An outbreak of hepatitis A virus infection in a secondary school in England with no undetected asymptomatic transmission among students.

In June 2019 the Health Protection Team in Yorkshire and Humber, England, was notified of cases of hepatitis A virus (HAV) infection in staff at a secondary school. Investigation revealed that an earlier case worked as a food handler in the school kitchen. Indirect transmission through food from the canteen was considered the most likely route of transmission. Cases were described according to setting of exposure. Oral fluid was obtained from students for serological testing. Environmental investigations were undertaken at settings where food handling was considered a potential transmission risk. Thirty-three confirmed cases were linked to the outbreak. All of those tested (n = 31) shared the same sequence with a HAV IB genotype. The first three cases were a household cluster and included the index case for the school. A further 19 cases (16 students, 3 staff) were associated with the school and consistent with indirect exposure to the food handler. One late onset case could not be ruled out as a secondary case within the school and resulted in vaccination of the school population. Five cases were linked to a bakery where a case from the initial household cluster worked as a food server. No concerns about hygiene standards were noted at either the school or the bakery. Oral fluid samples taken at the time of vaccination from asymptomatic students (n = 219, 11-16 years-old) showed no evidence of recent or current infection. This outbreak included household and foodborne transmission but limited (and possibly zero) person-to-person transmission among secondary school students. Where adequate hygiene exists, secondary transmission within older students may not occur.

A persistent recurring cluster of meticillin-resistant Staphylococcus aureus (MRSA) colonizations in a special care baby unit: a matched case-control study.

BACKGROUND: Between August 2016 and November 2019, a cluster of babies colonized with meticillin-resistant Staphylococcus aureus (MRSA) was reported in a special care baby unit in northern England. AIM: A case-control study was performed to identify the source and prevent further cases. METHODS: Cases were admitted neonates colonized or infected with MRSA (spa type t316). A retrospective case-control study was performed with two matched controls per case. Exposures were determined by medical record review. Cases were compared with controls using conditional logistic regression. Environmental investigations and staff screening were undertaken. FINDINGS: Thirty-one colonized cases were identified across the 3-year period, with no infections reported. Thirteen of the 31 cases were sequenced and were within a cluster of 25 single nucleotide polymorphisms, consistent with exposure to a common source over a prolonged period. Most MRSA cases had a prior negative screen (N=22, 71%). Environmental sampling and staff screening were performed on several occasions. In the analytical study, 31 cases were compared with 62 controls. One ward location and one healthcare worker were identified as significant exposures in the multi-variable analysis. CONCLUSIONS: Due to the sporadic nature of the colonizations, it was hypothesized that MRSA was being introduced intermittently, likely by a colonized healthcare worker, with possible transmission between infants also occurring within each temporal cluster. It is recommended that transiently colonized healthcare workers should be considered as a source of MRSA during outbreaks. This study highlights the importance of analytic epidemiological studies in persistent outbreaks of MRSA.

COVID-19: public health management of the first two confirmed cases identified in the UK.

We report key learning from the public health management of the first two confirmed cases of COVID-19 identified in the UK. The first case imported, and the second associated with probable person-to-person transmission within the UK. Contact tracing was complex and fast-moving. Potential exposures for both cases were reviewed, and 52 contacts were identified. No further confirmed COVID-19 cases have been linked epidemiologically to these two cases. As steps are made to enhance contact tracing across the UK, the lessons learned from earlier contact tracing during the country's containment phase are particularly important and timely.

An outbreak of campylobacteriosis at a hotel in England: the ongoing risk due to consumption of chicken liver dishes.

Despite a sizeable evidence base for the risk of campylobacteriosis associated with eating chicken liver pâté, associated outbreaks continue to occur. In January 2017, six cases of campylobacteriosis reported having eaten a Christmas set-menu meal at the same hotel in North Yorkshire, England on the same day. A retrospective cohort study was undertaken to test the null hypothesis that consumption of individual food items was not associated with an increased risk of illness. There were 19 cases of campylobacteriosis linked to the outbreak; seven confirmed and 12 probable cases. Chicken liver pâté was the food item most strongly associated with illness (P < 0.001) with a corresponding high crude relative risk (12.95). This relationship was supported by multivariable analysis, sensitivity analyses and a clear dose-response relationship. Three cases reported an incubation period of <24 h, consistent with other outbreaks of campylobacteriosis associated with consumption of poultry liver. The findings were suggestive of a single point source exposure with a strong association between the consumption of chicken liver pâté and campylobacteriosis. This outbreak highlights that despite evidence that simple cooking techniques can ensure that all campylobacter are killed during cooking, outbreaks continue to occur. Public and professional awareness needs to be raised through a strategic communication plan to reduce the risk of further outbreaks of campylobacteriosis linked to incorrectly cooked chicken liver dishes.

Cryptosporidiosis outbreak in visitors of a UK industry-compliant petting farm caused by a rare Cryptosporidium parvum subtype: a case-control study.

A case-control study was conducted to investigate an outbreak of 46 cases of cryptosporidiosis in visitors to a petting farm in England. Details of exposures on the farm were collected for 38 cases and 39 controls, recruited through snowball sampling. Multivariable logistic regression identified that cases were 5·5 times more likely than controls to have eaten without washing their hands [95% confidence interval (CI) 1·51-19·9, P = 0·01] and 10 times less likely to report being informed of risk of infection on arrival (odds ratio 0·10, 95% CI 0·01-0·71, P = 0·02). An uncommon Cryptosporidium parvum gp60 subtype (IIaA19G1R1) was identified in a lamb faecal sample and all subtyped cases (n = 22). We conclude that lack of verbal advice and non-compliance with hand washing are significantly associated with a risk of cryptosporidiosis on open farms. These findings highlight the public health importance of effectively communicating risk to petting farm visitors in order to prevent future outbreaks of zoonotic infections.

Recent outbreaks of infectious syphilis, United Kingdom, January 2012 to April 2014.

Six outbreaks of infectious syphilis in the United Kingdom, ongoing since 2012, have been investigated among men who have sex with men (MSM) and heterosexual men and women aged under 25 years. Interventions included case finding and raising awareness among healthcare professionals and the public. Targeting at-risk populations was complicated as many sexual encounters involved anonymous partners. Outbreaks among MSM were influenced by the use of geospatial real-time networking applications that allow users to locate other MSM within close proximity.

A practical review of 'containment' during the influenza A (H1N1): an audit of the flu response centre in Yorkshire and the Humber.

BACKGROUND: During the 'containment' phase of the influenza A (H1N1) pandemic 2009, antivirals were used for treatment and prophylaxis. This audit aimed to review the speed of the process involved in delivering antivirals and to assess whether this was likely to have occurred fast enough to be in keeping with the aims of reducing transmission. METHODS: Flu Response Centres in each region were tasked with co-ordinating local delivery and all case data were entered into Fluzone (an electronic case management system). All data between 1 June and 2 July in the Yorkshire and Humber region were reviewed. Forty-eight hours from the onset of illness to treatment and prophylaxis were used as reference standards. RESULTS: The median estimate for the earliest point cases could have received treatment was 2 days (95% CI 2-3 days) and the earliest point contacts of cases could have received prophylaxis was 4 days (95% CI 4-5 days). CONCLUSIONS: The logistical difficulties of delivering 'containment' according to the national algorithms meant there were significant time delays involved and that this was likely to have reduced the effectiveness of the strategy. This would be important to consider if a 'containment' strategy was to be employed in any future emergency.

Reliability of the Camberwell Assessment of Need--European Version. EPSILON Study 6. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs.

BACKGROUND: The five-country European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study aimed to develop standardised and reliable outcome instruments for people with schizophrenia. This paper reports reliability findings for the Camberwell Assessment of Need--European Version (CAN-EU). METHOD: The CAN-EU was administered in each country, at two points in time to assess test-retest reliability, and was rated by two interviewers at the first administration. Cronbach's alpha, test-retest reliability and interrater reliability were compared between the five sites. Reliability coefficients and standard errors of measurement for summary scores were estimated. RESULTS: Sites varied in levels and spread of needs. Alphas were 0.48, 0.58 and 0.64 for total, met and unmet needs respectively. Test-retest reliability estimates, pooled over sites, were 0.85 for the total needs, 0.69 for met needs and 0.78 for unmet needs. Pooled estimates for interrater reliability were higher, at 0.94, 0.85 and 0.79 for total, met and unmet needs respectively. There were statistically significant differences in interrater reliability between sites. CONCLUSION: The results confirm the feasibility of using CAN-EU across sites in Europe and its psychometric adequacy.