Viral respiratory infections at the Hajj: comparison between UK and Saudi pilgrims

A high incidence of respiratory infection, including influenza, has been reported at the Hajj in Mecca, Saudi Arabia. Reported rates of influenza have been higher among UK than among domestic pilgrims, but this could be explained by methodological differences among studies. Accordingly, the present study compared the frequencies of respiratory viruses among UK and Saudi pilgrims using the same study design. Pilgrims with upper respiratory tract symptoms were recruited from Mecca and the neighbouring valley Mina during the Hajj 2006. Nasal swabs were used for point-of-care influenza testing and real-time RT-PCR (rtRT-PCR) tests for influenza virus, rhinovirus, parainfluenza virus, adenovirus, human metapneumovirus and respiratory syncytial virus. Of 260 pilgrims investigated, 150 were from the UK and 110 were Saudi; of these, 38 (25%) UK pilgrims and 14 (13%) Saudi pilgrims had respiratory infections detectable by rtRT-PCR (p 0.01). In the UK group, there were 19 (13%) cases of rhinovirus infection, 15 (10%) cases of influenza virus infection, two (1%) cases of dual infections with influenza virus and rhinovirus, one (3%) case of parainfluenza virus infection, and one (1%) case of respiratory syncytial virus infection. Fifty-six (37%) UK pilgrims had been vaccinated against influenza virus, with the rates of influenza in the vaccinated and unvaccinated group being 7% and 14%, respectively (p 0.19). In the Saudi group, there were three (3%) cases of rhinovirus infection and 11 (10%) cases of influenza. Only four (4%) Saudi pilgrims had been vaccinated against influenza virus, and none of these was infected with influenza virus. Overall, a significantly higher proportion of the UK pilgrims had detectable respiratory infections (25% vs. 13%, p 0.01). Influenza rates were similar in both groups, but the reported rates of influenza vaccination differed.

Influenza and respiratory syncytial virus infections in British Hajj pilgrims

Viral respiratory infections including influenza and respiratory syncytial virus (RSV) have been reported during the Hajj among international pilgrims. To help establish the burden of these infections at the Hajj, we set up a study to confirm these diagnoses in symptomatic British pilgrims who attended the 2005 Hajj. UK pilgrims with symptoms of upper respiratory tract infection (URTI) were invited to participate; after taking medical history, nasal swabs were collected for point-of-care testing (PoCT) of influenza and for subsequent PCR analysis for influenza and RSV. Of the 205 patients recruited, 37 (18%) were positive for either influenza or RSV. Influenza A (H3) accounted for 54% (20/37) of the virus-positive samples, followed by RSV 24% (9/37), influenza B 19% (7/37), and influenza A (H1) 3% (1/37). Of the influenza-positive cases, 29% (8/28) had recently had a flu immunisation. Influenza was more common in those who gave a history of contact with a pilgrim with a respiratory illness than those who did not (17 versus 9%). The overall rate of RSV was 4% (9/202). This study confirms that influenza and RSV cause acute respiratory infections in British Hajj pilgrims. Continuing surveillance and a programme of interventions to contain the spread of infection are needed at the Hajj, particularly when the world is preparing for an influenza pandemic.

Contact tracing following exposure to measles at a wedding party in the United Kingdom, October 2007

On 22 October 2007, a case of suspected measles in an unvaccinated two-year-old was notified to Thames Valley Health Protection Unit by North East and North Central London Health Protection Unit.

Plutonium and americium inventories in atmospheric fallout and sediment cores from Blelham Tarn, Cumbria (UK)

The objective of this paper is to report on the results of a study of 238Pu, 239 + 240Pu and 241Am inventories onto Blelham Tarn in Cumbria (UK). The atmospheric fallout inventory was obtained by analysing soil cores and the results are in good agreement with the literature: 101 Bq m(-2) for 239 + 240Pu; 4.5 Bq m(-2) for 238Pu and 37 Bq m(-2) for 241Am. The sediment core inventory for the whole lake is compared to the atmospheric fallout inventory. The sediment activity is 60-80% higher than the estimated fallout activity, showing a catchment area contribution and in particular the stream input.

The duff, no duff casualty

A patient who presented with "hyperventilation syndrome" was initially mis-treated as severe crush injury, illustrating the need for thorough assessment of all casualties whilst on exercise prior to arranging casualty treatment and evacuation.

Management of asplenic patients in South Buckinghamshire: an audit of local practice

People without spleens have an increased risk of pneumococcal and other infections. Immunisation is advised for this group of patients, but the role of prophylactic antibiotics remains unresolved. Since 1992, general practitioners in South Buckinghamshire have been encouraged to immunise all asplenic patients against infections with Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b (Hib). In addition, an 'alert' card, similar in principle to a medical warning bracelet, has been produced for general practitioners to issue to asplenic patients. General practitioners' clinical records of 293 asplenic patients were subsequently examined to evaluate this programme and assess the use of prophylactic antibiotics. Uptakes of 91%, 80%, and 79% were achieved for vaccines against pneumococcal, meningococcal, and Hib infections, respectively. Twenty-three per cent of patients had been advised immediately after splenectomy to take prophylactic antibiotics. Prophylaxis was advised for different periods of time, particularly in children. Thirty-four different antibiotic regimens had been recommended for adults. Clinical records suggested that 9% of patients were taking antibiotic prophylaxis at the time of the analysis. 'Alert' cards had been distributed to 88% of patients who were eligible. It is likely that most districts within the United Kingdom could set up similar immunisation and 'alert' card programmes. The wide variation in recommendations for antibiotic prophylaxis highlights the need for further research and the development of national guidelines.

A re-evaluation of the pour plate blood culture method for the detection of Candida and other septicaemias

Over a 1-year period the use of a pour plate in detecting significant septicaemias due to bacteria and fungi was evaluated and compared with a conventional broth blood culture system. Of 207 significant bacterial blood culture isolates only 113 (56%) were detected by the pour plate. However, three out of four candidaemias were detected by the pour plate method alone. Despite its low positivity rate, the pour plate is cheap and allows for early detection of bacteraemia and candidaemia.