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There is limited research on whether inequalities exist among individuals from different ethnicities and deprivation status among enteric fever cases. The aim of the study was to investigate the association between the enteric fever incidence rates, ethnicity and deprivation for enteric fever cases in England. Additionally, it was assessed if ethnicity and deprivation were associated with symptom severity, hospital admission and absence from school/work using logistic regression models. Incidence rates were higher in the two most deprived index of multiple deprivation quintiles and those of Pakistani ethnicity (9.89, 95% CI 9.08–10.75) followed by Indian (7.81, 95% CI 7.18–8.49) and Bangladeshi (5.68, 95% CI 4.74–6.76) groups: the incidence rate in the White group was 0.07 (95% CI 0.06–0.08). Individuals representing Pakistani (3.00, 95% CI 1.66–5.43), Indian (2.05, 95% CI 1.18–3.54) and Other/Other Asian (3.51, 95% CI 1.52–8.14) ethnicities had significantly higher odds of hospital admission than individuals representing White (British/Other) ethnicity, although all three groups had statistically significantly lower symptom severity scores. Our results show that there are significant ethnic and socioeconomic inequalities in enteric fever incidence that should inform prevention and treatment strategies. Targeted, community-specific public health interventions are needed to impact on overall burden.

Using laboratory data and a novel address matching methodology, we identified 734 cases of coronavirus disease in 88 prisons in England during March 16-October 12, 2020. An additional 412 cases were identified in prison staff and household members. We identified 84 prison outbreaks involving 86% of all prison-associated cases.

Background The UK, like a number of other countries, has a refugee resettlement programme. External factors, such as higher prevalence of infectious diseases in the country of origin and circumstances of travel, are likely to increase the infectious disease risk of refugees, but published data is scarce. The International Organization for Migration carries out and collates data on standardised pre-entry health assessments (HA), including testing for infectious diseases, on all UK refugee applicants as part of the resettlement programme. From this data, we report the yield of selected infectious diseases (tuberculosis (TB), HIV, syphilis, hepatitis B and hepatitis C) and key risk factors with the aim of informing public health policy. Methods We examined a large cohort of refugees (n = 18,418) who underwent a comprehensive pre-entry HA between March 2013 and August 2017. We calculated yields of infectious diseases stratified by nationality and compared these with published (mostly WHO) estimates. We assessed factors associated with case positivity in univariable and multivariable logistic regression analysis. Results The number of refugees included in the analysis varied by disease (range 8506–9759). Overall yields were notably high for hepatitis B (188 cases; 2.04%, 95% CI 1.77–2.35%), while yields were below 1% for active TB (9 cases; 92 per 100,000, 48–177), HIV (31 cases; 0.4%, 0.3–0.5%), syphilis (23 cases; 0.24%, 0.15–0.36%) and hepatitis C (38 cases; 0.41%, 0.30–0.57%), and varied widely by nationality. In multivariable analysis, sub-Saharan African nationality was a risk factor for several infections (HIV: OR 51.72, 20.67–129.39; syphilis: OR 4.24, 1.21–24.82; hepatitis B: OR 4.37, 2.91–6.41). Hepatitis B (OR 2.23, 1.05–4.76) and hepatitis C (OR 5.19, 1.70–15.88) were associated with history of blood transfusion. Syphilis (OR 3.27, 1.07–9.95) was associated with history of torture, whereas HIV (OR 1521.54, 342.76–6754.23) and hepatitis B (OR 7.65, 2.33–25.18) were associated with sexually transmitted infection. Syphilis was associated with HIV (OR 10.27, 1.30–81.40). Conclusions Testing refugees in an overseas setting through a systematic HA identified patients with a range of infectious diseases. Our results reflect similar patterns found in other programmes and indicate that the yields for infectious diseases vary by region and nationality. This information may help in designing a more targeted approach to testing, which has already started in the UK programme. Further work is needed to refine how best to identify infections in refugees, taking these factors into account. Electronic supplementary material The online version of this article (10.1186/s12916-018-1125-4) contains supplementary material, which is available to authorized users.

In December 2014, Ebola virus disease (EVD) was diagnosed in a healthcare worker in the United Kingdom after the worker returned from an Ebola treatment center in Sierra Leone. The worker flew on 2 flights during the early stages of disease. Follow-up of 238 contacts showed no evidence of secondary transmission of Ebola virus.

Background We describe trends of malaria in London (2000–2014) in order to identify preventive opportunities and we estimated the cost of malaria admissions (2009/2010–2014/2015). Methods We identified all cases of malaria, resident in London, reported to the reference laboratory and obtained hospital admissions from Hospital Episode Statistics. Results The rate of malaria decreased (19.4[2001]-9.1[2014] per 100,000). Males were over-represented (62%). Cases in older age groups increased overtime. The rate was highest amongst people of Black African ethnicity followed by Indian, Pakistani, Bangladeshi ethnicities combined (103.3 and 5.5 per 100,000, respectively). The primary reason for travel was visiting friends and relatives (VFR) in their country of origin (69%), mostly sub-Saharan Africa (92%). The proportion of cases in VFRs increased (32%[2000]-50%[2014]) and those taking chemoprophylaxis decreased (36%[2000]-14%[2014]). The overall case fatality rate was 0.3%. We estimated the average healthcare cost of malaria admissions to be just over £1 million per year. Conclusion Our study highlighted that people of Black African ethnicity, travelling to sub-Saharan Africa to visit friends and relatives in their country of origin remain the most affected with also a decline in chemoprophylaxis use. Malaria awareness should focus on this group in order to have the biggest impact but may require new approaches.

Summary Involuntary migration is a crucially important global challenge from an economic, social, and public health perspective. The number of displaced people reached an unprecedented level in 2015, at a total of 60 million worldwide, with more than 1 million crossing into Europe in the past year alone. Migrants and refugees are often perceived to carry a higher load of infectious diseases, despite no systematic association. We propose three important contributions that the global health community can make to help address infectious disease risks and global health inequalities worldwide, with a particular focus on the refugee crisis in Europe. First, policy decisions should be based on a sound evidence base regarding health risks and burdens to health systems, rather than prejudice or unfounded fears. Second, for incoming refugees, we must focus on building inclusive, cost-effective health services to promote collective health security. Finally, alongside protracted conflicts, widening of health and socioeconomic inequalities between high-income and lower-income countries should be acknowledged as major drivers for the global refugee crisis, and fully considered in planning long-term solutions.

Prior to 2007, Zika virus (ZIKV) was generally considered an arbovirus of limited importance, causing a mild self-limiting febrile illness in tropical Africa and Southeast Asia. Now, a large, ongoing outbreak of ZIKV that started in Brazil in early 2015 is spreading rapidly across the Americas and has been potentially linked to congenital malformations (including microcephaly) and Guillain–Barre syndrome (GBS). In England, as of 4 February 2016, five adults have been diagnosed with ZIKV infection following travel to countries currently experiencing a ZIKV outbreak. ZIKV was first isolated from a monkey employed as a sentinel animal in a yellow fever study in the Zika forest, near Entebbe, Uganda, in 1947.1 ZIKV is an RNA arbovirus belonging to the Flaviviridae family, which also includes dengue, Japanese encephalitis and West Nile viruses. The virus is transmitted by female Aedes mosquitoes, especially, Aedes aegypti , which is also an effective vector of dengue and chikungunya virus. Unlike many other mosquito vectors (eg, Anopheles spp. that transmit malaria), Aedes are predominantly day-biting mosquitoes. While the majority of human infections with ZIKV are likely to be acquired via mosquitoes, the virus has been detected in semen2 and blood donors who were asymptomatic at the time of donation,3 raising the possibility of sexual transmission and transmission through blood transfusion, respectively. Up to 80% of individuals infected with ZIKV remain asymptomatic and the remainder usually develop a mild self-limiting febrile illness lasting 4–7 days associated with maculopapular rash, arthralgia, conjunctivitis, itching, myalgia and headache. The infection is seldom severe enough to warrant hospitalisation and ZIKV-related deaths are very rarely reported and are mostly associated with underlying comorbidities. Most recently, a teenager with sickle cell disease in Colombia died after developing acute respiratory distress syndrome and hepatic necrosis.4 There is no vaccine to prevent ZIKV …

Approximately 13% of the UK population in 2015 was born overseas. Most migrants have come to the UK to work or study although there has been a small increase in the number of asylum applications in the UK in recent years, reflective of the ongoing humanitarian situation across Europe. Migrants in the UK tend to be young and healthy, but some may face unique health needs as a result of their experiences before, during and after migration. For these needs to be appropriately recognised and addressed, evidence-based advice is needed for UK professionals. The Migrant Health Guide is a free online tool for healthcare professionals. It was launched in 2011 and is widely used in the UK and internationally. It has four sections: 1) Migrants and the NHS—information on access and entitlements to the National Health Service (NHS); 2) Assessing patients—includes a checklist for initial healthcare assessments and advice for patients travelling abroad to visit friends and relatives; 3) Countries—country-specific advice on infectious diseases, women's health and nutritional and metabolic concerns; and 4) Health topics—information about communicable and non-communicable diseases and other health issues. The guide has undergone an extensive update in 2017. In particular, the pages on mental health and human trafficking have been expanded. A formal evaluation will obtain feedback on the guide and measure changes in awareness, knowledge, opinions, attitudes and behaviour of end users. Findings will inform future revisions and updates to the guide. Public Health England's Migrant Health Guide is a valuable resource for healthcare professionals. The relaunched guide builds on the previous version in raising awareness of key issues and providing evidence-based advice to improve the health of migrants and refugees internationally and in the UK.

Between 2000 and 2015, 904 cases of acute Q fever were reported in England and Wales. The case dataset had a male to female ratio of 2.5:1, and a median age of 45 years. Two outbreaks were recognised during this time period, and the incidence of sporadic cases was highest across the southwest of England, and Wales. There are limitations in the surveillance system for Q fever, including possible geographical differences in reporting and limited epidemiological data collection. The surveillance system needs to be strengthened in order to improve the quality and completeness of the epidemiological dataset. The authors conclude with recommendations on how to achieve this.

During the summers of 2015 and 2016, the United Kingdom experienced large outbreaks of cyclosporiasis in travellers returning from Mexico. As the source of the outbreaks was not identified, there is the potential for a similar outbreak to occur in 2017; indeed 78 cases had already been reported as at 27 July 2017. Early communication and international collaboration is essential to provide a better understanding of the source and extent of this recurring situation.

Cyclospora cayetanensis was identified in 176 returned travellers from the Riviera Maya region of Mexico between 1 June and 22 September 2015; 79 in the United Kingdom (UK) and 97 in Canada. UK cases completed a food exposure questionnaire. This increase in reported Cyclospora cases highlights risks of gastrointestinal infections through travelling, limitations in Cyclospora surveillance and the need for improved hygiene in the production of food consumed in holiday resorts.

SUMMARYA report on Toxoplasma gondii by the UK Advisory Committee on the Microbiological Safety of Food recommended that more accurate figures on the burden of disease in the UK are needed. We present the first 5 years of data from an enhanced surveillance scheme for toxoplasmosis in England and Wales. Between 2008 and 2012, 1824 cases were reported, with an average of 365 each year. There were 1109 immunocompetent cases, the majority presenting with lymphadenopathy, and 364 immunosuppressed cases, with central nervous system and systemic symptoms most frequently reported. There were also 190 pregnant and 33 congenital cases. Of the pregnant cases, 148 were asymptomatic (probably detected during screening), while 28 suffered a fetal loss or stillbirth. The enhanced surveillance system has led to an improvement in the detection of toxoplasmosis in England and Wales. However, numbers are still likely to be an underestimate, biasing towards the more severe infections.

Surveillance (derived from the French word surveiller, meaning to watch over) is the ‘ongoing scrutiny, generally using methods distinguished by their practicability, uniformity, and frequently their rapidity, rather than for complete accuracy. Its main purpose is to detect changes in trend or distribution in order to initiate investigative, (preventive) or control or measures’ (Last 1988).Understanding the burden and detecting changes in the incidence of human and animal infections utilises a number of surveillance mechanisms, which rely on voluntary and/or statutory reporting systems. These include international as well as national surveillance schemes for outbreaks of infectious disease and laboratory-confirmed infections, enhanced surveillance schemes for specificzoonoses and notification of specified infectious diseases.

In their editorial, Arnold and colleagues outline their view on what is needed to respond to the health needs of refugees resettling in the UK.1 They highlight the potentially complex health needs of this group and argue that clinicians in the UK need to be appropriately prepared. We fully agree and describe below the work that Public Health England (PHE) is engaged …

SIR, — Earlier this year European bat lyssavirus (eblv) type 2 — a rabies-like virus that can cause rabies in humans — was confirmed in an injured bat. Six bat handlers who had been involved in the care of the bat, and the private veterinary surgeon who had operated to remove the bat's wing