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Davies HG, O'Sullivan CP, Al Janabi H, Rattue H, Trotter C, Mary Ramsay KG, Ladhani S, Lamagni T, Okike IO, Le Doare K, Heath PT. Comparison of neurodevelopmental outcomes in children with GBS Sepsis and Meningitis. Clin Infect Dis 2022; 75:922-923. [PMID: 35443067 DOI: 10.1093/cid/ciac318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hannah G Davies
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Catherine P O'Sullivan
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Hareth Al Janabi
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Hilary Rattue
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Caroline Trotter
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | | | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Theresa Lamagni
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Ifeanyichukwu O Okike
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
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Ladhani SN, Ireland G, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Aiano F, Amin-Chowdhury Z, Kall M, Borrow R, Linley E, Zambon M, Poh J, Warrener L, Lackenby A, Ellis J, Amirthalingam G, Brown KE, Ramsay ME. Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England. EClinicalMedicine 2022; 45:101319. [PMID: 35233517 PMCID: PMC8882000 DOI: 10.1016/j.eclinm.2022.101319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The role of educational settings in SARS-CoV-2 infection and transmission remains controversial. We investigated SARS-CoV-2 infection, seroprevalence, and seroconversion rates in secondary schools during the 2020/21 academic year, which included the emergence of the more transmissible alpha and delta variants, in England. METHODS The UK Health Security Agency (UKHSA) initiated prospective surveillance in 18 urban English secondary schools. Participants had nasal swabs for SARS-CoV-2 RT-PCR and blood sampling for SARS-CoV-2 nucleoprotein and spike protein antibodies at the start (Round 1: September-October 2020) and end (Round 2: December 2020) of the autumn term, when schools reopened after national lockdown was imposed in January 2021 (Round 3: March-April 2021), and end of the academic year (Round 4: May-July 2021). FINDINGS We enrolled 2314 participants (1277 students, 1037 staff; one participant had missing data for PCR testing). In-school testing identified 31 PCR-positive participants (20 students, 11 staff). Another 247 confirmed cases (112 students, 135 staff) were identified after linkage with national surveillance data, giving an overall positivity rate of 12.0% (278/2313; staff: 14.1%, 146/1037 vs students: 10.3%, 132/1276; p = 0.006). Trends were similar to national infection data. Nucleoprotein-antibody seroprevalence increased for students and staff between Rounds 1 and 3 but were similar between Rounds 3 and 4, when the delta variant was the dominant circulating strain. Overall, Nucleoprotein-antibody seroconversion was 18.4% (137/744) in staff and 18.8% (146/778) in students, while Spike-antibody seroconversion was higher in staff (72.8%, 525/721) than students (21.3%, 163/764) because of vaccination. INTERPRETATION SARS-CoV-2 infection rates in secondary schools remained low when community infection rates were low, even as the delta variant was emerging in England. FUNDING This study was funded by the UK Department of Health and Social Care.
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Affiliation(s)
- Shamez N. Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
- Paediatric Infectious Diseases Research Group, St. George's University of London, London SW17 0RE, UK
| | - Georgina Ireland
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
- Corresponding author.
| | - Frances Baawuah
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanne Beckmann
- East London NHS Foundation Trust, 9 Alie Street, London E1 8DE, UK
| | - Ifeanyichukwu O. Okike
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, 201 London Road, Derby DE1 2TZ, UK
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Holt Street, Aston B7 4BN, UK
| | - Andrew J. Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, UK
- University of Oxford, Wellington Square, Oxford OX1 2JD, UK
| | | | - Felicity Aiano
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Zahin Amin-Chowdhury
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Meaghan Kall
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ray Borrow
- UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Ezra Linley
- UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Maria Zambon
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - John Poh
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Lenesha Warrener
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Angie Lackenby
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanna Ellis
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kevin E. Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary E. Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
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Dowell AC, Butler MS, Jinks E, Tut G, Lancaster T, Sylla P, Begum J, Bruton R, Pearce H, Verma K, Logan N, Tyson G, Spalkova E, Margielewska-Davies S, Taylor GS, Syrimi E, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Ireland G, Aiano F, Amin-Chowdhury Z, Jones S, Borrow R, Linley E, Wright J, Azad R, Waiblinger D, Davis C, Thomson EC, Palmarini M, Willett BJ, Barclay WS, Poh J, Amirthalingam G, Brown KE, Ramsay ME, Zuo J, Moss P, Ladhani S. Children develop robust and sustained cross-reactive spike-specific immune responses to SARS-CoV-2 infection. Nat Immunol 2022; 23:40-49. [PMID: 34937928 PMCID: PMC8709786 DOI: 10.1038/s41590-021-01089-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
SARS-CoV-2 infection is generally mild or asymptomatic in children but a biological basis for this outcome is unclear. Here we compare antibody and cellular immunity in children (aged 3-11 years) and adults. Antibody responses against spike protein were high in children and seroconversion boosted responses against seasonal Beta-coronaviruses through cross-recognition of the S2 domain. Neutralization of viral variants was comparable between children and adults. Spike-specific T cell responses were more than twice as high in children and were also detected in many seronegative children, indicating pre-existing cross-reactive responses to seasonal coronaviruses. Importantly, children retained antibody and cellular responses 6 months after infection, whereas relative waning occurred in adults. Spike-specific responses were also broadly stable beyond 12 months. Therefore, children generate robust, cross-reactive and sustained immune responses to SARS-CoV-2 with focused specificity for the spike protein. These findings provide insight into the relative clinical protection that occurs in most children and might help to guide the design of pediatric vaccination regimens.
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Affiliation(s)
- Alexander C Dowell
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Megan S Butler
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Elizabeth Jinks
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gokhan Tut
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tara Lancaster
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Panagiota Sylla
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jusnara Begum
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Bruton
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Hayden Pearce
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kriti Verma
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nicola Logan
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Grace Tyson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Eliska Spalkova
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sandra Margielewska-Davies
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Graham S Taylor
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Eleni Syrimi
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Ifeanyichukwu O Okike
- Public Health England, 61 Colindale Avenue, London, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Aston, UK
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Andrew J Brent
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, Wellington Square, Oxford, UK
| | | | | | | | | | - Samuel Jones
- Public Health England, 61 Colindale Avenue, London, UK
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Ezra Linley
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rafaq Azad
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Dagmar Waiblinger
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Chris Davis
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | | | - Brian J Willett
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Wendy S Barclay
- Department of Infectious Disease, Imperial College, London, UK
| | - John Poh
- Public Health England, 61 Colindale Avenue, London, UK
| | | | - Kevin E Brown
- Public Health England, 61 Colindale Avenue, London, UK
| | - Mary E Ramsay
- Public Health England, 61 Colindale Avenue, London, UK
| | - Jianmin Zuo
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Paul Moss
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Shamez Ladhani
- Public Health England, 61 Colindale Avenue, London, UK
- Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
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Ireland G, Jeffery-Smith A, Zambon M, Hoschler K, Harris R, Poh J, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Aiano F, Amin-Chowdhury Z, Letley L, Jones SEI, Kall M, Patel M, Gopal R, Borrow R, Linley E, Amirthalingam G, Brown KE, Ramsay ME, Ladhani SN. Antibody persistence and neutralising activity in primary school students and staff: Prospective active surveillance, June to December 2020, England. EClinicalMedicine 2021; 41:101150. [PMID: 34608455 PMCID: PMC8481203 DOI: 10.1016/j.eclinm.2021.101150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prospective, longitudinal SARS-CoV-2 sero-surveillance in schools across England was initiated after the first national lockdown, allowing comparison of child and adult antibody responses over time. METHODS Prospective active serological surveillance in 46 primary schools in England tested for SARS-CoV-2 antibodies during June, July and December 2020. Samples were tested for nucleocapsid (N) and receptor binding domain (RBD) antibodies, to estimate antibody persistence at least 6 months after infection, and for the correlation of N, RBD and live virus neutralising activity. FINDINGS In June 2020, 1,344 staff and 835 students were tested. Overall, 11.5% (95%CI: 9.4-13.9) and 11.3% (95%CI: 9.2-13.6; p = 0.88) of students had nucleoprotein and RBD antibodies, compared to 15.6% (95%CI: 13.7-17.6) and 15.3% (95%CI: 13.4-17.3; p = 0.83) of staff. Live virus neutralising activity was detected in 79.8% (n = 71/89) of nucleocapsid and 85.5% (71/83) of RBD antibody positive children. RBD antibodies correlated more strongly with neutralising antibodies (rs=0.7527; p<0.0001) than nucleocapsid antibodies (rs=0.3698; p<0.0001). A median of 24.4 weeks later, 58.2% (107/184) participants had nucleocapsid antibody seroreversion, compared to 20.9% (33/158) for RBD (p<0.001). Similar seroreversion rates were observed between staff and students for nucleocapsid (p = 0.26) and RBD-antibodies (p = 0.43). Nucleocapsid and RBD antibody quantitative results were significantly lower in staff compared to students (p = 0.028 and <0.0001 respectively) at baseline, but not at 24 weeks (p = 0.16 and p = 0.37, respectively). INTERPRETATION The immune response in children following SARS-CoV-2 infection was robust and sustained (>6 months) but further work is required to understand the extent to which this protects against reinfection.
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Affiliation(s)
- Georgina Ireland
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Anna Jeffery-Smith
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Maria Zambon
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Katja Hoschler
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Ross Harris
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - John Poh
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Frances Baawuah
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Joanne Beckmann
- East London NHS Foundation Trust, 9 Allie Street, London E1 8DE, United Kingdom
| | - Ifeanyichukwu O Okike
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
- University Hospitals of Derby and Burton NHS Foundation Trust, 201 London Road, Derby DE1 2TZ, United Kingdom
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Holt Street, Aston, B7 4BN, United Kingdom
| | - Andrew J Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom
- Wellington Square, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Bernadette Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom
| | - Felicity Aiano
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Louise Letley
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Samuel E I Jones
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Meaghan Kall
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Monika Patel
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Robin Gopal
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ezra Linley
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Kevin E Brown
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
- Paediatric Infectious Diseases Research Group, St. George's University of London, London SW17 0RE, United Kingdom
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Ladhani SN, Ireland G, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Aiano F, Amin-Chowdhury Z, Kall M, Borrow R, Linley E, Zambon M, Poh J, Warrener L, Lackenby A, Ellis J, Amirthalingam G, Brown KE, Ramsay ME. Emergence of SARS-CoV-2 Alpha (B.1.1.7) variant, infection rates, antibody seroconversion and seroprevalence rates in secondary school students and staff: Active prospective surveillance, December 2020 to March 2021, England. J Infect 2021; 83:573-580. [PMID: 34400220 PMCID: PMC8361003 DOI: 10.1016/j.jinf.2021.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022]
Abstract
Objectives We assessed SARS-CoV-2 infection, seroprevalence and seroconversion in students and staff when secondary schools reopened in March 2021. Methods We initiated SARS-CoV-2 surveillance in 18 secondary schools across six regions in September 2020. Participants provided nasal swabs for RT-PCR and blood samples for SARS-CoV-2 antibodies at the beginning (September 2020) and end (December 2020) of the autumn term and at the start of the spring term (March 2021). Findings In March 2021, 1895 participants (1100 students:795 staff) were tested; 5.6% (61/1094) students and 4.4% (35/792) staff had laboratory-confirmed SARS-CoV-2 infection from December 2020-March 2021. Nucleoprotein-antibody seroprevalence was 36.3% (370/1018) in students and 31.9% (245/769) in staff, while spike-antibody prevalence was 39.5% (402/1018) and 59.8% (459/769), respectively, similar to regional community seroprevalence. Between December 2020 and March 2021, 14.8% (97/656; 95%CI: 12.2–17.7) students and 10.0% (59/590; 95%CI: 7.7–12.7) staff seroconverted. Weekly seroconversion rates were similar from September to December 2020 (8.0/1000) and from December 2020 to March 2021 (7.9/1000; students: 9.3/1,000; staff: 6.3/1,000). Interpretation By March 2021, a third of secondary school students and staff had evidence of prior infection based on N-antibody seropositivity, and an additional third of staff had evidence of vaccine-induced immunity based on S-antibody seropositivity.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; Paediatric Infectious Diseases Research Group, St. George's University of London, London SW17 0RE, United Kingdom
| | - Georgina Ireland
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Frances Baawuah
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Joanne Beckmann
- East London NHS Foundation Trust, 9 Alie Street, London E1 8DE, United Kingdom
| | - Ifeanyichukwu O Okike
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK, 201 London Road, Derby DE1 2TZ, United Kingdom
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Holt Street, Aston B7 4BN, United Kingdom
| | - Andrew J Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom; University of Oxford, Wellington Square, Oxford OX1 2JD, United Kingdom
| | - Bernadette Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom
| | - Felicity Aiano
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Meaghan Kall
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ezra Linley
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Maria Zambon
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - John Poh
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Lenesha Warrener
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Angie Lackenby
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Joanna Ellis
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Kevin E Brown
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
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Ladhani SN, Ireland G, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Walker J, Aiano F, Amin-Chowdhury Z, Letley L, Flood J, Jones SEI, Kall M, Borrow R, Linley E, Zambon M, Poh J, Lackenby A, Ellis J, Amirthalingam G, Brown KE, Ramsay ME. SARS-CoV-2 infection, antibody positivity and seroconversion rates in staff and students following full reopening of secondary schools in England: A prospective cohort study, September-December 2020. EClinicalMedicine 2021; 37:100948. [PMID: 34386740 PMCID: PMC8343251 DOI: 10.1016/j.eclinm.2021.100948] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Older children have higher SARS-CoV-2 infection rates than younger children. We investigated SARS-CoV-2 infection, seroprevalence and seroconversion rates in staff and students following the full reopening of all secondary schools in England. METHODS Public Health England (PHE) invited secondary schools in six regions (East and West London, Hertfordshire, Derbyshire, Manchester and Birmingham) to participate in SARS-CoV-2 surveillance during the 2020/21 academic year. Participants had nasal swabs for RT-PCR and blood samples for SARS-CoV-2 antibodies at the beginning (September 2020) and end (December 2020) of the autumn term. Multivariable logistic regression was used to assess independent risk factors for seropositivity and seroconversion. FINDINGS Eighteen schools in six regions enrolled 2,209 participants, including 1,189 (53.8%) students and 1,020 (46.2%) staff. SARS-CoV-2 infection rates were not significantly different between students and staff in round one (5/948; [0.53%] vs. 2/876 [0.23%]; p = 0.46) or round two (10/948 [1.05%] vs. 7/886 [0.79%]; p = 0.63), and similar to national prevalence. None of four and 7/15 (47%) sequenced strains in rounds 1 and 2 were the highly transmissible SARS-CoV-2 B.1.1.7 variant. In round 1, antibody seropositivity was higher in students than staff (114/893 [12.8%] vs. 79/861 [9.2%]; p = 0.016), but similar in round 2 (117/893 [13.1%] vs.117/872 [13.3%]; p = 0.85), comparable to local community seroprevalence. Between the two rounds, 8.7% (57/652) staff and 6.6% (36/549) students seroconverted (p = 0.16). INTERPRETATION In secondary schools, SARS-CoV-2 infection, seropositivity and seroconversion rates were similar in staff and students, and comparable to local community rates. Ongoing surveillance will be important for monitoring the impact of new variants in educational settings.
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Affiliation(s)
- Shamez N Ladhani
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
- Paediatric Infectious Diseases Research Group, St. George's University of London, London SW17 0RE, UK
| | - Georgina Ireland
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Frances Baawuah
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanne Beckmann
- East London NHS Foundation Trust, 9 Allie Street, London E1 8DE, UK
| | - Ifeanyichukwu O Okike
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK, 201 London Road, Derby DE1 2TZ, UK
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Holt Street, Aston B7 4BN, UK
| | - Andrew J Brent
- Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, UK
- Nuffield Department of Medicine, University of Oxford, Wellington Square, Oxford OX1 2JD, UK
| | - Bernadette Brent
- Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, UK
| | - Jemma Walker
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Felicity Aiano
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Zahin Amin-Chowdhury
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Louise Letley
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Jessica Flood
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Samuel E I Jones
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Meaghan Kall
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Ezra Linley
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Maria Zambon
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - John Poh
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Angie Lackenby
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanna Ellis
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gayatri Amirthalingam
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kevin E Brown
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary E Ramsay
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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Ferreras-Antolín L, Oligbu G, Okike IO, Ladhani S. Infection is associated with one in five childhood deaths in England and Wales: analysis of national death registrations data, 2013-15. Arch Dis Child 2020; 105:857-863. [PMID: 32209555 DOI: 10.1136/archdischild-2019-318001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the contribution of infections to childhood deaths in England and Wales over a 3-year period. DESIGN Retrospective analysis of national electronic death registration data. SETTING England and Wales. PATIENTS Children aged 28 days to 15 years who died during 2013-15. MAIN OUTCOME MEASURES The proportion of children who died of infection compared with total deaths over 3 years; the main pathogens responsible for infection-related deaths in different age groups; comparison with similar data from 2003 to 2005. RESULTS There were 5088 death registrations recorded in children aged 28 days to <15 years in England and Wales during the three calendar years, 2013-2015 (17.6 deaths/100 000 children annually) compared with 6897 (23.9/100 000) during 2003-05 (incidence rate ratios (IRR) 0.74, 95% CI 0.71 to 0.77). During 2013-15, there were 951 (18.7%, 951/5088) infection-related deaths compared with 1368 (19.8%, 1368/6897) during 2003-05, equivalent to an infection-related mortality rate of 3.3/100 000 compared with 4.8/100 000 during the two periods (IRR 0.69, 95% CI 0.64 to 0.75), respectively. An underlying comorbidity was recorded in 55.0% (523/951) of death registrations during 2013-15 and increased with age. Where recorded, respiratory tract infection was the most commonly reported presentation (374/876, 42.7%) during 2013-15. Central nervous system infections accounted for only 4.8% (42/876). Overall, 63.1% (378/599) of infection-related deaths were associated with a bacterial, 34.2% (205/599) with a viral and 2.5% (15/599) with a fungal infection. CONCLUSIONS Beyond the neonatal period, all-cause and infection-related childhood mortality rates have declined by 26% and 31%, respectively, over the past decade. However, infection continues to contribute to one in five childhood deaths.
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Affiliation(s)
- Laura Ferreras-Antolín
- Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK.,Paediatrics, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Godwin Oligbu
- Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK.,Paediatrics, Dr Gray's Hospital, Grampian, UK
| | - Ifeanyichukwu O Okike
- Paediatrics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK .,Immunisation Department, Public Health England, London, UK
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Okike IO, Ladhani SN, Anthony M, Ninis N, Heath PT. Assessment of healthcare delivery in the early management of bacterial meningitis in UK young infants: an observational study. BMJ Open 2017; 7:e015700. [PMID: 28827241 PMCID: PMC5724087 DOI: 10.1136/bmjopen-2016-015700] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To define early presenting features of bacterial meningitis in young infants in England and to review the adequacy of individual case management as compared with relevant national guidelines and an expert panel review. DESIGN Retrospective medical case note review and parental recall using standardised questionnaires. SETTING England and Wales. PARTICIPANTS Infants aged <90 days with bacterial meningitis diagnosed between July 2010 and July 2013. RESULTS Of the 97 cases recruited across England and Wales, 66 (68%) were admitted from home and 31 (32%) were in hospital prior to disease onset. Almost all symptoms reported by parents appeared at the onset of the illness, with very few new symptoms appearing subsequently. Overall, 20/66 (30%) infants were assessed to have received inappropriate prehospital management. The median time from onset of first symptoms to first help was 5 hours (IQR: 2-12) and from triage to receipt of first antibiotic dose was 2.0 hours (IQR: 1.0-3.3), significantly shorter in infants with fever or seizures at presentation compared with those without (1.7 (IQR: 1.0-3.0) vs 4.2 (IQR: 1.8-6.3) hours, p=0.02). Overall, 26 (39%) infants had a poor outcome in terms of death or neurological complication; seizures at presentation was the only significant independent risk factor (OR, 7.9; 95% CI 2.3 to 207.0). For cases in hospital already, the median time from onset to first dose of antibiotics was 2.6 (IQR: 1.3-9.8) hours, and 12/31 (39%) of infants had serious neurological sequelae at hospital discharge. Hearing test was not performed in 23% and when performed delayed by ≥4 weeks in 41%. CONCLUSIONS In young infants, the non-specific features associated with bacterial meningitis appear to show no progression from onset to admission, whereas there were small but significant differences in the proportion of infants with more specific symptoms at hospital admission compared with at the onset of the illness, highlighting the difficulties in early recognition by parents and healthcare professionals alike. A substantial proportion of infants received inappropriate prehospital and posthospital management. We propose a targeted campaign for education and harmonisation of practice with evidence-based management algorithms.
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Affiliation(s)
- Ifeanyichukwu O Okike
- Vaccine Institute and Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Shamez N Ladhani
- Institute for Infection and Immunity, St George’s, University of London, London, UK
- Immunisation, Hepatitis and Blood Safety Department, Public Health England Colindale, London, UK
| | - Mark Anthony
- Neonatal Unit, John Radcliffe Hospital, Oxford, UK
| | - Nelly Ninis
- Department of Paediatrics, St Mary’s Hospital, London, UK
| | - Paul T Heath
- Vaccine Institute and Institute for Infection and Immunity, St George’s, University of London, London, UK
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Okike IO, Awofisayo A, Adak B, Heath PT. Empirical antibiotic cover for Listeria monocytogenes infection beyond the neonatal period: a time for change? Arch Dis Child 2015; 100:423-5. [PMID: 25628458 DOI: 10.1136/archdischild-2014-307059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 01/05/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Ifeanyichukwu O Okike
- Vaccine Institute & Institute for Infection and Immunity, St George's, University of London, London, UK Honorary Research Fellow, Healthcare Associated Infection & Antimicrobial Resistance Department, Public Health England, London, UK
| | - Adedoyin Awofisayo
- Gastrointestinal, Emerging & Zoonotic Infections Department, Public Health England, London, UK
| | - Bob Adak
- Gastrointestinal, Emerging & Zoonotic Infections Department, Public Health England, London, UK
| | - Paul T Heath
- Vaccine Institute & Institute for Infection and Immunity, St George's, University of London, London, UK
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Read RC, Baxter D, Chadwick DR, Faust SN, Finn A, Gordon SB, Heath PT, Lewis DJM, Pollard AJ, Turner DPJ, Bazaz R, Ganguli A, Havelock T, Neal KR, Okike IO, Morales-Aza B, Patel K, Snape MD, Williams J, Gilchrist S, Gray SJ, Maiden MCJ, Toneatto D, Wang H, McCarthy M, Dull PM, Borrow R. Effect of a quadrivalent meningococcal ACWY glycoconjugate or a serogroup B meningococcal vaccine on meningococcal carriage: an observer-blind, phase 3 randomised clinical trial. Lancet 2014; 384:2123-31. [PMID: 25145775 DOI: 10.1016/s0140-6736(14)60842-4] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Meningococcal conjugate vaccines protect individuals directly, but can also confer herd protection by interrupting carriage transmission. We assessed the effects of meningococcal quadrivalent glycoconjugate (MenACWY-CRM) or serogroup B (4CMenB) vaccination on meningococcal carriage rates in 18-24-year-olds. METHODS In this phase 3, observer-blind, randomised controlled trial, university students aged 18-24 years from ten sites in England were randomly assigned (1:1:1, block size of three) to receive two doses 1 month apart of Japanese Encephalitis vaccine (controls), 4CMenB, or one dose of MenACWY-CRM then placebo. Participants were randomised with a validated computer-generated random allocation list. Participants and outcome-assessors were masked to the treatment group. Meningococci were isolated from oropharyngeal swabs collected before vaccination and at five scheduled intervals over 1 year. Primary outcomes were cross-sectional carriage 1 month after each vaccine course. Secondary outcomes included comparisons of carriage at any timepoint after primary analysis until study termination. Reactogenicity and adverse events were monitored throughout the study. Analysis was done on the modified intention-to-treat population, which included all enrolled participants who received a study vaccination and provided at least one assessable swab after baseline. This trial is registered with ClinicalTrials.gov, registration number NCT01214850. FINDINGS Between Sept 21 and Dec 21, 2010, 2954 participants were randomly assigned (987 assigned to control [984 analysed], 979 assigned to 4CMenB [974 analysed], 988 assigned to MenACWY-CRM [983 analysed]); 33% of the 4CMenB group, 34% of the MenACWY-CRM group, and 31% of the control group were positive for meningococcal carriage at study entry. By 1 month, there was no significant difference in carriage between controls and 4CMenB (odds ratio 1·2, 95% CI 0·8-1·7) or MenACWY-CRM (0·9, [0·6-1·3]) groups. From 3 months after dose two, 4CMenB vaccination resulted in significantly lower carriage of any meningococcal strain (18·2% [95% CI 3·4-30·8] carriage reduction), capsular groups BCWY (26·6% [10·5-39·9] carriage reduction), capsular groups CWY (29·6% [8·1-46·0] carriage reduction), and serogroups CWY (28·5% [2·8-47·5] carriage reduction) compared with control vaccination. Significantly lower carriage rates were also noted in the MenACWY-CRM group compared with controls: 39·0% (95% CI 17·3-55·0) carriage reduction for serogroup Y and 36·2% (15·6-51·7) carriage reduction for serogroup CWY. Study vaccines were generally well tolerated, with increased rates of transient local injection pain and myalgia in the 4CMenB group. No safety concerns were identified. INTERPRETATION Although we detected no significant difference between groups at 1 month after vaccine course, MenACWY-CRM and 4CMenB vaccines reduced meningococcal carriage rates during 12 months after vaccination and therefore might affect transmission when widely implemented. FUNDING Novartis Vaccines.
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Affiliation(s)
- Robert C Read
- Academic Unit of Clinical Experimental Sciences and NIHR Southampton Respiratory Biomedical Research Unit, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.
| | - David Baxter
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | | | - Saul N Faust
- Academic Unit of Clinical Experimental Sciences and NIHR Southampton Respiratory Biomedical Research Unit, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK; Southampton NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Adam Finn
- Schools of Clinical Science and Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul T Heath
- Division of Clinical Sciences, St George's, University of London, London, UK
| | - David J M Lewis
- Surrey Clinical Research Centre, University of Surrey, Guildford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Centre, Oxford, UK
| | - David P J Turner
- Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - Rohit Bazaz
- Department of Infection and Immunity, University of Sheffield, Sheffield, UK
| | - Amitava Ganguli
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tom Havelock
- Academic Unit of Clinical Experimental Sciences and NIHR Southampton Respiratory Biomedical Research Unit, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK; Southampton NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Keith R Neal
- Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | | | - Begonia Morales-Aza
- Schools of Clinical Science and Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Kamlesh Patel
- NIHR Wellcome Trust Clinical Research Facility, Manchester Royal Infirmary, Manchester, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Centre, Oxford, UK
| | - John Williams
- The James Cook University Hospital, Middlesborough, UK
| | | | - Steve J Gray
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | | | | | - Huajun Wang
- Novartis Vaccines and Diagnostics, Cambridge, MA, USA
| | | | - Peter M Dull
- Novartis Vaccines and Diagnostics, Cambridge, MA, USA
| | - Ray Borrow
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; Public Health England, Manchester Royal Infirmary, Manchester, UK
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Kadambari S, Bukasa A, Okike IO, Pebody R, Brown D, Gallimore C, Xerry J, Sharland M, Ladhani SN. Enterovirus infections in England and Wales, 2000-2011: the impact of increased molecular diagnostics. Clin Microbiol Infect 2014; 20:1289-96. [PMID: 25039903 DOI: 10.1111/1469-0691.12753] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/24/2014] [Accepted: 06/29/2014] [Indexed: 11/28/2022]
Abstract
There have recently been significant changes in diagnostic practices for detecting enterovirus (EV) infections across England and Wales. Reports of laboratory-confirmed EV infections submitted by National Health Service (NHS) hospital laboratories to Public Health England (PHE) over a 12-year period (2000-2011) were analysed. Additionally, the PHE Virus Reference Department (VRD) electronic database containing molecular typing data from 2004 onwards was interrogated. Of the 13,901 reports, there was a decline from a peak of 2254 in 2001 to 589 in 2006, and then an increase year-on-year to 1634 in 2011. This increase coincided with increasing PCR-based laboratory diagnosis, which accounted for 36% of reported cases in 2000 and 92% in 2011. The estimated annual incidence in 2011 was 3.9/100,000 overall and 238/100,000 in those aged <3 months, who accounted for almost one-quarter of reported cases (n = 2993, 23%). During 2004-2011, 2770 strains were submitted for molecular typing to the VRD, who found no evidence for a predominance of any particular strain. Thus, the recent increase in reported cases closely reflects the increase in PCR testing by NHS hospitals, but is associated with a lower proportion of samples being submitted for molecular typing. The high EV rate in young infants merits further investigation to inform evidence-based management guidance.
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Affiliation(s)
- S Kadambari
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
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12
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Affiliation(s)
- Paul T Heath
- Child Health and Vaccine Institute, St Georges, University of London, London, UK.
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