially the transmissibility.


Assuntos
Controle de Doenças Transmissíveis , Surtos de Doenças , Transmissão de Doença Infecciosa/estatística & dados numéricos , Vírus da Hepatite A/isolamento & purificação , Hepatite A/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Adulto , Austrália/epidemiologia , Teorema de Bayes , Estudos de Coortes , Transmissão de Doença Infecciosa/prevenção & controle , Hepatite A/diagnóstico , Humanos , Masculino , Cadeias de Markov , Estudos Retrospectivos , População Urbana
7.
Epidemiol Infect ; 146(16): 2042-2048, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30109834

RESUMO

During the 2009 influenza pandemic, a rapid assessment of disease severity was a challenge as a significant proportion of cases did not seek medical care; care-seeking behaviour changed and the proportion asymptomatic was unknown. A random-digit-dialling telephone survey was undertaken during the 2011/12 winter season in England and Wales to address the feasibility of answering these questions. A proportional quota sampling strategy was employed based on gender, age group, geographical location, employment status and level of education. Households were recruited pre-season and re-contacted immediately following peak seasonal influenza activity. The pre-peak survey was undertaken in October 2011 with 1061 individuals recruited and the post-peak telephone survey in March 2012. Eight hundred and thirty-four of the 1061 (78.6%) participants were successfully re-contacted. Their demographic characteristics compared well to national census data. In total, 8.4% of participants self-reported an influenza-like illness (ILI) in the previous 2 weeks, with 3.2% conforming to the World Health Organization (WHO) ILI case definition. In total, 29.6% of the cases reported consulting their general practitioner. 54.1% of the 1061 participants agreed to be re-contacted about providing biological samples. A population-based cohort was successfully recruited and followed up. Longitudinal survey methodology provides a practical tool to assess disease severity during future pandemics.


Assuntos
Influenza Humana/epidemiologia , Influenza Humana/patologia , Entrevistas como Assunto , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , País de Gales/epidemiologia , Adulto Jovem
8.
J Appl Microbiol ; 125(4): 1175-1185, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29802669

RESUMO

AIMS: To investigate the microbiological quality of imported fresh leaves on retail sale during 2017 with respect to Salmonella, Shiga-toxin-producing Escherichia coli (STEC) and levels of E. coli. METHODS AND RESULTS: Two hundred and seventy-nine samples of imported edible leaves (69 banana, 77 betel, 118 curry and 15 other types) were tested. Salmonella spp. were confirmed by whole-genome sequencing and isolated from 44 samples, 26% from curry leaves, 14% from betel and 2·4% from all other leaf types: 80% of all samples contained ≥102 , 44% ≥103 and 22% ≥104 CFU of E. coli CFU per g. All samples where Salmonella were detected also yielded ≥20 CFU of E. coli/g. 54 samples were tested for STEC which was detected in six samples and isolated from three: one was identified as STEC O157:H7. CONCLUSIONS: This report further highlights an ongoing problem of Salmonella contamination of imported fresh edible leaves. SIGNIFICANCE AND IMPACT OF THE STUDY: Among all food tested by Public Health England (approximately 11 000 per annum), curry leaves were the herb most commonly contaminated with Salmonella, and betel leaves were the most commonly contaminated ready-to-eat food. The high proportion with unsatisfactory E. coli levels and the detection of STEC suggests risks of contamination by multiple enteric pathogens.


Assuntos
Areca/microbiologia , Helichrysum/microbiologia , Folhas de Planta/microbiologia , Escherichia coli Shiga Toxigênica/crescimento & desenvolvimento , Especiarias/microbiologia , Inglaterra , Contaminação de Alimentos/análise , Contaminação de Alimentos/economia , Salmonella/genética , Salmonella/crescimento & desenvolvimento , Salmonella/isolamento & purificação , Escherichia coli Shiga Toxigênica/genética , Escherichia coli Shiga Toxigênica/isolamento & purificação , Especiarias/economia
9.
Epidemiol Infect ; 145(12): 2458-2465, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28724455

RESUMO

Recent cases of acute kidney injury due to Seoul hantavirus infection from exposure to wild or pet fancy rats suggest this infection is increasing in prevalence in the UK. We conducted a seroprevalence study in England to estimate cumulative exposure in at-risk groups with contact with domesticated and wild rats to assess risk and inform public health advice. From October 2013 to June 2014, 844 individual blood samples were collected. Hantavirus seroprevalence amongst the pet fancy rat owner group was 34.1% (95% CI 23·9-45·7%) compared with 3·3% (95% CI 1·6-6·0) in a baseline control group, 2·4% in those with occupational exposure to pet fancy rats (95% CI 0·6-5·9) and 1·7% with occupational exposure to wild rats (95% CI 0·2-5·9). Variation in seroprevalence across groups with different exposure suggests that occupational exposure to pet and wild rats carries a very low risk, if any. However incidence of hantavirus infection among pet fancy rat owners/breeders, whether asymptomatic, undiagnosed mild viral illness or more severe disease may be very common and public health advice needs to be targeted to this at-risk group.


Assuntos
Febre Hemorrágica com Síndrome Renal/epidemiologia , Exposição Ocupacional , Doenças dos Roedores/epidemiologia , Vírus Seoul/isolamento & purificação , Adolescente , Adulto , Animais , Inglaterra/epidemiologia , Febre Hemorrágica com Síndrome Renal/virologia , Humanos , Incidência , Pessoa de Meia-Idade , Animais de Estimação , Prevalência , Ratos , Doenças dos Roedores/virologia , Estudos Soroepidemiológicos , Adulto Jovem
11.
Epidemiol Infect ; 145(8): 1545-1556, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28190406

RESUMO

The purpose of this study was to investigate the microbiological quality of liver pâté. During 2012-13, a total of 870 samples, unrelated to the investigation of food-poisoning outbreaks, were collected either at retail (46%), catering (53%) or the point of manufacture (1%) and were tested using standard methods to detect Salmonella spp. or Campylobacter spp., and to enumerate for Listeria spp., including Listeria monocytogenes, Clostridium perfringens, coagulase-positive staphylococci including Staphylococcus aureus, Bacillus spp., including Bacillus cereus, Escherichia coli, Enterobacteriaceae, and aerobic colony counts (ACCs). Seventy-three percent of samples were of satisfactory microbiological quality, 18% were borderline and 9% unsatisfactory. Salmonella spp. or Campylobacter spp. was not recovered from any sample. The most common causes of unsatisfactory results were elevated ACCs (6% of the samples) and high Enterobacteriaceae counts (4% of samples). The remaining unsatisfactory results were due to elevated counts of: E. coli (three samples); B. cereus (one sample at 2·6 × 105 cfu/g); or L. monocytogenes (one sample at 2·9 × 103 cfu/g). Pâté from retail was less likely to be contaminated with L. monocytogenes than samples collected from catering and samples from supermarkets were of significantly better microbiological quality than those from catering establishments.


Assuntos
Bactérias/isolamento & purificação , Microbiologia de Alimentos , Serviços de Alimentação , Fígado/microbiologia , Produtos da Carne/microbiologia , Animais , Galinhas , Patos , Inglaterra , Restaurantes , Sus scrofa
12.
BMJ Open ; 6(1): e009933, 2016 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-26826153

RESUMO

OBJECTIVES: Assess the disease severity of Shiga toxin-producing Escherichia coli (STEC) O157 infection and factors influencing the development of typical haemolytic uraemic syndrome (tHUS). DESIGN: A retrospective cohort study using data collected through routine surveillance questionnaires between 2009 and 2012. PARTICIPANTS: 3323 symptomatic cases of STEC O157. MAIN OUTCOME MEASURES: Incidence of human STEC O157 and tHUS, proportion of cases reporting bloody diarrhoea, hospitalisation, tHUS and death. Odds of progression to tHUS and predicted percentage chance of developing tHUS based on case demographics, STEC O157 strain characteristics and clinical symptoms. RESULTS: From 2009 to 2012, 3323 cases of symptomatic STEC O157 with completed questionnaires were reported, of which 172 developed tHUS (5.18%). Being aged 1-4 years (OR 8.65, 95% CI 5.01 to 14.94, p=0.004) or female (OR 1.61, 95% CI 1.12 to 2.30, p=0.009), being infected with phage type (PT) 21/28 (OR 2.07, 95% CI 1.25 to 3.42, p=0.005) or PT 2 (OR 2.18, 95% CI 1.06 to 4.50, p=0.034), receiving ß-lactam antibiotics (OR 4.08, 95% CI 1.43 to 11.68, p=0.009) and presenting with vomiting (OR 3.16, 95% CI 2.16 to 4.62, p<0.001) or bloody diarrhoea (OR 2.10, 95% CI 1.38 to 3.20, p=0.001) were found to be significant risk factors for progression to tHUS. The predicted percentage chance of developing tHUS varied from under 1% to 50% if all risk factors were present. CONCLUSIONS: The data from this study indicate the use of ß-lactam antibiotics should be avoided in suspected cases of STEC infection in all age groups, particularly in those under the age of 5.


Assuntos
Infecções por Escherichia coli/microbiologia , Síndrome Hemolítico-Urêmica/microbiologia , Escherichia coli Shiga Toxigênica , Adolescente , Adulto , Idade de Início , Idoso , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Progressão da Doença , Inglaterra/epidemiologia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/epidemiologia , Feminino , Síndrome Hemolítico-Urêmica/tratamento farmacológico , Síndrome Hemolítico-Urêmica/epidemiologia , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Vigilância da População , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem , beta-Lactamas/uso terapêutico
13.
Epidemiol Infect ; 144(6): 1220-30, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26493476

RESUMO

Timely recruitment of population controls in infectious disease outbreak investigations is challenging. We evaluated the timeliness and cost of using a market research panel as a sampling frame for recruiting controls in a case-control study during an outbreak of Salmonella Mikawasima in the UK in 2013. We deployed a web-survey by email to targeted members of a market research panel (panel controls) in parallel to the outbreak control team interviewing randomly selected public health staff by telephone and completing paper-based questionnaires (staff controls). Recruitment and completion of exposure history web-surveys for panel controls (n = 123) took 14 h compared to 15 days for staff controls (n = 82). The average staff-time cost per questionnaire for staff controls was £13·13 compared to an invoiced cost of £3·60 per panel control. Differences in the distribution of some exposures existed between these control groups but case-control studies using each group found that illness was associated with consumption of chicken outside of the home and chicken from local butchers. Recruiting market research panel controls offers time and resource savings. More rapid investigations would enable more prompt implementation of control measures. We recommend that this method of recruiting controls is considered in future investigations and assessed further to better understand strengths and limitations.


Assuntos
Estudos de Casos e Controles , Surtos de Doenças , Internet , Marketing , Saúde Pública/métodos , Infecções por Salmonella/epidemiologia , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Infecções por Salmonella/microbiologia , Infecções por Salmonella/prevenção & controle , Salmonella enterica , Reino Unido/epidemiologia
15.
Epidemiol Infect ; 144(5): 968-75, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26424497

RESUMO

In November 2013, national public health agencies in England and Scotland identified an increase in laboratory-confirmed Salmonella Mikawasima. The role of proton pump inhibitors (PPIs) as a risk factor for salmonellosis is unclear; we therefore captured information on PPI usage as part of our outbreak investigation. We conducted a case-control study, comparing each case with two controls. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression. Thirty-nine of 61 eligible cases were included in the study. The median age of cases was 45 years; 56% were female. Of these, 33% were admitted to hospital and 31% reported taking PPIs. We identified an association between PPIs and non-typhoidal salmonellosis (aOR 8·8, 95% CI 2·0-38·3). There is increasing evidence supporting the existence of an association between salmonellosis and PPIs; however, biological studies are needed to understand the effect of PPIs in the pathogenesis of Salmonella. We recommend future outbreak studies investigate PPI usage to strengthen evidence on the relevance of PPIs in Salmonella infection. These findings should be used to support the development of guidelines for patients and prescribers on the risk of gastrointestinal infection and PPI usage.


Assuntos
Surtos de Doenças , Inibidores da Bomba de Prótons/administração & dosagem , Infecções por Salmonella/epidemiologia , Salmonella enterica/isolamento & purificação , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/efeitos adversos , Fatores de Risco , Infecções por Salmonella/induzido quimicamente , Escócia/epidemiologia , País de Gales/epidemiologia , Adulto Jovem
16.
Epidemiol Infect ; 144(1): 171-81, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26041509

RESUMO

Between December 2010 and July 2011, 252 cases of STEC O157 PT8 stx1 + 2 infection were reported in England, Scotland and Wales. This was the largest outbreak of STEC reported in England and the second largest in the UK to date. Eighty cases were hospitalized, with two cases of haemolytic uraemic syndrome and one death reported. Routine investigative data were used to generate a hypothesis but the subsequent case-control study was inconclusive. A second, more detailed, hypothesis generation exercise identified consumption or handling of vegetables as a potential mode of transmission. A second case-control study demonstrated that cases were more likely than controls to live in households whose members handled or prepared leeks bought unwrapped [odds ratio (OR) 40, 95% confidence interval (CI) 2·08-769·4], and potatoes bought in sacks (OR 13·13, 95% CI 1·19-145·3). This appears to be the first outbreak of STEC O157 infection linked to the handling of leeks.


Assuntos
Surtos de Doenças , Infecções por Escherichia coli/epidemiologia , Escherichia coli O157/genética , Microbiologia de Alimentos , Cebolas/microbiologia , Solanum tuberosum/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Eletroforese em Gel de Campo Pulsado , Inglaterra/epidemiologia , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/mortalidade , Escherichia coli O157/isolamento & purificação , Feminino , Síndrome Hemolítico-Urêmica/epidemiologia , Síndrome Hemolítico-Urêmica/etiologia , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Repetições Minissatélites , Tipagem de Sequências Multilocus , Escócia/epidemiologia , País de Gales/epidemiologia , Adulto Jovem
17.
Public Health ; 129(9): 1244-50, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26278476

RESUMO

OBJECTIVES: Sexually transmitted infections, HIV and unplanned pregnancies continue to be a major public health problem in England, especially in young adults. Strengthening the provision of free condoms, HIV testing, chlamydia screening and contraception within primary care will contribute to reducing poor sexual and reproductive health outcomes. Recent research demonstrated the benefit for general practices of educational support visits based on behaviour change theory. Public Health England (PHE) has piloted an educational training programme to improve the delivery of sexual health services and HIV testing within general practice. STUDY DESIGN & METHODS: The 3Cs & HIV programme used practice based workshops to improve staffs' awareness and skills in order to increase opportunistic offers of chlamydia testing, provision of contraceptive service information and free condoms (the '3Cs') to 15-24 year olds and HIV testing according to national guidelines. The programme was based on the theory of planned behaviour and has been implemented using a stepped wedge design. Process evaluation, testing and diagnosis data, plus qualitative interviews were all used in the evaluation. The primary outcome measures were chlamydia testing and diagnosis rates. Secondary outcome measures were HIV testing and diagnoses rates within each practice and rates of consultations where long acting reversible contraceptives had been discussed. CONCLUSION: A key strength of the 3Cs & HIV programme has been the evidence base underpinning the development of the resources and the formal process evaluation of its implementation. The programme was designed to encourage sustainable relationships between general practice staff and local sexual health services as well as the knowledge, awareness and behaviours cultivated during the programme.


Assuntos
Protocolos Clínicos , Medicina Geral , Serviços de Saúde Reprodutiva , Educação Sexual , Adolescente , Infecções por Chlamydia/prevenção & controle , Preservativos , Anticoncepção , Inglaterra , Infecções por HIV/prevenção & controle , Humanos , Programas de Rastreamento , Adulto Jovem
18.
Euro Surveill ; 20(10): 21058, 2015 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-25788252

RESUMO

This report aims to evaluate the usefulness of self-sampling as an approach for future national surveillance of emerging respiratory infections by comparing virological data from two parallel surveillance schemes in England. Nasal swabs were obtained via self-administered sampling from consenting adults (≥ 16 years-old) with influenza symptoms who had contacted the National Pandemic Flu Service (NPFS) health line during the 2009 influenza pandemic. Equivalent samples submitted by sentinel general practitioners participating in the national influenza surveillance scheme run jointly by the Royal College of General Practitioners (RCGP) and Health Protection Agency were also obtained. When comparable samples were analysed there was no significant difference in results obtained from self-sampling and clinician-led sampling schemes. These results demonstrate that self-sampling can be applied in a responsive and flexible manner, to supplement sentinel clinician-based sampling, to achieve a wide spread and geographically representative way of assessing community transmission of a known organism.


Assuntos
Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/virologia , Autoadministração/métodos , Vigilância de Evento Sentinela , Manejo de Espécimes/métodos , Adulto , Inglaterra/epidemiologia , Feminino , Humanos , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Masculino , Cavidade Nasal/virologia , Pandemias , RNA Viral/genética , Características de Residência , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Inquéritos e Questionários
19.
J Antimicrob Chemother ; 70(4): 1212-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25525198

RESUMO

OBJECTIVES: The objective of this study was to identify carbapenem-resistant organisms using routinely collected local microbiology data and describe the epidemiology of carbapenem resistance in two London teaching hospitals. METHODS: Data on inpatients infected or colonized with Gram-negative organisms between March 2009 and February 2012 were extracted. A computer algorithm was developed incorporating internationally recognized criteria to distinguish carbapenem-resistant organisms. Multivariable analysis was conducted to identify factors associated with infection or colonization with carbapenem-resistant organisms. Binomial regression was performed to detect changes in resistance trends over time. RESULTS: Yearly incidence of carbapenem resistance was observed to be increasing, with significant increasing trends in Acinetobacter baumannii (47.1% in 2009-10 to 77.2% in 2011-12; P<0.001) and Enterobacter spp. (2.2% in 2009-10 to 11.5% in 2011-12; P<0.001). Single-variable and multivariable analysis demonstrated differences in the proportion of carbapenem-resistant isolates across all variables investigated, including age, sex and clinical specialty; in the latter organism-specific niches were identified. Patients in the youngest age group (16-24 years old) had the highest odds of being infected or colonized with carbapenem-resistant isolates of Escherichia coli, Klebsiella spp. or Pseudomonas aeruginosa. Furthermore, proportions of carbapenem-resistant organisms differed between the hospitals. CONCLUSIONS: Carbapenem resistance is an emerging problem within the UK inpatient healthcare setting. This is not an issue confined to the Enterobacteriaceae and fine-resolution surveillance is needed to identify at-risk groups. Regular analysis of routinely collected data can provide insight into the evolving carbapenem-resistance threat, with the ability to inform efforts to prevent the spread of resistance.


Assuntos
Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Resistência beta-Lactâmica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/isolamento & purificação , Hospitais de Ensino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Epidemiol Infect ; 143(1): 1-12, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25023603

RESUMO

General Practitioner consultation rates for influenza-like illness (ILI) are monitored through several geographically distinct schemes in the UK, providing early warning to government and health services of community circulation and intensity of activity each winter. Following on from the 2009 pandemic, there has been a harmonization initiative to allow comparison across the distinct existing surveillance schemes each season. The moving epidemic method (MEM), proposed by the European Centre for Disease Prevention and Control for standardizing reporting of ILI rates, was piloted in 2011/12 and 2012/13 along with the previously proposed UK method of empirical percentiles. The MEM resulted in thresholds that were lower than traditional thresholds but more appropriate as indicators of the start of influenza virus circulation. The intensity of the influenza season assessed with the MEM was similar to that reported through the percentile approach. The MEM pre-epidemic threshold has now been adopted for reporting by each country of the UK. Further work will continue to assess intensity of activity and apply standardized methods to other influenza-related data sources.


Assuntos
Notificação de Doenças/métodos , Monitoramento Epidemiológico , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Atenção Primária à Saúde/métodos , Humanos , Reino Unido/epidemiologia
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