Salmonella Paratyphi B; Public Health and Parental Choice: When to Treat Asymptomatic Carriers of Infection?

BACKGROUND: Salmonella Paratyphi B (Paratyphoid B) is a rare infection and a notifiable disease in England. Disease is typically mild, and chronic carriage in children has been described in endemic countries. Almost all cases in England are imported, with very few cases of community transmission reported. METHODS: The aim of this work was to describe an unusual cluster of Paratyphoid B cases transmitted within England, examining clinical, epidemiologic and microbiologic data. Detailed phylogenetic analysis is presented to corroborate public health epidemiologic links between cases. RESULTS: One child had recently returned from an endemic area and had mild gastrointestinal symptoms. One year later, 2 other children with no travel history developed invasive disease requiring hospitalization. Epidemiologic links confirmed person-to-person spread between these three cases. All isolates of S. Paratyphi B (n = 93) received by the Gastrointestinal Bacteria Reference Unit between 2014 and 2019 were typed using whole genome sequencing. Three cases of Paratyphoid B were identified in the same geographical location over a 2-year period. S. Paratyphi B strains isolated from the stool and blood of the three cases were closely linked (0-5 single-nucleotide polymorphisms) using whole genome sequencing. CONCLUSIONS: This case series highlights the potential public health risks of paratyphoid B and the range of pediatric complications associated with this illness, especially in younger children. Although rare, chronic carriage of Paratyphoid B can lead to transmission in nonendemic areas and should be considered in all children presenting with signs of enteric fever even where there is no history of foreign travel.

Ongoing outbreak of invasive and non-invasive disease due to group A Streptococcus (GAS) type emm66 among homeless and people who inject drugs in England and Wales, January to December 2016.

We report an outbreak of invasive and non-invasive disease due to an unusual type of Streptococcus pyogenes (group A Streptococcus, emm66) among a vulnerable, largely homeless population in southern England and Wales, detected in September 2016. Twenty-seven confirmed cases were subsequently identified between 5 January and 29 December 2016; 20 injected drugs and six reported problematic alcohol use. To date, we have ruled out drug-related vehicles of infection and identified few common risk factors.

Hepatitis B vaccination coverage and uptake in prisons across England and Wales 2003-2010: a retrospective ecological study.

OBJECTIVE: To describe the custodial hepatitis B vaccination programme performance and examine these data by geographical region and prison category. DESIGN: Retrospective ecological study. DATA SOURCE: Health Protection Agency (HPA) published data. SETTING: Custodial primary healthcare providers located in prisons across England and Wales. PARTICIPANTS: 147 prisons which reported vaccination data between July 2003 and April 2010 to the HPA Prison Infection Prevention team. MAIN OUTCOME MEASURES: Hepatitis B vaccination coverage (July 2003 to April 2010) and uptake (December 2007 to April 2010). RESULTS: Median hepatitis B vaccination coverage was 22% (interquartile range [IQR] 5-49%) and uptake was 36% (IQR 16-59%). Vaccination coverage varied significantly between July 2003 and November 2007 compared to December 2007 and April 2010 (median 12% [IQR 2-31%] versus median 48% [IQR 26-67%], Mann-Whitney W=14,689,158.0, p<0.001). There was significant variation between vaccination coverage (Kruskal-Wallis H=613.44, DF=9, p<0.001) and uptake (Kruskal-Wallis H=247.99, DF=9, p<0.001) across the HPA regions. Compared to England and Wales, estimated population median vaccination coverage was significantly (p≤0.05) lower in three regions and one prison category and higher in four regions and seven prison categories; estimated population median vaccination uptake was significantly lower in three regions and three prison categories and higher in two regions and four prison categories. CONCLUSION: Prisoners are a vulnerable group with a high prevalence of hepatitis B infection and the custodial setting plays an important role in the delivery of hepatitis B vaccination to this hard to reach group. This study suggests that variation in hepatitis B vaccination coverage and uptake may exist by geographical region and prison category. Further research is required to confirm and identify possible explanations for our findings.