1
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Leston M, Elson WH, Watson C, Lakhani A, Aspden C, Bankhead CR, Borrow R, Button E, Byford R, Elliot AJ, Fan X, Hoang U, Linley E, Macartney J, Nicholson BD, Okusi C, Ramsay M, Smith G, Smith S, Thomas M, Todkill D, Tsang RS, Victor W, Williams AJ, Williams J, Zambon M, Howsam G, Amirthalingam G, Lopez-Bernal J, Hobbs FDR, de Lusignan S. Representativeness, Vaccination Uptake, and COVID-19 Clinical Outcomes 2020-2021 in the UK Oxford-Royal College of General Practitioners Research and Surveillance Network: Cohort Profile Summary. JMIR Public Health Surveill 2022; 8:e39141. [PMID: 36534462 PMCID: PMC9770023 DOI: 10.2196/39141] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) is one of Europe's oldest sentinel systems, working with the UK Health Security Agency (UKHSA) and its predecessor bodies for 55 years. Its surveillance report now runs twice weekly, supplemented by online observatories. In addition to conducting sentinel surveillance from a nationally representative group of practices, the RSC is now also providing data for syndromic surveillance. OBJECTIVE The aim of this study was to describe the cohort profile at the start of the 2021-2022 surveillance season and recent changes to our surveillance practice. METHODS The RSC's pseudonymized primary care data, linked to hospital and other data, are held in the Oxford-RCGP Clinical Informatics Digital Hub, a Trusted Research Environment. We describe the RSC's cohort profile as of September 2021, divided into a Primary Care Sentinel Cohort (PCSC)-collecting virological and serological specimens-and a larger group of syndromic surveillance general practices (SSGPs). We report changes to our sampling strategy that brings the RSC into alignment with European Centre for Disease Control guidance and then compare our cohort's sociodemographic characteristics with Office for National Statistics data. We further describe influenza and COVID-19 vaccine coverage for the 2020-2021 season (week 40 of 2020 to week 39 of 2021), with the latter differentiated by vaccine brand. Finally, we report COVID-19-related outcomes in terms of hospitalization, intensive care unit (ICU) admission, and death. RESULTS As a response to COVID-19, the RSC grew from just over 500 PCSC practices in 2019 to 1879 practices in 2021 (PCSC, n=938; SSGP, n=1203). This represents 28.6% of English general practices and 30.59% (17,299,780/56,550,136) of the population. In the reporting period, the PCSC collected >8000 virology and >23,000 serology samples. The RSC population was broadly representative of the national population in terms of age, gender, ethnicity, National Health Service Region, socioeconomic status, obesity, and smoking habit. The RSC captured vaccine coverage data for influenza (n=5.4 million) and COVID-19, reporting dose one (n=11.9 million), two (n=11 million), and three (n=0.4 million) for the latter as well as brand-specific uptake data (AstraZeneca vaccine, n=11.6 million; Pfizer, n=10.8 million; and Moderna, n=0.7 million). The median (IQR) number of COVID-19 hospitalizations and ICU admissions was 1181 (559-1559) and 115 (50-174) per week, respectively. CONCLUSIONS The RSC is broadly representative of the national population; its PCSC is geographically representative and its SSGPs are newly supporting UKHSA syndromic surveillance efforts. The network captures vaccine coverage and has expanded from reporting primary care attendances to providing data on onward hospital outcomes and deaths. The challenge remains to increase virological and serological sampling to monitor the effectiveness and waning of all vaccines available in a timely manner.
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Affiliation(s)
- Meredith Leston
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - William H Elson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Conall Watson
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, Colindale, London, United Kingdom
| | - Anissa Lakhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, Colindale, London, United Kingdom
| | - Carole Aspden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Clare R Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Elizabeth Button
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, Birmingham, United Kingdom
| | - Xuejuan Fan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Uy Hoang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ezra Linley
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Jack Macartney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, Colindale, London, United Kingdom
| | - Gillian Smith
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, Birmingham, United Kingdom
| | - Sue Smith
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, Birmingham, United Kingdom
| | - Mark Thomas
- Royal College of General Practitioners, London, United Kingdom
| | - Dan Todkill
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, Birmingham, United Kingdom
| | - Ruby Sm Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - William Victor
- Royal College of General Practitioners, London, United Kingdom
| | - Alice J Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Maria Zambon
- Reference Microbiology, UK Health Security Agency, Colindale, London, United Kingdom
| | - Gary Howsam
- Royal College of General Practitioners, London, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, Colindale, London, United Kingdom
| | - Jamie Lopez-Bernal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, Colindale, London, United Kingdom
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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de Lusignan S, Alexander H, Broderick C, Dennis J, McGovern A, Feeney C, Flohr C. The epidemiology of eczema in children and adults in England: A population-based study using primary care data. Clin Exp Allergy 2021; 51:471-482. [PMID: 33179341 PMCID: PMC7984097 DOI: 10.1111/cea.13784] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/12/2020] [Accepted: 11/04/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whilst eczema is a common inflammatory skin condition, we lack contemporary estimates of disease incidence and prevalence across the lifespan. OBJECTIVE To estimate the incidence and prevalence of eczema in children and adults in England and variation by sociodemographic factors (sex, socio-economic status, ethnicity, and geography). METHODS We used the Royal College of General Practitioners Research and Surveillance Centre primary care research database of 3.85 million children and adults registered with participating general practitioner practices between 2009 and 2018 inclusive. Eczema incidence was defined as the first-ever diagnosis of eczema recorded in the primary care record, and eczema prevalence was defined as fulfilment of criteria for active eczema (two eczema records appearing in the primary care record within any one-year period). RESULTS Eczema incidence was highest in infants younger than 1 year (15.0 per 100 person-years), lowest in adults aged 40-49 (0.35 p/100 person-years), and increased from middle age to a second smaller peak in people 80 years or older (0.79 p/100 person-years). Eczema prevalence was highest in children aged 2 (16.5%) and lowest in adults aged 30-39 (2.8%). Eczema incidence was higher in male infants (<2) and male adults older than 70; for all other ages, incidence was higher in females. Eczema was more common in Asian and black ethnic groups than in people of white ethnicity. Higher socio-economic status was associated with a greater incidence of eczema in infants younger than 2, but the reverse was seen for all other age groups. Both incidence and prevalence of eczema were greater in urban settings and in North-West England. CONCLUSIONS AND CLINICAL RELEVANCE Eczema has a bimodal distribution across the lifespan. We observed differences in incidence and prevalence of eczema by ethnicity, geography, sex, and socio-economic status, which varied in magnitude throughout life.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
- Royal College of General Practitioners Research and Surveillance CentreLondonUK
| | - Helen Alexander
- Unit for Population‐Based Dermatology Research, St John's Institute of Dermatology, Guy's & Thomas' NHS Foundation Trust and King's College LondonLondonUK
| | - Conor Broderick
- Unit for Population‐Based Dermatology Research, St John's Institute of Dermatology, Guy's & Thomas' NHS Foundation Trust and King's College LondonLondonUK
| | | | | | | | - Carsten Flohr
- Unit for Population‐Based Dermatology Research, St John's Institute of Dermatology, Guy's & Thomas' NHS Foundation Trust and King's College LondonLondonUK
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3
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Pan F, Wang B, Zhang H, Shi Y, Xu Q. The clinical application of Filmarray respiratory panel in children especially with severe respiratory tract infections. BMC Infect Dis 2021; 21:230. [PMID: 33639884 PMCID: PMC7910784 DOI: 10.1186/s12879-021-05900-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/12/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Respiratory tract infections (RTIs) are the common diseases in children and the routine detection methods frequently fail to identify the infectious pathogens especially for viruses. The Filmarray respiratory panel (FARP) can reliably and rapidly identify viruses and bacteria pathogens. This study is to evaluate the performance and clinical significance of FARP in children. METHODS Children diagnosed with RTIs in pediatric intensive care unit (PICU) were enrolled in this study. Nasopharyngeal secretion (NPS) samples of these children were collected and the FARP assay for 17 pathogens and routine microbiological methods were performed. Clinical data of all patients was also collected and evaluated. RESULTS A total of 90 children were enrolled into this study and 58 patients (64.4%) were positive for 13 pathogens by FARP, with 18 being detected positive with multiple-virus (31.3%, 18/58). Human rhinovirus/enterovirus (21.0%%, 17/58) were the predominant pathogen, followed by adenovirus (18.5%). Higher proportions of various pathogens were identified in the infant and toddler (0-2 years) groups with human rhinovirus/enterovirus being mostly virus. Adenovirus were common in the group aged 3-5 years, but only three pathogens including M.pneumoniae, respiratory syncytial virus, and adenovirus were also found in age group (6-14 years). Among 58 FARP positive patients, significant differences were found in antibiotic prescription and use of glucocorticoid between the single-organism-positive group and the multi-organism-positive group (P < 0.05). Furthermore, there was significant difference in use of anti-virus and usage of glucocorticoid between severe respiratory infections group and non severe respiratory infections group (P < 0.05). CONCLUSIONS This study demonstrated that FARP can provide the rapid detection of respiratory virus and atypical bacteria for children, especially with severe respiratory tract infections.
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Affiliation(s)
- Fen Pan
- Department of clinical laboratory, Shanghai Children's Hospital, Shanghai Jiaotong University, Luding Road 355, Putuo District, Shanghai, 200062, China
| | - Bingjie Wang
- Department of clinical laboratory, Shanghai Children's Hospital, Shanghai Jiaotong University, Luding Road 355, Putuo District, Shanghai, 200062, China
| | - Hong Zhang
- Department of clinical laboratory, Shanghai Children's Hospital, Shanghai Jiaotong University, Luding Road 355, Putuo District, Shanghai, 200062, China.
| | - Yingying Shi
- Department of clinical laboratory, Shanghai Children's Hospital, Shanghai Jiaotong University, Luding Road 355, Putuo District, Shanghai, 200062, China
| | - Qi Xu
- Department of clinical laboratory, Shanghai Children's Hospital, Shanghai Jiaotong University, Luding Road 355, Putuo District, Shanghai, 200062, China
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4
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de Lusignan S, Sherlock J, Akinyemi O, Pebody R, Elliot A, Byford R, Yonova I, Zambon M, Joy M. Household presentation of influenza and acute respiratory illnesses to a primary care sentinel network: retrospective database studies (2013-2018). BMC Public Health 2020; 20:1748. [PMID: 33218318 PMCID: PMC7677442 DOI: 10.1186/s12889-020-09790-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 10/29/2020] [Indexed: 12/12/2022] Open
Abstract
Background Direct observation of the household spread of influenza and respiratory infections is limited; much of our understanding comes from mathematical models. The study aims to determine household incidence of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections within a primary care routine data and identify factors associated with the diseases’ incidence. Methods We conducted two five-year retrospective analyses of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections using the England Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care sentinel network database; a cross-sectional study reporting incident rate ratio (IRR) from a negative binomial model and a retrospective cohort study, using a shared gamma frailty survival model, reporting hazard ratios (HR). We reported the following household characteristics: children < 5 years old, each extra household member, gender, ethnicity (reference white), chronic disease, pregnancy, and rurality. Results The IRR where there was a child < 5 years were 1·62 (1·38–1·89, p < 0·0001), 2·40 (2.04–2.83, p < 0·0001) and 4·46 (3.79–5.255, p < 0·0001) for ILI, LRTI and URTI respectively. IRR also increased with household size, rurality and presentations and by female gender, compared to male. Household incidence of URTI and LRTI changed little between years whereas influenza did and were greater in years with lower vaccine effectiveness. The HR where there was a child < 5 years were 2·34 (95%CI 1·88–2·90, p < 0·0001), 2·97 (95%CI 2·76–3·2, p < 0·0001) and 10·32 (95%CI 10.04–10.62, p < 0·0001) for ILI, LRTI and URTI respectively. HR were increased with female gender, rurality, and increasing household size. Conclusions Patterns of household incidence can be measured from routine data and may provide insights for the modelling of disease transmission and public health policy. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09790-3.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK. .,Royal College of General Practitioners Research and Surveillance Centre, 30 Euston Square, London, NW1 2FB, UK. .,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK.
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Oluwafunmi Akinyemi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Richard Pebody
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Alex Elliot
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Ivelina Yonova
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Maria Zambon
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
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5
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Morrison KE, Colón-González FJ, Morbey RA, Hunter PR, Rutter J, Stuttard G, de Lusignan S, Yeates A, Pebody R, Smith G, Elliot AJ, Lake IR. Demographic and socioeconomic patterns in healthcare-seeking behaviour for respiratory symptoms in England: a comparison with non-respiratory symptoms and between three healthcare services. BMJ Open 2020; 10:e038356. [PMID: 33158821 PMCID: PMC7651740 DOI: 10.1136/bmjopen-2020-038356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE This study will analyse respiratory contacts to three healthcare services that capture more of the community disease burden than acute data sources, such as hospitalisations. The objective is to explore associations between contacts to these services and the patient's age, gender and deprivation. Results will be compared between healthcare services, and with non-respiratory contacts to explore how contacts differ by service and illness. It is crucial to investigate the sociodemographic patterns in healthcare-seeking behaviour to enable targeted public health interventions. DESIGN Ecological study. SETTING Surveillance of respiratory contacts to three healthcare services in England: telehealth helpline (NHS111); general practitioner in-hours (GPIH); and general practitioner out of hours unscheduled care (GPOOH). PARTICIPANTS 13 million respiratory contacts to NHS111, GPIH and GPOOH. OUTCOME MEASURES Respiratory contacts to NHS111, GPIH and GPOOH, and non-respiratory contacts to NHS111 and GPOOH. RESULTS More respiratory contacts were observed for females, with 1.59, 1.73, and 1.95 times the rate of contacts to NHS111, GPOOH and GPIH, respectively. When compared with 15-44 year olds, there were 37.32, 18.66 and 6.21 times the rate of respiratory contacts to NHS111, GPOOH and GPIH in children <1 year. There were 1.75 and 2.70 times the rate of respiratory contacts in the most deprived areas compared with the least deprived to NHS111 and GPOOH. Elevated respiratory contacts were observed for males <5 years compared with females <5 years. Healthcare-seeking behaviours between respiratory and non-respiratory contacts were similar. CONCLUSION When contacts to services that capture more of the disease burden are explored, the demographic patterns are similar to those described in the literature for acute systems. Comparable results were observed between respiratory and non-respiratory contacts suggesting that when a wider spectrum of disease is explored, sociodemographic factors may be the strongest influencers of healthcare-seeking behaviour.
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Affiliation(s)
- Kirsty E Morrison
- School of Environmental Sciences, University of East Anglia, Norwich, UK
| | - Felipe J Colón-González
- School of Environmental Sciences, University of East Anglia, Norwich, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Roger A Morbey
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Royal College of General Practitioners Research and Surveillance Centre, London, UK
| | | | - Richard Pebody
- Influenza and Other Respiratory Virus Section, Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Gillian Smith
- School of Environmental Sciences, University of East Anglia, Norwich, UK
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - Iain R Lake
- School of Environmental Sciences, University of East Anglia, Norwich, UK
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de Lusignan S, Sherlock J, Ferreira F, O'Brien S, Joy M. Household presentation of acute gastroenteritis in a primary care sentinel network: retrospective database studies. BMC Public Health 2020; 20:445. [PMID: 32248812 PMCID: PMC7132989 DOI: 10.1186/s12889-020-08525-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/13/2020] [Indexed: 12/27/2022] Open
Abstract
Background Acute gastroenteritis (AGE) is a highly transmissible condition spreading rapidly between individuals and within households. Rotavirus vaccination was introduced in the UK in 2013. The study objectives were to investigate how acute gastroenteritis incidence changed over 25 years and household incidence of AGE since 2013. Methods Repeated cross-sectional study of Royal College of General Practitioners Research and Surveillance Centre network. We used a negative binomial model to report incidence rate ratio (IRR) using the last 5 years data. We also conducted a retrospective cohort analysis, using a shared gamma frailty model (2013–2017). We explored the impact of child under 5- years, household size, socioeconomic status quintile, and rurality. Results In the cross-sectional analysis, the IRR of AGE in households with a child of under 5 years was 12.20 (95%CI 11.08–13.45-, p < 0.001) compared with households without; the IRR fell across IMD quintiles, for example there is a 37% decrease in incidence comparing IMD quintile 1 to quintile 5 (95%CI -0.52-0.76, p < 0.001), The cohort study revealed that the presence of an under 5 in the household was associated with a higher risk of household presentation (HR = 6.29, 95% CI 5.61–7.06, p < 0.001). In addition, we observe a reduction in risk of presentation from the most to the least deprived socioeconomic quintile (second quintile: HR = 0.74 (95%CI 0.59–0.92), to least deprived quintile, HR = 0.55 (95%CI 0.41–0.74). We saw a lower association with male gender, white ethnicity and living outside London, but an increased association with increasing household size. Conclusions The incidence of AGE has changed over time: pre-school children, larger households, and living in London were associated with higher rates, and male gender and higher economic status associated with lower rates.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, UK. .,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, UK. .,Royal College of General Practitioners Research and Surveillance Centre, 30 Euston Square, London, UK.
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, UK
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, UK
| | - Sarah O'Brien
- Department of Public Health and Policy, Institute of population Health Sciences, University of Liverpool, Liverpool, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, UK
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7
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You C, Ran G, Wu X, Wang Y, Tian H, Fan J, Yao Z, Wang F. High immunoglobulin E level is associated with increased readmission in children with bronchopneumonia. Ther Adv Respir Dis 2020; 13:1753466619879832. [PMID: 31588854 PMCID: PMC6783659 DOI: 10.1177/1753466619879832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Increased immunoglobulin E (IgE) is associated with lower respiratory tract
infections. The study aimed to evaluate the association between IgE and the
rate of bronchopneumonia-related readmission within 12 months in
children. Methods: A total of 1099 children aged over 1 year with bronchopneumonia, from 1
January 2015 to 31 December 2016, were enrolled. Unplanned readmissions
within 12 months after discharge were observed. Multivariate regression
analysis was used to identify independent risk factors for
rehospitalization. Results: The rate of rehospitalization was 11.4% (125/1099). Compared to the
nonreadmission children, IgE levels, the proportion of children with asthma
and hospitalization duration were significantly higher in the readmission
children (p < 0.05). Compared to the children with
normal IgE (≤ 165 IU/ml) levels, the risk of rehospitalization was
significantly higher in children with abnormal IgE [odds ratio (OR) 1.781,
95% confidence interval (CI) 1.209–2.624, p = 0.004].
Children with IgE level more than three times the upper limit had even
higher risks of readmission (OR 2.037, 95%CI 1.172–3.540, p
= 0.012). Meanwhile, the risk of readmission in children with abnormal IgE
combined with or without bronchial asthma was significantly higher (OR 2.548
and 1.918, 95% CI 1.490–4.358 and 1.218–3.020, p = 0.001
and 0.005, respectively). Conclusions: Children aged over 1 year with bronchopneumonia who had higher IgE levels are
at increased risk for rehospitalization within the first 12 months of the
index hospitalization and IgE level may be used as a predictor of
rehospitalization in children with bronchopneumonia.
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Affiliation(s)
- Cun You
- Department of Pediatrics, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo Ran
- Department of Anesthesiology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Xiao Wu
- Emergency Department, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yu Wang
- Jiuting Town Community Healthcare Center of Songjiang District, Shanghai, China
| | - Hua Tian
- Jiuting Town Community Healthcare Center of Songjiang District, Shanghai, China
| | - Jiabao Fan
- Department of Clinical Laboratory, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zezhong Yao
- Department of pediatrics, Minhang Branch, Zhongshan Hospital, Fudan University, No.170, Xinsong Rd, Minhang, Shanghai 201199, China
| | - Fei Wang
- Emergency Department, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, No.1, Chengbei Rd, Jiading, Shanghai 201800, China
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8
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de Vries E, van Hout RWNM. Respiratory Symptoms in Post-infancy Children. A Dutch Pediatric Cohort Study. Front Pediatr 2020; 8:583630. [PMID: 33392115 PMCID: PMC7773946 DOI: 10.3389/fped.2020.583630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/16/2020] [Indexed: 12/03/2022] Open
Abstract
Aim: To study the pattern of respiratory symptoms in children in the general population. Method: We followed a cohort of children for up to 2 years through parents completing weekly online questionnaires in the Child-Is-Ill study ("Kind-en-Ziekmeting" in Dutch); the study was running 2012-2015. Inclusion criteria were "an ordinary child" (according to the parents) and <18 years old at inclusion. We especially encouraged participation of post-infancy children. Age at inclusion, sex, smoking exposure, allergy in the family, and frequent infections in the family were noted. Pearson's correlation, principal component analysis, latent class analysis, latent profile analysis, linear regression, and linear mixed effects regression were used in the statistical analyses. Results: Data were collected on 55,524 childweeks in 755 children (50% girls; median age, 7 years; interquartile range, 4-11 years, 97% ≥2 years at inclusion), with reported symptom(s) in 8,425 childweeks (15%), leading to school absenteeism in 25%, doctor's visits in 12%, and parental sick leave in 8%; symptoms lasting ≥3 weeks were rare (2% of episodes). Linear mixed effects regression showed significant, but only limited, effects of season on the proportion of "symptom(s) reported" per individual child. Only runny nose showed a significant, but very small, age effect. However, the variability between the children was considerable. There were no obvious subgroups of children with specific symptom combinations. Conclusion: In any randomly chosen week, the vast majority of children (85%) in our-mainly-post-infancy cohort derived from the general population did not have any symptom, even in the younger age group, even in winter. The children showed considerable variability; no clear subgroups of symptom patterns could be identified, underlining the difficult position of healthcare providers. These results support our opinion that post-infancy children in the general population should not be evaluated as if they are infants when they have recurrent respiratory symptoms. If they clearly deviate from the above-described most common pattern, it is wise to keep an eye on potential, maybe even rare, serious underlying causes.
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Affiliation(s)
- Esther de Vries
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands.,Jeroen Bosch Academy Research, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
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Bundle N, Verlander NQ, Morbey R, Edeghere O, Balasegaram S, de Lusignan S, Smith G, Elliot AJ. Monitoring epidemiological trends in back to school asthma among preschool and school-aged children using real-time syndromic surveillance in England, 2012-2016. J Epidemiol Community Health 2019; 73:825-831. [PMID: 31262728 DOI: 10.1136/jech-2018-211936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/12/2019] [Accepted: 05/14/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND : Back to school (BTS) asthma has been previously reported in children; however, its epidemiology and associated healthcare burden are unclear. We aimed to describe the timing and magnitude of BTS asthma using surveillance data from different health services in England. METHODS : Asthma morbidity data from emergency department attendances and general practitioner (GP) consultations between April 2012 and December 2016 were used from national syndromic surveillance systems in England. Age-specific and sex-specific rates and time series of asthma peaks relative to school term dates were described. The timing of a BTS excess period and adjusted rates of asthma relative to a baseline period were estimated using cumulative sum control chart plots and negative binomial regression. RESULTS : BTS asthma among children aged below 15 years was most pronounced at the start of the school year in September. This effect was not present among those aged 15 years and above. After controlling for sex and study year, the adjusted daily rate of childhood GP in-hours asthma consultations was 2.5-3 times higher in the BTS excess period, with a significantly higher effect among children aged 0-4 years. A distinct age-specific pattern of sex differences in asthma presentations was present, with a higher burden among males in children and among females aged over 15 years. CONCLUSION: We found evidence of a BTS asthma peak in children using surveillance data across a range of healthcare systems, supporting the need for further preventative work to reduce the impact of BTS asthma in children.
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Affiliation(s)
- Nick Bundle
- United Kingdom Field Epidemiology Training Programme, Public Health England, London, UK.,Field Epidemiology South East and London, Field Service, National Infection Service, Public Health England, London, UK
| | - Neville Q Verlander
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Roger Morbey
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
| | - Obaghe Edeghere
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
| | - Sooria Balasegaram
- Field Epidemiology South East and London, Field Service, National Infection Service, Public Health England, London, UK
| | - Simon de Lusignan
- Research & Surveillance Centre, Royal College of General Practitioners, London, UK.,Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Gillian Smith
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
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Factors Associated with Atopic Dermatitis and Allergic Rhinitis among Residents of Two Municipal Areas in South Korea. ACTA ACUST UNITED AC 2019; 55:medicina55050131. [PMID: 31083640 PMCID: PMC6572473 DOI: 10.3390/medicina55050131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/24/2019] [Accepted: 05/08/2019] [Indexed: 01/16/2023]
Abstract
Background and Objectives: The growing burden and deleterious health consequences of allergic diseases, especially of allergic rhinitis (AR) and atopic dermatitis (AD), in developed countries remains an important public health issue. The current study aimed to assess the prevalence and to identify the risk factors of atopic dermatitis and allergic rhinitis among residents of Pohang-Si and Yeongdeok-Gun, two municipal areas in South Korea. Materials and Methods: A cross-sectional study was conducted in both municipal areas between 12 November and 13 December 2017. A total of 302 subjects were recruited from 100 households (25 apartments and 25 houses in each municipality), by system extraction according to district code numbers. Data were collected using International Study of Asthma and Allergies in Childhood (ISAAC) Standard Questionnaires for children and a health questionnaire for adults. Risk factors were identified by multivariate logistic regression analysis. Results: Of the 302 study participants, 12.9% and 25.5% had AD and AR, respectively. The significant factors associated with AD by multivariate logistic regression analysis were age ≥19 years (aOR (adjusted odds ratio) 6.9; 95% CI (confidence interval) (2.9–16.37)), residence in Pohang-Si (aOR 2.5; 95% CI (1.18–5.53)), and family history of allergic disease (aOR 2.3; 95% CI (1.09–4.9)). Similarly, the significant factors associated with AR were male gender (aOR 2.3; 95% CI (1.24–4.42)), age ≥19 years (aOR 4.4; 95% CI (2.28–8.48)), residence in Pohang-Si (aOR 2.8; 95% CI (1.51–5.37)), and family history of allergic disease (aOR 6.7; 95% CI (3.50–12.82)). Conclusion: The present study shows that age ≥19 years, residence in Pohang-Si, and family history of allergic disease are risk factors for AD and AR, and that, additionally, male gender is a risk factor of AR. Understanding the risk factors of allergic diseases can aid the design and implementation of evidence-specific strategies to reduce the long-standing problems associated with allergic disease.
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