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Large outbreak of multiple gastrointestinal pathogens associated with fresh curry leaves in North East England, 2013. Epidemiol Infect 2018; 146:1940-1947. [PMID: 30109832 DOI: 10.1017/s095026881800225x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A total of 592 people reported gastrointestinal illness following attendance at Street Spice, a food festival held in Newcastle-upon-Tyne, North East England in February/March 2013. Epidemiological, microbiological and environmental investigations were undertaken to identify the source and prevent further cases. Several epidemiological analyses were conducted; a cohort study; a follow-up survey of cases and capture re-capture to estimate the true burden of cases. Indistinguishable isolates of Salmonella Agona phage type 40 were identified in cases and on fresh curry leaves used in one of the accompaniments served at the event. Molecular testing indicated entero-aggregative Escherichia coli and Shigella also contributed to the burden of illness. Analytical studies found strong associations between illness and eating food from a particular stall and with food items including coconut chutney which contained fresh curry leaves. Further investigation of the food supply chain and food preparation techniques identified a lack of clear instruction on the use of fresh uncooked curry leaves in finished dishes and uncertainty about their status as a ready-to-eat product. We describe the investigation of one of the largest outbreaks of food poisoning in England, involving several gastrointestinal pathogens including a strain of Salmonella Agona not previously seen in the UK.
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Karampatsas K, Osborne L, Seah ML, Tong CYW, Prendergast AJ. Clinical characteristics and complications of rotavirus gastroenteritis in children in east London: A retrospective case-control study. PLoS One 2018; 13:e0194009. [PMID: 29565992 PMCID: PMC5863974 DOI: 10.1371/journal.pone.0194009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/22/2018] [Indexed: 12/22/2022] Open
Abstract
Background Rotavirus is the leading cause of acute gastroenteritis in children and is associated with neurological complications such as seizures and encephalopathy. The aim of this study was to investigate the presentation and complications of rotavirus compared to non-rotavirus gastroenteritis in UK children. Methods This was a retrospective, case-control, hospital-based study conducted at three sites in east London, UK. Cases were children aged 1 month to 16 years diagnosed with acute gastroenteritis between 1 June 2011 and 31 December 2013, in whom stool virology investigations confirmed presence of rotavirus by PCR. They were matched by age, gender and month of presentation to controls with rotavirus-negative gastroenteritis. Results Data were collected from 116 children (50 cases and 66 controls). Children with rotavirus gastroenteritis tended to present more frequently with metabolic acidosis (pH 7.30 vs 7.37, P = 0.011) and fever (74% versus 46%; P = 0.005) and were more likely to require hospitalisation compared to children with non-rotavirus gastroenteritis (93% versus 73%; P = 0.019). Neurological complications were the most common extra-intestinal manifestations, but did not differ significantly between children with rotavirus-positive gastroenteritis (RPG) and rotavirus-negative gastroenteritis (RNG) (24% versus 15%, respectively; P = 0.24). Encephalopathy occurred only in children with rotavirus infection (n = 3, 6%). Conclusion Rotavirus causes longer and more severe disease compared to other viral pathogens. Seizures and milder neurological signs were surprisingly common and associated with multiple pathogens, but encephalopathy occurred only in children with rotavirus gastroenteritis. Rotavirus vaccination may reduce seizures and presentation to hospital, but vaccines against other pathogens causing gastroenteritis are required.
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Affiliation(s)
- Konstantinos Karampatsas
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- * E-mail:
| | - Leanne Osborne
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - May-Li Seah
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Cheuk Y. W. Tong
- Department of Virology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Andrew J. Prendergast
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- Blizard Institute, Queen Mary University of London, London, United Kingdom
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Newitt S, MacGregor V, Robbins V, Bayliss L, Chattaway MA, Dallman T, Ready D, Aird H, Puleston R, Hawker J. Two Linked Enteroinvasive Escherichia coli Outbreaks, Nottingham, UK, June 2014. Emerg Infect Dis 2018; 22:1178-84. [PMID: 27314432 PMCID: PMC4918187 DOI: 10.3201/eid2207.152080] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Enteroinvasive Escherichia coli (EIEC) outbreaks are uncommon in Europe. In June 2014, two EIEC outbreaks occurred in Nottingham, UK, within 2 days; outbreak A was linked to a takeaway restaurant and outbreak B to a wedding party. We conducted 2 analytical studies: a case-control study for outbreak A and a cohort study for outbreak B. We tested microbiological and environmental samples, including by using whole-genome sequencing. For both outbreaks combined, we identified 157 probable case-patients; 27 were laboratory-confirmed as EIEC O96:H19-positive. Combined epidemiologic, microbiological, and environmental findings implicated lettuce as the vehicle of infection in outbreak A, but the source of the organism remained unknown. Whole-genome sequencing identified the same organism in cases from both outbreaks, but no epidemiologic link was confirmed. These outbreaks highlight that EIEC has the capacity to cause large and severe gastrointestinal disease outbreaks and should be considered as a potential pathogen in foodborne outbreaks in Europe.
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Cummins M, Ready D. Role of the Hospital Environment in Norovirus Containment. J Infect Dis 2016; 213 Suppl 1:S12-4. [DOI: 10.1093/infdis/jiv529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Duraisingham SS, Manson A, Grigoriadou S, Buckland M, Tong CYW, Longhurst HJ. Immune deficiency: changing spectrum of pathogens. Clin Exp Immunol 2015; 181:267-74. [PMID: 25677249 PMCID: PMC4516442 DOI: 10.1111/cei.12600] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/15/2015] [Accepted: 01/19/2015] [Indexed: 11/28/2022] Open
Abstract
Current UK national standards recommend routine bacteriology surveillance in severe antibody-deficient patients, but less guidance exists on virology screening and viral infections in these patients. In this retrospective audit, we assessed the proportion of positive virology or bacteriology respiratory and stool samples from patients with severe, partial or no immune deficiency during a 2-year period. Medical notes were reviewed to identify symptomatic viral infections and to describe the course of persistent viral infections. During the 2-year period, 31 of 78 (39·7%) severe immune-deficient patients tested had a positive virology result and 89 of 160 (55.6%) had a positive bacteriology result. The most commonly detected pathogens were rhinovirus (12 patients), norovirus (6), Haemophilus influenzae (24), Pseudomonas spp. (22) and Staphylococcus aureus (21). Ninety-seven per cent of positive viral detection samples were from patients who were symptomatic. Low serum immunoglobulin IgA levels were more prevalent in patients with a positive virology sample compared to the total cohort (P = 0·0078). Three patients had persistent norovirus infection with sequential positive isolates for 9, 30 and 16 months. Virology screening of symptomatic antibody-deficient patients may be useful as a guide to anti-microbial treatment. A proportion of these patients may experience persistent viral infections with significant morbidity.
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Affiliation(s)
| | - A Manson
- Immunology Department, Barts Health NHS Trust, London, UK
| | - S Grigoriadou
- Immunology Department, Barts Health NHS Trust, London, UK
| | - M Buckland
- Immunology Department, Barts Health NHS Trust, London, UK
| | - C Y W Tong
- Department of Infection, Barts Health NHS Trust, London, UK
| | - H J Longhurst
- Immunology Department, Barts Health NHS Trust, London, UK
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Severi E, Kitching A, Crook P. Evaluation of the Health Protection Event-Based Surveillance for the London 2012 Olympic and Paralympic Games. ACTA ACUST UNITED AC 2014; 19. [PMID: 24970374 DOI: 10.2807/1560-7917.es2014.19.24.20832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Health Protection Agency (HPA) (currently Public Health England) implemented the Health Protection Event-Based Surveillance (EBS) to provide additional national epidemic intelligence for the 2012 London Olympic and Paralympic Games (the Games). We describe EBS and evaluate the system attributes. EBS aimed at identifying, assessing and reporting to the HPA Olympic Coordination Centre (OCC) possible national infectious disease threats that may significantly impact the Games. EBS reported events in England from 2 July to 12 September 2012. EBS sourced events from reports from local health protection units and from screening an electronic application 'HPZone Dashboard' (DB). During this period, 147 new events were reported to EBS, mostly food-borne and vaccine-preventable diseases: 79 from regional units, 144 from DB (76 from both). EBS reported 61 events to the OCC: 21 of these were reported onwards. EBS sensitivity was 95.2%; positive predictive value was 32.8%; reports were timely (median one day; 10th percentile: 0 days - same day; 90th percentile: 3.6 days); completeness was 99.7%; stability was 100%; EBS simplicity was assessed as good; the daily time per regional or national unit dedicated to EBS was approximately 4 hours (weekdays) and 3 hours (weekends). OCC directors judged EBS as efficient, fast and responsive. EBS provided reliable, reassuring, timely, simple and stable national epidemic intelligence for the Games.
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Affiliation(s)
- E Severi
- Health Protection Agency, London regional Epidemiology Unit, London, United Kingdom
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McCloskey B, Endericks T, Catchpole M, Zambon M, McLauchlin J, Shetty N, Manuel R, Turbitt D, Smith G, Crook P, Severi E, Jones J, Ibbotson S, Marshall R, Smallwood CAH, Isla N, Memish ZA, Al-Rabeeah AA, Barbeschi M, Heymann DL, Zumla A. London 2012 Olympic and Paralympic Games: public health surveillance and epidemiology. Lancet 2014; 383:2083-2089. [PMID: 24857700 PMCID: PMC7138022 DOI: 10.1016/s0140-6736(13)62342-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mass gatherings are regarded as potential risks for transmission of infectious diseases, and might compromise the health system of countries in which they are hosted. The evidence for increased transmission of infectious diseases at international sporting mass gatherings that attract many visitors from all over the world is not clear, and the evidence base for public health surveillance, epidemiology, and response at events such as the Olympics is small. However, infectious diseases are a recognised risk, and public health planning is, and should remain, a crucial part of the overall planning of sporting events. In this Series paper, we set out the planning and the surveillance systems that were used to monitor public health risks during the London 2012 Olympic and Paralympic Games in the summer of 2012, and draw attention to the public health issues-infectious diseases and chemical, radiation, and environmental hazards-that arose. Although the absolute risk of health-protection problems, including infectious diseases, at sporting mass gatherings is small, the need for reassurance of the absence of problems is higher than has previously been considered; this could challenge conventional public health surveillance systems. Recognition of the limitations of health-surveillance systems needs to be part of the planning for future sporting events.
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Affiliation(s)
- Brian McCloskey
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Global Health and WHO Collaborating Centre on Mass Gatherings, London, UK.
| | - Tina Endericks
- Global Health and WHO Collaborating Centre on Mass Gatherings, London, UK
| | - Mike Catchpole
- Centre for Infectious Disease Surveillance and Control, London, UK
| | | | - Jim McLauchlin
- Food, Water, and Environmental Microbiology Services, London, UK
| | | | | | | | | | | | - Ettore Severi
- European Programme for Intervention Epidemiology Training, London, UK
| | - Jane Jones
- Travel and Migrant Health Section, London, UK
| | | | | | | | - Nicolas Isla
- Global Preparedness, Surveillance and and Response, WHO, Geneva, Switzerland
| | - Ziad A Memish
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia; Al-Faisal University, Riyadh, Saudi Arabia
| | - Abdullah A Al-Rabeeah
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia
| | - Maurizio Barbeschi
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Global Capacities, Alert and Response, WHO, Geneva, Switzerland
| | - David L Heymann
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Public Health England, London, UK; Royal Institute of International Affairs, Chatham House, London, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - Alimuddin Zumla
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Division of Infection and Immunity, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
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An investigation of the diversity of strains of enteroaggregative Escherichia coli isolated from cases associated with a large multi-pathogen foodborne outbreak in the UK. PLoS One 2014; 9:e98103. [PMID: 24844597 PMCID: PMC4028294 DOI: 10.1371/journal.pone.0098103] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/28/2014] [Indexed: 11/19/2022] Open
Abstract
Following a large outbreak of foodborne gastrointestinal (GI) disease, a multiplex PCR approach was used retrospectively to investigate faecal specimens from 88 of the 413 reported cases. Gene targets from a range of bacterial GI pathogens were detected, including Salmonella species, Shigella species and Shiga toxin-producing Escherichia coli, with the majority (75%) of faecal specimens being PCR positive for aggR associated with the Enteroaggregative E. coli (EAEC) group. The 20 isolates of EAEC recovered from the outbreak specimens exhibited a range of serotypes, the most frequent being O104:H4 and O131:H27. None of the EAEC isolates had the Shiga toxin (stx) genes. Multilocus sequence typing and single nucleotide polymorphism analysis of the core genome confirmed the diverse phylogeny of the strains. The analysis also revealed a close phylogenetic relationship between the EAEC O104:H4 strains in this outbreak and the strain of E. coli O104:H4 associated with a large outbreak of haemolytic ureamic syndrome in Germany in 2011. Further analysis of the EAEC plasmids, encoding the key enteroaggregative virulence genes, showed diversity with respect to FIB/FII type, gene content and genomic architecture. Known EAEC virulence genes, such as aggR, aat and aap, were present in all but one of the strains. A variety of fimbrial genes were observed, including genes encoding all five known fimbrial types, AAF/1 to AAF/V. The AAI operon was present in its entirety in 15 of the EAEC strains, absent in three and present, but incomplete, in two isolates. EAEC is known to be a diverse pathotype and this study demonstrates that a high level of diversity in strains recovered from cases associated with a single outbreak. Although the EAEC in this study did not carry the stx genes, this outbreak provides further evidence of the pathogenic potential of the EAEC O104:H4 serotype.
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Williams K, Sinclair C, McEwan R, Fleet K, Balasegaram S, Manuel R. Impact of the London 2012 Olympic and Paralympic Games on demand for microbiology gastrointestinal diagnostic services at the Public Health Laboratory London. J Med Microbiol 2014; 63:968-974. [PMID: 24809387 DOI: 10.1099/jmm.0.070821-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Planning for the London 2012 Olympic and Paralympic Games at the Public Health Laboratory London was based on the requirement to meet potential increased demand with scalable capacity. The aim of this study was to determine the impact on demand for microbiology gastrointestinal diagnostic services during the Games period. Retrospective cross-sectional time-series data analysis was used to assess the number of gastrointestinal specimens received in the laboratory and the number of positive results. There was no increase in the number of gastrointestinal specimens received during the Games period, thus the Games had no impact on demand for microbiology gastrointestinal diagnostic services at the laboratory. There was a decrease in the number of public health specimens received for culture [incidence rate ratio = 0.34, 95% confidence interval (CI) = 0.13-0.86, P = 0.02] and a decrease in the number of culture positive community specimens (odds ratio = 0.59, 95 % CI = 0.40-0.85, P = 0.005), suggesting a decrease in gastrointestinal illness during the Games period. As previous planning assumptions were not based on actual specimen activity, the results of this study may modify the extent of additional planning for microbiological services required for mass gatherings.
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Affiliation(s)
- K Williams
- Public Health Laboratory London, Public Health England, London, UK
| | - C Sinclair
- Field Epidemiology Services Victoria, Public Health England, London, UK
| | - R McEwan
- Public Health Laboratory London, Public Health England, London, UK
| | - K Fleet
- North East and North Central London Health Protection Team, Public Health England, London, UK
| | - S Balasegaram
- Field Epidemiology Services Victoria, Public Health England, London, UK
| | - R Manuel
- Public Health Laboratory London, Public Health England, London, UK
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Harcourt SE, Fletcher J, Loveridge P, Bains A, Morbey R, Yeates A, McCloskey B, Smyth B, Ibbotson S, Smith GE, Elliot AJ. Developing a new syndromic surveillance system for the London 2012 Olympic and Paralympic Games. Epidemiol Infect 2012; 140:2152-6. [PMID: 22892324 PMCID: PMC9152336 DOI: 10.1017/s0950268812001781] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 11/06/2022] Open
Abstract
Syndromic surveillance is vital for monitoring public health during mass gatherings. The London 2012 Olympic and Paralympic Games represents a major challenge to health protection services and community surveillance. In response to this challenge the Health Protection Agency has developed a new syndromic surveillance system that monitors daily general practitioner out-of-hours and unscheduled care attendances. This new national system will fill a gap identified in the existing general practice-based syndromic surveillance systems by providing surveillance capability of general practice activity during evenings/nights, over weekends and public holidays. The system will complement and supplement the existing tele-health phone line, general practitioner and emergency department syndromic surveillance systems. This new national system will contribute to improving public health reassurance, especially to meet the challenges of the London 2012 Olympic and Paralympic Games.
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Affiliation(s)
- S E Harcourt
- Health Protection Agency, Real-time Syndromic Surveillance Team, Birmingham, UK.
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