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Love NK, Douglas A, Gharbia S, Hughes H, Morbey R, Oliver I, Smith GE, Elliot AJ. Understanding the impact of the COVID-19 pandemic response on GI infection surveillance trends in England, January 2020-April 2022. Epidemiol Infect 2023; 151:e147. [PMID: 37622322 PMCID: PMC10540168 DOI: 10.1017/s095026882300136x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/13/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
Stepwise non-pharmaceutical interventions and health system changes implemented as part of the COVID-19 response have had implications on the incidence, diagnosis, and reporting of other communicable diseases. Here, we established the impact of the COVID-19 outbreak response on gastrointestinal (GI) infection trends using routinely collected surveillance data from six national English laboratory, outbreak, and syndromic surveillance systems using key dates of governmental policy to assign phases for comparison between pandemic and historic data. Following decreases across all indicators during the first lockdown (March-May 2020), bacterial and parasitic pathogens associated with foodborne or environmental transmission routes recovered rapidly between June and September 2020, while those associated with travel and/or person-to-person transmission remained lower than expected for 2021. High out-of-season norovirus activity was observed with the easing of lockdown measures between June and October 2021, with this trend reflected in laboratory and outbreak systems and syndromic surveillance indicators. Above expected increases in emergency department (ED) attendances may have reflected changes in health-seeking behaviour and provision. Differential reductions across specific GI pathogens are indicative of the underlying routes of transmission. These results provide further insight into the drivers for transmission, which can help inform control measures for GI infections.
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Affiliation(s)
- Nicola K. Love
- North East Field Services, Health Protection Operations, UK Health Security Agency, Newcastle upon Tyne, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Amy Douglas
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, London, UK
| | - Saheer Gharbia
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, London, UK
| | - Helen Hughes
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Real-time Syndromic Surveillance Team, Field Service, Health Protection Operations, UK Health Security Agency, Birmingham, UK
- Farr Institute@HeRC, University of Liverpool, Liverpool, UK
| | - Roger Morbey
- Real-time Syndromic Surveillance Team, Field Service, Health Protection Operations, UK Health Security Agency, Birmingham, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, King’s College London, London, UK
| | - Isabel Oliver
- Science Group, UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Population Health Sciences, University of Bristol, Bristol, UK
| | - Gillian E. Smith
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Real-time Syndromic Surveillance Team, Field Service, Health Protection Operations, UK Health Security Agency, Birmingham, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, King’s College London, London, UK
| | - Alex J. Elliot
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Real-time Syndromic Surveillance Team, Field Service, Health Protection Operations, UK Health Security Agency, Birmingham, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, King’s College London, London, UK
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Love NK, Elliot AJ, Chalmers RM, Douglas A, Gharbia S, McCormick J, Hughes H, Morbey R, Oliver I, Vivancos R, Smith G. Impact of the COVID-19 pandemic on gastrointestinal infection trends in England, February-July 2020. BMJ Open 2022; 12:e050469. [PMID: 35314468 PMCID: PMC8968111 DOI: 10.1136/bmjopen-2021-050469] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To establish the impact of the first 6 months of the COVID-19 outbreak response on gastrointestinal (GI) infection trends in England. DESIGN Retrospective ecological study using routinely collected national and regional surveillance data from seven UK Health Security Agency coordinated laboratory, outbreak and syndromic surveillance systems using key dates of UK governmental policy change to assign phases for comparison between 2020 and historic data. RESULTS Decreases in GI illness activity were observed across all surveillance indicators as COVID-19 cases began to peak. Compared with the 5-year average (2015-2019), during the first 6 months of the COVID-19 response, there was a 52% decrease in GI outbreaks reported (1544 vs 3208 (95% CI 2938 to 3478)) and a 34% decrease in laboratory confirmed cases (27 859 vs 42 495 (95% CI 40 068 to 44 922)). GI indicators began to rise during the first lockdown and lockdown easing, although all remained substantially lower than historic figures. Reductions in laboratory confirmed cases were observed across all age groups and both sexes, with geographical heterogeneity observed in diagnosis trends. Health seeking behaviour changed substantially, with attendances decreasing prior to lockdown across all indicators. CONCLUSIONS There has been a marked change in trends of GI infections in the context of the COVID-19 pandemic. The drivers of this change are likely to be multifactorial; while changes in health seeking behaviour, pressure on diagnostic services and surveillance system ascertainment have undoubtably played a role, there has likely been a true decrease in the incidence for some pathogens resulting from the control measures and restrictions implemented. This suggests that if some of these changes in behaviour such as improved hand hygiene were maintained, then we could potentially see sustained reductions in the burden of GI illness.
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Affiliation(s)
- Nicola K Love
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Alex J Elliot
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | - Rachel M Chalmers
- Cryptosporidium Reference Unit, Public Health Wales Microbiology and Health Protection, Singleton Hospital, Swansea, UK
| | | | | | | | - Helen Hughes
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Roger Morbey
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | - Isabel Oliver
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Roberto Vivancos
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Gillian Smith
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
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Describing the indirect impact of COVID-19 on healthcare utilisation using syndromic surveillance systems. BMC Public Health 2021; 21:2019. [PMID: 34740346 PMCID: PMC8571013 DOI: 10.1186/s12889-021-12117-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023] Open
Abstract
Background Since the end of January 2020, the coronavirus (COVID-19) pandemic has been responsible for a global health crisis. In England a number of non-pharmaceutical interventions have been introduced throughout the pandemic, including guidelines on healthcare attendance (for example, promoting remote consultations), increased handwashing and social distancing. These interventions are likely to have impacted the incidence of non–COVID-19 conditions as well as healthcare seeking behaviour. Syndromic Surveillance Systems offer the ability to monitor trends in healthcare usage over time. Methods This study describes the indirect impact of COVID-19 on healthcare utilisation using a range of syndromic indicators including eye conditions, mumps, fractures, herpes zoster and cardiac conditions. Data from the syndromic surveillance systems monitored by Public Health England were used to describe the number of contacts with NHS 111, general practitioner (GP) In Hours (GPIH) and Out-of-Hours (GPOOH), Ambulance and Emergency Department (ED) services over comparable periods before and during the pandemic. Results The peak pandemic period in 2020 (weeks 13–20), compared to the same period in 2019, displayed on average a 12% increase in NHS 111 calls, an 11% decrease in GPOOH consultations, and a 49% decrease in ED attendances. In the GP In Hours system, conjunctivitis consultations decreased by 64% and mumps consultations by 31%. There was a 49% reduction in attendance at EDs for fractures, and there was no longer any weekend increase in ED fracture attendances, with similar attendance patterns observed across each day of the week. There was a decrease in the number of ED attendances with diagnoses of myocardial ischaemia. Conclusion The COVID-19 pandemic drastically impacted healthcare utilisation for non-COVID-19 conditions, due to a combination of a probable decrease in incidence of certain conditions and changes in healthcare seeking behaviour. Syndromic surveillance has a valuable role in describing and understanding these trends. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12117-5.
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Epidemiology of norovirus and viral gastroenteritis in Ontario, Canada, 2009-2014. CANADA COMMUNICABLE DISEASE REPORT = RELEVÉ DES MALADIES TRANSMISSIBLES AU CANADA 2021; 47:397-404. [PMID: 34737671 DOI: 10.14745/ccdr.v47i10a01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Norovirus is the most common cause of acute gastroenteritis in Canada. The illness causes great morbidity and high societal costs. The objective of this article is to describe the epidemiology of norovirus in the province of Ontario, Canada from 2009 to 2014. Methods To assess activity of norovirus and viral gastroenteritis (VGE) in Ontario, three datasets were acquired from the provincial government: two traditional surveillance datasets (outbreak and laboratory) and syndromic surveillance data (telehealth), all spanning 2009-2014. All outbreaks, laboratory submissions and telehealth calls were first assessed for total VGE. Norovirus and norovirus-like illness totals were calculated as a proportion of VGE to estimate agent-specific activity levels. Affected institution types, sexes and age groups were also analyzed. Results Between 2009 and 2014, 41.5% of VGE outbreaks, 63.4% of VGE laboratory submissions and 36.6% of all acute gastroenteritis-related (not restricted to viral causes) telehealth calls were attributed to norovirus and norovirus-like illness in Ontario. The most commonly affected institution type was long-term care homes and the most commonly affected age groups were younger (younger than five years) and older (older than 65 years) individuals. Females were slightly more frequently affected than males. Conclusion Norovirus and norovirus-like illnesses were the leading cause of VGE in Ontario between 2009 and 2014. They comprised the greatest percentage of VGE when compared with all other VGE-associated viruses. Additional work is needed to determine all component costs and necessary public health actions to reduce the burden of disease.
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Yandle Z, Coughlan S, Dean J, Hare D, De Gascun CF. Indirect impact of rotavirus vaccination on viral causes of acute gastroenteritis in the elderly. J Clin Virol 2021; 137:104780. [PMID: 33647802 DOI: 10.1016/j.jcv.2021.104780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/20/2021] [Accepted: 02/18/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Rotavirus is considered a childhood infection causing acute gastroenteritis however, it also causes disease in adults which may be underestimated due to less frequent testing in this age-group. OBJECTIVES To determine if paediatric rotavirus vaccination, introduced into Ireland in December 2016, affected the viral aetiology in those aged ≥65 yrs presenting with gastroenteritis in the pre- and post-vaccination years. Additionally, rotavirus genotypes in this age-group will be described. METHODS Faecal samples from 2015 to 2019 for the investigation of gastroenteritis were tested by real-time (RT-) PCR for norovirus, adenovirus, rotavirus, Rotarix, astrovirus and sapovirus. Rotaviruses were genotyped by multiplex real-time RT-PCR or hemi-nested RT-PCR and a proportion confirmed by sequencing. RESULTS 22,593 samples from adults aged ≥65 yrs were tested and 2566 (11 %) had ≥1 virus detected. Of 2566 positive samples, norovirus was detected in 82 %, rotavirus 9 %, sapovirus 6 %, astrovirus 3 % and adenovirus 1 %. Rotavirus and norovirus infections decreased between pre and post-vaccine year groups p < 0.001, whereas sapovirus, astrovirus and adenovirus remained unchanged. Between 2015-16 and 2018-19, G2P[4] increased and G4P[8] decreased, p < 0.001. In 2015-2019 there were 37 rotavirus outbreaks. Five geriatric outbreaks were genotyped and caused by G4P[8] (n = 1), G1P[8] (n = 1), G2P[4] (n = 2) and G12P[8] (n = 1). CONCLUSION Rotavirus causes acute gastroenteritis in older people. Paediatric vaccination may have contributed to a decline in infections in the elderly; nevertheless, rotavirus continued to circulate in older people following vaccine introduction. Genotype distribution changed between the pre- and post-vaccine era however genotypes in outbreak and endemic settings were comparable.
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Affiliation(s)
- Z Yandle
- UCD National Virus Reference Laboratory, University College Dublin, Dublin 4, Ireland.
| | - S Coughlan
- UCD National Virus Reference Laboratory, University College Dublin, Dublin 4, Ireland
| | - J Dean
- UCD National Virus Reference Laboratory, University College Dublin, Dublin 4, Ireland
| | - D Hare
- UCD National Virus Reference Laboratory, University College Dublin, Dublin 4, Ireland
| | - C F De Gascun
- UCD National Virus Reference Laboratory, University College Dublin, Dublin 4, Ireland
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Hughes HE, Elliot AJ, Hughes TC, Hungerford D, Morbey RA, Smith GE, Vivancos R, O’Brien SJ. Using emergency department syndromic surveillance to investigate the impact of a national vaccination program: A retrospective observational study. PLoS One 2020; 15:e0240021. [PMID: 33031389 PMCID: PMC7544051 DOI: 10.1371/journal.pone.0240021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rotavirus infection is a common cause of gastroenteritis in children worldwide, with a high mortality burden in developing countries, particularly during the first two years of life. Rotavirus vaccination was introduced into the United Kingdom childhood vaccination schedule in July 2013, with high coverage (>90%) achieved by June 2016. We used an emergency department (ED) syndromic surveillance system to assess the impact of the rotavirus vaccination programme, specifically through the demonstration of any immediate and continuing impact on ED gastroenteritis visits in England. METHODS This retrospective, observational study used syndromic surveillance data collected from 3 EDs in the two years before (July 2011-June 2013) and 3 years post (July 2013-June 2016) introduction of rotavirus vaccination. The weekly levels of ED visits for gastroenteritis (by age group and in total) during the period before rotavirus vaccination was first described alongside the findings of laboratory surveillance of rotavirus during the same period. An interrupted time-series analysis was then performed to demonstrate the impact of rotavirus vaccination introduction on gastroenteritis ED visit levels. RESULTS During the two years before vaccine introduction ED visits for gastroenteritis in total and for the 0-4 years age group were seen to rise and fall in line with the seasonal rotavirus increases reported by laboratory surveillance. ED gastroenteritis visits by young children were lower in the three years following introduction of rotavirus vaccination (reduced from 8% of visits to 6% of visits). These attendance levels in young children (0-4years) remained higher than in older age groups, however the previously large seasonal increases in children were greatly reduced, from peaks of 16% to 3-10% of ED visits per week. CONCLUSIONS ED syndromic surveillance demonstrated a reduction in gastroenteritis visits following rotavirus vaccine introduction. This work establishes ED syndromic surveillance as a platform for rapid impact assessment of future vaccine programmes.
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Affiliation(s)
- Helen E. Hughes
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, United Kingdom
- Farr Institute at HeRC, University of Liverpool, Liverpool, United Kingdom
| | - Alex J. Elliot
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, United Kingdom
| | | | - Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Field Epidemiology North West, Field Service, National Infection Service, Public Health England, Liverpool, United Kingdom
| | - Roger A. Morbey
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, United Kingdom
| | - Gillian E. Smith
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, United Kingdom
| | - Roberto Vivancos
- Field Epidemiology North West, Field Service, National Infection Service, Public Health England, Liverpool, United Kingdom
| | - Sarah J. O’Brien
- School of Natural and Environmental Sciences, Newcastle University, Newcastle, United Kingdom
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Morbey RA, Elliot AJ, Smith GE, Charlett A. Adapting Syndromic Surveillance Baselines After Public Health Interventions. Public Health Rep 2020; 135:737-745. [PMID: 33026959 DOI: 10.1177/0033354920959080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Public health surveillance requires historical baselines to identify unusual activity. However, these baselines require adjustment after public health interventions. We describe an example of such an adjustment after the introduction of rotavirus vaccine in England in July 2013. METHODS We retrospectively measured the magnitude of differences between baselines and observed counts (residuals) before and after the introduction of a public health intervention, the introduction of a rotavirus vaccine in July 2013. We considered gastroenteritis, diarrhea, and vomiting to be indicators for national syndromic surveillance, including telephone calls to a telehealth system, emergency department visits, and unscheduled consultations with general practitioners. The start of the preintervention period varied depending on the availability of surveillance data: June 2005 for telehealth, November 2009 for emergency departments, and July 2010 for general practitioner data. The postintervention period was July 2013 to the second quarter of 2016. We then determined whether baselines incorporating a step-change reduction or a change in seasonality resulted in more accurate models of activity. RESULTS Residuals in the unadjusted baseline models increased by 42%-198% from preintervention to postintervention. Increases in residuals for vomiting indicators were 19%-44% higher than for diarrhea. Both step-change and seasonality adjustments improved the surveillance models; we found the greatest reduction in residuals in seasonally adjusted models (4%-75%). CONCLUSION Our results demonstrated the importance of adjusting surveillance baselines after public health interventions, particularly accounting for changes in seasonality. Adjusted baselines produced more representative expected values than did unadjusted baselines, resulting in fewer false alarms and a greater likelihood of detecting public health threats.
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Affiliation(s)
- Roger Antony Morbey
- 371011 Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - Alex James Elliot
- 371011 Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - Gillian Elizabeth Smith
- 371011 Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - Andre Charlett
- 371011 Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
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Abstract
The COVID-19 pandemic is exerting major pressures on society, health and social care services and science. Understanding the progression and current impact of the pandemic is fundamental to planning, management and mitigation of future impact on the population. Surveillance is the core function of any public health system, and a multi-component surveillance system for COVID-19 is essential to understand the burden across the different strata of any health system and the population. Many countries and public health bodies utilise ‘syndromic surveillance’ (using real-time, often non-specific symptom/preliminary diagnosis information collected during routine healthcare provision) to supplement public health surveillance programmes. The current COVID-19 pandemic has revealed a series of unprecedented challenges to syndromic surveillance including: the impact of media reporting during early stages of the pandemic; changes in healthcare-seeking behaviour resulting from government guidance on social distancing and accessing healthcare services; and changes in clinical coding and patient management systems. These have impacted on the presentation of syndromic outputs, with changes in denominators creating challenges for the interpretation of surveillance data. Monitoring changes in healthcare utilisation is key to interpreting COVID-19 surveillance data, which can then be used to better understand the impact of the pandemic on the population. Syndromic surveillance systems have had to adapt to encompass these changes, whilst also innovating by taking opportunities to work with data providers to establish new data feeds and develop new COVID-19 indicators. These developments are supporting the current public health response to COVID-19, and will also be instrumental in the continued and future fight against the disease.
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Abstract
Syndromic surveillance is a form of surveillance that generates information for public health action by collecting, analysing and interpreting routine health-related data on symptoms and clinical signs reported by patients and clinicians rather than being based on microbiologically or clinically confirmed cases. In England, a suite of national real-time syndromic surveillance systems (SSS) have been developed over the last 20 years, utilising data from a variety of health care settings (a telehealth triage system, general practice and emergency departments). The real-time systems in England have been used for early detection (e.g. seasonal influenza), for situational awareness (e.g. describing the size and demographics of the impact of a heatwave) and for reassurance of lack of impact on population health of mass gatherings (e.g. the London 2012 Olympic and Paralympic Games).We highlight the lessons learnt from running SSS, for nearly two decades, and propose questions and issues still to be addressed. We feel that syndromic surveillance is an example of the use of ‘big data’, but contend that the focus for sustainable and useful systems should be on the added value of such systems and the importance of people working together to maximise the value for the public health of syndromic surveillance services.
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Nichols GL, Lo Iacono G. Examining the influence of weather on rotavirus infection. Lancet Planet Health 2019; 3:e236-e237. [PMID: 31228993 DOI: 10.1016/s2542-5196(19)30093-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Gordon L Nichols
- Climate Change Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK.
| | - Giovanni Lo Iacono
- School of Veterinary Medicine, Department of Veterinary Epidemiology and Public Health, University of Surrey, Surrey, UK
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Hungerford D, Allen DJ, Nawaz S, Collins S, Ladhani S, Vivancos R, Iturriza-Gómara M. Impact of rotavirus vaccination on rotavirus genotype distribution and diversity in England, September 2006 to August 2016. Euro Surveill 2019; 24:1700774. [PMID: 30755297 PMCID: PMC6373066 DOI: 10.2807/1560-7917.es.2019.24.6.1700774] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IntroductionRotavirus vaccination with the live-attenuated monovalent (a G1P[8] human rotavirus strain) two-dose Rotarix vaccine was introduced in England in July 2013. Since then, there have been significant reductions in rotavirus gastroenteritis incidence.AimWe assessed the vaccine's impact on rotavirus genotype distribution and diversity 3 years post-vaccine introduction.MethodsEpidemiological and microbiological data on genotyped rotavirus-positive samples between September 2006 and August 2016 were supplied by EuroRotaNet and Public Health England. Multinomial multivariable logistic regression adjusting for year, season and age was used to quantify changes in genotype prevalence in the vaccine period. Genotype diversity was measured using the Shannon's index (H') and Simpson's index of diversity (D).ResultsWe analysed genotypes from 8,044 faecal samples. In the pre-vaccine era, G1P[8] was most prevalent, ranging from 39% (411/1,057) to 74% (527/709) per year. In the vaccine era, G1P[8] prevalence declined each season (35%, 231/654; 12%, 154/1,257; 5%, 34/726) and genotype diversity increased significantly in 6-59 months old children (H' p < 0.001: D p < 0.001). In multinomial analysis, G2P[4] (adjusted multinomial odds ratio (aMOR): 9.51; 95% confidence interval (CI): 7.02-12.90), G3P[8] (aMOR: 2.83; 95% CI: 2.17-3.81), G12P[8] (aMOR: 2.46; 95% CI: 1.62-3.73) and G4P[8] (aMOR: 1.42; 95% CI: 1.02-1.96) significantly increased relative to G1P[8].ConclusionsIn the context of reduced rotavirus disease incidence, genotype diversity has increased, with a relative change in the dominant genotype from G1P[8] to G2P[4] after vaccine introduction. These changes will need continued surveillance as the number and age of vaccinated birth cohorts increase in the future.
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Affiliation(s)
- Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom,Field Epidemiology Services, National Infection Service, Public Health England, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - David J Allen
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sameena Nawaz
- Virus Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Sarah Collins
- Immunisation Department, National Infection Service, Public Health England, London, United Kingdom
| | - Shamez Ladhani
- Immunisation Department, National Infection Service, Public Health England, London, United Kingdom,NIHR Health Protection Research Unit in Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roberto Vivancos
- Field Epidemiology Services, National Infection Service, Public Health England, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Miren Iturriza-Gómara
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
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Rivière M, Baroux N, Bousquet V, Ambert-Balay K, Beaudeau P, Jourdan-Da Silva N, Van Cauteren D, Bounoure F, Cahuzac F, Blanchon T, Prazuck T, Turbelin C, Hanslik T. Secular trends in incidence of acute gastroenteritis in general practice, France, 1991 to 2015. ACTA ACUST UNITED AC 2018; 22. [PMID: 29258648 PMCID: PMC5743098 DOI: 10.2807/1560-7917.es.2017.22.50.17-00121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We analysed 25 years of general practitioner (GP) visits for acute gastroenteritis (AG) surveillance in France, by the GP Sentinelles network. We searched for time trends of acute gastroenteritis incidence during winter periods. Data from emergency departments and drug reimbursement were additional data sources. A time-series analysis was performed using a generalised additive model for all data sources for the winter period. Virological data were incorporated and compared with the three data sources. The cumulative incidence of GP visits for winter AG exhibited an increasing trend from 1991 until 2008, when it reached 6,466 per 100,000 inhabitants. It decreased thereafter to 3,918 per 100,000 inhabitants in 2015. This decreasing trend was observed for all age groups and confirmed by the generalised additive model. For emergency department visits a decreasing trend was observed from 2004. Drug reimbursement data analyses demonstrated a decreasing trend from when data began in 2009. The incidence reported by GPs and emergency departments was lower following the emergence of norovirus GII.4 2012 (p < 0.0001). Winter AG incidences seem to follow long-term rising and decreasing trends that are important to monitor through continuous surveillance to evaluate the impact of prevention strategies, such as future immunisation against acute viral gastroenteritis.
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Affiliation(s)
- Mathieu Rivière
- Infectious disease department, CHR Orléans La Source, Orléans, France.,Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Noémie Baroux
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Vanina Bousquet
- Santé publique France, the French national public health agency, Saint-Maurice, France
| | - Katia Ambert-Balay
- National Reference Center for Gastroenteritis Viruses, Laboratory of Virology, CHU of Dijon, Dijon, France
| | - Pascal Beaudeau
- Santé publique France, the French national public health agency, Saint-Maurice, France
| | | | - Dieter Van Cauteren
- Santé publique France, the French national public health agency, Saint-Maurice, France
| | - Frédéric Bounoure
- Pharmaceutics Laboratory (DC2N INSERM U982), Faculty of Medicine and Pharmacy, University of Rouen, Rouen, France
| | - Fanny Cahuzac
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Thierry Blanchon
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Thierry Prazuck
- Infectious disease department, CHR Orléans La Source, Orléans, France.,Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Clément Turbelin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Thomas Hanslik
- Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France.,Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
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13
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Adriaenssens EM, Farkas K, Harrison C, Jones DL, Allison HE, McCarthy AJ. Viromic Analysis of Wastewater Input to a River Catchment Reveals a Diverse Assemblage of RNA Viruses. mSystems 2018; 3:e00025-18. [PMID: 29795788 PMCID: PMC5964442 DOI: 10.1128/msystems.00025-18] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/01/2018] [Indexed: 02/05/2023] Open
Abstract
Detection of viruses in the environment is heavily dependent on PCR-based approaches that require reference sequences for primer design. While this strategy can accurately detect known viruses, it will not find novel genotypes or emerging and invasive viral species. In this study, we investigated the use of viromics, i.e., high-throughput sequencing of the biosphere's viral fraction, to detect human-/animal-pathogenic RNA viruses in the Conwy river catchment area in Wales, United Kingdom. Using a combination of filtering and nuclease treatment, we extracted the viral fraction from wastewater and estuarine river water and sediment, followed by high-throughput RNA sequencing (RNA-Seq) analysis on the Illumina HiSeq platform, for the discovery of RNA virus genomes. We found a higher richness of RNA viruses in wastewater samples than in river water and sediment, and we assembled a complete norovirus genotype GI.2 genome from wastewater effluent, which was not contemporaneously detected by conventional reverse transcription-quantitative PCR (qRT-PCR). The simultaneous presence of diverse rotavirus signatures in wastewater indicated the potential for zoonotic infections in the area and suggested runoff from pig farms as a possible origin of these viruses. Our results show that viromics can be an important tool in the discovery of pathogenic viruses in the environment and can be used to inform and optimize reference-based detection methods provided appropriate and rigorous controls are included. IMPORTANCE Enteric viruses cause gastrointestinal illness and are commonly transmitted through the fecal-oral route. When wastewater is released into river systems, these viruses can contaminate the environment. Our results show that we can use viromics to find the range of potentially pathogenic viruses that are present in the environment and identify prevalent genotypes. The ultimate goal is to trace the fate of these pathogenic viruses from origin to the point where they are a threat to human health, informing reference-based detection methods and water quality management.
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Affiliation(s)
- Evelien M. Adriaenssens
- Microbiology Research Group, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Kata Farkas
- School of Environment, Natural Resources and Geography, Bangor University, Bangor, United Kingdom
| | - Christian Harrison
- Microbiology Research Group, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - David L. Jones
- School of Environment, Natural Resources and Geography, Bangor University, Bangor, United Kingdom
| | - Heather E. Allison
- Microbiology Research Group, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Alan J. McCarthy
- Microbiology Research Group, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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14
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Adriaenssens EM, Farkas K, Harrison C, Jones DL, Allison HE, McCarthy AJ. Viromic Analysis of Wastewater Input to a River Catchment Reveals a Diverse Assemblage of RNA Viruses. mSystems 2018. [PMID: 29795788 DOI: 10.1128/msystems.00025-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
Detection of viruses in the environment is heavily dependent on PCR-based approaches that require reference sequences for primer design. While this strategy can accurately detect known viruses, it will not find novel genotypes or emerging and invasive viral species. In this study, we investigated the use of viromics, i.e., high-throughput sequencing of the biosphere's viral fraction, to detect human-/animal-pathogenic RNA viruses in the Conwy river catchment area in Wales, United Kingdom. Using a combination of filtering and nuclease treatment, we extracted the viral fraction from wastewater and estuarine river water and sediment, followed by high-throughput RNA sequencing (RNA-Seq) analysis on the Illumina HiSeq platform, for the discovery of RNA virus genomes. We found a higher richness of RNA viruses in wastewater samples than in river water and sediment, and we assembled a complete norovirus genotype GI.2 genome from wastewater effluent, which was not contemporaneously detected by conventional reverse transcription-quantitative PCR (qRT-PCR). The simultaneous presence of diverse rotavirus signatures in wastewater indicated the potential for zoonotic infections in the area and suggested runoff from pig farms as a possible origin of these viruses. Our results show that viromics can be an important tool in the discovery of pathogenic viruses in the environment and can be used to inform and optimize reference-based detection methods provided appropriate and rigorous controls are included. IMPORTANCE Enteric viruses cause gastrointestinal illness and are commonly transmitted through the fecal-oral route. When wastewater is released into river systems, these viruses can contaminate the environment. Our results show that we can use viromics to find the range of potentially pathogenic viruses that are present in the environment and identify prevalent genotypes. The ultimate goal is to trace the fate of these pathogenic viruses from origin to the point where they are a threat to human health, informing reference-based detection methods and water quality management.
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Affiliation(s)
- Evelien M Adriaenssens
- Microbiology Research Group, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Kata Farkas
- School of Environment, Natural Resources and Geography, Bangor University, Bangor, United Kingdom
| | - Christian Harrison
- Microbiology Research Group, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - David L Jones
- School of Environment, Natural Resources and Geography, Bangor University, Bangor, United Kingdom
| | - Heather E Allison
- Microbiology Research Group, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Alan J McCarthy
- Microbiology Research Group, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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15
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Hungerford D, Vivancos R, Read JM, Iturriza-Gόmara M, French N, Cunliffe NA. Rotavirus vaccine impact and socioeconomic deprivation: an interrupted time-series analysis of gastrointestinal disease outcomes across primary and secondary care in the UK. BMC Med 2018; 16:10. [PMID: 29375036 PMCID: PMC5787923 DOI: 10.1186/s12916-017-0989-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/08/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Rotavirus causes severe gastroenteritis in infants and young children worldwide. The UK introduced the monovalent rotavirus vaccine (Rotarix®) in July 2013. Vaccination is free of charge to parents, with two doses delivered at 8 and 12 weeks of age. We evaluated vaccine impact across a health system in relation to socioeconomic deprivation. METHODS We used interrupted time-series analyses to assess changes in monthly health-care attendances in Merseyside, UK, for all ages, from July 2013 to June 2016, compared to predicted counterfactual attendances without vaccination spanning 3-11 years pre-vaccine. Outcome measures included laboratory-confirmed rotavirus gastroenteritis (RVGE) hospitalisations, acute gastroenteritis (AGE) hospitalisations, emergency department (ED) attendances for gastrointestinal conditions and consultations for infectious gastroenteritis at community walk-in centres (WIC) and general practices (GP). All analyses were stratified by age. Hospitalisations were additionally stratified by vaccine uptake and small-area-level socioeconomic deprivation. RESULTS The uptake of the first and second doses of rotavirus vaccine was 91.4% (29,108/31,836) and 86.7% (27,594/31,836), respectively. Among children aged < 5 years, the incidence of gastrointestinal disease decreased across all outcomes post-vaccine introduction: 80% (95% confidence interval [CI] 70-87%; p < 0.001) for RVGE hospitalisation, 44% (95% CI 35-53%; p < 0.001) for AGE hospitalisations, 23% (95% CI 11-33%; p < 0.001) for ED, 32% (95% CI 7-50%; p = 0.02) for WIC and 13% (95% CI -3-26%; p = 0.10) for GP. The impact was greatest during the rotavirus season and for vaccine-eligible age groups. In adults aged 65+ years, AGE hospitalisations fell by 25% (95% CI 19-30%; p < 0.001). The pre-vaccine risk of AGE hospitalisation was highest in the most socioeconomically deprived communities (adjusted incident rate ratio 1.57; 95% CI 1.51-1.64; p < 0.001), as was the risk for non-vaccination (adjusted risk ratio 1.54; 95% CI 1.34-1.75; p < 0.001). The rate of AGE hospitalisations averted per 1,000 first doses of vaccine was higher among infants in the most deprived communities compared to the least deprived in 2014/15 (28; 95% CI 25-31 vs. 15; 95% CI 12-17) and in 2015/16 (26; 95% CI 23-30 vs. 13; 95% CI 11-16). CONCLUSIONS Following the introduction of rotavirus vaccination, incidence of gastrointestinal disease reduced across the health-care system. Vaccine impact was greatest among the most deprived populations, despite lower vaccine uptake. Prioritising vaccine uptake in socioeconomically deprived communities should give the greatest health benefit in terms of population disease burden.
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Affiliation(s)
- Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK. .,Field Epidemiology Services, Public Health England, L3 1DS, Liverpool, UK. .,NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK. .,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, L69 3GL, Liverpool, UK.
| | - Roberto Vivancos
- Field Epidemiology Services, Public Health England, L3 1DS, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, L69 3GL, Liverpool, UK
| | - Jonathan M Read
- NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, L69 3GL, Liverpool, UK.,Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
| | - Miren Iturriza-Gόmara
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK
| | - Neil French
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK
| | - Nigel A Cunliffe
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK.,Department of Microbiology, Alder Hey Children's NHS Foundation Trust, L12 2AP, Liverpool, UK
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16
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Estimating primary care attendance rates for fever in infants after meningococcal B vaccination in England using national syndromic surveillance data. Vaccine 2018; 36:565-571. [DOI: 10.1016/j.vaccine.2017.11.076] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 01/29/2023]
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17
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Elliot AJ, Morbey R, Edeghere O, Lake IR, Colón-González FJ, Vivancos R, Rubin GJ, O'Brien SJ, Smith GE. Developing a Multidisciplinary Syndromic Surveillance Academic Research Program in the United Kingdom: Benefits for Public Health Surveillance. Public Health Rep 2017; 132:111S-115S. [PMID: 28692401 DOI: 10.1177/0033354917706953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alex J Elliot
- 1 Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham, United Kingdom.,2 Health Protection Research Unit in Emergency Preparedness and Response, National Institute for Health Research, London, United Kingdom
| | - Roger Morbey
- 1 Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham, United Kingdom.,2 Health Protection Research Unit in Emergency Preparedness and Response, National Institute for Health Research, London, United Kingdom
| | - Obaghe Edeghere
- 1 Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham, United Kingdom.,2 Health Protection Research Unit in Emergency Preparedness and Response, National Institute for Health Research, London, United Kingdom
| | - Iain R Lake
- 2 Health Protection Research Unit in Emergency Preparedness and Response, National Institute for Health Research, London, United Kingdom.,3 School of Environmental Sciences, University of East Anglia, Norwich, United Kingdom
| | - Felipe J Colón-González
- 2 Health Protection Research Unit in Emergency Preparedness and Response, National Institute for Health Research, London, United Kingdom.,3 School of Environmental Sciences, University of East Anglia, Norwich, United Kingdom
| | - Roberto Vivancos
- 4 Field Epidemiology Services, National Infection Service, Public Health England, Liverpool, United Kingdom.,5 Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,6 Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, United Kingdom
| | - G James Rubin
- 2 Health Protection Research Unit in Emergency Preparedness and Response, National Institute for Health Research, London, United Kingdom.,7 Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Sarah J O'Brien
- 5 Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,6 Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, United Kingdom
| | - Gillian E Smith
- 1 Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham, United Kingdom.,2 Health Protection Research Unit in Emergency Preparedness and Response, National Institute for Health Research, London, United Kingdom
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18
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Noel G, Viudes G, Laporte R, Minodier P. Evaluation of the Impact of Pneumococcal Conjugate Vaccine on Pediatric Community-Acquired Pneumonia Using an Emergency Database System. J Pediatric Infect Dis Soc 2017; 6:129-133. [PMID: 27125271 DOI: 10.1093/jpids/piw019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/19/2016] [Indexed: 11/13/2022]
Abstract
BACKGROUND. A 13-valent pneumococcal conjugate vaccine (PCV13) seems to be associated with a reduction of community-acquired pneumonia (CAP) in children. METHODS. To explore the link between PCV13 implementation and children' visits in emergency departments (EDs) for pneumonia, we analyzed mandatory Electronics Emergency Department Abstracts (EEDA), in 7 EDs, located in southern France, from 2009 to 2014. Diagnosis related to visits were coded using International Classification Diseases-10 codes. All codes available for EEDA were used to define bacterial pneumonia (BP), viral pneumonia (VP), and nonspecific pneumonia (NSP). For adjustment, we also used codes related to influenza and bronchiolitis. Comparisons between periods (pre-PCV13, transitional, early post-PCV13, and late post-PCV13) were made by logistic regression. On daily aggregated data, a general linear model was constructed with daily proportion of BP as dependent variable, period as fixed factor, and daily proportion of viral respiratory infections (flu plus bronchiolitis) as covariate. RESULTS. Among 718 758 visits, 7284 were coded as CAP. A significant decline in CAP was noted only for children between 2 and 5 years of age. In contrast, the proportion of BP was dramatically reduced: 2.49 vs 5.17/1000 visits (odds ratio, 0.48; 95% confidence interval, 0.42-0.55), whereas the proportion of VP was similar and NSP increased. After adjustment on influenza plus bronchiolitis, the decrease of BP remained significant. CONCLUSIONS. Electronics Emergency Department Abstracts analysis confirms an important reduction in children ED visits for BP after PCV13 implementation. The EEDA also allow a real-time surveillance of pneumonia and an adjustment on confounding factors, such as viral respiratory infections.
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Affiliation(s)
- Guilhem Noel
- PACA Emergency Network Observatory, Hyères, and.,Pediatric Emergency Department, North Hospital, APHM, Marseille, France
| | | | - Remi Laporte
- Pediatric Emergency Department, North Hospital, APHM, Marseille, France
| | - Philippe Minodier
- Pediatric Emergency Department, North Hospital, APHM, Marseille, France
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19
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The burden of seasonal respiratory infections on a national telehealth service in England. Epidemiol Infect 2017; 145:1922-1932. [PMID: 28413995 DOI: 10.1017/s095026881700070x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Seasonal respiratory illnesses present a major burden on primary care services. We assessed the burden of respiratory illness on a national telehealth system in England and investigated the potential for providing early warning of respiratory infection. We compared weekly laboratory reports for respiratory pathogens with telehealth calls (NHS 111) between week 40 in 2013 and week 29 in 2015. Multiple linear regression was used to identify which pathogens had a significant association with respiratory calls. Children aged <5 and 5-14 years, and adults over 65 years were modelled separately as were time lags of up to 4 weeks between calls and laboratory specimen dates. Associations with respiratory pathogens explained over 83% of the variation in cold/flu, cough and difficulty breathing calls. Based on the first two seasons available, the greatest burden was associated with respiratory syncytial virus (RSV) and influenza, with associations found in all age bands. The most sensitive signal for influenza was calls for 'cold/flu', whilst for RSV it was calls for cough. The best-fitting models showed calls increasing a week before laboratory specimen dates. Daily surveillance of these calls can provide early warning of seasonal rises in influenza and RSV, contributing to the national respiratory surveillance programme.
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20
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Thomas SL, Walker JL, Fenty J, Atkins KE, Elliot AJ, Hughes HE, Stowe J, Ladhani S, Andrews NJ. Impact of the national rotavirus vaccination programme on acute gastroenteritis in England and associated costs averted. Vaccine 2016; 35:680-686. [PMID: 28007397 PMCID: PMC5267482 DOI: 10.1016/j.vaccine.2016.11.057] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/11/2016] [Accepted: 11/15/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Introduction of infant oral rotavirus vaccination in the UK in July 2013 has resulted in decreased hospitalisations and Emergency Department (ED) visits for acute gastroenteritis (AGE), for both adults and children. We investigated reductions in AGE incidence seen in primary care in the two years after vaccine introduction, and estimated the healthcare costs averted across healthcare settings in the first year of the vaccination programme. METHODS We used primary care data from the Clinical Practice Research Datalink and age-stratified time-series analyses to derive adjusted incidence rate ratios (IRRa) for AGE in the first two years of the post-vaccination era (July 2013-April 2015) compared to the pre-vaccination era (July 2008-June 2013). We estimated cases averted among children aged <5years in the first year of the vaccination programme by comparing observed numbers of AGE cases in 2013-2014 to numbers predicted from the time-series models. We then estimated the healthcare costs averted for general practice consultations, ED visits and hospitalisations. RESULTS In general practice, AGE rates in infants (the target group for vaccination) decreased by 15% overall after vaccine introduction (IRRa=0.85; 95%CI=0.76-0.95), and by 41% in the months of historically high rotavirus circulation (IRRa=0.59; 95%CI=0.53-0.66). Rates also decreased in other young children and to a lesser degree in older individuals, indicating herd immunity. Across all three settings (general practice, EDs, and hospitalisations) an estimated 87,376 (95% prediction interval: 62,588-113,561) AGE visits by children aged <5years were averted in 2013-14, associated with an estimated £12.5million (9,209-16,198) reduction in healthcare costs. CONCLUSIONS The marked decreases in the general practice AGE burden after rotavirus vaccine introduction mirror decreases seen in other UK healthcare settings. Overall, these decreases are associated with substantial averted healthcare costs.
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Affiliation(s)
- Sara L Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Jemma L Walker
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Justin Fenty
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Katherine E Atkins
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Public Health England, 6th Floor 5 St Philips Place, Birmingham B3 2PW, UK
| | - Helen E Hughes
- Real-time Syndromic Surveillance Team, Public Health England, 6th Floor 5 St Philips Place, Birmingham B3 2PW, UK
| | - Julia Stowe
- Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Shamez Ladhani
- Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nick J Andrews
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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21
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Jabeen F. Detection of rotavirus infection in an era of vaccination. J Hosp Infect 2016; 93:115-6. [DOI: 10.1016/j.jhin.2016.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
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22
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Inns T, Trindall A, Dunling-Hall S, Shankar AG. Introduction of a new Rotavirus vaccine: Initial results of uptake and impact on laboratory confirmed cases in Anglia and Essex, United Kingdom, July 2015. Hum Vaccin Immunother 2016; 12:1040-4. [PMID: 26618660 PMCID: PMC4962965 DOI: 10.1080/21645515.2015.1108501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/01/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022] Open
Abstract
Rotavirus gastroenteritis accounts for an estimated 130,000 GP consultations and 13,000 hospitalisations for children under 5 y old each year in England and Wales. In July 2013, an oral live attenuated rotavirus vaccine (Rotarix®) was introduced into the UK infant immunisation program as a 2 dose schedule at 2 and 3 months of age. We collected vaccination uptake from October 2013 to March 2015 and laboratory confirmed cases data on children under the age of 5 y from 1 January 2004 to 31 May 2015. The vaccine uptake rates and laboratory confirmed cases were compared to provide evidence of the impact of this vaccination program. Vaccine uptake rates were available from sentinel data with between 91-98% of GP practices in Anglia and Essex providing data every month. These data showed from February 2014 to March 2015 between 90-92% of infants received the recommended 2 doses of Rotarix® each month. The numbers of rotavirus cases reported by laboratories decreased on average by 82% in the post vaccination seasons. The mean number of cases reported in weeks 1-22 for 2004-2013 in Anglia and Essex was 1,318. For the same period in 2014, 256 cases were reported and initial data for 2015 report 226 cases. In the first 5 months 2014 the greatest reduction in cases (89%) was seen in those under 1 yr (who would have been directly affected by vaccination) with case numbers falling to 59 from a mean 537 cases in the equivalent period for 2004-2013. Initially data suggests a 92% reduction in 2015 compared to the same pre-vaccination periods. For those aged 1 to <5 y who would not have been vaccinated, a reduction of 75% was also evident in 2014 and 77% in 2015, suggesting indirect protection in this group. In conclusion, initial results following the introduction of the Rotavirus vaccine clearly indicates a very good uptake of the vaccine and a significant reduction in the numbers of laboratory confirmed cases.
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Affiliation(s)
- Thomas Inns
- Epidemiology and Surveillance Scientist, Field Epidemiology Services, Public Health England, Liverpool, UK
| | - Amy Trindall
- Epidemiological Scientist, Field Epidemiology Services, Public Health England, Cambridge, UK
| | - Sara Dunling-Hall
- Specialist Registrar in Public Health, Health Protection Team, Public Health England East of England
| | - Ananda Giri Shankar
- Consultant in Communicable Disease Control, Health Protection Team, Public Health England East of England
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23
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What is the utility of using syndromic surveillance systems during large subnational infectious gastrointestinal disease outbreaks? An observational study using case studies from the past 5 years in England. Epidemiol Infect 2016; 144:2241-50. [PMID: 27033409 DOI: 10.1017/s0950268816000480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Syndromic surveillance systems in England have demonstrated utility in the early identification of seasonal gastrointestinal illness (GI) tracking its spatio-temporal distribution and enabling early public health action. There would be additional public health utility if syndromic surveillance systems could detect or track subnational infectious disease outbreaks. To investigate using syndromic surveillance for this purpose we retrospectively identified eight large GI outbreaks between 2009 and 2014 (four randomly and four purposively sampled). We then examined syndromic surveillance information prospectively collected by the Real-time Syndromic Surveillance team within Public Health England for evidence of possible outbreak-related changes. None of the outbreaks were identified contemporaneously and no alerts were made to relevant public health teams. Retrospectively, two of the outbreaks - which happened at similar times and in proximal geographical locations - demonstrated changes in the local trends of relevant syndromic indicators and exhibited a clustering of statistical alarms, but did not warrant alerting local health protection teams. Our suite of syndromic surveillance systems may be more suited to their original purposes than as means of detecting or monitoring localized, subnational GI outbreaks. This should, however, be considered in the context of this study's limitations; further prospective work is needed to fully explore the use of syndromic surveillance for this purpose. Provided geographical coverage is sufficient, syndromic surveillance systems could be able to provide reassurance of no or minor excess healthcare systems usage during localized GI incidents.
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24
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Czerkinsky C, Holmgren J. Vaccines against enteric infections for the developing world. Philos Trans R Soc Lond B Biol Sci 2016; 370:rstb.2015.0142. [PMID: 25964464 DOI: 10.1098/rstb.2015.0142] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Since the first licensure of the Sabin oral polio vaccine more than 50 years ago, only eight enteric vaccines have been licensed for four disease indications, and all are given orally. While mucosal vaccines offer programmatically attractive tools for facilitating vaccine deployment, their development remains hampered by several factors: -limited knowledge regarding the properties of the gut immune system during early life; -lack of mucosal adjuvants, limiting mucosal vaccine development to live-attenuated or killed whole virus and bacterial vaccines; -lack of correlates/surrogates of mucosal immune protection; and -limited knowledge of the factors contributing to oral vaccine underperformance in children from developing countries. There are now reasons to believe that the development of safe and effective mucosal adjuvants and of programmatically sound intervention strategies could enhance the efficacy of current and next-generation enteric vaccines, especially in lesser developed countries which are often co-endemic for enteric infections and malnutrition. These vaccines must be safe and affordable for the world's poorest, confer long-term protection and herd immunity, and must be able to contain epidemics.
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Affiliation(s)
- Cecil Czerkinsky
- CNRS, INSERM, Institut de Pharmacologie Moleculaire et Cellulaire, Université Nice Sophia Antipolis, 06103 Nice, France
| | - Jan Holmgren
- Department of Microbiology and Immunology, University of Gothenburg Vaccine Research Institute (GUVAX), Gothenburg 405 30, Sweden
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Comeau JL, Gagneur A, Quach C. Impact of a publicly funded monovalent rotavirus vaccination program in the Province of Quebec (Canada). Vaccine 2016; 34:893-8. [PMID: 26795368 DOI: 10.1016/j.vaccine.2016.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/01/2016] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED In November 2011, the province of Quebec, Canada implemented a publicly funded rotavirus (RV) vaccination program using the monovalent RV vaccine (RV1). To assess its impact, trends in passive RV laboratory detection and Emergency Department (ED) visits for gastroenteritis (GE) at two pediatric centers were evaluated. METHODS RV tests performed were extracted from the virology laboratory databases and ED visits for GE between July 1, 2006 and June 30, 2013, from the ED databases of The Montreal Children's Hospital (MCH) and Centre Hospitalier Universitaire de Sherbrooke (CHUS). The percent positive RV tests over time and season duration were assessed using 5-week moving averages. We defined season start and end as the first two and the last two consecutive weeks where the percent positive RV tests were ≥ 10%, respectively. RESULTS Comparing the pre- and post-vaccination program periods, a decrease in the proportion of positive RV tests was seen: 15.9% vs. 5.1% (p<0.001). Pre-vaccination program, RV seasons started between December and February, peaked in March or April and ended in May. In 2011-2012, the season started in March, peaked in April, and ended in May. In 2012-2013, the season lasted 3 weeks in May. ED visits for GE decreased post-introduction of the RV1 program: from 4.8% to 3.4% in 2011-2012, and 4.2% in 2012-13 (p<0.001). In children <2 years of age, ED GE visits decreased from 7.5% to 4.8% in 2011-2012, and 5.2% in 2012-2013 (p<0.001). Admissions for GE also decreased significantly from 0.41% of all ED visits to 0.14% in 2011-2012 and 0.22% in 2012-2013 (p<0.005). CONCLUSION Implementation of a publicly funded RV vaccination program had a major impact on the epidemiology of RV infections in Quebec: RV seasons have started later and been of shorter duration, peak positives were fewer, and ED visits for GE decreased.
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Affiliation(s)
- Jeannette L Comeau
- Division of Infectious Diseases, Department of Pediatrics and Department of Medical Microbiology, The Montreal Children's Hospital, McGill University, E05-1954 - 1001 Decarie Blvd, Montreal (QC) H4A 3J1, Canada.
| | - Arnaud Gagneur
- Department of Pediatrics, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke (QC) J1H 5N4, Canada.
| | - Caroline Quach
- Division of Infectious Diseases, Department of Pediatrics and Department of Medical Microbiology, The Montreal Children's Hospital, McGill University, E05-1954 - 1001 Decarie Blvd, Montreal (QC) H4A 3J1, Canada; Division des risques biologiques et de la santé au travail - Institut national de santé publique du Québec, 190 Crémazie Blvd E., Montreal (QC) H2P 1E2, Canada; Department of Epidemiology, Biostatistics, and Occupational Health - McGill University, 1020 Pine Avenue W, Montreal (QC) H3A 1A2, Canada; MUHC Vaccine Study Centre, 14770 Pierrefonds Blvd, Suite 204, Montreal (QC) H9H 4Y6, Canada.
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