A seroprevalence study to determine the frequency of hantavirus infection in people exposed to wild and pet fancy rats in England.

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.

Variation in incidence and notification of Campylobacter and Salmonella by general practice in the Thames Valley area.

OBJECTIVES: To test whether there is unexplained variation in a) incidence of diagnosed bacterial food poisoning; and b) notification of bacterial food poisoning between general practices. STUDY DESIGN: Observational study using routine surveillance data collected between 1 January 2008 and 31 December 2009. METHODS: Poisson regression, and the pseudo-R(2) statistic, was used to test for the unexplained (i.e. after adjustment for measured confounders) variation in incidence between practices. A generalized linear model, and the pseudo-R(2) statistic, was used to test for variation in notifications between practices. Both models were adjusted for demographic factors and organisational factors (Primary Care Trust and Quality and Outcomes Framework score). RESULTS: A total of 5766 incident cases (811 Salmonella and 4955 Campylobacter) were included. The adjusted incidence of Salmonella and Campylobacter was 128.3 cases per 100,000 persons per year. The adjusted incidence by general practice ranged from 9.8 to 281 per 100,000 (IQR: 90.2-151) persons per year. The median practice notification rate for Salmonella was 25% (range: 0%-100%), and 14.3% (range: 0%-87.5%) for Campylobacter. The Poisson regression model had a pseudo-R(2) of 0.080 for the total number of Salmonella and Campylobacter cases, after adjustment for Primary Care Trust and practice deprivation, suggesting substantial variation. The Generalized Linear regression model (predicting notification by general practice) had a pseudo-R(2) of 0.040 for Salmonella and Campylobacter, after adjustment for Primary Care Trust and practice deprivation, suggesting substantial unexplained variation. CONCLUSION: Substantial variation in the diagnosed incidence and notification of Salmonella and Campylobacter by general practice in the Thames Valley area exists. Practice-level factors are likely to account for some of the difference in testing and under-notification. This is important for interpreting data from surveillance systems. Further research is needed to inform interventions designed to increase notifications or improve testing.

Impact of ambient air pollution on birth weight in Sydney, Australia.

BACKGROUND: Studies in Asia, Europe, and the Americas have provided evidence that ambient air pollution may have an adverse effect on birth weight, although results are not consistent. METHODS: Average exposure during pregnancy to five common air pollutants was estimated for births in metropolitan Sydney between 1998 and 2000. The effects of pollutant exposure in the first, second, and third trimesters of pregnancy on risk of "small for gestational age" (SGA), and of pollutant exposure during pregnancy on birth weight were examined. RESULTS: There were 138,056 singleton births in Sydney between 1998 and 2000; 9.7% of babies (13,402) were classified as SGA. Air pollution levels in Sydney were found to be quite low. In linear regression models carbon monoxide and nitrogen dioxide concentrations in the second and third trimesters had a statistically significant adverse effect on birth weight. For a 1 part per million increase in mean carbon monoxide levels a reduction of 7 (95% CI -5 to 19) to 29 (95% CI 7 to 51) grams in birth weight was estimated. For a 1 part per billion increase in mean nitrogen dioxide levels a reduction of 1 (95% CI 0 to 2) to 34 (95% CI 24 to 43) grams in birth weight was estimated. Particulate matter (diameter less than ten microns) in the second trimester had a small statistically significant adverse effect on birth weight. For a 1 microgram per cubic metre increase in mean particulate matter levels a reduction of 4 grams (95% CI 3 to 6) in birth weight was estimated. CONCLUSION: These findings of an association between carbon monoxide, nitrogen dioxide, and particulate matter, and reduction in birth weight should be corroborated by further study.