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Prisons are susceptible to outbreaks. Control measures focusing on isolation and cohorting negatively affect wellbeing. We present an outbreak of coronavirus disease 2019 (COVID-19) in a large male prison in Wales, UK, October 2020 to April 2021, and discuss control measures.We gathered case-information, including demographics, staff-residence postcode, resident cell number, work areas/dates, test results, staff interview dates/notes and resident prison-transfer dates. Epidemiological curves were mapped by prison location. Control measures included isolation (exclusion from work or cell-isolation), cohorting (new admissions and work-area groups), asymptomatic testing (case-finding), removal of communal dining and movement restrictions. Facemask use and enhanced hygiene were already in place. Whole-genome sequencing (WGS) and interviews determined the genetic relationship between cases plausibility of transmission.Of 453 cases, 53% ( n = 242) were staff, most aged 25-34 years (11.5% females, 27.15% males) and symptomatic (64%). Crude attack-rate was higher in staff (29%, 95% CI 26-64%) than in residents (12%, 95% CI 9-15%).Whole-genome sequencing can help differentiate multiple introductions from person-to-person transmission in prisons. It should be introduced alongside asymptomatic testing as soon as possible to control prison outbreaks. Timely epidemiological investigation, including data visualisation, allowed dynamic risk assessment and proportionate control measures, minimising the reduction in resident welfare.

Introduction: The 1998 National Health Service White Paper stated that anyone suspected of having a cancer would be seen by a specialist within two weeks. The 'trigger symptoms' prompting such referral have been nationally agreed by the National Institute for Health and Clinical Excellence. This study aimed to quantify the diagnostic yield of urgent referrals for suspected head and neck malignancy, and to identify reasons why patients ultimately diagnosed with malignancy may not have been referred via this pathway., Materials and Methods: All patients referred to the trust with suspected head and neck malignancy in 2005 were included in the study. Data were obtained on date of referral, date of appointment, reason for referral and which National Institute for Health and Clinical Excellence guideline heading the referral fell under, clinical findings, and final diagnosis. Concurrently, all patients in the trust with a histological diagnosis of head and neck malignancy were identified using the computer records of the pathology department., Results: One hundred and seventy-seven patients were referred with suspected head and neck malignancy over the one-year study period. Of these, 169 were seen within two weeks. The commonest causes of referral were hoarseness and neck lumps. Of these patients, 22 (12 per cent) were ultimately diagnosed with malignancy. During the one-year study period, 39 patients were diagnosed hospital-wide with head and neck malignancy, 17 of whom had not been referred via the urgent referral pathway. No unifying theme was identified to explain why these patients had not been referred via this pathway., Conclusion: In a group of patients with symptoms suggestive of head and neck malignancy, only 12 per cent were ultimately diagnosed with cancer. Of all the patients within the trust diagnosed with head and neck cancer, 44 per cent had come from outside the urgent referral pathway.