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Adedire O, Love NK, Hughes HE, Buchan I, Vivancos R, Elliot AJ. Early Detection and Monitoring of Gastrointestinal Infections Using Syndromic Surveillance: A Systematic Review. Int J Environ Res Public Health 2024; 21:489. [PMID: 38673400 PMCID: PMC11050429 DOI: 10.3390/ijerph21040489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
The underreporting of laboratory-reported cases of community-based gastrointestinal (GI) infections poses a challenge for epidemiologists understanding the burden and seasonal patterns of GI pathogens. Syndromic surveillance has the potential to overcome the limitations of laboratory reporting through real-time data and more representative population coverage. This systematic review summarizes the utility of syndromic surveillance for early detection and surveillance of GI infections. Relevant articles were identified using the following keyword combinations: 'early warning', 'detection', 'gastrointestinal activity', 'gastrointestinal infections', 'syndrome monitoring', 'real-time monitoring', 'syndromic surveillance'. In total, 1820 studies were identified, 126 duplicates were removed, and 1694 studies were reviewed. Data extraction focused on studies reporting the routine use and effectiveness of syndromic surveillance for GI infections using relevant GI symptoms. Eligible studies (n = 29) were included in the narrative synthesis. Syndromic surveillance for GI infections has been implemented and validated for routine use in ten countries, with emergency department attendances being the most common source. Evidence suggests that syndromic surveillance can be effective in the early detection and routine monitoring of GI infections; however, 24% of the included studies did not provide conclusive findings. Further investigation is necessary to comprehensively understand the strengths and limitations associated with each type of syndromic surveillance system.
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Affiliation(s)
- Olubusola Adedire
- Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK;
- Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK; (H.E.H.); (A.J.E.)
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK; (N.K.L.); (R.V.)
| | - Nicola K. Love
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK; (N.K.L.); (R.V.)
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Wirral CH64 7TE, UK
| | - Helen E. Hughes
- Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK; (H.E.H.); (A.J.E.)
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK; (N.K.L.); (R.V.)
| | - Iain Buchan
- Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK;
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK; (N.K.L.); (R.V.)
| | - Roberto Vivancos
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK; (N.K.L.); (R.V.)
- Field Services North-West, Health Protection Operations, UK Health Security Agency, Liverpool L3 1DS, UK
| | - Alex J. Elliot
- Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK; (H.E.H.); (A.J.E.)
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK; (N.K.L.); (R.V.)
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Witzel TC, Ghobrial A, Palich R, Charles H, Rodger AJ, Sabin C, Sparrowhawk A, Pool ER, Prochazka M, Vivancos R, Sinka K, Folkard K, Burns FM, Saunders J. Experiences of mpox illness and case management among cis and trans gay, bisexual and other men who have sex with men in England: a qualitative study. EClinicalMedicine 2024; 70:102522. [PMID: 38685928 PMCID: PMC11056388 DOI: 10.1016/j.eclinm.2024.102522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/21/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 05/02/2024] Open
Abstract
Background The 2022-2024 global mpox outbreak, occurring primarily in the sexual networks of gay, bisexual and other men who have sex with men (GBMSM), has not been accompanied by a focus on patient perspectives of illness. We explore the experiences of GBMSM diagnosed with mpox in England to understand needs for social and clinical support. Methods In-depth interviews (March/July 2023) were conducted with 22 GBMSM diagnosed with mpox in 2022, randomly selected from a national mpox surveillance database, and 4 stakeholders from clinical/community-based organisations. Interviews covered experiences of illness, testing, diagnosis, treatment and contact tracing, and were recorded, transcribed and analysed with a thematic framework. Findings Media coverage drawing on homophobic stereotypes around sex between men contributed to feelings of stigma and shame. GBMSM living with HIV appeared to cope better with mpox stigma, drawing on their experiences of being diagnosed with HIV for resilience. Younger GBMSM with less experience of stigmatising illness found mpox diagnosis more traumatic and sometimes required support beyond what was provided. Accessing testing could be complicated when healthcare professionals did not recognise mpox symptoms. Men felt information on course of illness, isolation and vaccination after recovery was often inconsistent and contradictory. GBMSM described that care from sexual health and infectious disease units usually better met their emotional and medical needs. This was frequently linked by men to these services having skills in working with the GBMSM community and managing infection risk sensitively. General hospital services and centralised contact tracing could increase feelings and experiences of stigma as some staff were perceived to lack skills in supporting GBMSM and, sometimes, clinical knowledge. Long-term impacts described by men included mental health challenges, urethral/rectal symptoms and life-changing disability. Interpretation In this study stigma was a central feature of mpox illness among GBMSM and could be exacerbated or lessened depending on the clinical and social support provided. Involving communities affected by outbreaks in co-producing, planning and delivering care (including contact-tracing) may help improve support provided. Funding TCW, AJR, AS and FMB received support from the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research Programme (Ref: NIHR202038). CS and JS receive support from the National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with UKHSA; RV receives support from the NIHR HPRU in Emerging and Zoonotic Infections and NIHR HPRU in Gastrointestinal Infections. The views expressed are those of the author(s) and not necessarily those of the NIHR, UK Health Security Agency, World Health Organization or the Department of Health and Social Care.
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Affiliation(s)
- T Charles Witzel
- Institute for Global Health, University College London, London, UK
| | - Andrew Ghobrial
- Institute for Global Health, University College London, London, UK
| | - Romain Palich
- Institute for Global Health, University College London, London, UK
- AP-HP.Sorbonne Université, Paris, France
| | | | - Alison J. Rodger
- Institute for Global Health, University College London, London, UK
| | - Caroline Sabin
- Institute for Global Health, University College London, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in Partnership with (UKHSA), London, UK
| | | | - Erica R.M. Pool
- Institute for Global Health, University College London, London, UK
| | | | - Roberto Vivancos
- UK Health Security Agency (UKHSA), London, UK
- NIHR HPRU in Emerging and Zoonotic Infections at the University of Liverpool, Liverpool, UK
- NIHR HPRU in Gastrointestinal Infections at the University of Liverpool, Liverpool, UK
| | - Katy Sinka
- UK Health Security Agency (UKHSA), London, UK
| | | | - Fiona M. Burns
- Institute for Global Health, University College London, London, UK
| | - John Saunders
- Institute for Global Health, University College London, London, UK
- UK Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in Partnership with (UKHSA), London, UK
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Bray N, Sopwith W, Edmunds M, Vansteenhouse H, Feenstra JDM, Jacobs P, Rajput K, O'Connell AM, Smith ML, Blomquist P, Hatziioanou D, Elson R, Vivancos R, Gallagher E, Wigglesworth MJ, Dominiczak A, Hopkins S, Lake IR. RT-PCR genotyping assays to identify SARS-CoV-2 variants in England in 2021: a design and retrospective evaluation study. Lancet Microbe 2024; 5:e173-e180. [PMID: 38244555 DOI: 10.1016/s2666-5247(23)00320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Whole-genome sequencing (WGS) is the gold standard diagnostic tool to identify and genetically characterise emerging pathogen mutations (variants), but cost, capacity, and timeliness limit its use when large populations need rapidly assessing. We assessed the potential of genotyping assays to provide accurate and timely variant information at scale by retrospectively examining surveillance for SARS-CoV-2 variants in England between March and September, 2021, when genotyping assays were used widely for variant detection. METHODS We chose a panel of four RT-PCR genotyping assays to detect circulating variants of SARS-COV-2 in England and developed a decision algorithm to assign a probable SARS-CoV-2 variant to samples using the assay results. We extracted surveillance data from the UK Health Security Agency databases for 115 934 SARS-CoV-2-positive samples (March 1-Sept 6, 2021) when variant information was available from both genotyping and WGS. By comparing the genotyping and WGS variant result, we calculated accuracy metrics (ie, sensitivity, specificity, and positive predictive value [PPV]) and the time difference between the sample collection date and the availability of variant information. We assessed the number of samples with a variant assigned from genotyping or WGS, or both, over time. FINDINGS Genotyping and an initial decision algorithm (April 10-May 11, 2021 data) were accurate for key variant assignment: sensitivities and PPVs were 0·99 (95% CI 0·99-0·99) for the alpha, 1·00 (1·00-1·00) for the beta, and 0·91 (0·80-1·00) for the gamma variants; specificities were 0·97 (0·96-0·98), 1·00 (1·00-1·00), and 1·00 (1·00-1·00), respectively. A subsequent decision algorithm over a longer time period (May 27-Sept 6, 2021 data) remained accurate for key variant assignment: sensitivities were 0·91 (95% CI 0·74-1·00) for the beta, 0·98 (0·98-0·99) for the delta, and 0·93 (0·81-1·00) for the gamma variants; specificities were 1·00 (1·00-1·00), 0·96 (0·96-0·97), and 1·00 (1·00-1·00), respectively; and PPVs were 0·83 (0·62-1·00), 1·00 (1·00-1·00), and 0·78 (0·59-0·97), respectively. Genotyping produced variant information a median of 3 days (IQR 2-4) after the sample collection date, which was faster than with WGS (9 days [8-11]). The flexibility of genotyping enabled a nine-times increase in the quantity of samples tested for variants by this method (from 5000 to 45 000). INTERPRETATION RT-PCR genotyping assays are suitable for high-throughput variant surveillance and could complement WGS, enabling larger scale testing for known variants and timelier results, with important implications for effective public health responses and disease control globally, especially in settings with low WGS capacity. However, the choice of panels of RT-PCR assays is highly dependent on database information on circulating variants generated by WGS, which could limit the use of genotyping assays when new variants are emerging and spreading rapidly. FUNDING UK Health Security Agency and National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response.
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Affiliation(s)
- Neil Bray
- UK Health Security Agency, London, UK
| | | | | | - Harper Vansteenhouse
- UK Health Security Agency, London, UK; BioClavis, Glasgow, UK; NHS Test and Trace, Department of Health & Social Care, London, UK; Alderley Lighthouse Labs, Macclesfield, UK
| | | | - Peter Jacobs
- Thermo Fisher Scientific, South San Francisco, CA, USA
| | - Kamal Rajput
- NHS Test and Trace, Department of Health & Social Care, London, UK
| | | | | | | | | | - Richard Elson
- UK Health Security Agency, London, UK; School of Environmental Sciences, University of East Anglia, Norwich, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Roberto Vivancos
- UK Health Security Agency, London, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections and NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
| | | | | | - Anna Dominiczak
- UK Health Security Agency, London, UK; NHS Test and Trace, Department of Health & Social Care, London, UK; School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Susan Hopkins
- UK Health Security Agency, London, UK; NIHR Health Protection Research Unit in in Health Care Acquired Infections and Antimicrobial Resistance, London, UK
| | - Iain R Lake
- UK Health Security Agency, London, UK; School of Environmental Sciences, University of East Anglia, Norwich, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK.
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Ondrikova N, Clough H, Douglas A, Vivancos R, Itturiza-Gomara M, Cunliffe N, Harris JP. Comparison of statistical approaches to predicting norovirus laboratory reports before and during COVID-19: insights to inform public health surveillance. Sci Rep 2023; 13:21457. [PMID: 38052922 PMCID: PMC10697939 DOI: 10.1038/s41598-023-48069-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
Social distancing interrupted transmission patterns of contact-driven infectious agents such as norovirus during the Covid-19 pandemic. Since routine surveillance of norovirus was additionally disrupted during the pandemic, traditional naïve forecasts that rely only on past public health surveillance data may not reliably represent norovirus activity. This study investigates the use of statistical modelling to predict the number of norovirus laboratory reports in England 4-weeks ahead of time before and during Covid-19 pandemic thus providing insights to inform existing practices in norovirus surveillance in England. We compare the predictive performance from three forecasting approaches that assume different underlying structure of the norovirus data and utilized various external data sources including mobility, air temperature and relative internet searches (Time Series and Regularized Generalized Linear Model, and Quantile Regression Forest). The performance of each approach was evaluated using multiple metrics, including a relative prediction error against the traditional naive forecast of a five-season mean. Our data suggest that all three forecasting approaches improve predictive performance over the naïve forecasts, especially in the 2020/21 season (30-45% relative improvement) when the number of norovirus reports reduced. The improvement ranged from 7 to 22% before the pandemic. However, performance varied: regularized regression incorporating internet searches showed the best forecasting score pre-pandemic and the time series approach achieved the best results post pandemic onset without external data. Overall, our results demonstrate that there is a significant value for public health in considering the adoption of more sophisticated forecasting tools, moving beyond traditional naïve methods, and utilizing available software to enhance the precision and timeliness of norovirus surveillance in England.
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Affiliation(s)
- Nikola Ondrikova
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
- Institute for Risk and Uncertainty, University of Liverpool, Liverpool, UK.
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.
| | - Helen Clough
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Amy Douglas
- National Surveillance Gastrointestinal Pathogens Unit, UK Health Security Agency, London, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Health Protection Operations, UK Health Security Agency, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | | | - Nigel Cunliffe
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - John P Harris
- Health Protection Operations, UK Health Security Agency, Liverpool, UK
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Bray N, Blomquist P, Hardstaff J, Jarvis C, Melchin D, Turner C, Graham A, Balasegaram S, Vivancos R. Did anonymity in self-administered questionnaires improve disclosure of sensitive information during the 2022 mpox outbreak in England? An observational study. Lancet 2023; 402 Suppl 1:S29. [PMID: 37997069 DOI: 10.1016/s0140-6736(23)02121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Between May 6, 2022, and Jan 16, 2023, 3555 mpox cases were reported in England, predominantly in gay, bisexual, and other men who have sex with men. Initially, the UK Health Security agency administered questionnaires to laboratory-detected cases via telephone calls. From June, 2022, cases were requested by text or email to complete the questionnaire online, with optional anonymous completion. To inform future approaches, we assess whether anonymity improved disclosure of sensitive information. METHODS In this observational study we analysed questionnaire data completed by people with a laboratory-detected case of mpox. We included questionnaires that were completed from May 25, 2022, to Jan 16, 2023, and restricted them to anonymous or identifiable self-completed responses. Questionnaires with forename, surname, and birth date, or an ID emailed to participants, which therefore could link to laboratory data, were considered identifiable. Questionnaires without any personal identifiable information were considered anonymous. We compared the responses to seven sensitive risk factor or exposure questions using Pearson's χ2. FINDINGS All 3555 people diagnosed with mpox infection in England were invited to complete the questionnaire through either phone call or web link.We obtained 1075 (30%) completed questionnaires, with a response rate decreasing from 45% in May to 20% in July 2022. We included 531 self-completed questionnaires in this analysis, of which 259 (49%) were anonymous and 272 (51%) were identifiable. The median age of participants was 39 years, with 514 (97%) men, 12 (2%) women, and five (1%) other. The largest ethnic groups were white (79%; n=422) and mixed or multiple ethnic groups (9%; n=47). Results of all seven questions were similar: 98% (n=254/259) of anonymous and 97% (n=265/272) of identifiable cases answered all seven questions, 49% (n=127) and 54% (n=147) reported a sexually transmitted infection diagnosis in the past 12 months (p=0·2), 24% (n=63) and 27% (n=73) reported ten or more sexual partners in the past 3 months (p=0·8), and 15% (n=38) and 18% (n=50) reported knowing another person with mpox infection (p=0·5), respectively. INTERPRETATION Transitioning to self-completed questionnaires resulted in reduced uptake, although optional anonymity possibly prevented a steeper drop. Anonymity did not appear to affect reporting of sensitive information, specifically of sexual behaviours or history associated with mpox risk, which reinforces results of previous literature. Our interpretation is limited, however, by relatively low questionnaire uptake, and by only analysing reported rather than true risk. The decision to implement anonymous questionnaires should therefore weigh the potential benefits of increased uptake against the disadvantage of restricted data linkage. FUNDING None.
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Affiliation(s)
- Neil Bray
- UK Health Security Agency, London, UK.
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Risby H, Robinson G, Chandra N, King G, Vivancos R, Smith R, Thomas D, Fox A, McCarthy N, Chalmers RM. Application of a new multi-locus variable number tandem repeat analysis (MLVA) scheme for the seasonal investigation of Cryptosporidium parvum cases in Wales and the northwest of England, spring 2022. Curr Res Parasitol Vector Borne Dis 2023; 4:100151. [PMID: 38021189 PMCID: PMC10665698 DOI: 10.1016/j.crpvbd.2023.100151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023]
Abstract
The protozoan Cryptosporidium parvum is an important cause of gastroenteritis in humans and livestock, and cryptosporidiosis outbreaks are common. However, a multi-locus genotyping scheme is not widely adopted. We describe the further development and application of a seven-locus multi-locus variable number of tandem repeats analysis (MLVA) scheme. From 28th March to 31st July 2022, confirmed C. parvum stools (n = 213) from cryptosporidiosis patients (cases) in Wales (n = 95) and the north west of England (n = 118) were tested by MLVA. Typability (defined as alleles identified at all seven loci in a sample) was 81.2% and discriminatory power estimated by Hunter Gaston Discriminatory Index was 0.99. A MLVA profile was constructed from the alleles, expressed in chromosomal order. Profiles were defined as simple (single allele at each locus) or mixed (more than one allele at any locus). A total of 161 MLVA profiles were identified; 13 were mixed, an additional 38 simple profiles contained null records, and 110 were complete simple profiles. A minimum spanning tree was constructed of simple MLVA profiles and those identical at all seven loci defined genetic clusters of cases (here, null records were considered as an allele); 77 cases formed 25 clusters, ranging from two to nine (mode = two) cases. The largest cluster, following epidemiological investigation, signalled a newly-identified outbreak. Two other cases with mixed profiles that contained the outbreak alleles were included in the outbreak investigation. In another epidemiologically-identified outbreak of six initial cases, MLVA detected two additional cases. In a third, small outbreak of three cases, identical MLVA profiles strengthened the microbiological evidence. Review of the performance characteristics of the individual loci and of the seven-locus scheme suggested that two loci might be candidates for review, but a larger dataset over a wider geographical area and longer timeframe will help inform decision-making about the scheme by user laboratories and stakeholders (such as public health agencies). This MLVA scheme is straightforward in use, fast and cheap compared to sequence-based methods, identifies mixed infections, provides an important tool for C. parvum surveillance, and can enhance outbreak investigations and public health action.
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Affiliation(s)
- Harriet Risby
- Cryptosporidium Reference Unit, Public Health Wales Microbiology and Health Protection, Singleton Hospital, Swansea, SA2 8QA, UK
| | - Guy Robinson
- Cryptosporidium Reference Unit, Public Health Wales Microbiology and Health Protection, Singleton Hospital, Swansea, SA2 8QA, UK
- Swansea University Medical School, Singleton Park, Swansea, SA2 8PP, UK
| | - Nastassya Chandra
- United Kingdom Health Security Agency, Field Service North West, Suite 3B, 3rd Floor, Cunard Building, Water Street, Liverpool, L3 1DS, UK
| | - Grace King
- Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Roberto Vivancos
- United Kingdom Health Security Agency, Field Service North West, Suite 3B, 3rd Floor, Cunard Building, Water Street, Liverpool, L3 1DS, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, L69 3GL, UK
- Trinity College Dublin, Dublin, D02 PN40, Ireland
| | - Robert Smith
- Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Daniel Thomas
- Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Andrew Fox
- United Kingdom Health Security Agency, Field Service North West, Suite 3B, 3rd Floor, Cunard Building, Water Street, Liverpool, L3 1DS, UK
| | - Noel McCarthy
- University of Warwick, Coventry, CV4 7AL, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, L69 3GL, UK
- Trinity College Dublin, Dublin, D02 PN40, Ireland
| | - Rachel M. Chalmers
- Cryptosporidium Reference Unit, Public Health Wales Microbiology and Health Protection, Singleton Hospital, Swansea, SA2 8QA, UK
- Swansea University Medical School, Singleton Park, Swansea, SA2 8PP, UK
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Kintz E, Brainard J, Vanderes M, Vivancos R, Byrne L, Butt S, Jenkins C, Elson R, Lake I, Hunter P. Animal and environmental risk factors for sporadic Shiga toxin-producing Escherichia coli (STEC) infection in England: a case control study for O157, O26 and other STEC serotypes. Pathog Glob Health 2023; 117:655-663. [PMID: 37016510 PMCID: PMC10498794 DOI: 10.1080/20477724.2023.2197672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
Most Shiga toxin-producing E. coli (STEC) infections are sporadic. Routine enhanced surveillance questionnaires of confirmed STEC cases in England contained promising data to conduct a case-control study to identify non-food exposures linked to the risk of becoming infected with different STEC serotypes, including O157, O26 and all others; this study pulled eligible cases from the recorded enhanced surveillance data. Controls were recruited from the general population and answered a comparable postal questionnaire. Logistic regression was performed to identify risk factors associated with STEC infection for O157, O26 and other serotype cases. In adjusted models, travel outside of the U.K. and childcare occupations raised the risk of infection for all serotypes. Day trips within the UK, exposure to dogs and contact with soil were linked to lower infection risk. Resident region within England was often linked to decreased risk. Summer season was linked to O157 and O26, but not other STEC. Swimming in the sea was linked to increased risk of infection by O157, but not other types of STEC. Correlations between exposures and infection were similar when the analysis was repeated excluding participants with a history of foreign travel. As the first case-control study in England to include sporadic non-O157 STEC, the varying risk factors between O157 and non-O157 cases suggest there are potentially unique reservoirs for different serotypes.
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Affiliation(s)
- Erica Kintz
- Norwich Medical School, University of East Anglia, Norwich, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich, UK
- NIHR Health Protection Research Unit in Emergency Preparedness, University of East Anglia, Norwich, UK
| | - Mike Vanderes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Field Epidemiology Services, UK Health Security Agency, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Lisa Byrne
- Gastrointestinal Pathogens Unit, UK Health Security Agency, London, UK
| | - Saira Butt
- Gastrointestinal Pathogens Unit, UK Health Security Agency, London, UK
| | - Claire Jenkins
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Gastrointestinal Pathogens Unit, UK Health Security Agency, London, UK
| | - Richard Elson
- Gastrointestinal Pathogens Unit, UK Health Security Agency, London, UK
- School of Environmental Sciences, University of East Anglia, Norwich, UK
| | - Iain Lake
- NIHR Health Protection Research Unit in Emergency Preparedness, University of East Anglia, Norwich, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- School of Environmental Sciences, University of East Anglia, Norwich, UK
| | - Paul Hunter
- Norwich Medical School, University of East Anglia, Norwich, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emergency Preparedness, University of East Anglia, Norwich, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
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Peake L, Inns T, Jarvis C, King G, Rabie H, Henderson J, Wensley A, Jarratt R, Roberts C, Williams C, Orife O, Browning L, Neilson M, McCarthy C, Millar P, Love N, Elwin K, Robinson G, Mannes T, Young N, Chalmers R, Elson R, Vivancos R. Preliminary investigation of a significant national Cryptosporidium exceedance in the United Kingdom, August 2023 and ongoing. Euro Surveill 2023; 28:2300538. [PMID: 37883039 PMCID: PMC10604540 DOI: 10.2807/1560-7917.es.2023.28.43.2300538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 10/27/2023] Open
Abstract
Routine laboratory surveillance has identified an unprecedented and ongoing exceedance of Cryptosporidium spp. across the United Kingdom, notably driven by C. hominis transmission, since 14 August 2023. Information from 477 reported cases in England and Wales, followed up with a standardised exposure questionnaire as of 25 September 2023, identified foreign travel in 250 (54%) of 463 respondents and swimming in 234 (66%) of 353 cases. A significant, common exposure has not yet been identified in first analyses.
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Affiliation(s)
- Lewis Peake
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Thomas Inns
- United Kingdom Health Security Agency, London, the United Kingdom
| | | | - Grace King
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Hussein Rabie
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Joan Henderson
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Adrian Wensley
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Reece Jarratt
- United Kingdom Health Security Agency, London, the United Kingdom
| | | | | | | | | | | | | | - Paul Millar
- Health and Safety Committee (HSC) Public Health Agency, Belfast, Northern Ireland, the United Kingdom
| | - Nicola Love
- United Kingdom Health Security Agency, London, the United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, Liverpool, the United Kingdom
| | - Kristin Elwin
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, the United Kingdom
| | - Guy Robinson
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, the United Kingdom
| | - Trish Mannes
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Nick Young
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Rachel Chalmers
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, the United Kingdom
| | - Richard Elson
- United Kingdom Health Security Agency, London, the United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, Liverpool, the United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, the United Kingdom
| | - Roberto Vivancos
- United Kingdom Health Security Agency, London, the United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, Liverpool, the United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, the United Kingdom
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9
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Kwiatkowska R, Yaxley N, Moore G, Bennett A, Donati M, Love N, Vivancos R, Hickman M, Ready DR. Environmental sampling for SARS-CoV-2 in long term care facilities: lessons from a pilot study. Wellcome Open Res 2023; 6:235. [PMID: 38406228 PMCID: PMC10891430 DOI: 10.12688/wellcomeopenres.17047.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 02/27/2024] Open
Abstract
Background: The SARS-CoV-2 pandemic has highlighted the risk of infection in long-term care facilities (LTCF) and the vulnerability of residents to severe outcomes. Environmental surveillance may help detect pathogens early and inform Infection Prevention and Control (IPC) measures in these settings. Methods: Upon notification of SARS-CoV-2 outbreaks, LTCF within a local authority in South West England were approached to take part in this pilot study. Investigators visited to swab common touch-points and elevated 'non-touch' surfaces (>1.5m above ground level) and samples were analysed for presence of SARS-CoV-2 genetic material (RNA). Data were collected regarding LTCF infrastructure, staff behaviours, clinical and epidemiological risk factors for infection (staff and residents), and IPC measures. Criteria for success were: recruitment of three LTCF; detection of SARS-COV-2 RNA; variation in proportion of SARS-CoV-2 positive surfaces by sampling zone; and collection of clinical and epidemiological data for context. Results: Three LTCFs were recruited, ranging in size and resident demographics. Outbreaks lasted 63, 50 and 30 days with resident attack rates of 53%, 40% and 8%, respectively. The proportion of sample sites on which SARS-CoV-2 was detected was highest in rooms occupied by infected residents and varied elsewhere in the LTCF, with low levels in a facility implementing enhanced IPC measures. The heterogeneity of settings and difficulty obtaining data made it unfeasible to assess association between environmental contamination and infection. A greater proportion of elevated surfaces tested positive for SARS-CoV-2 RNA than common touch-points. Conclusions: SARS-CoV-2 RNA can be detected in a variety of LTCF outbreak settings, both on common-touch items and in elevated sites out of reach. This suggests that further work is justified, to assess feasibility and utility of environmental sampling for infection surveillance in LTCF.
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Affiliation(s)
- Rachel Kwiatkowska
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Field Service, Health Protection Operations, UKHSA, Bristol, UK
| | - Nicola Yaxley
- Biosafety, Air and Water Microbiology Group, UKHSA, Porton Down, Salisbury, UK
| | - Ginny Moore
- Biosafety, Air and Water Microbiology Group, UKHSA, Porton Down, Salisbury, UK
| | - Allan Bennett
- Biosafety, Air and Water Microbiology Group, UKHSA, Porton Down, Salisbury, UK
| | - Matthew Donati
- Severn Infection Sciences, North Bristol NHS Trust, Bristol, UK
- UKHSA Specialised Microbiology and Laboratories,, South West Regional Laboratory, Bristol, UK
| | - Nicola Love
- Field Service, Health Protection Operations, UKHSA, Newcastle, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Field Service, Health Protection Operations, UKHSA, Liverpool, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Derren R Ready
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Field Service, Health Protection Operations, UKHSA, Bristol, UK
- Eastman Dental Institute, University College London, London, UK
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10
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Willgert K, Hardstaff J, Shadwell S, Bhattacharya A, Blomquist P, Vivancos R, Simms I. Influence of SARS-CoV-2 surveillance outputs produced by the UK health security agency (UKHSA) outbreak surveillance team on decision-making by local stakeholders. BMC Public Health 2023; 23:926. [PMID: 37217907 DOI: 10.1186/s12889-023-15784-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/28/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND The UK Health Security Agency (UKHSA) COVID-19 Outbreak Surveillance Team (OST) was established in June 2020 to provide Local Authorities (LAs) in England with surveillance intelligence to aid their response to the SARS-CoV-2 epidemic. Reports were produced using standardised metrics in an automated format. Here we evaluate how the SARS-CoV-2 surveillance reports influenced decision making, how resources evolved and how they could be refined to meet the requirements of stakeholders in the future. METHODS Public health professionals (n = 2,400) involved in the COVID-19 response from the 316 English LAs were invited to take part in an online survey. The questionnaire covered five themes: (i) report use; (ii) influence of surveillance outputs on local intervention strategies; (iii) timeliness; (iv) current and future data requirements; and (v) content development. RESULTS Of the 366 respondents to the survey, most worked in public health, data science, epidemiology, or business intelligence. Over 70% of respondents used the LA Report and Regional Situational Awareness Report daily or weekly. The information had been used by 88% to inform decision making within their organisations and 68% considered that intervention strategies had been instituted as a result of these decisions. Examples of changes instigated included targeted communications, pharmaceutical and non-pharmaceutical interventions, and the timing of interventions. Most responders considered that the surveillance content had reacted well to evolving demands. The majority (89%) said that their information requirements would be met if the surveillance reports were incorporated into the COVID-19 Situational Awareness Explorer Portal. Additional information suggested by stakeholders included vaccination and hospitalisation data as well as information on underlying health conditions, infection during pregnancy, school absence and wastewater testing. CONCLUSIONS The OST surveillance reports were a valuable information resource used by local stakeholders in their response to the SARS-CoV-2 epidemic. Control measures that affect disease epidemiology and monitoring requirements need to be considered in the continuous maintenance of surveillance outputs. We identified areas for further development and, since the evaluation, information on repeat infections and vaccination data have been included in the surveillance reports. Furthermore, timeliness of publications has been improved by updating the data flow pathways.
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Affiliation(s)
- Katriina Willgert
- Outbreak Surveillance Team, Field Services, UK Health Security Agency, London, UK.
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Madingley Road, CB3 0ES, Cambridge, UK.
| | - Jo Hardstaff
- Outbreak Surveillance Team, Field Services, UK Health Security Agency, London, UK
| | - Stephanie Shadwell
- Data Product Development, Data Operations, UK Health Security Agency, London, UK
| | - Alex Bhattacharya
- Outbreak Surveillance Team, Field Services, UK Health Security Agency, London, UK
| | - Paula Blomquist
- Outbreak Surveillance Team, Field Services, UK Health Security Agency, London, UK
| | - Roberto Vivancos
- Outbreak Surveillance Team, Field Services, UK Health Security Agency, London, UK
| | - Ian Simms
- Outbreak Surveillance Team, Field Services, UK Health Security Agency, London, UK
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11
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Ondrikova N, Harris JP, Douglas A, Hughes HE, Iturriza-Gomara M, Vivancos R, Elliot AJ, Cunliffe NA, Clough HE. Predicting Norovirus in England Using Existing and Emerging Syndromic Data: Infodemiology Study. J Med Internet Res 2023; 25:e37540. [PMID: 37155231 DOI: 10.2196/37540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/22/2022] [Revised: 11/28/2022] [Accepted: 02/19/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Norovirus is associated with approximately 18% of the global burden of gastroenteritis and affects all age groups. There is currently no licensed vaccine or available antiviral treatment. However, well-designed early warning systems and forecasting can guide nonpharmaceutical approaches to norovirus infection prevention and control. OBJECTIVE This study evaluates the predictive power of existing syndromic surveillance data and emerging data sources, such as internet searches and Wikipedia page views, to predict norovirus activity across a range of age groups across England. METHODS We used existing syndromic surveillance and emerging syndromic data to predict laboratory data indicating norovirus activity. Two methods are used to evaluate the predictive potential of syndromic variables. First, the Granger causality framework was used to assess whether individual variables precede changes in norovirus laboratory reports in a given region or an age group. Then, we used random forest modeling to estimate the importance of each variable in the context of others with two methods: (1) change in the mean square error and (2) node purity. Finally, these results were combined into a visualization indicating the most influential predictors for norovirus laboratory reports in a specific age group and region. RESULTS Our results suggest that syndromic surveillance data include valuable predictors for norovirus laboratory reports in England. However, Wikipedia page views are less likely to provide prediction improvements on top of Google Trends and Existing Syndromic Data. Predictors displayed varying relevance across age groups and regions. For example, the random forest modeling based on selected existing and emerging syndromic variables explained 60% variance in the ≥65 years age group, 42% in the East of England, but only 13% in the South West region. Emerging data sets highlighted relative search volumes, including "flu symptoms," "norovirus in pregnancy," and norovirus activity in specific years, such as "norovirus 2016." Symptoms of vomiting and gastroenteritis in multiple age groups were identified as important predictors within existing data sources. CONCLUSIONS Existing and emerging data sources can help predict norovirus activity in England in some age groups and geographic regions, particularly, predictors concerning vomiting, gastroenteritis, and norovirus in the vulnerable populations and historical terms such as stomach flu. However, syndromic predictors were less relevant in some age groups and regions likely due to contrasting public health practices between regions and health information-seeking behavior between age groups. Additionally, predictors relevant to one norovirus season may not contribute to other seasons. Data biases, such as low spatial granularity in Google Trends and especially in Wikipedia data, also play a role in the results. Moreover, internet searches can provide insight into mental models, that is, an individual's conceptual understanding of norovirus infection and transmission, which could be used in public health communication strategies.
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Affiliation(s)
- Nikola Ondrikova
- Institute of Infection, Ecological and Veterinary Sciences, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Institute for Risk and Uncertainty, University of Liverpool, Liverpool, United Kingdom
| | - John P Harris
- Field Service, Health Protection Operations, United Kingdom Health Security Agency, Liverpool, United Kingdom
| | - Amy Douglas
- Gastrointestinal Infections and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, United Kingdom
| | - Helen E Hughes
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Real-time Syndromic Surveillance Team, Health Protection Operations, United Kingdom Health Security Agency, Birmingham, United Kingdom
| | | | - Roberto Vivancos
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Field Service, Health Protection Operations, United Kingdom Health Security Agency, Liverpool, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Alex J Elliot
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Real-time Syndromic Surveillance Team, Health Protection Operations, United Kingdom Health Security Agency, Birmingham, United Kingdom
| | - Nigel A Cunliffe
- Institute of Infection, Ecological and Veterinary Sciences, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
| | - Helen E Clough
- Institute of Infection, Ecological and Veterinary Sciences, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
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12
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Vaughan AM, Cenciarelli O, Colombe S, Alves de Sousa L, Fischer N, Gossner CM, Pires J, Scardina G, Aspelund G, Avercenko M, Bengtsson S, Blomquist P, Caraglia A, Chazelle E, Cohen O, Diaz A, Dillon C, Dontsenko I, Kotkavaara K, Fafangel M, Ferraro F, Firth R, Fonager J, Frank C, Carrasco MG, Gkolfinopoulou K, Grenersen MP, Guzmán Herrador BR, Henczkó J, Hoornenborg E, Igoe D, Ilić M, Jansen K, Janță DG, Johansen TB, Kasradze A, Koch A, Kyncl J, Martins JV, McAuley A, Mellou K, Molnár Z, Mor Z, Mossong J, Novacek A, Orlikova H, Pem Novosel I, Rossi MK, Sadkowska-Todys M, Sawyer C, Schmid D, Sîrbu A, Sondén K, Tarantola A, Tavares M, Thordardottir M, Učakar V, Van Ewijk C, Varjas J, Vergison A, Vivancos R, Zakrzewska K, Pebody R, Haussig JM. A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022. Euro Surveill 2022; 27. [PMID: 36082686 PMCID: PMC9461311 DOI: 10.2807/1560-7917.es.2022.27.36.2200620] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Following the report of a non-travel-associated cluster of monkeypox cases by the United Kingdom in May 2022, 41 countries across the WHO European Region have reported 21,098 cases and two deaths by 23 August 2022. Nowcasting suggests a plateauing in case notifications. Most cases (97%) are MSM, with atypical rash-illness presentation. Spread is mainly through close contact during sexual activities. Few cases are reported among women and children. Targeted interventions of at-risk groups are needed to stop further transmission.
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Affiliation(s)
- Aisling M Vaughan
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | | | - Soledad Colombe
- Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium.,Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland.,World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | | | - Natalie Fischer
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland.,World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Celine M Gossner
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jeff Pires
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Giuditta Scardina
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Gudrun Aspelund
- Centre for Health Security and Communicable Disease Control, The Directorate of Health, Reykjavik, Iceland
| | - Margarita Avercenko
- Infectious Disease Prevention and Control Unit, Department of Infectious Risks Analysis and Prevention, Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Sara Bengtsson
- Unit for Diagnostics Preparedness of Notifiable and High Consequence Pathogens, Public Health Agency of Sweden, Solna, Sweden
| | - Paula Blomquist
- Field Services, United Kingdom Health Security Agency, London, United Kingdom
| | - Anna Caraglia
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | - Emilie Chazelle
- Santé publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Orna Cohen
- Division of Epidemiology, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Asuncion Diaz
- National Centre of Epidemiology, Carlos III Health Institute, CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Christina Dillon
- Health Services Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Irina Dontsenko
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | - Katja Kotkavaara
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mario Fafangel
- Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Federica Ferraro
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | | | - Jannik Fonager
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Christina Frank
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mireia G Carrasco
- Ministry of Health, Government of Andorra, Andorra la Vella, Andorra
| | - Kassiani Gkolfinopoulou
- Surveillance Coordination Department. Hellenic National Public Health Organization (EODY), Athens, Greece
| | | | - Bernardo R Guzmán Herrador
- Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | - Judit Henczkó
- Department of Microbiological Reference Laboratory, National Public Health Center, Budapest, Hungary
| | - Elske Hoornenborg
- Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, the Netherlands
| | - Derval Igoe
- Health Services Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Maja Ilić
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Klaus Jansen
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Denisa-Georgiana Janță
- National Centre of Surveillance and Control of Communicable Disease, National Institute of Public Health Romania, Bucharest, Romania
| | | | - Ana Kasradze
- Head of Public Health Emergency Preparedness and Response Division, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Anders Koch
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Jan Kyncl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
| | - João Vieira Martins
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Andrew McAuley
- Public Health Scotland, Edinburgh, Scotland, United Kingdom
| | - Kassiani Mellou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, Hellenic National Public Health Organization (EODY), Athens, Greece
| | - Zsuzsanna Molnár
- Department of Communicable Disease Epidemiology and Infection Control, National Public Health Center, Budapest, Hungary
| | - Zohar Mor
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel.,Public Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Alina Novacek
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - Hana Orlikova
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
| | | | - Maria K Rossi
- Public Health Scotland, Edinburgh, Scotland, United Kingdom
| | | | - Clare Sawyer
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
| | - Daniela Schmid
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - Anca Sîrbu
- National Centre of Surveillance and Control of Communicable Disease, National Institute of Public Health Romania, Bucharest, Romania
| | - Klara Sondén
- Unit for Diagnostics Preparedness of Notifiable and High Consequence Pathogens, Public Health Agency of Sweden, Solna, Sweden
| | - Arnaud Tarantola
- Santé publique France Regional Office, Saint-Denis, Île-de-France, France
| | - Margarida Tavares
- National Program for Sexually Transmitted Infections and HIV Infection, Directorate-General of Health, Lisbon, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), and EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Emerging Infectious Diseases Unit, Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Marianna Thordardottir
- Centre for Health Security and Communicable Disease Control, The Directorate of Health, Reykjavik, Iceland
| | - Veronika Učakar
- Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Catharina Van Ewijk
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.,National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Juta Varjas
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | | | - Roberto Vivancos
- Field Services, United Kingdom Health Security Agency, London, United Kingdom
| | - Karolina Zakrzewska
- National Institute of Public Health (NIH) - National Research Institute, Warsaw, Poland
| | - Richard Pebody
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Joana M Haussig
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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13
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Donaldson AL, Harris JP, Vivancos R, O'Brien SJ. Can cases and outbreaks of norovirus in children provide an early warning of seasonal norovirus infection: an analysis of nine seasons of surveillance data in England UK. BMC Public Health 2022; 22:1393. [PMID: 35858892 PMCID: PMC9301858 DOI: 10.1186/s12889-022-13771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background Children are important transmitters of norovirus infection and there is evidence that laboratory reports in children increase earlier in the norovirus season than in adults. This raises the question as to whether cases and outbreaks in children could provide an early warning of seasonal norovirus before cases start increasing in older, more vulnerable age groups. Methods This study uses weekly national surveillance data on reported outbreaks within schools, care homes and hospitals, general practice (GP) consultations for infectious intestinal disease (IID), telehealth calls for diarrhoea and/or vomiting and laboratory norovirus reports from across England, UK for nine norovirus seasons (2010/11–2018/19). Lagged correlation analysis was undertaken to identify lead or lag times between cases in children and those in adults for each surveillance dataset. A partial correlation analysis explored whether school outbreaks provided a lead time ahead of other surveillance indicators, controlling for breaks in the data due to school holidays. A breakpoint analysis was used to identify which surveillance indicator and age group provided the earliest warning of the norovirus season each year. Results School outbreaks occurred 3-weeks before care home and hospital outbreaks, norovirus laboratory reports and NHS 111 calls for diarrhoea, and provided a 2-week lead time ahead of NHS 111 calls for vomiting. Children provided a lead time ahead of adults for norovirus laboratory reports (+ 1–2 weeks), NHS 111 calls for vomiting (+ 1 week) and NHS 111 calls for diarrhoea (+ 1 week) but occurred concurrently with adults for GP consultations. Breakpoint analysis revealed an earlier seasonal increase in cases among children compared to adults for laboratory, GP and NHS 111 data, with school outbreaks increasing earlier than other surveillance indicators in five out of nine surveillance years. Conclusion These findings suggest that monitoring cases and outbreaks of norovirus in children could provide an early warning of seasonal norovirus infection. However, both school outbreak data and syndromic surveillance data are not norovirus specific and will also capture other causes of IID. The use of school outbreak data as an early warning indicator may be improved by enhancing sampling in community outbreaks to confirm the causative organism.
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Affiliation(s)
- Anna L Donaldson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK. .,Institute of Population Health, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK. .,Field Epidemiology Service, Public Health England, Liverpool, UK.
| | - John P Harris
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Institute of Population Health, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.,Cumbria and Lancashire Health Protection Team, Public Health England, Preston, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Field Epidemiology Service, Public Health England, Liverpool, UK
| | - Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Institute of Population Health, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
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14
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Donaldson AL, Harris JP, Vivancos R, O’Brien SJ. Symptom profiling for infectious intestinal disease (IID): Do symptom profiles alter with age? PLoS One 2022; 17:e0269676. [PMID: 35771750 PMCID: PMC9246150 DOI: 10.1371/journal.pone.0269676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Symptom profiles have previously been identified for infectious intestinal disease (IID) which distinguish bacterial from viral organisms. However, there is evidence that the seasonality, severity, and duration of IID may differ between children, adults and elderly. A secondary data analysis was undertaken to explore whether symptom profiles for bacterial and viral IID vary across different age groups. Data from 844 cases of IID were divided into three age categories: <16 years, 16–65 years and >65 years. Multivariable logistic regression modelling was used to compare the significance of different symptoms across the three age groups. The odds of bacterial IID in children were increased by onset in the summer, diarrhoea in the absence of vomiting and fever. These symptoms were also associated with lower odds of a viral pathogen. In adults, diarrhoea but no vomiting, bloody diarrhoea and diarrhoea lasting more than 3 days were associated with increased odds of a bacterial organism, whilst onset in the winter or spring and a loss of appetite were associated with viral IID. In the elderly, diarrhoea in the absence of vomiting and diarrhoea lasting more than 3 days were associated with higher odds of bacterial IID and lower odds of a viral cause. Only diarrhoea in the absence of vomiting emerged as a key symptom across all three age groups. Variation in symptom profiles by age has implications for clinicians, public health specialists and epidemiologists who use symptoms to guide presumptive diagnoses in the absence of microbiological confirmation.
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Affiliation(s)
- Anna L. Donaldson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- National Infection Service: Field Epidemiology, Public Health England, Liverpool, United Kingdom
- * E-mail:
| | - John P. Harris
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- National Infection Service: Field Epidemiology, Public Health England, Liverpool, United Kingdom
| | - Sarah J. O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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15
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Vivancos R, Anderson C, Blomquist P, Balasegaram S, Bell A, Bishop L, Brown CS, Chow Y, Edeghere O, Florence I, Logan S, Manley P, Crowe W, McAuley A, Shankar AG, Mora-Peris B, Paranthaman K, Prochazka M, Ryan C, Simons D, Vipond R, Byers C, Watkins NA, Welfare W, Whittaker E, Dewsnap C, Wilson A, Young Y, Chand M, Riley S, Hopkins S. Community transmission of monkeypox in the United Kingdom, April to May 2022. Euro Surveill 2022; 27:2200422. [PMID: 35656834 PMCID: PMC9164677 DOI: 10.2807/1560-7917.es.2022.27.22.2200422] [Citation(s) in RCA: 188] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/20/2022] Open
Abstract
Between 7 and 25 May, 86 monkeypox cases were confirmed in the United Kingdom (UK). Only one case is known to have travelled to a monkeypox virus (MPXV) endemic country. Seventy-nine cases with information were male and 66 reported being gay, bisexual, or other men who have sex with men. This is the first reported sustained MPXV transmission in the UK, with human-to-human transmission through close contacts, including in sexual networks. Improving case ascertainment and onward-transmission preventive measures are ongoing.
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Affiliation(s)
- Roberto Vivancos
- UK Health Security Agency, London, England, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, UKHSA, England, United Kingdom
- NIHR Health Protection Research Unit in Gastrointestinal Infections, UKHSA, England, United Kingdom
| | | | | | | | - Anita Bell
- UK Health Security Agency, London, England, United Kingdom
| | - Louise Bishop
- UK Health Security Agency, London, England, United Kingdom
| | - Colin S Brown
- UK Health Security Agency, London, England, United Kingdom
- NIHR Health Protection Research Unit in Healthcare Acquired Infections and Antimicrobial Resistance, UKHSA, England, United Kingdom
| | - Yimmy Chow
- UK Health Security Agency, London, England, United Kingdom
| | | | - Isaac Florence
- UK Health Security Agency, London, England, United Kingdom
| | - Sarah Logan
- University College London Hospitals NHS Trust, London, England, United Kingdom
| | - Petra Manley
- UK Health Security Agency, London, England, United Kingdom
| | - William Crowe
- Health and Social Care Northern Ireland, Antrim, Northern Ireland, United Kingdom
| | - Andrew McAuley
- Public Health Scotland, Edinburgh, Scotland, United Kingdom
| | | | - Borja Mora-Peris
- Imperial College Healthcare NHS Trust, London, England, United Kingdom
| | | | | | - Cian Ryan
- UK Health Security Agency, London, England, United Kingdom
| | - David Simons
- UK Health Security Agency, London, England, United Kingdom
| | - Richard Vipond
- UK Health Security Agency, London, England, United Kingdom
| | - Chloe Byers
- UK Health Security Agency, London, England, United Kingdom
| | | | - Will Welfare
- UK Health Security Agency, London, England, United Kingdom
| | | | - Claire Dewsnap
- The British Association for Sexual Health & HIV, England & Wales, United Kingdom
| | - Allegra Wilson
- UK Health Security Agency, London, England, United Kingdom
| | - Yvonne Young
- UK Health Security Agency, London, England, United Kingdom
| | - Meera Chand
- UK Health Security Agency, London, England, United Kingdom
| | - Steven Riley
- UK Health Security Agency, London, England, United Kingdom
| | - Susan Hopkins
- UK Health Security Agency, London, England, United Kingdom
- NIHR Health Protection Research Unit in Healthcare Acquired Infections and Antimicrobial Resistance, UKHSA, England, United Kingdom
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16
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Davies R, Iturriza-Gómara M, Glennon-Alty R, Elliot AJ, Vivancos R, Alvarez Nishio A, Cunliffe NA, Hungerford D. Public acceptability of a technology-mediated stool sample collection platform to inform community-based surveillance of infectious intestinal disease: a pilot study. BMC Public Health 2022; 22:958. [PMID: 35562817 PMCID: PMC9099322 DOI: 10.1186/s12889-022-13307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the UK approximately a quarter of the population experience infectious intestinal disease (IID) each year. However, only 2% present to primary care, preventing a true determination of community burden and pathogen aetiology. The aim of this pilot study was to gauge public acceptability of a technology-mediated platform for reporting episodes of IID and for providing stool samples. METHODS This study employed a cross-sectional online survey design, targeting individuals 16 + years old within Liverpool City Region, UK. Information sought included demographics, comfortability of reporting illness and IID symptoms, willingness to provide stool, and favoured stool-provision method. Univariable logistic regression was used to examine associations between demographic variables and providing a stool sample. Odds ratios (OR) and associated 95% confidence intervals (CIs) were produced. RESULTS A total of 174 eligible participants completed the survey, with 69% female. The sample was skewed towards younger populations, with 2.9% aged 65 + years. Nearly a third (29%) had a household income of less than £30,000 per annum and 70% had attained a degree or higher. The majority identified as White British (81%) and 11% identified as ethnicities typically grouped Black, Asian and minority ethnic (BAME). Three quarters of participants were either 'Comfortable' or 'Very Comfortable' with reporting illness (75%) and with answering symptom-related questions (79%); 78% reported that they would provide a stool sample. Upon univariable analysis, increasing age - being 55 + (OR 6.28, 95% CI 1.15-117.48), and lower income (OR 2.5, 95% CI 1.02-6.60), was associated with willingness to provide a stool sample. Additionally, respondents identifying as BAME ethnicities and men may be less inclined to provide a stool sample. CONCLUSIONS This pilot study assessed the acceptability of technology-mediated platforms for reporting IID and provision of stool samples in the community. Respondents were biased towards younger, technologically inclined, more affluent and educated populations. Acceptability for reporting illness and providing a stool sample through technology-mediated platforms was high. While older populations were under-represented, they were more likely to agree to provide a stool sample. Qualitative research is required to better reach older and more deprived populations, and to understand potential age, gender and ethnic differences in compliance with stool sampling.
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Affiliation(s)
- Rowan Davies
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,School of Medicine, University of Liverpool, Liverpool, UK
| | - Miren Iturriza-Gómara
- Centre for Vaccine Innovation and Access, PATH, Geneva, Switzerland.,Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Rebecca Glennon-Alty
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Alex J Elliot
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Real-Time Syndromic Surveillance Team, Field Service, Health Protection Operations, UK Health Security Agency, Birmingham, UK.,National Institute for Health and Care Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | - Roberto Vivancos
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK.,Field Epidemiology North West, Field Service, Health Protection Operations, UK Health Security Agency, Liverpool, UK.,National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | | | - Nigel A Cunliffe
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Daniel Hungerford
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK. .,Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK. .,Field Epidemiology North West, Field Service, Health Protection Operations, UK Health Security Agency, Liverpool, UK. .,National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.
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17
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Lopez Bernal J, Panagiotopoulos N, Byers C, Garcia Vilaplana T, Boddington N, Zhang XS, Charlett A, Elgohari S, Coughlan L, Whillock R, Logan S, Bolt H, Sinnathamby M, Letley L, MacDonald P, Vivancos R, Edeghere O, Anderson C, Paranthaman K, Cottrell S, McMenamin J, Zambon M, Dabrera G, Ramsay M, Saliba V. Transmission dynamics of COVID-19 in household and community settings in the United Kingdom, January to March 2020. Euro Surveill 2022; 27. [PMID: 35426357 DOI: 10.1101/2020.08.19.20177188] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
BackgroundHouseholds appear to be the highest risk setting for COVID-19 transmission. Large household transmission studies in the early stages of the pandemic in Asia reported secondary attack rates ranging from 5 to 30%.AimWe aimed to investigate the transmission dynamics of COVID-19 in household and community settings in the UK.MethodsA prospective case-ascertained study design based on the World Health Organization FFX protocol was undertaken in the UK following the detection of the first case in late January 2020. Household contacts of cases were followed using enhanced surveillance forms to establish whether they developed symptoms of COVID-19, became confirmed cases and their outcomes. We estimated household secondary attack rates (SAR), serial intervals and individual and household basic reproduction numbers. The incubation period was estimated using known point source exposures that resulted in secondary cases.ResultsWe included 233 households with two or more people with 472 contacts. The overall household SAR was 37% (95% CI: 31-43%) with a mean serial interval of 4.67 days, an R0 of 1.85 and a household reproduction number of 2.33. SAR were lower in larger households and highest when the primary case was younger than 18 years. We estimated a mean incubation period of around 4.5 days.ConclusionsRates of COVID-19 household transmission were high in the UK for ages above and under 18 years, emphasising the need for preventative measures in this setting. This study highlights the importance of the FFX protocol in providing early insights on transmission dynamics.
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Affiliation(s)
- Jamie Lopez Bernal
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Chloe Byers
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Nicki Boddington
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Xu-Sheng Zhang
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Andre Charlett
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Suzanne Elgohari
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Laura Coughlan
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Rosie Whillock
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Sophie Logan
- Field Services Division, Public Health England, London, United Kingdom
| | - Hikaru Bolt
- Field Services Division, Public Health England, London, United Kingdom
| | - Mary Sinnathamby
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Louise Letley
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Pauline MacDonald
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Roberto Vivancos
- Field Services Division, Public Health England, London, United Kingdom
| | - Obaghe Edeghere
- Field Services Division, Public Health England, London, United Kingdom
| | | | | | | | | | - Maria Zambon
- TARGET Department, Public Health England, London, United Kingdom
| | - Gavin Dabrera
- TARGET Department, Public Health England, London, United Kingdom
| | - Mary Ramsay
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Vanessa Saliba
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
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18
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Lopez Bernal J, Panagiotopoulos N, Byers C, Garcia Vilaplana T, Boddington N, Zhang XS, Charlett A, Elgohari S, Coughlan L, Whillock R, Logan S, Bolt H, Sinnathamby M, Letley L, MacDonald P, Vivancos R, Edeghere O, Anderson C, Paranthaman K, Cottrell S, McMenamin J, Zambon M, Dabrera G, Ramsay M, Saliba V. Transmission dynamics of COVID-19 in household and community settings in the United Kingdom, January to March 2020. Euro Surveill 2022; 27:2001551. [PMID: 35426357 PMCID: PMC9012093 DOI: 10.2807/1560-7917.es.2022.27.15.2001551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/20/2022] [Indexed: 12/23/2022] Open
Abstract
BackgroundHouseholds appear to be the highest risk setting for COVID-19 transmission. Large household transmission studies in the early stages of the pandemic in Asia reported secondary attack rates ranging from 5 to 30%.AimWe aimed to investigate the transmission dynamics of COVID-19 in household and community settings in the UK.MethodsA prospective case-ascertained study design based on the World Health Organization FFX protocol was undertaken in the UK following the detection of the first case in late January 2020. Household contacts of cases were followed using enhanced surveillance forms to establish whether they developed symptoms of COVID-19, became confirmed cases and their outcomes. We estimated household secondary attack rates (SAR), serial intervals and individual and household basic reproduction numbers. The incubation period was estimated using known point source exposures that resulted in secondary cases.ResultsWe included 233 households with two or more people with 472 contacts. The overall household SAR was 37% (95% CI: 31-43%) with a mean serial interval of 4.67 days, an R0 of 1.85 and a household reproduction number of 2.33. SAR were lower in larger households and highest when the primary case was younger than 18 years. We estimated a mean incubation period of around 4.5 days.ConclusionsRates of COVID-19 household transmission were high in the UK for ages above and under 18 years, emphasising the need for preventative measures in this setting. This study highlights the importance of the FFX protocol in providing early insights on transmission dynamics.
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Affiliation(s)
- Jamie Lopez Bernal
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Chloe Byers
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Nicki Boddington
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Xu-Sheng Zhang
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Andre Charlett
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Suzanne Elgohari
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Laura Coughlan
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Rosie Whillock
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Sophie Logan
- Field Services Division, Public Health England, London, United Kingdom
| | - Hikaru Bolt
- Field Services Division, Public Health England, London, United Kingdom
| | - Mary Sinnathamby
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Louise Letley
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Pauline MacDonald
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Roberto Vivancos
- Field Services Division, Public Health England, London, United Kingdom
| | - Obaghe Edeghere
- Field Services Division, Public Health England, London, United Kingdom
| | | | | | | | | | - Maria Zambon
- TARGET Department, Public Health England, London, United Kingdom
| | - Gavin Dabrera
- TARGET Department, Public Health England, London, United Kingdom
| | - Mary Ramsay
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Vanessa Saliba
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
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19
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Love NK, Elliot AJ, Chalmers RM, Douglas A, Gharbia S, McCormick J, Hughes H, Morbey R, Oliver I, Vivancos R, Smith G. Impact of the COVID-19 pandemic on gastrointestinal infection trends in England, February-July 2020. BMJ Open 2022; 12:e050469. [PMID: 35314468 PMCID: PMC8968111 DOI: 10.1136/bmjopen-2021-050469] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To establish the impact of the first 6 months of the COVID-19 outbreak response on gastrointestinal (GI) infection trends in England. DESIGN Retrospective ecological study using routinely collected national and regional surveillance data from seven UK Health Security Agency coordinated laboratory, outbreak and syndromic surveillance systems using key dates of UK governmental policy change to assign phases for comparison between 2020 and historic data. RESULTS Decreases in GI illness activity were observed across all surveillance indicators as COVID-19 cases began to peak. Compared with the 5-year average (2015-2019), during the first 6 months of the COVID-19 response, there was a 52% decrease in GI outbreaks reported (1544 vs 3208 (95% CI 2938 to 3478)) and a 34% decrease in laboratory confirmed cases (27 859 vs 42 495 (95% CI 40 068 to 44 922)). GI indicators began to rise during the first lockdown and lockdown easing, although all remained substantially lower than historic figures. Reductions in laboratory confirmed cases were observed across all age groups and both sexes, with geographical heterogeneity observed in diagnosis trends. Health seeking behaviour changed substantially, with attendances decreasing prior to lockdown across all indicators. CONCLUSIONS There has been a marked change in trends of GI infections in the context of the COVID-19 pandemic. The drivers of this change are likely to be multifactorial; while changes in health seeking behaviour, pressure on diagnostic services and surveillance system ascertainment have undoubtably played a role, there has likely been a true decrease in the incidence for some pathogens resulting from the control measures and restrictions implemented. This suggests that if some of these changes in behaviour such as improved hand hygiene were maintained, then we could potentially see sustained reductions in the burden of GI illness.
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Affiliation(s)
- Nicola K Love
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Alex J Elliot
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | - Rachel M Chalmers
- Cryptosporidium Reference Unit, Public Health Wales Microbiology and Health Protection, Singleton Hospital, Swansea, UK
| | | | | | | | - Helen Hughes
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Roger Morbey
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | - Isabel Oliver
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Roberto Vivancos
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Gillian Smith
- UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
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20
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Blomquist PB, Bridgen J, Bray N, O'Connell AM, West D, Groves N, Gallagher E, Utsi L, Jarvis CI, Hardstaff JL, Byers C, Metelmann S, Simons D, Zaidi A, Twohig KA, Savagar B, Løchen A, Ryan C, Wrenn K, Saavedra-Campos M, Abedin Z, Florence I, Cleary P, Elson R, Vivancos R, Lake IR. Enhancing epidemiological surveillance of the emergence of the SARS-CoV-2 Omicron variant using spike gene target failure data, England, 15 November to 31 December 2021. Euro Surveill 2022; 27. [PMID: 35301981 PMCID: PMC8971917 DOI: 10.2807/1560-7917.es.2022.27.11.2200143] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When SARS-CoV-2 Omicron emerged in 2021, S gene target failure enabled differentiation between Omicron and the dominant Delta variant. In England, where S gene target surveillance (SGTS) was already established, this led to rapid identification (within ca 3 days of sample collection) of possible Omicron cases, alongside real-time surveillance and modelling of Omicron growth. SGTS was key to public health action (including case identification and incident management), and we share applied insights on how and when to use SGTS.
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Affiliation(s)
- Paula B Blomquist
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Jessica Bridgen
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Neil Bray
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Anne Marie O'Connell
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Daniel West
- UK Health Security Agency, London, United Kingdom
| | | | | | - Lara Utsi
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Christopher I Jarvis
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Jo L Hardstaff
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Chloe Byers
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Soeren Metelmann
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - David Simons
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Asad Zaidi
- UK Health Security Agency, London, United Kingdom
| | | | - Bethan Savagar
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Alessandra Løchen
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Cian Ryan
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Katie Wrenn
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - María Saavedra-Campos
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Zahidul Abedin
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | | | - Paul Cleary
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Richard Elson
- School of Environmental Sciences, UEA, Norwich, United Kingdom.,COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Roberto Vivancos
- COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
| | - Iain R Lake
- School of Environmental Sciences, UEA, Norwich, United Kingdom.,COVID-19 Outbreak Surveillance Team, UK Health Security Agency, London, United Kingdom
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21
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McKerr C, Chalmers RM, Elwin K, Ayres H, Vivancos R, O’Brien SJ, Christley RM. Cross-sectional household transmission study of Cryptosporidium shows that C. hominis infections are a key risk factor for spread. BMC Infect Dis 2022; 22:114. [PMID: 35105330 PMCID: PMC8807379 DOI: 10.1186/s12879-022-07086-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/07/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Infection with the Cryptosporidium parasite causes over 4000 cases of diagnosed illness (cryptosporidiosis) in England and Wales each year. The incidence of sporadic disease has not been sufficiently established, and how frequently this arises from contact with other infected people is not well documented. This project aimed to explore potential transmission in the home and attempt to identify asymptomatic infections, which might play a role in transmission. Risk factors and characteristics associated with spread of infection in the home were described including any differences between Cryptosporidium species. METHODS The study identified cryptosporidiosis cases from North West England and Wales over a year and invited them and their household to take part. Each household was sent a study pack containing study information and a questionnaire, and stool sample kits to provide samples from consenting household members. Cryptosporidium-positive stool samples, identified by immunofluorescence microscopy, were characterised using molecular methods to help describe any patterns of transmission. Characteristics of households with and without additional cases were described, and compared using odds ratios (OR) and a multivariable logistic regression identified independent risk factors for household transmission. Data collection ran for one year, beginning in September 2018 with an initial pilot phase. RESULTS We enrolled 128 index cases and their households. Additional illness occurred in over a quarter of homes, each reporting an average of two additional cases. The majority of these were undiagnosed and unreported to surveillance. This burden was even greater in households where the index case was infected with C. hominis versus C. parvum, or the index case was under five years old, with mums and siblings most at risk of secondary infection. Only having an index case of C. hominis was independently associated with transmission in the multivariable model (OR 4.46; p = 0.01). CONCLUSIONS Cryptosporidium was a considerable burden in the home. At-risk homes were those where the index was less than five years old and/or infected with C. hominis. Of particular risk were female caregivers and siblings. Hygiene advice should be specifically directed here. This work provides evidence for humans as sources of C. hominis infection and that person-person is a key pathway. We recommend that all stools submitted for the investigation of gastrointestinal pathogens are tested for Cryptosporidium to better capture cases, inclusion of speciation data in routine surveillance, and the consideration of specific clinical advice on prevention for high-risk homes.
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Affiliation(s)
- Caoimhe McKerr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, The University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Swansea Medical School, Swansea University, Swansea, UK
- Present Address: Public Health Wales, Cardiff, UK
| | - Rachel M. Chalmers
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, UK
- Swansea Medical School, Swansea University, Swansea, UK
- Present Address: Public Health Wales, Cardiff, UK
| | - Kristin Elwin
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, UK
- Present Address: Public Health Wales, Cardiff, UK
| | - Heather Ayres
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, UK
- Present Address: Public Health Wales, Cardiff, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, The University of Liverpool, Liverpool, UK
- Field Epidemiology Services, Public Health England, Liverpool, UK
| | - Sarah J. O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Liverpool, UK
| | - Robert M. Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, The University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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22
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Donaldson AL, Harris JP, Vivancos R, Hungerford D, Hall I, O'Brien SJ. School Attendance Registers for the Syndromic Surveillance of Infectious Intestinal Disease in UK Children: Protocol for a Retrospective Analysis. JMIR Res Protoc 2022; 11:e30078. [PMID: 35049509 PMCID: PMC8814921 DOI: 10.2196/30078] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Infectious intestinal disease (IID) is common, and children are more likely than adults both to have IID and to transmit infection onto others. Before the introduction of the vaccine, rotavirus was the leading cause of severe childhood diarrhea, with norovirus and Campylobacter predominate pathogens. Public health surveillance of IID is primarily based on health care data, and as such, illness that is managed within the community will often go undetected. School attendance registers offer a novel data set that has the potential to identify community cases and outbreaks of IID that would otherwise be missed by current health surveillance systems. Although studies have explored the role of school attendance registers in the monitoring of influenza among children, no studies have been identified that consider this approach in the surveillance of IID. Objective The aim of this study is to explore the role and utility of school attendance registers in the detection and surveillance of IID in children. The secondary aims are to estimate the burden of IID on school absenteeism and to assess the impact of the rotavirus vaccine on illness absence among school-aged children. Methods This study is a retrospective analysis of school attendance registers to investigate whether school absences due to illness can be used to capture seasonal trends and outbreaks of infectious intestinal disease among school-aged children. School absences in Merseyside, United Kingdom will be compared and combined with routine health surveillance data from primary care, laboratories, and telehealth services. These data will be used to model spatial and temporal variations in the incidence of IID and to apportion likely causes to changes in school absenteeism trends. This will be used to assess the potential utility of school attendance data in the surveillance of IID and to estimate the burden of IID absenteeism in schools. It will also inform an analysis of the impact of the rotavirus vaccine on disease within this age group. Results This study has received ethical approval from the University of Liverpool Research Ethics Committee (reference number 1819). Use of general practice data has been approved for the evaluation of rotavirus vaccination in Merseyside by NHS Research Ethics Committee, South Central-Berkshire REC Reference 14/SC/1140. Conclusions This study is unique in considering whether school attendance registers could be used to enhance the surveillance of IID. Such data have multiple potential applications and could improve the identification of outbreaks within schools, allowing early intervention to reduce transmission both within and outside of school settings. These data have the potential to act as an early warning system, identifying infections circulating within the community before they enter health care settings. School attendance data could also inform the evaluation of vaccination programs, such as rotavirus and, in time, norovirus. International Registered Report Identifier (IRRID) DERR1-10.2196/30078
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Affiliation(s)
- Anna L Donaldson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Institute of Population Health, University of Liverpool, Liverpool, United Kingdom.,Field Epidemiology Service, Public Health England, Liverpool, United Kingdom
| | - John P Harris
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Field Epidemiology Service, Public Health England, Liverpool, United Kingdom
| | - Daniel Hungerford
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Field Epidemiology Service, Public Health England, Liverpool, United Kingdom.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Ian Hall
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Department of Mathematics and School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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23
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Kwiatkowska R, Yaxley N, Moore G, Bennett A, Donati M, Love N, Vivancos R, Hickman M, Ready DR. Environmental screening for SARS-CoV-2 in long term care facilities: lessons from a pilot study. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17047.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The SARS-CoV-2 pandemic has highlighted the risk of infection transmission in long-term care facilities (LTCF) and the vulnerability of resident populations. It is essential to understand the environmental spread of the virus and risk of indirect transmission to inform Infection Prevention and Control (IPC) measures in these settings. Methods: Upon notification of SARS-CoV-2 outbreaks, LTCF within a local authority in the South West of England were approached to take part in this pilot study. Investigators visited to swab common touch-points and elevated ‘non-touch’ surfaces and samples were analysed for presence of SARS-CoV-2 genetic material (RNA). Data were collected regarding LTCF infrastructure, staff behaviours, clinical and epidemiological risk factors for infection (staff and residents), and IPC measures. Criteria for success were: recruitment of three LTCF; detection of SARS-COV-2 RNA; variation in proportion of SARS-CoV-2 positive surfaces by sampling zone; potential to assess infection risk from SARS-CoV-2 positive surfaces. Results: Three LTCFs were recruited, ranging in size and resident demographics. Outbreaks lasted 63, 50 and 30 days with resident attack rates of 53%, 40% and 8%, respectively. The proportion of sample sites on which SARS-CoV-2 was detected was highest in rooms occupied by infected residents and varied elsewhere in the LTCF, with low levels in a facility implementing enhanced IPC measures. The heterogeneity of settings and difficulty obtaining data made it difficult to assess association between environmental contamination and infection. Elevated surfaces were more likely to test positive for SARS-CoV-2 RNA than common touch-points. Conclusions: SARS-CoV-2 RNA can be detected in a variety of LTCF outbreak settings. We identified variation in environmental spread which could be associated with implementation of IPC measures, though we were unable to assess the impact on infection risk. Sampling elevated surfaces could add to ongoing public health surveillance for SARS-CoV-2 and other airborne pathogens in LTCF.
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24
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Ondrikova N, Clough HE, Douglas A, Iturriza-Gomara M, Larkin L, Vivancos R, Harris JP, Cunliffe NA. Differential impact of the COVID-19 pandemic on laboratory reporting of norovirus and Campylobacter in England: A modelling approach. PLoS One 2021; 16:e0256638. [PMID: 34432849 PMCID: PMC8386829 DOI: 10.1371/journal.pone.0256638] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/11/2021] [Indexed: 12/15/2022] Open
Abstract
Background The COVID-19 pandemic has impacted surveillance activities for multiple pathogens. Since March 2020, there was a decline in the number of reports of norovirus and Campylobacter recorded by England’s national laboratory surveillance system. The aim is to estimate and compare the impact of the COVID-19 pandemic on norovirus and Campylobacter surveillance data in England. Methods We utilised two quasi-experimental approaches based on a generalised linear model for sequential count data. The first approach estimates overall impact and the second approach focuses on the impact of specific elements of the pandemic response (COVID-19 diagnostic testing and control measures). The following time series (27, 2015–43, 2020) were used: weekly laboratory-confirmed norovirus and Campylobacter reports, air temperature, conducted Sars-CoV-2 tests and Index of COVID-19 control measures stringency. Results The period of Sars-CoV-2 emergence and subsequent sustained transmission was associated with persistent reductions in norovirus laboratory reports (p = 0.001), whereas the reductions were more pronounced during pandemic emergence and later recovered for Campylobacter (p = 0.075). The total estimated reduction was 47% - 79% for norovirus (12–43, 2020). The total reduction varied by time for Campylobacter, e.g. 19% - 33% in April, 1% - 7% in August. Conclusion Laboratory reporting of norovirus was more adversely impacted than Campylobacter by the COVID-19 pandemic. This may be partially explained by a comparatively stronger effect of behavioural interventions on norovirus transmission and a relatively greater reduction in norovirus testing capacity. Our study underlines the differential impact a pandemic may have on surveillance of gastrointestinal infectious diseases.
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Affiliation(s)
- Nikola Ondrikova
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Institute for Risk & Uncertainty, University of Liverpool, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Helen E. Clough
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
| | - Amy Douglas
- Gastrointestinal Pathogens Unit, National Infection Service, Public Health England, London, United Kingdom
| | | | - Lesley Larkin
- Gastrointestinal Pathogens Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Field Service, National Infection Service, Public Health England, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - John P. Harris
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- North West Health Protection Team, Public Health England, Liverpool, United Kingdom
| | - Nigel A. Cunliffe
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
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25
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Donaldson AL, Hardstaff JL, Harris JP, Vivancos R, O'Brien SJ. School-based surveillance of acute infectious disease in children: a systematic review. BMC Infect Dis 2021; 21:744. [PMID: 34344304 PMCID: PMC8330200 DOI: 10.1186/s12879-021-06444-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/10/2019] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syndromic surveillance systems are an essential component of public health surveillance and can provide timely detection of infectious disease cases and outbreaks. Whilst surveillance systems are generally embedded within healthcare, there is increasing interest in novel data sources for monitoring trends in illness, such as over-the-counter purchases, internet-based health searches and worker absenteeism. This systematic review considers the utility of school attendance registers in the surveillance of infectious disease outbreaks and occurrences amongst children. METHODS We searched eight databases using key words related to school absence, infectious disease and syndromic surveillance. Studies were limited to those published after 1st January 1995. Studies based in nursery schools or higher education settings were excluded. Article screening was undertaken by two independent reviewers using agreed eligibility criteria. Data extraction was performed using a standardised data extraction form. Outcomes included estimates of absenteeism, correlation with existing surveillance systems and associated lead or lag times. RESULTS Fifteen studies met the inclusion criteria, all of which were concerned with the surveillance of influenza. The specificity of absence data varied between all-cause absence, illness absence and syndrome-specific absence. Systems differed in terms of the frequency of data submissions from schools and the level of aggregation of the data. Baseline rates of illness absence varied between 2.3-3.7%, with peak absences ranging between 4.1-9.8%. Syndrome-specific absenteeism had the strongest correlation with other surveillance systems (r = 0.92), with illness absenteeism generating mixed results and all-cause absenteeism performing the least well. A similar pattern of results emerged in terms of lead and lag times, with influenza-like illness (ILI)-specific absence providing a 1-2 week lead time, compared to lag times reported for all-cause absence data and inconsistent results for illness absence data. CONCLUSION Syndrome-specific school absences have potential utility in the syndromic surveillance of influenza, demonstrating good correlation with healthcare surveillance data and a lead time of 1-2 weeks ahead of existing surveillance measures. Further research should consider the utility of school attendance registers for conditions other than influenza, to broaden our understanding of the potential application of this data for infectious disease surveillance in children. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2019 CRD42019119737.
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Affiliation(s)
- A L Donaldson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.
- Field Epidemiology Service, Public Health England, Liverpool, UK.
| | - J L Hardstaff
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - J P Harris
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - R Vivancos
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
- Field Epidemiology Service, Public Health England, Liverpool, UK
| | - S J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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26
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Ondrikova N, Clough HE, Cunliffe NA, Iturriza-Gomara M, Vivancos R, Harris JP. Understanding norovirus reporting patterns in England: a mixed model approach. BMC Public Health 2021; 21:1245. [PMID: 34182979 PMCID: PMC8240379 DOI: 10.1186/s12889-021-11317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Norovirus has a higher level of under-reporting in England compared to other intestinal infectious agents such as Campylobacter or Salmonella, despite being recognised as the most common cause of gastroenteritis globally. In England, this under-reporting is a consequence of the frequently mild/self-limiting nature of the disease, combined with the passive surveillance system for infectious diseases reporting. We investigated heterogeneity in passive surveillance system in order to improve understanding of differences in reporting and laboratory testing practices of norovirus in England. METHODS The reporting patterns of norovirus relating to age and geographical region of England were investigated using a multivariate negative binomial model. Multiple model formulations were compared, and the best performing model was determined by proper scoring rules based on one-week-ahead predictions. The reporting patterns are represented by epidemic and endemic random intercepts; values close to one and less than one imply a lower number of reports than expected in the given region and age-group. RESULTS The best performing model highlighted atypically large and small amounts of reporting by comparison with the average in England. Endemic random intercept varied from the lowest in East Midlands in those in the under 5 year age-group (0.36, CI 0.18-0.72) to the highest in the same age group in South West (3.00, CI 1.68-5.35) and Yorkshire & the Humber (2.93, CI 1.74-4.94). Reporting by age groups showed the highest variability in young children. CONCLUSION We identified substantial variability in reporting patterns of norovirus by age and by region of England. Our findings highlight the importance of considering uncertainty in the design of forecasting tools for norovirus, and to inform the development of more targeted risk management approaches for norovirus disease.
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Affiliation(s)
- N. Ondrikova
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Institute for Risk & Uncertainty, University of Liverpool, Liverpool, UK
| | - H. E. Clough
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - N. A. Cunliffe
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Public Health England, Liverpool, UK
| | - M. Iturriza-Gomara
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Centre for Vaccine Innovation and Access, PATH, Geneva, Switzerland
| | - R. Vivancos
- NIHR Health Protection Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Public Health England, Liverpool, UK
- NIHR Health Protection Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - J. P. Harris
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Public Health England, Liverpool, UK
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27
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Setiabudi W, Hungerford D, Subramaniam K, Vaselli NM, Shaw VE, Wilton M, Vivancos R, Aston S, Platt G, Moitt T, Jones AP, Gabbay M, Buchan I, Carrol ED, Iturriza-Gomara M, Solomon T, Greenhalf W, Naisbitt DJ, Adams ER, Cunliffe NA, Turtle L, French N. Prospective observational study of SARS-CoV-2 infection, transmission and immunity in a cohort of households in Liverpool City Region, UK (COVID-LIV): a study protocol. BMJ Open 2021; 11:e048317. [PMID: 33737446 PMCID: PMC7977072 DOI: 10.1136/bmjopen-2020-048317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The emergence and rapid spread of COVID-19 have caused widespread and catastrophic public health and economic impact, requiring governments to restrict societal activity to reduce the spread of the disease. The role of household transmission in the population spread of SARS-CoV-2, and of host immunity in limiting transmission, is poorly understood. This paper describes a protocol for a prospective observational study of a cohort of households in Liverpool City Region, UK, which addresses the transmission of SARS-CoV-2 between household members and how immunological response to the infection changes over time. METHODS AND ANALYSIS Households in the Liverpool City Region, in which members have not previously tested positive for SARS-CoV-2 with a nucleic acid amplification test, are followed up for an initial period of 12 weeks. Participants are asked to provide weekly self-throat and nasal swabs and record their activity and presence of symptoms. Incidence of infection and household secondary attack rates of COVID-19 are measured. Transmission of SARS-CoV-2 will be investigated against a range of demographic and behavioural variables. Blood and faecal samples are collected at several time points to evaluate immune responses to SARS-CoV-2 infection and prevalence and risk factors for faecal shedding of SARS-CoV-2, respectively. ETHICS AND DISSEMINATION The study has received approval from the National Health Service Research Ethics Committee; REC Reference: 20/HRA/2297, IRAS Number: 283 464. Results will be disseminated through scientific conferences and peer-reviewed open access publications. A report of the findings will also be shared with participants. The study will quantify the scale and determinants of household transmission of SARS-CoV-2. Additionally, immunological responses before and during the different stages of infection will be analysed, adding to the understanding of the range of immunological response by infection severity.
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Affiliation(s)
- Wega Setiabudi
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Daniel Hungerford
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Krishanthi Subramaniam
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Natasha Marcella Vaselli
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Victoria E Shaw
- Liverpool Experimental Cancer Medicines Centre, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Moon Wilton
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Field Epidemiology North West, Field Service, National Infection Service, Public Health England, London, UK
| | - Stephen Aston
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Gareth Platt
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Tracy Moitt
- Liverpool Clinical Trial Centre, University of Liverpool, Liverpool, UK
| | - Ashley P Jones
- Liverpool Clinical Trial Centre, University of Liverpool, Liverpool, UK
| | - Mark Gabbay
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Iain Buchan
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Department of Public Health and Policy, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Enitan D Carrol
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Miren Iturriza-Gomara
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Tom Solomon
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Department of Neurology, Walton Centre, NHS Foundation Trust, Liverpool, UK
| | - William Greenhalf
- Liverpool Experimental Cancer Medicines Centre, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Dean J Naisbitt
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Emily R Adams
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nigel A Cunliffe
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Lance Turtle
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Neil French
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
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Boddington NL, Charlett A, Elgohari S, Byers C, Coughlan L, Vilaplana TG, Whillock R, Sinnathamby M, Panagiotopoulos N, Letley L, MacDonald P, Vivancos R, Edeghere O, Shingleton J, Bennett E, Cottrell S, McMenamin J, Zambon M, Ramsay M, Dabrera G, Saliba V, Bernal JL. Epidemiological and clinical characteristics of early COVID-19 cases, United Kingdom of Great Britain and Northern Ireland. Bull World Health Organ 2021; 99:178-189. [PMID: 33716340 PMCID: PMC7941108 DOI: 10.2471/blt.20.265603] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 05/15/2020] [Revised: 09/11/2020] [Accepted: 10/06/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To describe the clinical presentation, course of disease and health-care seeking behaviour of the first few hundred cases of coronavirus disease 2019 (COVID-19) in the United Kingdom of Great Britain and Northern Ireland. METHODS We implemented the World Health Organization's First Few X cases and contacts investigation protocol for COVID-19. Trained public health professionals collected information on 381 virologically confirmed COVID-19 cases from 31 January 2020 to 9 April 2020. We actively followed up cases to identify exposure to infection, symptoms and outcomes. We also collected limited data on 752 symptomatic people testing negative for COVID-19, as a control group for analyses of the sensitivity, specificity and predictive value of symptoms. FINDINGS Approximately half of the COVID-19 cases were imported (196 cases; 51.4%), of whom the majority had recent travel to Italy (140 cases; 71.4%). Of the 94 (24.7%) secondary cases, almost all reported close contact with a confirmed case (93 cases; 98.9%), many through household contact (37 cases; 39.8%). By age, a lower proportion of children had COVID-19. Most cases presented with cough, fever and fatigue. The sensitivity and specificity of symptoms varied by age, with nonlinear relationships with age. Although the proportion of COVID-19 cases with fever increased with age, for those with other respiratory infections the occurrence of fever decreased with age. The occurrence of shortness of breath also increased with age in a greater proportion of COVID-19 cases. CONCLUSION The study has provided useful evidence for generating case definitions and has informed modelling studies of the likely burden of COVID-19.
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Affiliation(s)
| | - Andre Charlett
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Suzanne Elgohari
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Chloe Byers
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Laura Coughlan
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | | | - Rosie Whillock
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Mary Sinnathamby
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | | | - Louise Letley
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Pauline MacDonald
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | | | | | | | | | | | | | - Maria Zambon
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Mary Ramsay
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Gavin Dabrera
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Vanessa Saliba
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
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Tulloch JSP, Owczarczak-Garstecka SC, Fleming KM, Vivancos R, Westgarth C. English hospital episode data analysis (1998-2018) reveal that the rise in dog bite hospital admissions is driven by adult cases. Sci Rep 2021; 11:1767. [PMID: 33469116 PMCID: PMC7815787 DOI: 10.1038/s41598-021-81527-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022] Open
Abstract
Dog bites are a global health issue that can lead to severe health outcomes. This study aims to describe the incidence and sociodemographics of patients admitted to English National Health Service (NHS) hospitals for dog bites (1998-2018), and to estimate their annual direct health care costs. An analysis of patient level data utilising hospital episode statistics for NHS England, including: temporal trends in annual incidence of admission, Poisson models of the sociodemographic characteristics of admitted patients, and direct health care cost estimates. The incidence of dog bite admissions rose from 6.34 (95%CI 6.12-6.56) in 1998 to 14.99 (95%CI 14.67-15.31) admissions per 100,000 population in 2018, with large geographic variation. The increase was driven by a tripling of incidence in adults. Males had the highest rates of admission in childhood. Females had two peaks in admission, childhood and 35-64 years old. Two percent (2.05%, 95%CI 0.93-3.17) of emergency department attendances resulted in admission. Direct health care costs increased and peaked in the financial year 2017/2018 (admission costs: £25.1 million, emergency attendance costs: £45.7million). Dog bite related hospital admissions have increased solely in adults. Further work exploring human-dog interactions, stratified by demographic factors, is urgently needed to enable the development of appropriate risk reduction intervention strategies.
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Affiliation(s)
- John S P Tulloch
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK.
- Public Health England, Liverpool, L3 1DS, UK.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, CH64 7TE, UK.
| | - Sara C Owczarczak-Garstecka
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, CH64 7TE, UK
- Institute of Risk and Uncertainty, University of Liverpool, Liverpool, L69 7ZF, UK
- Dogs Trust, London, EC1V 7RQ, UK
| | - Kate M Fleming
- Institute of Population Health, University of Liverpool, Liverpool, L69 3GL, UK
| | - Roberto Vivancos
- Public Health England, Liverpool, L3 1DS, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Liverpool, L3 1DS, UK
| | - Carri Westgarth
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, CH64 7TE, UK
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30
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Green R, Tulloch JSP, Tunnah C, Coffey E, Lawrenson K, Fox A, Mason J, Barnett R, Constantine A, Shepherd W, Ashton M, Beadsworth MBJ, Vivancos R, Hall I, Walker N, Ghebrehewet S. COVID-19 testing in outbreak-free care homes: what are the public health benefits? J Hosp Infect 2021; 111:89-95. [PMID: 33453349 PMCID: PMC7837210 DOI: 10.1016/j.jhin.2020.12.024] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/03/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND COVID-19 care home outbreaks represent a significant proportion of COVID-19 morbidity and mortality in the UK. National testing initially focused on symptomatic care home residents, before extending to asymptomatic cohorts. AIM The aim was to describe the epidemiology and transmission of COVID-19 in outbreak free care homes. METHODS A two-point prevalence survey of COVID-19, in 34 Liverpool care homes, was performed in April and May 2020. Changes in prevalence were analysed. Associations between care home characteristics, reported infection, prevention and control interventions, and COVID-19 status were described and analysed. FINDINGS No resident developed COVID-19 symptoms during the study. There was no significant difference between: the number of care homes containing at least one test positive resident between the first (17.6%, 95% confidence interval (CI) 6.8-34.5) and second round (14.7%, 95% CI 5.0-31.1) of testing (p>0.99); and the number of residents testing positive between the first (2.1%, 95% CI 1.2-3.4) and second round (1.0%, 95% CI 0.5-2.1) of testing (P=0.11). Care homes providing nursing care (risk ratio (RR) 7.99, 95% CI 1.1-57.3) and employing agency staff (RR 8.4, 95% CI 1.2-60.8) were more likely to contain test positive residents. Closing residents shared space was not associated with residents testing positive (RR 2.63, 95% CI 0.4-18.5). CONCLUSIONS Asymptomatic COVID-19 care homes showed no evidence of disease transmission or development of outbreaks; suggesting that current infection prevention and control measures are effective in preventing transmission. Repeat testing at two to three weeks had limited or no public health benefits over regular daily monitoring of staff and residents for symptoms. These results should inform policies calling for regular testing of asymptomatic residents.
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Affiliation(s)
- R Green
- Public Health England (PHE), North West, UK
| | - J S P Tulloch
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - C Tunnah
- Liverpool City Council, Liverpool, UK
| | - E Coffey
- Liverpool City Council, Liverpool, UK
| | | | - A Fox
- National Infection Service, Public Health England (PHE), UK
| | - J Mason
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - R Barnett
- Liverpool Local Medical Committee, Liverpool, UK
| | - A Constantine
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - W Shepherd
- Public Health England (PHE), North West, UK
| | - M Ashton
- Liverpool City Council, Liverpool, UK
| | - M B J Beadsworth
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - R Vivancos
- Public Health England (PHE), North West, UK
| | - I Hall
- Department of Mathematics, University of Manchester, Manchester, UK
| | - N Walker
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool School of Tropical Medicine, Liverpool, UK
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31
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Hughes HE, Edeghere O, O'Brien SJ, Vivancos R, Elliot AJ. Emergency department syndromic surveillance systems: a systematic review. BMC Public Health 2020; 20:1891. [PMID: 33298000 PMCID: PMC7724621 DOI: 10.1186/s12889-020-09949-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/18/2020] [Accepted: 11/19/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Syndromic surveillance provides public health intelligence to aid in early warning and monitoring of public health impacts (e.g. seasonal influenza), or reassurance when an impact has not occurred. Using information collected during routine patient care, syndromic surveillance can be based on signs/symptoms/preliminary diagnoses. This approach makes syndromic surveillance much timelier than surveillance requiring laboratory confirmed diagnoses. The provision of healthcare services and patient access to them varies globally. However, emergency departments (EDs) exist worldwide, providing unscheduled urgent care to people in acute need. This provision of care makes ED syndromic surveillance (EDSyS) a potentially valuable tool for public health surveillance internationally. The objective of this study was to identify and describe the key characteristics of EDSyS systems that have been established and used globally. METHODS We systematically reviewed studies published in peer review journals and presented at International Society of Infectious Disease Surveillance conferences (up to and including 2017) to identify EDSyS systems which have been created and used for public health purposes. Search criteria developed to identify "emergency department" and "syndromic surveillance" were applied to NICE healthcare, Global Health and Scopus databases. RESULTS In total, 559 studies were identified as eligible for inclusion in the review, comprising 136 journal articles and 423 conference abstracts/papers. From these studies we identified 115 EDSyS systems in 15 different countries/territories across North America, Europe, Asia and Australasia. Systems ranged from local surveillance based on a single ED, to comprehensive national systems. National EDSyS systems were identified in 8 countries/territories: 2 reported inclusion of ≥85% of ED visits nationally (France and Taiwan). CONCLUSIONS EDSyS provides a valuable tool for the identification and monitoring of trends in severe illness. Technological advances, particularly in the emergency care patient record, have enabled the evolution of EDSyS over time. EDSyS reporting has become closer to 'real-time', with automated, secure electronic extraction and analysis possible on a daily, or more frequent basis. The dissemination of methods employed and evidence of successful application to public health practice should be encouraged to support learning from best practice, enabling future improvement, harmonisation and collaboration between systems in future. PROSPERO NUMBER CRD42017069150 .
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Affiliation(s)
- Helen E Hughes
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK.
- Farr Institute@HeRC, University of Liverpool, Liverpool, UK.
| | - Obaghe Edeghere
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
- Field Epidemiology West Midlands, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - Sarah J O'Brien
- School of Natural and Environmental Sciences, Newcastle University, Newcastle, UK
| | - Roberto Vivancos
- Field Epidemiology North West, Field Service, National Infection Service, Public Health England, Liverpool, UK
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
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32
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Begemann S, Watkins F, Van Hoyweghen I, Vivancos R, Christley R, Perkins E. The Governance of UK Dairy Antibiotic Use: Industry-Led Policy in Action. Front Vet Sci 2020; 7:557. [PMID: 33088824 PMCID: PMC7500462 DOI: 10.3389/fvets.2020.00557] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
This article analyses the progress made in the UK with regard to tackling antibiotic "misuse and overuse" in food-producing animals. Moving beyond statistical realities, the paper examines how the UK's industry-led policy approach is shaping practice. Using a multi-sited ethnography situated in Actor Network Theory and Callon's sociology of markets, the UK dairy supply chain policies and practices were studied. Findings reveal that dairy industry policies only partially address the complex network of people, animals, and the environment in which dairy antibiotics circulate. Antibiotic "misuse and overuse" in agriculture is far from a behavioural matter, with solely farmers and veterinarians to blame. Instead, antibiotic use in food animals is embedded in complex economic networks that constrain radical changes in dairy husbandry management and antibiotic use on farms. More attention toward the needs of the dairy supply chain actors and wider environmental considerations is essential to reduce the dairy sector's dependency on antibiotics and support transition toward responsible farming in the UK.
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Affiliation(s)
- Stephanie Begemann
- Knowledge, Technology and Innovation Group, University of Wageningen, Wageningen, Netherlands.,NIHR HPRU in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Francine Watkins
- Department of Public Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Ine Van Hoyweghen
- Life Sciences & Society Lab, Centre of Sociological Research, KU Leuven, Leuven, Belgium
| | - Roberto Vivancos
- Field Service, Public Health England, Liverpool, United Kingdom.,NIHR HPRU in Gastrointestinal Infections, Liverpool, United Kingdom
| | - Robert Christley
- NIHR HPRU in Emerging and Zoonotic Infections, Liverpool, United Kingdom.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Elizabeth Perkins
- Health Services Research, Institute of Psychology Health and Society, University of Liverpool, Liverpool, United Kingdom
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33
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Morgan M, Watts V, Allen D, Curtis D, Kirolos A, Macdonald N, Maslen E, Morgan D, Saei A, Sedgwick J, Stevenson J, Turbitt D, Vivancos R, Waugh C, Williams C, Decraene V. Challenges of investigating a large food-borne norovirus outbreak across all branches of a restaurant group in the United Kingdom, October 2016. ACTA ACUST UNITED AC 2020; 24. [PMID: 31064638 PMCID: PMC6505182 DOI: 10.2807/1560-7917.es.2019.24.18.1800511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
During October and November 2016, over 1,000 customers and staff reported gastroenteritis after eating at all 23 branches of a restaurant group in the United Kingdom. The outbreak coincided with a new menu launch and norovirus was identified as the causative agent. We conducted four retrospective cohort studies; one among all restaurant staff and three in customers at four branches. We investigated the dishes consumed, reviewed recipes, interviewed chefs and inspected restaurants to identify common ingredients and preparation methods for implicated dishes. Investigations were complicated by three public health agencies concurrently conducting multiple analytical studies, the complex menu with many shared constituent ingredients and the high media attention. The likely source was a contaminated batch of a nationally distributed ingredient, but analytical studies were unable to implicate a single ingredient. The most likely vehicle was a new chipotle chilli product imported from outside the European Union, that was used uncooked in the implicated dishes. This outbreak exemplifies the possibility of rapid spread of infectious agents within a restaurant supply chain, following introduction of a contaminated ingredient. It underlines the importance of appropriate risk assessments and control measures being in place, particularly for new ingredients and ready-to-eat foods.
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Affiliation(s)
- Mari Morgan
- These authors share first authorship.,European Programme for Intervention Epidemiology Training, Stockholm, Sweden.,Health Protection, Public Health Wales NHS Trust, Cardiff, United Kingdom
| | - Vicky Watts
- Field Service - Epidemiology, National Infection Service, Public Health England, Liverpool, United Kingdom.,United Kingdom Field Epidemiology Training Programme, Public Health England, London, United Kingdom.,These authors share first authorship
| | - David Allen
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.,National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, United Kingdom.,Virus Reference Department, National Infection Service, Colindale, Public Health England, London, United Kingdom
| | - Daniele Curtis
- Field Service - Epidemiology, National Infection Service, Public Health England, London, United Kingdom
| | - Amir Kirolos
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, Scotland
| | - Neil Macdonald
- Field Service - Epidemiology, National Infection Service, Public Health England, London, United Kingdom
| | - Ellie Maslen
- North East North Central London Health Protection Team, Public Health England, London, United Kingdom
| | - Deb Morgan
- Incidents & Resilience Team, Food Standards Agency, London, United Kingdom
| | - Ayoub Saei
- Statistics, Modelling & Economics Department, National Infection Service - Data & Analytical Sciences, Public Health England, London, United Kingdom
| | - James Sedgwick
- Field Service - Epidemiology, National Infection Service, Public Health England, London, United Kingdom
| | - Janet Stevenson
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, Scotland
| | - Deborah Turbitt
- Public Health England London, Public Health England, London, United Kingdom
| | - Roberto Vivancos
- Field Service - Epidemiology, National Infection Service, Public Health England, Liverpool, United Kingdom
| | - Catriona Waugh
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, Scotland
| | - Chris Williams
- Health Protection, Public Health Wales NHS Trust, Cardiff, United Kingdom
| | - Valerie Decraene
- Field Service - Epidemiology, National Infection Service, Public Health England, Liverpool, United Kingdom
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34
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Tulloch JSP, Christley RM, Radford AD, Warner JC, Beadsworth MBJ, Beeching NJ, Vivancos R. A descriptive epidemiological study of the incidence of newly diagnosed Lyme disease cases in a UK primary care cohort, 1998-2016. BMC Infect Dis 2020; 20:285. [PMID: 32299372 PMCID: PMC7164244 DOI: 10.1186/s12879-020-05018-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/06/2019] [Accepted: 04/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Primary care is likely to see the highest number of Lyme disease patients. Despite this, there is limited published data regarding Lyme disease patients accessing primary care in the UK. We aim to describe trends in the incidence of a new diagnosis, and demographics of patients identified in a primary care electronic health database. METHODS A descriptive epidemiological study of Lyme disease coded patients in UK primary care. 3725 patients coded for Lyme disease during 1998-2016 were identified within The Health Improvement Network (THIN). Incidence rates and the demographics of cases identified were described. Poisson regression was used to analyse socio-demographic characteristics of the cases. RESULTS There was an increase in annual crude incidence rates, peaking in 2015 at 5.47 (95% CI 4.85-6.14) cases per 100,000 population per year. Multivariable analysis showed there were significant differences in the ages of those affected, incidence of a new diagnosis rose as deprivation levels improved, and that there was a higher incidence of cases living in rural areas compared to urban areas. There was no significant difference between sexes for the UK. Cases were significantly more likely to identify with being white compared to the national population. CONCLUSIONS An increasing incidence of patients newly coded with Lyme disease related Read codes was identified using data from a UK national primary care database. By comparing these incidence figures with national laboratory-confirmed surveillance data, a multiplication factor of 2.35 (95%CI 1.81-2.88) can be calculated in order to estimate the annual number of cases seen in primary care. The significant socio-demographic variables associated with a Lyme disease diagnosis likely reflect a complex interplay of socio-economic issues, which needs to be further explored. Future work is needed to examine the treatment and management of patients within this database.
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Affiliation(s)
- John S P Tulloch
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK.
- Public Health England, L3 1DS, Liverpool, UK.
| | - Robert M Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Alan D Radford
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Jenny C Warner
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, SP4 0JQ, UK
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, SP4 0JQ, UK
| | - Mike B J Beadsworth
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Nick J Beeching
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Roberto Vivancos
- Public Health England, L3 1DS, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Liverpool, L3 1DS, UK
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Vaughan A, Aarons E, Astbury J, Brooks T, Chand M, Flegg P, Hardman A, Harper N, Jarvis R, Mawdsley S, McGivern M, Morgan D, Morris G, Nixon G, O'Connor C, Palmer R, Phin N, Price DA, Russell K, Said B, Schmid ML, Vivancos R, Walsh A, Welfare W, Wilburn J, Dunning J. Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018. Emerg Infect Dis 2020; 26:782-785. [PMID: 32023204 PMCID: PMC7101111 DOI: 10.3201/eid2604.191164] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In September 2018, monkeypox virus was transmitted from a patient to a healthcare worker in the United Kingdom. Transmission was probably through contact with contaminated bedding. Infection control precautions for contacts (vaccination, daily monitoring, staying home from work) were implemented. Of 134 potential contacts, 4 became ill; all patients survived.
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36
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Hopkins MJ, Todd S, Beadsworth M, Anderson C, Mohamed Z, Muir D, Vivancos R, Brown AS, Ruf M, Chawla A. Consistent high prevalence of undiagnosed blood-borne virus infection in patients attending large urban emergency departments in England. J Viral Hepat 2020; 27:88-91. [PMID: 31448490 PMCID: PMC6972612 DOI: 10.1111/jvh.13197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/24/2019] [Revised: 07/22/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Abstract
Understanding local viral hepatitis and HIV epidemiology is essential if WHO elimination targets are to be achieved. We demonstrate a consistently high prevalence of undiagnosed active infection in urban emergency department attendees in England, with variations in local risk groups crucial to informing targeted testing initiatives.
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Affiliation(s)
- Mark J. Hopkins
- Department of Infection and ImmunityRoyal Liverpool University HospitalLiverpoolUK
| | - Stacy Todd
- Tropical and Infectious Disease UnitRoyal Liverpool University HospitalLiverpoolUK
| | - Mike Beadsworth
- Tropical and Infectious Disease UnitRoyal Liverpool University HospitalLiverpoolUK
| | | | - Zameer Mohamed
- Department of HepatologyImperial College Healthcare NHS TrustLondonUK
| | - David Muir
- Department of Infection and ImmunityNorthwest London PathologyLondonUK
| | | | - Ashley S. Brown
- Department of HepatologyImperial College Healthcare NHS TrustLondonUK
| | - Murad Ruf
- Medical DepartmentGilead SciencesLondonUK
| | - Anu Chawla
- Department of Infection and ImmunityRoyal Liverpool University HospitalLiverpoolUK
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37
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Inns T, Wilson D, Manley P, Harris JP, O'Brien SJ, Vivancos R. What proportion of care home outbreaks are caused by norovirus? An analysis of viral causes of gastroenteritis outbreaks in care homes, North East England, 2016-2018. BMC Infect Dis 2019; 20:2. [PMID: 31892311 PMCID: PMC6938643 DOI: 10.1186/s12879-019-4726-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outbreaks of infectious gastroenteritis are common in care homes for the elderly. Norovirus can cause these outbreaks, but diagnosis is frequently based solely on clinical characteristics. Our objective in this study was to describe the epidemiology of norovirus and other gastrointestinal pathogens in these settings. METHODS We analysed surveillance data from gastroenteritis outbreaks reported in North East England between 04 July 2016 to 01 July 2018. Stool samples taken during these outbreaks were tested for a range of viral and bacterial pathogens. We described the epidemiology of these outbreaks and explored the characteristics of norovirus outbreaks versus from other viral causes using multivariable logistic regression. RESULTS From the 566 care home gastroenteritis outbreaks in this study, we found that norovirus was the pathogen most frequently isolated. Norovirus was detected in 64% of outbreaks with a pathogen identified. Sapovirus was found in 13%; rotavirus in 11%. We found that norovirus outbreaks were associated with higher attack rates (aOR 1.03, 95% CI 1.01-1.05) and fewer cases sampled (aOR 0.74, 95% CI 0.60-0.91), compared to outbreaks caused by other viral pathogens. CONCLUSIONS These results are important as they quantify the contribution of norovirus to gastroenteritis outbreaks in care homes. Given this evidence, we emphasize the importance of non-specific outbreak interventions that can affect the impact of all such outbreaks. We further recommend that these findings are used to inform the implementation strategies of any norovirus-specific interventions such as a norovirus vaccine.
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Affiliation(s)
- Thomas Inns
- Field Epidemiology, Field Service, National Infection Service, Public Health England, London, UK. .,Institute of Population Health Sciences, University of Liverpool, Liverpool, UK. .,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.
| | - Deb Wilson
- North East Health Protection Team, Public Health England, Newcastle-upon-Tyne, UK
| | - Petra Manley
- Field Epidemiology, Field Service, National Infection Service, Public Health England, London, UK
| | - John P Harris
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Sarah J O'Brien
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Roberto Vivancos
- Field Epidemiology, Field Service, National Infection Service, Public Health England, London, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
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Inns T, Pulawska-Czub A, Harris JP, Vivancos R, Beeching NJ, Iturriza-Gomara M, O'Brien SJ. Prospective cohort study to investigate the burden and transmission of acute gastroenteritis in care homes: epidemiological results. BMJ Open 2019; 9:e033239. [PMID: 31818842 PMCID: PMC6924874 DOI: 10.1136/bmjopen-2019-033239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To estimate the incidence of gastroenteritis in individuals in care homes. DESIGN Prospective cohort study. SETTING Five participating care homes in North West England, UK. PARTICIPANTS Residents and staff present at the five study care homes between 15 August 2017 and 30 May 2019 (n=268). OUTCOME MEASURES We calculated incidence rates for all gastroenteritis cases per 1000 person-years at risk and per 1000 bed-days at risk. We also calculated the incidence rate of gastroenteritis outbreaks per 100 care homes per year. RESULTS In total 45 cases were reported during the surveillance period, equating to 133.7 cases per 1000 person-years at risk. In residents the incidence rate was 0.62 cases per 1000 bed-days. We observed seven outbreaks in all care homes included in surveillance, a rate of 76.4 outbreaks per 100 care homes per year. 15 stool samples were tested; three were positive for norovirus, no other pathogens were detected. CONCLUSIONS We found that surveillance of infectious gastroenteritis disease in care homes based on outbreaks, the current general approach, detected a majority of cases of gastroenteritis. However, if policymakers are to estimate the burden of infectious gastroenteritis in this setting using only routine outbreak surveillance data and not accounting for non-outbreak cases, this study implies that the total burden will be underestimated.
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Affiliation(s)
- Thomas Inns
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Anna Pulawska-Czub
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, Merseyside, UK
| | - John P Harris
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Field Epidemiology Services, Public Health England, London, UK
| | - Nicholas J Beeching
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
- Clinical Sciences Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Miren Iturriza-Gomara
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- School of Natural and Environmental Science, Newcastle University, Newcastle upon Tyne, UK
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39
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Kintz E, Byrne L, Jenkins C, McCARTHY N, Vivancos R, Hunter P. Outbreaks of Shiga Toxin-Producing Escherichia coli Linked to Sprouted Seeds, Salad, and Leafy Greens: A Systematic Review. J Food Prot 2019; 82:1950-1958. [PMID: 31638410 DOI: 10.4315/0362-028x.jfp-19-014] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Shiga toxin-producing Escherichia coli (STEC) outbreaks involving ready-to-eat salad products have been described in the scientific literature since 1995. These products typically do not undergo a definitive control step such as cooking to eliminate pathogens. To reduce the number of STEC infections from salad products, efforts will need to focus on preventing and reducing contamination throughout the food chain. We performed a systematic review of STEC outbreaks involving sprouted seeds, salad, or leafy green products to determine whether there were recurrent features, such as availability of microbiological evidence or identification of the contamination event, which may inform future investigations and prevention and control strategies. Thirty-five STEC outbreaks linked to contaminated leafy greens were identified for inclusion. The outbreaks occurred from 1995 to 2018 and ranged from 8 to more than 8,500 cases. Detection of STEC in the food product was rare (4 of 35 outbreaks). For the remaining outbreaks, the determination of leafy greens as the source of the outbreak mainly relied on analytical epidemiology (20 of 35) or descriptive evidence (11 of 35). The traceback investigation in 21 of 32 outbreaks was not able to identify possible routes leading to where the STEC bacteria came from or how the leaves were contaminated. Investigations in eight outbreaks found poor practice during processing that may have contributed to the outbreak, such as insufficient postharvest disinfection of the product. Six outbreak investigations were able to identify the outbreak strain in animal feces near the growing fields; two of these were also able to find it in irrigation water on the farms, providing a likely route of contamination. These results highlight the limitations of relying on microbiological confirmation as a basis to initiate investigations of upstream production to understand the source of contamination. This review also demonstrates the importance of, and difficulties associated with, food-chain traceback studies to inform control measures and future prevention.
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Affiliation(s)
- Erica Kintz
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK (ORCID: https://orcid.org/0000-0002-6829-5701 [E.K.]).,NIHR Health Protection Research Unit in Gastrointestinal Infections, UK
| | - Lisa Byrne
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Claire Jenkins
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Noel McCARTHY
- NIHR Health Protection Research Unit in Gastrointestinal Infections, UK.,Department of Zoology, University of Oxford, UK.,Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, UK.,National Infection Service, Public Health England, London NW9 5EQ, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, UK
| | - Paul Hunter
- NIHR Health Protection Research Unit in Gastrointestinal Infections, UK.,Department of Environmental Health, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa
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40
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Elson R, Davies TM, Jenkins C, Vivancos R, O'Brien SJ, Lake IR. Application of kernel smoothing to estimate the spatio-temporal variation in risk of STEC O157 in England. Spat Spatiotemporal Epidemiol 2019; 32:100305. [PMID: 32007279 DOI: 10.1016/j.sste.2019.100305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 01/27/2023]
Abstract
Identifying geographical areas with significantly higher or lower rates of infectious diseases can provide important aetiological clues to inform the development of public health policy and interventions designed to reduce morbidity. We applied kernel smoothing to estimate the spatial and spatio-temporal variation in risk of STEC O157 infection in England between 2009 and 2015, and to explore differences between the residential locations of cases reporting travel and those not reporting travel. We provide evidence that the distribution of STEC O157 infection in England is non-uniform with respect to the distribution of the at-risk population; that the spatial distribution of the three main genetic lineages infecting humans (I, II and I/II) differs significantly and that the spatio-temporal risk is highly dynamic. Our results also indicate that cases of STEC O157 reporting travel within or outside the UK are more likely to live in the south/south-east of the country, meaning that their residential location may not reflect the location of exposure that led to their infection. We suggest that the observed variation in risk reflects exposure to sources of STEC O157 that are geographically prescribed. These differences may be related to a combination of changes in the strains circulating in the ruminant reservoir, animal movements (livestock, birds or wildlife) or the behavior of individuals prior to infection. Further work to identify the importance of behaviours and exposures reported by cases relative to residential location is needed.
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Affiliation(s)
- Richard Elson
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, United Kingdom; School of Environmental Sciences, University of East Anglia, United Kingdom.
| | - Tilman M Davies
- Department of Mathematics & Statistics, University of Otago, Dunedin, New Zealand
| | - Claire Jenkins
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, United Kingdom
| | - Roberto Vivancos
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, United Kingdom; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections, United Kingdom
| | - Sarah J O'Brien
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, United Kingdom; Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Iain R Lake
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, United Kingdom; School of Environmental Sciences, University of East Anglia, United Kingdom
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McIntyre KM, Bolton FJ, Christley RM, Cleary P, Deja E, Durie AE, Diggle PJ, Hughes DA, de Lusignan S, Orton L, Radford AD, Elliot AJ, Smith GE, Snape DA, Stanistreet D, Vivancos R, Winstanley C, O'Brien SJ. A Fully Integrated Real-Time Detection, Diagnosis, and Control of Community Diarrheal Disease Clusters and Outbreaks (the INTEGRATE Project): Protocol for an Enhanced Surveillance System. JMIR Res Protoc 2019; 8:e13941. [PMID: 31573952 PMCID: PMC6787530 DOI: 10.2196/13941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/23/2023] Open
Abstract
Background Diarrheal disease, which affects 1 in 4 people in the United Kingdom annually, is the most common cause of outbreaks in community and health care settings. Traditional surveillance methods tend to detect point-source outbreaks of diarrhea and vomiting; they are less effective at identifying low-level and intermittent food supply contamination. Furthermore, it can take up to 9 weeks for infections to be confirmed, reducing slow-burn outbreak recognition, potentially impacting hundreds or thousands of people over wide geographical areas. There is a need to address fundamental problems in traditional diarrheal disease surveillance because of underreporting and subsequent unconfirmed infection by patients and general practitioners (GPs); varying submission practices and selective testing of samples in laboratories; limitations in traditional microbiological diagnostics, meaning that the timeliness of sample testing and etiology of most cases remains unknown; and poorly integrated human and animal surveillance systems, meaning that identification of zoonoses is delayed or missed. Objective This study aims to detect anomalous patterns in the incidence of gastrointestinal disease in the (human) community; to target sampling; to test traditional diagnostic methods against rapid, modern, and sensitive molecular and genomic microbiology methods that identify and characterize responsible pathogens rapidly and more completely; and to determine the cost-effectiveness of rapid, modern, sensitive molecular and genomic microbiology methods. Methods Syndromic surveillance will be used to aid identification of anomalous patterns in microbiological events based on temporal associations, demographic similarities among patients and animals, and changes in trends in acute gastroenteritis cases using a point process statistical model. Stool samples will be obtained from patients’ consulting GPs, to improve the timeliness of cluster detection and characterize the pathogens responsible, allowing health protection professionals to investigate and control outbreaks quickly, limiting their size and impact. The cost-effectiveness of the proposed system will be examined using formal cost-utility analysis to inform decisions on national implementation. Results The project commenced on April 1, 2013. Favorable approval was obtained from the Research Ethics Committee on June 15, 2015, and the first patient was recruited on October 13, 2015, with 1407 patients recruited and samples processed using traditional laboratory techniques as of March 2017. Conclusions The overall aim of this study is to create a new One Health paradigm for detecting and investigating diarrhea and vomiting in the community in near-real time, shifting from passive human surveillance and management of laboratory-confirmed infection toward an integrated, interdisciplinary enhanced surveillance system including management of people with symptoms. International Registered Report Identifier (IRRID) DERR1-10.2196/13941
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Affiliation(s)
- Kirsty Marie McIntyre
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom.,National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
| | - Frederick J Bolton
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Rob M Christley
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Paul Cleary
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom.,Field Epidemiology Services, Public Health England, Liverpool, United Kingdom
| | - Elizabeth Deja
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Ann E Durie
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Peter J Diggle
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom.,Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Simon de Lusignan
- Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lois Orton
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Alan D Radford
- Department of Infection Biology, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Alex J Elliot
- Real-Time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, United Kingdom
| | - Gillian E Smith
- Real-Time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, United Kingdom
| | - Darlene A Snape
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Debbi Stanistreet
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Roberto Vivancos
- Field Epidemiology Services, Public Health England, Liverpool, United Kingdom
| | - Craig Winstanley
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Sarah J O'Brien
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom.,Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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Hungerford DJ, French N, Iturriza-Gómara M, Read JM, Cunliffe NA, Vivancos R. Reduction in hospitalisations for acute gastroenteritis-associated childhood seizures since introduction of rotavirus vaccination: a time-series and change-point analysis of hospital admissions in England. J Epidemiol Community Health 2019; 73:1020-1025. [PMID: 31511311 PMCID: PMC6877709 DOI: 10.1136/jech-2019-213055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 01/17/2023]
Abstract
Introduction The incidence of severe childhood diarrhoea has fallen substantially following the introduction of rotavirus vaccine in the UK in July 2013. Since children with rotavirus infection may experience febrile and afebrile seizures, we evaluated the impact of rotavirus vaccination on seizure hospitalisations in children in England. Methods Using data from Hospital Episode Statistics, we employed interrupted time-series analyses to assess changes in monthly hospital admissions for seizures among children aged <5 years from July 2000 to June 2017. Outcome measures comprised all seizures and febrile seizures, with and without a co-diagnosis of acute gastroenteritis (AGE). Models were adjusted for pneumococcal conjugate vaccine (PCV) introduction. Change-point analysis was used to independently identify step-changes in the time-series. Results Among hospitalised children aged <5 years, the incidence of any seizures and febrile seizures with AGE decreased post-vaccine introduction by 23% (95% CI: 11% to 33%) and 31% (95% CI: 19% to 41%), respectively. For febrile seizures with AGE, a single change-point was identified in July 2013 (95% CI: June 2013 to December 2013). Reductions in seizure incidence were higher during the rotavirus season (49%, 95% CI: 37% to 58%) compared with out-of-season (13%, 95% CI: −4 to 28%) and showed no relation to PCV introduction. There were small reductions in any seizures with any co-diagnosis (4%, 95% CI: 0% to 8%) and in febrile seizures with any co-diagnosis (10%, 95% CI: 2% to 16%). Conclusion Rotavirus vaccination has reduced hospitalisations for seizures associated with AGE in England, providing additional evidence of population-level impact of rotavirus vaccination on seizure incidence in high-income countries.
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Affiliation(s)
- Daniel James Hungerford
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK .,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.,Field Service, National Infection Service, Public Health England, Liverpool, UK
| | - Neil French
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, members of Liverpool Health Partners, Liverpool, United Kingdom
| | - Miren Iturriza-Gómara
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
| | - Jonathan M Read
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.,Centre for Health Informatics, Computing and Statistics, Lancaster University, Faculty of Health and Medicine, Lancaster, UK
| | - Nigel A Cunliffe
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Department of Microbiology, Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, United Kingdom
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.,Field Service, National Infection Service, Public Health England, Liverpool, UK
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Tulloch JSP, Decraene V, Christley RM, Radford AD, Warner JC, Vivancos R. Characteristics and patient pathways of Lyme disease patients: a retrospective analysis of hospital episode data in England and Wales (1998-2015). BMC Public Health 2019; 19:931. [PMID: 31412819 PMCID: PMC6694565 DOI: 10.1186/s12889-019-7245-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
Background Lyme disease is a tick-borne disease of increasing global importance. There is scant information on Lyme disease patient demographics in England and Wales, and how they interact with the National Health Service (NHS). Our aims were to explore the demographic characteristics of Lyme disease patients within the Hospital Episode Statistics (HES) and Patient Episode Database for Wales (PEDW), and to describe patient pathways. Methods Data from 1st January 1998 to 31st December 2015 was retrieved from the two administrative hospital datasets (HES and PEDW), based on patients coded with Lyme disease. Information was collected on demographic characteristics, home address and case management. Incidence rates were calculated, and demographics compared to the national population. Results Within HES and PEDW, 2361 patients were coded with Lyme disease. There was a significant increase (p < 0.01) in incidence from 0.08 cases/100,000 in 1998, to 0.53 cases/100,000 in 2015. There was a bimodal age distribution, patients were predominantly female, white and from areas of low deprivation. New cases peaked annually in August, with higher incidence rates in southern central and western England. Within hospital admission data (n = 2066), most cases were either referred from primary care (28.8%, n = 596) or admitted via accident and emergency (A&E) (29.5%, n = 610). This population entering secondary care through A&E suggest a poor understanding of the recommended care pathways for symptoms related to Lyme disease by the general population. Conclusions These data can be used to inform future investigations into Lyme disease burden, and patient management within the NHS. They provide demographic information for clinicians to target public health messaging or interventions.
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Affiliation(s)
- John S P Tulloch
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK. .,Public Health England, Liverpool, L3 1DS, UK.
| | | | - Rob M Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Alan D Radford
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Jenny C Warner
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, SP4 0JQ, UK.,Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, SP4 0JQ, UK
| | - Roberto Vivancos
- Public Health England, Liverpool, L3 1DS, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Liverpool, L3 1DS, UK
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44
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Tulloch JSP, Semper AE, Brooks TJG, Russell K, Halsby KD, Christley RM, Radford AD, Vivancos R, Warner JC. The demographics and geographic distribution of laboratory-confirmed Lyme disease cases in England and Wales (2013-2016): an ecological study. BMJ Open 2019; 9:e028064. [PMID: 31362976 PMCID: PMC6677960 DOI: 10.1136/bmjopen-2018-028064] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Lyme disease is a tick-borne disease of increasing incidence and public concern across the Northern Hemisphere. However, the socio-demographics and geographic distribution of the population affected in England and Wales are poorly understood. Therefore, the proposed study was designed to describe the demographics and distribution of laboratory-confirmed cases of Lyme disease from a national testing laboratory. DESIGN An ecological study of routinely collected laboratory surveillance data. SETTING Public Health England's national Lyme disease testing laboratory. PARTICIPANTS 3986 laboratory-confirmed cases of Lyme disease between 2013 and 2016. RESULTS In England and Wales, the incidence of laboratory-confirmed Lyme disease rose significantly over the study period from 1.62 cases per 100 000 in 2013 to 1.95 cases per 100 000 in 2016. There was a bimodal age distribution (with peaks at 6-10 and 61-65 years age bands) with a predominance of male patients. A significant clustering of areas with high Lyme disease incidence was located in southern England. An association was found between disease incidence and socioeconomic status, based on the patient's resident postcode, with more cases found in less deprived areas. Cases were disproportionately found in rural areas compared with the national population distribution. CONCLUSIONS These results suggest that Lyme disease patients originate from areas with higher socioeconomic status and disproportionately in rural areas. Identification of the Lyme disease hotspots in southern England, alongside the socio-demographics described, will enable a targeted approach to public health interventions and messages.
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Affiliation(s)
- John S P Tulloch
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Field Epidemiology Service, Public Health England, Liverpool, UK
| | - Amanda E Semper
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, UK
| | - Tim J G Brooks
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, UK
| | | | - Kate D Halsby
- National Infection Service, Public Health England, London, UK
| | - Robert M Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Neston, UK
| | - Alan D Radford
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Neston, UK
| | - Roberto Vivancos
- Field Epidemiology Service, Public Health England, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Liverpool, UK
| | - Jenny C Warner
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, UK
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45
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McKerr C, Chalmers RM, Vivancos R, O'Brien SJ, Mugarza J, Christley RM. Cross-sectional investigation of household transmission of Cryptosporidium in England and Wales: the epiCrypt study protocol. BMJ Open 2019; 9:e026116. [PMID: 31230003 PMCID: PMC6596955 DOI: 10.1136/bmjopen-2018-026116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/08/2019] [Accepted: 05/23/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Infection with the Cryptosporidium parasite causes over 4000 cases of diagnosed illness (cryptosporidiosis) in England and Wales each year. Risk factors are often estimated from outbreak investigations, and in the UK include ingestion of contaminated water and food, farm/animal contact and person-to-person spread in institutions. However, reported outbreaks only represent about 10% of cases and the transmission routes for sporadic disease may not be the same. Contact with other people has been highlighted as a factor in the transmission of Cryptosporidium, but the incidence of sporadic disease has not been sufficiently established, and how frequently this arises from contact with other infected people is not well documented. This project will estimate the amount of secondary spread that occurs in the home and potentially identify asymptomatic infections which might have a role in transmission. Risk factors and characteristics associated with secondary spread will be described including any differences in transmission between Cryptosporidium species. METHODS AND ANALYSIS The study will prospectively identify cryptosporidiosis cases from North West England and Wales over 1 year and invite them and their household to take part. Each household will complete a questionnaire and each household member will be asked to provide a stool sample. Clinical, demographic and home variables will be described, and further analyses undertaken to investigate associations with secondary spread in the home. Cryptosporidium-positive stool samples, identified by immunofluorescence microscopy, will be characterised using molecular methods to describe patterns of transmission. Data collection is expected to take 1 year, beginning in September 2018. ETHICS AND DISSEMINATION The study has been approved by the North West-Liverpool East NHS Research Ethics Committee (Reference: 18/NW/0300) and the Confidentiality and Advisory Group (Reference 18/CAG/0084). Outputs will include scientific conferences and peer-reviewed publications. In addition, a short, lay report of findings will be produced for participants, who can opt to receive this when they take part. TRIAL REGISTRATION NUMBER CPMS ID: 39458.
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Affiliation(s)
- Caoimhe McKerr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Neston, UK
| | - Rachel M Chalmers
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, UK
- Swansea University Medical School, Swansea, UK
| | - Roberto Vivancos
- Field Epidemiology Services, Health Protection, Public Health England, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, The University of Liverpool, Liverpool, UK
| | - Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Julie Mugarza
- NIHR Clinical Research Network North West Coast, Liverpool, UK
| | - Robert M Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Neston, UK
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, UK
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Hungerford D, Allen DJ, Nawaz S, Collins S, Ladhani S, Vivancos R, Iturriza-Gómara M. Impact of rotavirus vaccination on rotavirus genotype distribution and diversity in England, September 2006 to August 2016. Euro Surveill 2019; 24:1700774. [PMID: 30755297 PMCID: PMC6373066 DOI: 10.2807/1560-7917.es.2019.24.6.1700774] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IntroductionRotavirus vaccination with the live-attenuated monovalent (a G1P[8] human rotavirus strain) two-dose Rotarix vaccine was introduced in England in July 2013. Since then, there have been significant reductions in rotavirus gastroenteritis incidence.AimWe assessed the vaccine's impact on rotavirus genotype distribution and diversity 3 years post-vaccine introduction.MethodsEpidemiological and microbiological data on genotyped rotavirus-positive samples between September 2006 and August 2016 were supplied by EuroRotaNet and Public Health England. Multinomial multivariable logistic regression adjusting for year, season and age was used to quantify changes in genotype prevalence in the vaccine period. Genotype diversity was measured using the Shannon's index (H') and Simpson's index of diversity (D).ResultsWe analysed genotypes from 8,044 faecal samples. In the pre-vaccine era, G1P[8] was most prevalent, ranging from 39% (411/1,057) to 74% (527/709) per year. In the vaccine era, G1P[8] prevalence declined each season (35%, 231/654; 12%, 154/1,257; 5%, 34/726) and genotype diversity increased significantly in 6-59 months old children (H' p < 0.001: D p < 0.001). In multinomial analysis, G2P[4] (adjusted multinomial odds ratio (aMOR): 9.51; 95% confidence interval (CI): 7.02-12.90), G3P[8] (aMOR: 2.83; 95% CI: 2.17-3.81), G12P[8] (aMOR: 2.46; 95% CI: 1.62-3.73) and G4P[8] (aMOR: 1.42; 95% CI: 1.02-1.96) significantly increased relative to G1P[8].ConclusionsIn the context of reduced rotavirus disease incidence, genotype diversity has increased, with a relative change in the dominant genotype from G1P[8] to G2P[4] after vaccine introduction. These changes will need continued surveillance as the number and age of vaccinated birth cohorts increase in the future.
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Affiliation(s)
- Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom,Field Epidemiology Services, National Infection Service, Public Health England, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - David J Allen
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sameena Nawaz
- Virus Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Sarah Collins
- Immunisation Department, National Infection Service, Public Health England, London, United Kingdom
| | - Shamez Ladhani
- Immunisation Department, National Infection Service, Public Health England, London, United Kingdom,NIHR Health Protection Research Unit in Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roberto Vivancos
- Field Epidemiology Services, National Infection Service, Public Health England, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Miren Iturriza-Gómara
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
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47
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Inns T, Clough HE, Harris JP, Vivancos R, Adams N, O'Brien SJ. Estimating the burden of care home gastroenteritis outbreaks in England, 2014-2016. BMC Infect Dis 2019; 19:12. [PMID: 30611217 PMCID: PMC6321657 DOI: 10.1186/s12879-018-3642-3] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Outbreaks of infectious gastroenteritis in care homes are common, with norovirus a frequent cause. In England there is no co-ordinated national surveillance system. We aimed to estimate the burden of these outbreaks. METHODS Using a generalised linear mixed effects regression model we described the relationship between the observed number of care home outbreaks and covariates. Estimated model parameters were used to infer uplift in the number of outbreaks expected if all areas were subjected to enhanced surveillance. From this we then estimated the total burden of care home gastroenteritis outbreaks in this period. RESULTS We estimated a total of 14,146 care home gastroenteritis outbreaks in England during 2014-2016; this is 47% higher than the reported total and a rate of 32.4 outbreaks per 100 care homes per year. The median number of outbreaks from the model estimates was 31 (IQR 20-46) compared to 19 (IQR 12-34) reported from routine surveillance. CONCLUSIONS This estimated care home gastroenteritis burden in England indicates that current surveillance substantially underestimates the number of outbreaks, by almost half. Improving this surveillance could provide better epidemiological knowledge of the burden of norovirus to inform public health policy, particularly with the advent of norovirus vaccines.
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Affiliation(s)
- Thomas Inns
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK. .,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK. .,National Infection Service, Public Health England, London, UK.
| | - Helen E Clough
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - John P Harris
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,National Infection Service, Public Health England, London, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Natalie Adams
- National Infection Service, Public Health England, London, UK
| | - Sarah J O'Brien
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
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48
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Hungerford D, Vivancos R, Read JM, Bonnett LJ, Bar-Zeev N, Iturriza-Gómara M, Cunliffe NA, French N. Mitigating bias in observational vaccine effectiveness studies using simulated comparator populations: Application to rotavirus vaccination in the UK. Vaccine 2018; 36:6674-6682. [PMID: 30293764 DOI: 10.1016/j.vaccine.2018.09.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/15/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Measuring vaccine effectiveness (VE) relies on the use of observational study designs. However, achieving robust estimates of direct and indirect VE is frequently compromised by bias, particularly when using syndromic diagnoses of low-specificity. METHODS In order to mitigate confounding between the measured outcome and vaccine uptake, we developed a method to balance comparator populations using individual-level propensity scoring derived from the vaccine-exposed population, and applied it to the unexposed comparator population. Indirect VE was estimated by comparing the unvaccinated vaccine-exposed group with a propensity score-simulated unvaccinated, unexposed group. Direct VE was derived by removing indirect VE from the overall VE. We applied this method to an evaluation of the effectiveness of infant rotavirus vaccination in the UK. Using a general practice cohort of 45,259 live births between May 2010 and December 2015, we calculated indirect and direct VE against consultations for acute gastroenteritis using conventional and vaccination-propensity adjustment comparator populations. RESULTS The overall VE during the rotavirus-season (January-May) calculated using mixed-effects Cox regression was 30% [95% confidence intervals (95% CI: 25,35%)]. Use of conventional comparator populations resulted in implausible VE estimates -14% (95% CI: -41,7%) for direct and 29% (95% CI: 14,42%) for indirect effects. Applying our alternative method, direct VE was 26% (95% CI: 1,45%) and indirect VE was 8% (95% CI: -19,29%). CONCLUSIONS Estimating VE using propensity score simulated comparator populations, particularly for studies using routine health data with syndromic, low-specificity endpoints will aid accurate measurement of the broader public health impact of a vaccine programme.
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Affiliation(s)
- Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK; Field Epidemiology Services, National Infection Service, Public Health England, Suite 3b, Third Floor, The Cunard Building, Water Street, Liverpool L3 1DS, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, The Farr Institute@HeRC, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
| | - Roberto Vivancos
- Field Epidemiology Services, National Infection Service, Public Health England, Suite 3b, Third Floor, The Cunard Building, Water Street, Liverpool L3 1DS, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, The Farr Institute@HeRC, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
| | - Jonathan M Read
- NIHR Health Protection Research Unit in Gastrointestinal Infections, The Farr Institute@HeRC, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK; Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK.
| | - Laura J Bonnett
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK.
| | - Naor Bar-Zeev
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, MD 21231, USA
| | - Miren Iturriza-Gómara
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, The Farr Institute@HeRC, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
| | - Nigel A Cunliffe
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
| | - Neil French
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
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Vaughan A, Aarons E, Astbury J, Balasegaram S, Beadsworth M, Beck CR, Chand M, O'Connor C, Dunning J, Ghebrehewet S, Harper N, Howlett-Shipley R, Ihekweazu C, Jacobs M, Kaindama L, Katwa P, Khoo S, Lamb L, Mawdsley S, Morgan D, Palmer R, Phin N, Russell K, Said B, Simpson A, Vivancos R, Wade M, Walsh A, Wilburn J. Two cases of monkeypox imported to the United Kingdom, September 2018. Euro Surveill 2018; 23:1800509. [PMID: 30255836 PMCID: PMC6157091 DOI: 10.2807/1560-7917.es.2018.23.38.1800509] [Citation(s) in RCA: 228] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 11/26/2022] Open
Abstract
In early September 2018, two cases of monkeypox were reported in the United Kingdom (UK), diagnosed on 7 September in Cornwall (South West England) and 11 September in Blackpool (North West England). The cases were epidemiologically unconnected and had recently travelled to the UK from Nigeria, where monkeypox is currently circulating. We describe the epidemiology and the public health response for the first diagnosed cases outside the African continent since 2003.
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Affiliation(s)
- Aisling Vaughan
- Emerging Infections and Zoonoses Section, National Infection Service, Public Health England, Colindale, London, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Emma Aarons
- Rare and Imported Pathogens Laboratory, Public Health England, Porton, Salisbury, United Kingdom
| | - John Astbury
- Field Service, National Infection Service, Public Health England, United Kingdom
| | - Sooria Balasegaram
- Field Service, National Infection Service, Public Health England, United Kingdom
| | - Mike Beadsworth
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
- University of Liverpool, Liverpool, United Kingdom, Liverpool, United Kingdom
| | - Charles R Beck
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Field Service, National Infection Service, Public Health England, United Kingdom
| | - Meera Chand
- National Infection Service, Public Health England, Colindale, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, United Kingdom
| | - Catherine O'Connor
- Emerging Infections and Zoonoses Section, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Jake Dunning
- National Infection Service, Public Health England, Colindale, London, United Kingdom
- Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sam Ghebrehewet
- Field Service, National Infection Service, Public Health England, United Kingdom
| | - Nick Harper
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | | | | | - Michael Jacobs
- Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Lukeki Kaindama
- Travel and Migrant Health Section, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Parisha Katwa
- Travel and Migrant Health Section, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Saye Khoo
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
- University of Liverpool, Liverpool, United Kingdom, Liverpool, United Kingdom
| | - Lucy Lamb
- Defence Medical Services, Ministry of Defence (MOD), United Kingdom
- Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sharon Mawdsley
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Dilys Morgan
- Emerging Infections and Zoonoses Section, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Ruth Palmer
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Nick Phin
- National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Katherine Russell
- Emerging Infections and Zoonoses Section, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Bengü Said
- Emerging Infections and Zoonoses Section, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Andrew Simpson
- Rare and Imported Pathogens Laboratory, Public Health England, Porton, Salisbury, United Kingdom
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Field Service, National Infection Service, Public Health England, United Kingdom
| | - Michael Wade
- Field Service, National Infection Service, Public Health England, United Kingdom
| | - Amanda Walsh
- Emerging Infections and Zoonoses Section, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Jennifer Wilburn
- Emerging Infections and Zoonoses Section, National Infection Service, Public Health England, Colindale, London, United Kingdom
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50
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McKerr C, O’Brien SJ, Chalmers RM, Vivancos R, Christley RM. Exposures associated with infection with Cryptosporidium in industrialised countries: a systematic review protocol. Syst Rev 2018; 7:70. [PMID: 29720280 PMCID: PMC5932784 DOI: 10.1186/s13643-018-0731-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cryptosporidium is a protozoan parasite of humans and other animals worldwide and is one of the greatest contributors to human diarrhoeal illness. Transmission can occur indirectly via contaminated food or water, or directly via contact with animals or other infected people. Risk exposures are often identified from outbreak investigations, but a subset of cases remains unexplained, and sources for sporadic disease and pathways to infection are still unclear. Given the few systematic syntheses of reported evidence in industrialised populations, the aim of this review is to consolidate the literature to describe exposures associated with human cryptosporidiosis in industrialised countries, specifically including the UK, and describe any differences between outbreak-associated and sporadic disease. METHODS/DESIGN Where relevant, methods will follow the recommendations made in the Cochrane Handbook for Systematic Reviews of Interventions. Three steps will be used to identify the literature including electronic database searching using PubMed, Scopus, Embase and Web of Science; reference list trawling; and an exploration of the grey literature. Screening of results will be undertaken by two reviewers using pre-defined criteria. Studies conducted in industrialised countries and reporting on human subjects will be included. All observational studies will be included where they report exposures and relevant quantitative results. Data will be extracted using a standardised form. Study quality will be assessed using the ROBINS-I tool. Data will be summarised presenting the papers' main findings including population under study, outcomes, and exposures, and whether these were considered outbreak or sporadic cases. A narrative summary will also be included. Where populations are appropriate, available data will be pooled in a meta-analysis combining the significant exposures across studies. DISCUSSION This review aims to consolidate the evidence for transmission routes and exposures for Cryptosporidium in industrialised countries, with particular reference to how these may apply to the UK. In addition, the review will seek to describe differences between outbreak and sporadic cases. This will help to identify those most vulnerable, highlighting pathways where interventions and public health response may be appropriate. SYSTEMATIC REVIEW REGISTRATION PROSPERO number CRD42017056589 .
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Affiliation(s)
- Caoimhe McKerr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, The University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Waterhouse Building (2nd Floor, Block F), 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Sarah J. O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Liverpool, UK
| | | | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, The University of Liverpool, Liverpool, UK
- Field Epidemiology Services, Public Health England, Liverpool, UK
| | - Robert M. Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, The University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Waterhouse Building (2nd Floor, Block F), 1-5 Brownlow Street, Liverpool, L69 3GL UK
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