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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. Objectif Decrire la manifestation clinique, l'evolution de la maladie et la propension a recourir aux services de sante des premieres centaines de cas de maladie a coronavirus 2019 (COVID-19) au Royaume-Uni de Grande-Bretagne et d'Irlande du Nord. Methodes Nous avons applique le Protocole d'enquete sur la maladie a coronavirus 2019 (COVID-19)--les X premiers cas et contacts (FFX) publie par l'Organisation mondiale de la Sante. Des professionnels de la sante formes a cet effet ont collecte des informations sur 381 cas virologiquement confirmes de COVID-19 entre le 31 janvier 2020 et le 9 avril 2020. Nous avons etroitement surveille ces cas afin d'identifier la source d'exposition a l'infection, les symptomes observes et l'issue de la maladie. Nous avons egalement recolte des donnees sur 752 personnes symptomatiques testees negatives a la COVID-19 qui ont servi de groupe de controle pour analyser la sensibilite, la specificite et la valeur predictive des symptomes. Resultats Environ la moitie des cas de COVID-19 ont ete importes (196 cas; 51,4%), la majorite s'etant recemment rendue en Italie (140 cas; 71,4%). Sur les 94 (24,7%) cas secondaires, presque tous ont signale un contact rapproche avec un cas confirme (93 cas; 98,9%), generalement au sein de leur foyer (37 cas; 39,8%). Au niveau de l'age, la proportion d'enfants ayant contracte la COVID-19 etait moindre. La plupart des cas avaient de la toux, de la fievre et de la fatigue. La sensibilite et la specificite des symptomes variaient en fonction de l'age, presentant une relation non lineaire avec cet element. Plus l'age des cas de COVID-19 avancait, plus ils etaient susceptibles de developper de la fievre, a l'exception de ceux touches par d'autres infections respiratoires. Le risque d'essoufflement augmentait lui aussi avec l'age chez une grande partie des cas de COVID-19. Conclusion Cette etude a apporte un eclairage utile dans l'etablissement d'une definition des cas. Elle a egalement fourni, pour diverses modelisations, des indications sur la charge que pourrait faire peser la COVID-19. Objetivo Describir la presentacion clinica, el curso de la enfermedad y el comportamiento de busqueda de atencion sanitaria de los primeros cientos de casos de la enfermedad del coronavirus de 2019 (COVID-19) en Reino Unido e Irlanda del Norte. Metodos Implementamos el protocolo de investigacion de los primeros casos y contactos de la Organizacion Mundial de la Salud para la COVID-19. Profesionales expertos en el area de la salud publica recopilaron informacion sobre 381 casos virologicamente confirmados de COVID-19 entre el 31 de enero de 2020 y el 9 de abril de 2020. Realizamos un seguimiento activo de los casos para identificar la exposicion a la infeccion, los sintomas y los resultados. Tambien recogimos datos limitados sobre 752 personas sintomaticas que dieron negativo en los resultados de la COVID-19, como grupo de control para el analisis de la sensibilidad, la especificidad y el valor predictivo de los sintomas. Resultados Casi la mitad de los casos de COVID-19 fueron importados (196 casos; 51,4%), de los cuales la mayoria habia hecho un viaje reciente a Italia (140 casos; 71,4%). De los 94 (24,7%) casos secundarios, casi todos informaron de un contacto cercano con un caso confirmado (93 casos; 98,9%), muchos de ellos a traves del contacto con el hogar (37 casos; 39,8%). Por edad, una proporcion menor de ninos tenia COVID-19. La mayoria de los casos se presentaban con tos, fiebre y fatiga. La sensibilidad y especificidad de los sintomas variaba segun la edad, con relaciones no lineales con la edad. Aunque la proporcion de casos de COVID-19 con fiebre aumentaba con la edad, en el caso de los que tenian otras infecciones respiratorias la aparicion de fiebre disminuia con la edad. La incidencia de la falta de aliento tambien aumento con la edad en una mayor proporcion de casos de COVID-19. Conclusion El estudio ha aportado pruebas utiles para generar definiciones de casos y tambien ha servido de base a los estudios de modelizacion del probable coste de la COVID-19., Introduction The World Health Organization (WHO) recommended that Member States implement their established First Few X enhanced surveillance protocol (1) to investigate the clinical and epidemiological characteristics of at least [...]

Introduction: The introduction of a national evaluation of newborn screening for Severe Combined Immunodeficiency (SCID) in England triggered a change to the selective Bacillus Calmette-Guerin (BCG) vaccination programme delivery pathway, as this live attenuated vaccine is contraindicated in infants with SCID. The neonatal BCG vaccination programme is a targeted programme for infants at increased risk of tuberculosis and used to be offered shortly after birth. Since September 2021 the BCG vaccine is given to eligible infants within 28 days of birth, when the SCID screening outcome is available. We explore the experiences of those implementing the new pathway, and how they made sense of, engaged with, and appraised the change. Methods: A mixed-methods evaluation was conducted between October 2022 and February 2023. This involved national online surveys with BCG commissioners and providers and qualitative semi-structured interviews with commissioners, providers, and Child Health Information System stakeholders in two urban areas. Survey data was analysed using descriptive statistics and interview data was analysed thematically. The data was triangulated using Normalization Process Theory as a guiding framework. Results: Survey respondents (n = 65) and qualitative interviewees (n = 16) revealed that making sense of the new pathway was an iterative process. Some expressed a desire for more direction on how to implement the new pathway. The perceived value of the change varied from positive, ambivalent, to concerned. Some felt well-prepared and that improvements to data capture, eligibility screening, and accountably brought by the change were valuable. Others were concerned about the feasibility of the 28-day target, reductions in vaccination coverage, increased resource burden, and the outcome of the SCID evaluation. New collaborations and communities of practice were required to facilitate the change. Three main challenges in implementing the pathway and meeting the 28-day vaccination target were identified: appointment non-attendance; appointment and data systems; and staffing and resourcing. Feedback mechanisms were informal and took place in tandem with implementation. Conclusion: The new NHS neonatal BCG service specification has created an effective structure for monitoring and managing the BCG vaccination programme, but further work is required to support delivery of the 28-day vaccination target and improve uptake rates. [ABSTRACT FROM AUTHOR]

Objective To illustrate how data triangulation involving routine data sources can optimize data usage and provide insights into vaccine programme effectiveness by considering measles vaccination and disease incidence data in England. Methods We obtained data on measles, mumps and rubella (MMR) vaccine coverage in birth cohorts from 1985 to 2016 from child health records and adjusted for under-ascertainment and catch-up campaigns. We assumed that the population had no natural immunity and that vaccine effectiveness was 95% for one dose and 99.75% for two doses. Vaccinations done outside the routine schedule and in people who entered England after the age of immunization were identified from primary care records. Measles susceptibility was defined as the percentage of individuals who were not immune despite all vaccination activities. We triangulated measles susceptibility and incidence data. Findings Median susceptibility was 4.6% (range: 1.2--9.2). Among cohorts eligible for two MMR vaccine doses, those born between 1998 and 2004 were most susceptible. Measles incidence was highest in these cohorts. Data from primary care and child health records were comparable for cohorts after 2000, suggesting that little supplementary vaccination took place. For cohorts before 2000, primary care data quality was insufficient for accurately estimating coverage. Conclusion Triangulating routine data on measles vaccination coverage and disease surveillance provided new insights into population immunity and helped identify vulnerable groups, which was useful for prioritizing public health actions to close gaps in immunity. This approach could be applied in any country that routinely records vaccine coverage and disease incidence. Objectif Illustrer comment la triangulation des donnees incluant des sources de donnees ordinaires peut optimiser l'utilisation des donnees et donner une idee de l'efficacite du programme de vaccination en considerant des donnees relatives a la vaccination contre la rougeole et a l'incidence de la maladie en Angleterre. Methodes Nous avons obtenu des donnees sur la couverture vaccinale contre la rougeole, les oreillons et la rubeole dans les cohortes de naissances de 1985 a 2016 a partir des dossiers medicaux des enfants et nous les avons ajustees en fonction de la sous-determination et des campagnes de rattrapage. Nous sommes partis du principe que la population n'avait pas d'immunite naturelle et que l'efficacite du vaccin etait de 95% pour une dose et de 99,75% pour deux doses. Les vaccinations pratiquees en dehors du calendrier habituel et chez des personnes entrees en Angleterre apres l'age de vaccination ont ete identifies a partir des dossiers relatifs aux soins primaires. La sensibilite a la rougeole a ete definie comme le pourcentage d'individus qui n'etaient pas immunises malgre toutes les activites de vaccination. Nous avons triangule les donnees relatives a la sensibilite a la rougeole et a l'incidence de la rougeole. Resultats La sensibilite mediane etait de 4,6% (etendue: 1,2-9,2). Parmi les cohortes pouvant beneficier de deux doses de vaccins ROR, celles nees entre 1998 et 2004 etaient les plus sensibles. Lincidence de la rougeole etait plus elevee dans ces cohortes. Les donnees tirees des dossiers relatifs aux soins primaires et des dossiers medicaux des enfants etaient comparables pour les cohortes ulterieures a 2000, ce qui laisse entendre que peu de vaccinations supplementaires ont ete pratiquees. Dans le cas des cohortes anterieures a 2000, la qualite des donnees sur les soins primaires etait insuffisante pour permettre une estimation precise de la couverture. Conclusion La triangulation des donnees ordinaires sur la couverture vaccinale antirougeoleuse et la surveillance de la maladie a jete une lumiere nouvelle sur l'immunite de la population et aide a identifier les groupes vulnerables, ce qui a permis d'etablir l'ordre de priorite des actions de sante publique destinees a combler les lacunes en matiere d'immunite. Cette approche pourrait etre appliquee dans tous les pays qui enregistrent systematiquement la couverture vaccinale et l'incidence de la maladie. Objetivo Ilustrar como la triangulacion de datos con fuentes rutinarias de datos puede optimizar el uso de los mismos y proporcionar informacion sobre la eficacia de los programas de vacunacion al considerar la vacunacion contra el sarampion y los datos de incidencia de la enfermedad en Inglaterra. Metodos Se obtuvieron datos sobre la cobertura de la vacuna contra el sarampion, las paperas y la rubeola (SPR) en las cohortes de nacimiento de 1985 a 2016 a partir de los registros de salud infantil y se ajustaron para tener en cuenta las campanas de recuperacion y de los errores por la falta de observaciones. Se asumio que la poblacion no tenia inmunidad natural y que la efectividad de la vacuna era del 95 % para una dosis y del 99,75 % para dos dosis. Las vacunas realizadas fuera del horario de rutina y en personas que ingresaron a Inglaterra despues de la edad de vacunacion fueron identificadas en los registros de atencion primaria. La susceptibilidad al sarampion se definio como el porcentaje de individuos que no eran inmunes a pesar de todas las actividades de vacunacion. Se triangularon los datos de susceptibilidad e incidencia del sarampion. Resultados La mediana de susceptibilidad fue de 4,6 % (rango: 1,29,2). Entre las cohortes elegibles para dos dosis de la vacuna triple viral, las que nacieron entre 1998 y 2004 fueron las mas susceptibles. La incidencia de sarampion fue mayor en estas cohortes. Los datos de los registros de atencion primaria y de salud infantil fueron comparables para las cohortes despues de 2000, lo que sugiere que se realizo muy poca vacunacion suplementaria. Para las cohortes anteriores a 2000, la calidad de los datos de atencion primaria fue insuficiente para estimar con precision la cobertura. Conclusion La triangulacion de los datos de rutina sobre la cobertura de la vacunacion contra el sarampion y la vigilancia de las enfermedades proporciono nueva informacion sobre la inmunidad de la poblacion y ayudo a identificar a los grupos vulnerables, lo que resulto util para establecer prioridades en las medidas de salud publica a fin de subsanar las deficiencias en materia de inmunidad. Este enfoque podria aplicarse en cualquier pais que registre de forma rutinaria la cobertura de la vacuna y la incidencia de la enfermedad., Introduction A considerable amount of immunization coverage and surveillance data are available nationally, regionally and globally. (1) Often, however, these data could be better used to aid decision-making on national [...]

During 2014, England and Wales had a sharp increase in the incidence of scarlet fever, which by 2016 had reached 33.2 cases/100,000 person-years, the highest rate in almost 50 years [...]