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Oligbu G, Collins S, Sheppard C, Fry N, Dick M, Streetly A, Ladhani S. Risk of Invasive Pneumococcal Disease in Children with Sickle Cell Disease in England: A National Observational Cohort Study, 2010-2015. Arch Dis Child 2018; 103:643-647. [PMID: 29282225 DOI: 10.1136/archdischild-2017-313611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the clinical presentation, risk factors, serotype distribution and outcomes of invasive pneumococcal disease (IPD) in children with sickle cell disease (SCD) following the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in the UK. DESIGN Prospective national newborn screening for SCD and enhanced national IPD surveillance. PARTICIPANTS Children with SCD born in England between 1 September 2010 and 31 August 2014 who developed laboratory-confirmed IPD by 31 December 2015. MAIN OUTCOMES AND MEASURES Risk of IPD in children with SCD compared with children without SCD during the surveillance period. RESULTS Eleven children homozygote for haemoglobin S (HbSS) and one double heterozygote for haemoglobin S and C (HbSC) developed IPD. Septicaemia (n=7) and lower respiratory tract infection (n=4) were the main clinical presentations, and serogroup 15 (not present in PCV13) was responsible for 73% (8/11) of cases. Three children with HbSS (27%) died compared with <5% nationally. Children with HbSS had a 49-fold (95% CI 27 to 89, P<0.001) higher risk of IPD compared with their peers without SCD. CONCLUSIONS Children with SCD remain at increased risk of IPD despite national newborn screening, early penicillin prophylaxis and high pneumococcal vaccine uptake. They are also more likely to die of their infection compared with their peers without SCD. Most IPD cases are now due to serotypes not covered by PCV13. Healthcare professionals need to work more closely with families with SCD and local communities to emphasise the importance of penicillin prophylaxis, explore barriers, allay misguided beliefs and facilitate rapid access to healthcare.
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Affiliation(s)
- Godwin Oligbu
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,Immunisation, Hepatitis and Blood Safety Department (IHBSD), Public Health England, London, UK
| | - Sarah Collins
- Immunisation, Hepatitis and Blood Safety Department (IHBSD), Public Health England, London, UK
| | - Carmen Sheppard
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health England, London, UK
| | - Norman Fry
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health England, London, UK
| | - Moira Dick
- Division of Health and Social Care Research, King's College London, London, UK
| | - Allison Streetly
- Division of Health and Social Care Research, King's College London, London, UK.,Deputy National Lead Healthcare Public Health, Public Health England, London, UK
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,Immunisation, Hepatitis and Blood Safety Department (IHBSD), Public Health England, London, UK
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Downing M, Pollitt R. Newborn bloodspot screening in the UK – past, present and future. Ann Clin Biochem 2008; 45:11-7. [DOI: 10.1258/acb.2007.007127] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Screening newborn babies for inherited metabolic disease began in the UK in the late 1950s with the ‘nappy test’ for phenylketonuria. In 1969 the Department of Health recommended changing to bloodspot screening using the techniques developed in the USA by Robert Guthrie and his associates. Bloodspot screening for various other disorders (galactosaemia, maple syrup urine disease, homocystinuria, cystic fibrosis and others) was introduced on a patchy local basis but, until 2000, the only additional disorder officially recommended was congenital hypothyroidism. Screening for haemoglobinopathies received official support in 2000 and for cystic fibrosis in 2001 though implementation was slow, particularly for the latter. Both these screens have raised difficult issues relating to genetic privacy and the detection of carrier status in children. During the last decade screening has become increasingly subject to central control. Though a more consistent and systematic approach was clearly needed, this has undoubtedly slowed the rate of innovation. In particular the UK has lagged behind many other European countries in the application of tandem mass spectrometry (MS-MS) though, following a major pilot study, screening for medium-chain acyl-CoA dehydrogenase deficiency is now in the process of introduction. Attempts to codify clinical and laboratory procedures have also proved controversial, highlighting marked differences in practice in various parts of the country and the difficulty of rationalizing these within a practicable and scientifically justified framework. Notwithstanding this, there are many positive developments and newborn screening remains a stimulating and rewarding field in which to work.
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Affiliation(s)
- Melanie Downing
- Clinical Chemistry and Newborn Screening, The Children's Hospital, Western Bank, Sheffield S10 2TH, UK
| | - Rodney Pollitt
- Clinical Chemistry and Newborn Screening, The Children's Hospital, Western Bank, Sheffield S10 2TH, UK
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Sharrard M, Pollitt R. Metabolic screening in children: newborn screening for metabolic diseases past, present and future. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.paed.2007.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Leeming W. Ideas about heredity, genetics, and 'medical genetics' in Britain, 1900-1982. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2005; 36:538-58. [PMID: 16137602 DOI: 10.1016/j.shpsc.2005.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2004] [Revised: 03/15/2005] [Indexed: 05/04/2023]
Abstract
The aim of this paper is to understand how evolving ideas about heredity and genetics influenced new medical interests and practices and, eventually, the formation of 'medical genetics' as a medical specialism in Britain. I begin the paper by highlighting the social and institutional changes through which these ideas passed. I argue that, with time, there was a decisive convergence in thought that combined ideas about the familial aspects of heredity and the health needs of populations with an omnibus 'genetic' approach to health and illness that focused on the structures and activities of chromosomes and genes in individuals. I show how this convergence in thought was spurred on, first, by innovations in genetic science and technology in the years after 1960, and, second, by negotiated protocols and standards of medical practice worked out by bodies such as the relevant royal colleges, the linked associations and societies for medical professionals, affected training and research authorities, and the state. The notion of 'medical genetics' in Britain consequently gained a semblance of unanimity over its basic reference points and arrived at a meaning directly tributary to current acceptance of the term in the context of a medical specialism.
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Affiliation(s)
- William Leeming
- Faculty of Liberal Studies, Ontario College of Art and Design, 100 McCaul Street, Toronto, ON M5T 1W1, Canada.
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Kerruish NJ, Robertson SP. Newborn screening: new developments, new dilemmas. JOURNAL OF MEDICAL ETHICS 2005; 31:393-8. [PMID: 15994357 PMCID: PMC1734185 DOI: 10.1136/jme.2004.008219] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Scientific and technological advances are lending pressure to expand the scope of newborn screening. Whereas this has great potential for improving child health, it also challenges our current perception of such programmes. Standard newborn screening programmes are clearly justified by the fact that early detection and treatment of affected individuals avoids significant morbidity and mortality. However, proposals to expand the scope and complexity of such testing are not all supported by a similar level of evidence for unequivocal benefit. We argue that screening for genetic susceptibility to complex disorders is inherently different from standard screening and, while of potential value, must be considered separately from conventional testing.
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Affiliation(s)
- N J Kerruish
- Department of Paediatrics and Child Health, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand.
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Application of nuclear magnetic resonance spectroscopy combined with principal component analysis in detecting inborn errors of metabolism using blood spots: a metabonomic approach. Anal Chim Acta 2004. [DOI: 10.1016/j.aca.2004.02.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
UNLABELLED Recent technological advances have led to an expansion in inborn errors that can be detected in the newborn period. Further developments in newborn screening will increase this number further. There are two main arguments put forward to support the developments of an expanded newborn screening programme. Firstly there may be an improvement in patient outcome. The early detection of disorders either in the pre-symptomatic or early symptomatic phase should, with treatment, result in the prevention of severe illness. This is evident for phenylketonuria and generally accepted for homocystinuria and medium-chain acyl-CoA dehydrogenase deficiency, disorders which have a long pre-symptomatic phase. However, other inborn errors may present within the first 10 days of life with severe illness, particularly neonatal encephalopathy. In order to effectively stop the rapid progression of these disorders, screening must be undertaken early although where severe metabolic decompensation occurs within 2 to 3 days of birth, newborn screening programmes are unlikely to be of direct benefit. Secondly an early diagnosis, even when this does not affect that individual's prognosis, may allow for accurate genetic advise to be given to the family and the opportunity to have prenatal diagnosis for future pregnancies. CONCLUSION For the clinician, the introduction of an expanded and early newborn screening presents opportunities for improved patient and family care. However, it is important to be aware of possible detrimental effects on families of early screening. Screening tests must have adequate sensitivity and high specificity. Furthermore with early screening, close liaison between the laboratory, clinicians and community services is essential.
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Affiliation(s)
- John H Walter
- Willink Biochemical Genetics Unit, Royal Manchester Children's Hospital, M27 4HA, Manchester, UK.
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Affiliation(s)
- M Blair
- Department of Paediatrics, Imperial College School of Medicine and Northwick Park Hospital (North West London Hospital NHS Trust) Harrow, Middlesex HA1 3UJ, UK.
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Affiliation(s)
- M Blair
- Department of Paediatrics, Imperial College School of Medicine and Northwick Park Hospital (North West London Hospital NHS Trust), Harrow, Middlesex HA1 3UJ, UK
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Simpson N, Randall R, Lenton S, Walker S. Audit of neonatal screening programme for phenylketonuria and congenital hypothyroidism. Arch Dis Child Fetal Neonatal Ed 1997; 77:F228-34. [PMID: 9462195 PMCID: PMC1720724 DOI: 10.1136/fn.77.3.f228] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The performance of the neonatal screening programme was audited against clinical standards in the Bath clinical area from 1 April 1994 to 31 March 1996. The standards and policy were agreed by local service provider representatives of the screening and were audited, using laboratory and child health computer systems and medical records. Two annual reports were produced with recommendations for improvement communicated to representatives of the service. Thus the first audit loop has been completed. The audit shows that the coverage of the service is excellent, with all eligible babies being offered screening; those with congenital hypothyroidism or phenylketonuria receive appropriate treatment by the 28 day standard. The process works extremely well, although areas for improvement have been identified, to increase the efficiency of the service. It is concluded that an effective and efficient audit cycle can be established, to monitor and improve the performance of the neonatal screening service.
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Affiliation(s)
- N Simpson
- Salisbury District, General Hospital, Wilts
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Hutchinson EJ, Streetly A, Grant C, Pollitt R, Eldridge P, Nicoll A. Impact of incomplete coverage of neonatal dried blood spot screening on estimating HIV-1 seroprevalence. Epidemiol Infect 1996; 117:173-7. [PMID: 8760966 PMCID: PMC2271670 DOI: 10.1017/s095026880000128x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The aim of this study was to determine the extent to which selective under-coverage of births to mothers more likely to be at risk of HIV-1 infection will result in a significant under-estimation of the true neonatal seroprevalence. Census data, local birth statistics, maternity data and data from the prevalence monitoring programme were used to produce a model to predict the effects of under-coverage in the uptake of neonatal metabolic screening which has been observed in babies with a mother of ethnic group black African. The adjustment factor which allows for under-coverage is the relative inclusion ratio (RIR); the probability that samples from a group at different risk of HIV infection were included in the survey divided by the probability of inclusion for samples from all other babies. The RIR was found to be close to unity (0.97), indicating a minimal bias. Under usual conditions only if the relative inclusion ratio (RIR) declined to values of 0.87 or below would there be a substantial bias. Despite some selective under representation, the results obtained from the Unlinked Anonymous HIV Monitoring Programme Dried Blood Spot Survey would seem to identify levels of prevalence in the population of child-bearing women with a good degree of accuracy and remains a useful tool for resource allocation, planning of services, provision of care and counselling.
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Affiliation(s)
- E J Hutchinson
- Public Health Laboratory Service Communicable Disease Surveillance Centre, London
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Cappuccio FP, Hickman M, Barker M. Neonatal screening. Performance is hard to monitor. BMJ (CLINICAL RESEARCH ED.) 1996; 312:182. [PMID: 8563549 PMCID: PMC2349848 DOI: 10.1136/bmj.312.7024.182b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Edwards A. Neonatal screening. Pretest counselling and informed consent should be prerequisites. BMJ (CLINICAL RESEARCH ED.) 1996; 312:182-3. [PMID: 8563552 PMCID: PMC2349801 DOI: 10.1136/bmj.312.7024.182c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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