Ebola 2014: Setting up a port health screening programme at an international train station.

An outbreak of Ebola virus disease (EVD) began in Guinea in December 2013 and was declared a Public Health Emergency of International Concern by the World Health Organization in August 2014. In October, the UK government tasked Public Health England (PHE) to set up EVD screening at key ports. The key aim of port-of-entry screening was to identify passengers coming from areas with high risk of EVD, and give them advice to raise their awareness of symptoms and what actions to take. Direct flights from Sierra Leone, Guinea or Liberia had all been cancelled, so intelligence on passenger numbers and routes was used to identify the most commonly used routes from the affected countries into the UK. One of these was St Pancras International train station. Screening had never previously been implemented at a UK train station so had to be set up from scratch. Key to the success of this was excellent multi-agency working between PHE, the UK Border Force, Eurostar, Network Rail and the Cabinet Office. This paper gives an overview of the activation of EVD screening at St Pancras International and the subsequent decommissioning.

An outbreak of invasive group A streptococcal infection among elderly patients receiving care from a district nursing team, October 2013 - May 2014.

Between October 2013 and April 2014 five elderly patients living within a 2 square mile radius, were admitted to local hospitals with severe group A streptococcal cellulitis and septicaemia. Molecular typing confirmed four patients for whom typing results were available to have the same emm gene sequence type, emm st89. An outbreak investigation was launched and identified that each patient had received care interventions from a district nursing team at their home or local health clinic in the 7 days prior to onset of symptoms.

Patterns of early transmission of pandemic influenza in London - link with deprivation.

BACKGROUND: During the early containment phase in England from April to June 2009, the national strategy for H1N1 pandemic influenza involved case investigation and treatment, and tracing and prophylaxis of contacts. OBJECTIVE: To describe the relationship between early transmission of H1N1 pandemic influenza in London and age and socio-economic status. METHODS: Epidemiological data on cases of pandemic flu in London reported to the London Flu Response Centre were analysed to determine patterns of transmission. RESULTS: There were 3487 reported cases (2202 confirmed, 1272 presumed and 14 probable) from 20 April to 28 June 2009, during the 'containment' period. The highest report rate of 206 per 100 000 (95% CI 195-218) was seen in primary school-age children (5-11 years) followed by 129 (95% CI 119-139) in secondary school-age children (12-18 years). Reports of cases were initially concentrated in affluent areas but overall showed a clear trend with deprivation and risk ratio of 2·32 (95% CI 1·94-2·78) between the most deprived and the least deprived. CONCLUSION: Early transmissions were highest amongst school-aged children but linked with socio-economic deprivation across all age groups.

Pandemic (H1N1) 2009: setting up a multi-agency regional response centre--a toolkit for other public health emergencies.

The H1N1 pandemic emerged from Mexico in April 2009. In the UK, local Health Protection Units were quickly overwhelmed with calls from health professionals seeking public health advice on this novel virus. The Health Protection Agency (HPA) led the initial response and established regional flu response centres (FRCs). In London, the HPA's flu response moved swiftly from four in-house emergency operations centres to a fully functional multiagency response centre in rented office space, working with a new database, IT and telephone systems to provide a regional response. Surge capacity was sought from the National Health Service (NHS) and other agencies. The London FRC transferred to NHS leadership supported by the existing management team to assist the NHS in London prior to the opening of the National Pandemic Flu Service. Structured debriefs were undertaken, identifying lessons for future evolving incidents. This paper gives an overview of the activation, resilience and decommissioning of the London FRC, incorporating the lessons identified and key recommendations into a toolkit for future emergency evolving incidents that adopt a regional response centre model.

Methicillin-resistant Staphylococcus aureus, Clostridium difficile, and extended-spectrum beta-lactamase-producing Escherichia coli in the community: assessing the problem and controlling the spread.

Although health care-associated methicillin resistant staphylococcus aureus and clostridium difficile strains are primarily a risk to hospital patients, people are increasingly concerned about their potential to circulate in the community and the home. They are thus looking for support in order to understand the extent of the risk, and guidance on how to deal with situations where preventing infection from these species becomes their responsibility. A further concern are the community-acquired MRSA and C. difficile strains, and other antibiotic resistant strains circulating in the community such as the Extended-spectrum beta-lactamase (ESBL) Escherichia coli. In response to concerns about such organisms in the community, the International Scientific Forum on Home Hygiene has produced a report evaluating MRSA, C. difficile, and ESBL-producing E. coli from a community viewpoint. The report summarizes what is known about their prevalence in the community, their mode of transmission in the home, and the extent to which they represent a risk. It also includes "advice sheets" giving practical guidance on what to do when there is a risk of infection transmission in the home.