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The speciation of both redox reactive and volatile selenium (Se) compounds, barely reported in pristine aquatic environments, has never been investigated in remote alpine lakes, considered as sensitive ecosystems to detect the effect of global change. This work presents an integrated investigation on Se distribution and speciation conducted in 20 high altitude pristine lakes from the central-western Pyrenees. Five seasonal sampling campaigns were carried out after snowmelt (June/July) and in early fall (October) for the period 2017-2019. Concentrations of total dissolved Se (TDSe) ranged from 7 to 78 ng L -1 , with selenate being ubiquitously observed in most cases (median of 61% of TDSe). Selenite was only occasionally detected up to 4 ng L -1 , therefore a fraction of TDSe was presumably in the forms of elemental Se(0) and/or selenides. Depth profiles obtained in different lakes showed the occurrence of such Se(-II, 0) pools in bottom hypoxic to anoxic waters. The production of volatile Se compounds presented a low median total concentration (TVSe) of 33 pg L -1 (range 3-120 pg L -1 ), mainly in the form of dimethylselenide in subsurface samples (median of 82% of TVSe). The Se concentration in lake waters was significantly correlated with the sulphate concentration ( ρ = 0.93, p < 0.0001), demonstrating that it is influenced by erosion and dissolution of Se and S-enriched parent bedrocks. In addition, for Se depleted alpine lake-bedrock systems, long-range transport and wet atmospheric depositions represent a major source of Se for lake waters.

Background: We aimed to quantify the unknown losses in health-related quality of life of coronavirus disease 2019 (COVID-19) cases using quality-adjusted lifedays (QALDs) and the recommended EQ-5D instrument in England., Methods: Prospective cohort study of nonhospitalized, polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus 2-positive (SARS-CoV-2-positive) cases aged 12-85 years and followed up for 6 months from 1 December 2020, with cross-sectional comparison to SARS-CoV-2-negative controls. Main outcomes were QALD losses; physical symptoms; and COVID-19-related private expenditures. We analyzed results using multivariable regressions with post hoc weighting by age and sex, and conditional logistic regressions for the association of each symptom and EQ-5D limitation on cases and controls., Results: Of 548 cases (mean age 41.1 years; 61.5% female), 16.8% reported physical symptoms at month 6 (most frequently extreme tiredness, headache, loss of taste and/or smell, and shortness of breath). Cases reported more limitations with doing usual activities than controls. Almost half of cases spent a mean of £18.1 on nonprescription drugs (median: £10.0), and 52.7% missed work or school for a mean of 12 days (median: 10). On average, all cases lost 13.7 (95% confidence interval [CI]: 9.7, 17.7) QALDs, whereas those reporting symptoms at month 6 lost 32.9 (95% CI: 24.5, 37.6) QALDs. Losses also increased with older age. Cumulatively, the health loss from morbidity contributes at least 18% of the total COVID-19-related disease burden in the England., Conclusions: One in 6 cases report ongoing symptoms at 6 months, and 10% report prolonged loss of function compared to pre-COVID-19 baselines. A marked health burden was observed among older COVID-19 cases and those with persistent physical symptoms., (© Crown copyright 2022.)

Competing Interests: Competing interests: ET and JS are employees of the UK HSA. AM is an honorary consultant in public health with the UK HSA.

Objective: To determine characteristics associated with COVID-19 vaccine coverage among individuals aged 50 years and above in England since the beginning of the programme., Design: Observational cross-sectional study assessed by logistic regression and mean prevalence margins., Setting: COVID-19 vaccinations delivered in England from 8 December 2020 to 17 May 2021., Participants: 30 624 257/61 967 781 (49.4%) and 17 360 045/61 967 781 (28.1%) individuals in England were recorded as vaccinated in the National Immunisation Management System with a first dose and a second dose of a COVID-19 vaccine, respectively., Interventions: Vaccination status with COVID-19 vaccinations., Main Outcome Measures: Proportion, adjusted ORs and mean prevalence margins for individuals not vaccinated with dose 1 among those aged 50-69 years and dose 1 and 2 among those aged 70 years and above., Results: Of individuals aged 50 years and above, black/African/Caribbean ethnic group was the least likely of all ethnic groups to be vaccinated with dose 1 of the COVID-19 vaccine. However, of those aged 70 years and above, the odds of not having dose 2 was 5.53 (95% CI 5.42 to 5.63) and 5.36 (95% CI 5.29 to 5.43) greater among Pakistani and black/African/Caribbean compared with white British ethnicity, respectively. The odds of not receiving dose 2 was 1.18 (95% CI 1.16 to 1.20) higher among individuals who lived in a care home compared with those who did not. This was the opposite to that observed for dose 1, where the odds of being unvaccinated was significantly higher among those not living in a care home (0.89 (95% CI 0.87 to 0.91))., Conclusions: We found that there are characteristics associated with low COVID-19 vaccine coverage. Inequalities, such as ethnicity are a major contributor to suboptimal coverage and tailored interventions are required to improve coverage and protect the population from SARS-CoV-2., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In March 2020, England went into its first lockdown in response to the COVID-19 pandemic. Restrictions eased temporarily, followed by second and third waves in October 2020 and January 2021. Recent data showed that the COVID-19 pandemic resulted in reduced transmission of some invasive diseases. We assess the impact of the COVID-19 pandemic on pertussis incidence and on the immunisation programme in England., Methods: We assessed trends in pertussis cases from 2012 to 2020 by age group and month. Incidence from the time that England eased its initial lockdown measures in July 2020 through to summer 2021 was calculated and the incidence rate ratios of pertussis cases from five years prior to the pandemic (July 2014 - June 2019) compared to the same time period during the pandemic (July 2020 - June 2021). Vaccine coverage estimates for pertussis containing vaccines were reviewed for the maternal and childhood programmes., Results: A substantial decline in pertussis cases was observed from April 2020 onwards, marking the lowest number of cases in the last decade. Pertussis incidence dropped in all age groups, particularly among infants less than one year old (0.50 / 100,000 during July 2020 to June 2021 compared to 24.49/ 100,000 from July 2014 to June 2019). The incidence rate ratio was 0.02 (95% CI 0.01 to 0.02) for July 2014 to June 2019 (pre-pandemic) compared to the pandemic period of July 2020 to June 2021. None of the cases had a co-infection with SARS-CoV-2. Vaccine coverage for infants born between January to March 2020 with three doses of pertussis vaccine by 12 months of age decreased by 1.1% points compared to infants born between January to March 2019 (91.6% and 92.7%, respectively). Prenatal pertussis coverage for the 2020 to 2021 financial year was 2.7% points lower than the year prior to the pandemic (70.5% and 76.8%, respectively)., Conclusions: Lockdown measures due to the COVID-19 pandemic have had a significant impact on pertussis transmission. With the easing of restrictions it is important to continue monitoring pertussis cases in England alongside coverage of the maternal and childhood immunisation programmes., (© 2022. The Author(s).)

Background: In 2020, the SARS-CoV-2 (COVID-19) pandemic and lockdown control measures threatened to disrupt routine childhood immunisation programmes with early reports suggesting uptake would fall. In response, public health bodies in Scotland and England collected national data for childhood immunisations on a weekly or monthly basis to allow for rapid analysis of trends. The aim of this study was to use these data to assess the impact of different phases of the pandemic on infant and preschool immunisation uptake rates., Methods and Findings: We conducted an observational study using routinely collected data for the year prior to the pandemic (2019) and immediately before (22 January to March 2020), during (23 March to 26 July), and after (27 July to 4 October) the first UK "lockdown". Data were obtained for Scotland from the Public Health Scotland "COVID19 wider impacts on the health care system" dashboard and for England from ImmForm. Five vaccinations delivered at different ages were evaluated; 3 doses of "6-in-1" diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B vaccine (DTaP/IPV/Hib/HepB) and 2 doses of measles, mumps, and rubella (MMR) vaccine. This represented 439,754 invitations to be vaccinated in Scotland and 4.1 million for England. Uptake during the 2020 periods was compared to the previous year (2019) using binary logistic regression analysis. For Scotland, uptake within 4 weeks of a child becoming eligible by age was analysed along with geographical region and indices of deprivation. For Scotland and England, we assessed whether immunisations were up-to-date at approximately 6 months (all doses 6-in-1) and 16 to 18 months (first MMR) of age. We found that uptake within 4 weeks of eligibility in Scotland for all the 5 vaccines was higher during lockdown than in 2019. Differences ranged from 1.3% for first dose 6-in-1 vaccine (95.3 versus 94%, odds ratio [OR] compared to 2019 1.28, 95% confidence intervals [CIs] 1.18 to 1.39) to 14.3% for second MMR dose (66.1 versus 51.8%, OR compared to 2019 1.8, 95% CI 1.74 to 1.87). Significant increases in uptake were seen across all deprivation levels. In England, fewer children due to receive their immunisations during the lockdown period were up to date at 6 months (6-in-1) or 18 months (first dose MMR). The fall in percentage uptake ranged from 0.5% for first 6-in-1 (95.8 versus 96.3%, OR compared to 2019 0.89, 95% CI 0.86- to 0.91) to 2.1% for third 6-in-1 (86.6 versus 88.7%, OR compared to 2019 0.82, 95% CI 0.81 to 0.83). The use of routinely collected data used in this study was a limiting factor as detailed information on potential confounding factors were not available and we were unable to eliminate the possibility of seasonal trends in immunisation uptake., Conclusions: In this study, we observed that the national lockdown in Scotland was associated with an increase in timely childhood immunisation uptake; however, in England, uptake fell slightly. Reasons for the improved uptake in Scotland may include active measures taken to promote immunisation at local and national levels during this period and should be explored further. Promoting immunisation uptake and addressing potential vaccine hesitancy is particularly important given the ongoing pandemic and COVID-19 vaccination campaigns., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: AS is a member of the Scottish Government Chief Medical Officer’s COVID-19 Advisory Group. AS is a member of the Editorial Board of PLOS Medicine. HB is a member of the NICE committee developing guidance on increasing vaccine uptake. CRS declares funding from the Medical Research Council, the National Institute for Health Research, Chief Scientist Office, and New Zealand Ministry for Business, Innovation and Employment and Health Research Council during the conduct of this study. All other authors declare no competing interests.

Photochemical reactions are major pathways for the removal of Hg species from aquatic ecosystems, lowering the concentration of monomethylmercury (MMHg) and its bioaccumulation in foodwebs. Here, we investigated the rates and environmental drivers of MMHg photodegradation and inorganic Hg (IHg) photoreduction in waters of two high-altitude lakes from the Bolivian Altiplano representing meso- to eutrophic conditions. We incubated three contrasting waters in situ at two depths after adding Hg-enriched isotopic species to derive rate constants. We found that transformations mostly occurred in subsurface waters exposed to UV radiation and were mainly modulated by the dissolved organic matter (DOM) level. In parallel, we incubated the same waters after the addition of low concentrations of natural MMHg and followed the stable isotope composition of the remaining Hg species by compound-specific isotope analysis allowing the determination of enrichment factors and mass-independent fractionation (MIF) slopes (Δ 199 Hg/Δ 201 Hg) during in situ MMHg photodegradation in natural waters. We found that MIF enrichment factors potentially range from -11 to -19‰ and average -14.3 ± 0.6‰ (1 SE). The MIF slope diverged depending on the DOM level, ranging from 1.24 ± 0.03 to 1.34 ± 0.02 for the low and high DOM waters, respectively, and matched the MMHg MIF slope recorded in fish from the same lake. Our in situ results thus reveal (i) a relatively similar extent of Hg isotopic fractionation during MMHg photodegradation among contrasted natural waters and compared to previous laboratory experiments and (ii) that the MMHg MIF recorded in fish is characteristic for the MMHg bonding environment. They will enable a better assessment of the extent and conditions conducive to MMHg photodegradation in aquatic ecosystems.

Objective: To identify risk factors for a woman to experience pregnancy denial., Design, Setting and Population: A French multicentric prospective case-control study with 71 mother-infant dyads having experienced a pregnancy denial versus a control group of 71 dyads., Methods: Data were collected in the week after delivery using an observational leaflet and two psychiatric scales (MINI and QSSP)., Main Outcome Measures: Statistically significant differences between the two groups regarding social, demographic, medical and psychiatric data., Results: Not being in a stable relationship (odds ratio [OR] 17.18, 95% CI 3.37-87.60]; P < 0.0001), not having a high school diploma (OR 1.11, 95% CI 1.04-1.38]; P < 0.0001) and having a psychiatric history (OR 6.33, 95% CI 1.62-24.76; P = 0.0002) were risk factors to experience pregnancy denial, whereas being older was a protective factor (OR 0.86, 95% CI 0.79-0.93; P = 0.0054) (logistic regression, Wald 95% CI). Other risk factors included late declarations of pregnancy history and past pregnancy denials (case n = 7, 9.7% versus 0% in controls; P = 0.01), past pregnancy denials in the family (case n = 13, 18% versus control n = 4, 5.6%; P = 0.03), and use of a contraceptive method (75% for cases versus 7% in control; P < 0.0001), primarily an oral contraceptive (75%)., Conclusion: Family or personal history of pregnancy denial should be part of the systematic anamnesis during the first visit of a patient of child-bearing age. Further, our study points out that life context (young age, single status, socio-economic precarity, pill-based contraception) could be a trigger for pregnancy denial in certain women., Tweetable Abstract: Life context can be a trigger for pregnancy denial., (© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Background: Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), have been used since December 2020 in the United Kingdom. Real-world data have shown the vaccines to be highly effective against Covid-19 and related severe disease and death. Vaccine effectiveness may wane over time since the receipt of the second dose of the ChAdOx1-S (ChAdOx1 nCoV-19) and BNT162b2 vaccines., Methods: We used a test-negative case-control design to estimate vaccine effectiveness against symptomatic Covid-19 and related hospitalization and death in England. Effectiveness of the ChAdOx1-S and BNT162b2 vaccines was assessed according to participant age and status with regard to coexisting conditions and over time since receipt of the second vaccine dose to investigate waning of effectiveness separately for the B.1.1.7 (alpha) and B.1.617.2 (delta) variants., Results: Vaccine effectiveness against symptomatic Covid-19 with the delta variant peaked in the early weeks after receipt of the second dose and then decreased by 20 weeks to 44.3% (95% confidence interval [CI], 43.2 to 45.4) with the ChAdOx1-S vaccine and to 66.3% (95% CI, 65.7 to 66.9) with the BNT162b2 vaccine. Waning of vaccine effectiveness was greater in persons 65 years of age or older than in those 40 to 64 years of age. At 20 weeks or more after vaccination, vaccine effectiveness decreased less against both hospitalization, to 80.0% (95% CI, 76.8 to 82.7) with the ChAdOx1-S vaccine and 91.7% (95% CI, 90.2 to 93.0) with the BNT162b2 vaccine, and death, to 84.8% (95% CI, 76.2 to 90.3) and 91.9% (95% CI, 88.5 to 94.3), respectively. Greater waning in vaccine effectiveness against hospitalization was observed in persons 65 years of age or older in a clinically extremely vulnerable group and in persons 40 to 64 years of age with underlying medical conditions than in healthy adults., Conclusions: We observed limited waning in vaccine effectiveness against Covid-19-related hospitalization and death at 20 weeks or more after vaccination with two doses of the ChAdOx1-S or BNT162b2 vaccine. Waning was greater in older adults and in those in a clinical risk group., (Copyright © 2022 Massachusetts Medical Society.)

Background: Vaccination coverage of dose two of MMR (MMR2) at 5th birthday has been consistently low in London and measured 76.3% in 2018/19. Since the early 2000s seven boroughs in London started offering dose two earlier, from 15 to 18 months onwards instead of the recommended 3 years 4 months. In this study we investigate whether the accelerated schedule of MMR2 leads to a change in coverage of MMR2 and other childhood vaccines with an ecological study using childhood immunisation data from 2009 to 2018 in London., Methods: We modelled coverage used generalized estimating equations (GEE) adjusted for year and DTaP/IPV/Hib3 coverage measured at 2nd birthday as a proxy for baseline local vaccination programme performance to determine the percentage point difference in coverage of MMR2 and other childhood vaccines., Results: Average MMR2 coverage was higher among early implementing boroughs from 2012/13 onwards. Coverage difference was highest in 2017/18 (9.2 percentage points, 95% CI 4.8, 13.5, p < 0.001). On average over the 6 years, compared to London boroughs on the routine schedule, MMR2 coverage among early implementing boroughs was 3.3 percentage points higher (95% CI 1.3, 5.3, p = 0.01) after adjusting for DTaP/IPV/Hib3 coverage, IMD score and year., Conclusion: Earlier vaccination of MMR2 is associated with significantly higher coverage at five years for this vaccine in London. Further research is needed to assess the association at a more granular level, but our findings underline a potential opportunity to increase MMR coverage., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The Immunisation and Countermeasures Division has provided vaccine manufactures with post-marketing surveillance reports, not related to measles, mumps or rubella, which the Marketing Authorization Holders are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

Background: In the 2016/2017 influenza season, England was in its fourth season of the roll-out of a live-attenuated influenza vaccine (LAIV) targeted at healthy children aged two to less than 17 years. For the first time, all healthy children aged 2 to 8 years were offered LAIV at national level in 2016/2017. Since the commencement of the programme in 2013/2014, a series of geographically discrete pilot areas have been in place where quadrivalent LAIV was also offered to all school age children. In 2016/2017, these were children aged 8 to 11 years, other than those targeted by the national programme., Methods: We evaluated the overall and indirect impact of vaccinating primary school age children, on the population of England, by measuring vaccine uptake levels and comparing cumulative disease incidence through various influenza surveillance schemes, in targeted and non-targeted age groups in pilot and non-pilot areas in 2016/2017., Results: Our findings indicate that cumulative primary care influenza-like consultations, primary and secondary care swab positivity, influenza confirmed hospitalisations and emergency department attendances in pilot areas were overall lower than those observed in non-pilot areas; however, significant differences were not always observed in both targeted and non-targeted age groups. Excess mortality was higher in pilot areas compared with non-pilot areas., Conclusions: These results are similar to earlier seasons of the programme indicating the importance and continuing support of vaccinating all primary school children with LAIV to reduce influenza related illness across the population, although further work is needed to understand the differences in excess mortality., (© 2021 Crown copyright. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd. This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.)

The UK prioritised delivery of the first dose of BNT162b2 (Pfizer/BioNTech) and AZD1222 (AstraZeneca) vaccines by extending the interval between doses up to 12 weeks. In 750 participants aged 50-89 years, we here compare serological responses after BNT162b2 and AZD1222 vaccination with varying dose intervals, and evaluate these against real-world national vaccine effectiveness (VE) estimates against COVID-19 in England. We show that antibody levels 14-35 days after dose two are higher in BNT162b2 recipients with an extended vaccine interval (65-84 days) compared with those vaccinated with a standard (19-29 days) interval. Following the extended schedule, antibody levels were 6-fold higher at 14-35 days post dose 2 for BNT162b2 than AZD1222. For both vaccines, VE was higher across all age-groups from 14 days after dose two compared to one dose, but the magnitude varied with dose interval. Higher dose two VE was observed with >6 week interval between BNT162b2 doses compared to the standard schedule. Our findings suggest higher effectiveness against infection using an extended vaccine schedule. Given global vaccine constraints these results are relevant to policymakers., (© 2021. Crown.)

Easing of COVID-19 restrictions in England in the summer of 2021 was followed by a sharp rise in cases among school-aged children. Weekly rates of SARS-CoV-2 infection in primary and secondary school children reached 733.3 and 1,664.7/100,000 population, respectively, by week 39 2021. A surge in household clusters with school-aged index cases was noted at the start of the school term, with secondary cases predominantly in children aged 5-15 years and adults aged 30-49 years.

Mercury (Hg) pollution in the ocean is an issue of global concern, however bioaccumulation regimes of this ubiquitous pollutant in marine apex predators have important knowledge gaps. Our fish length and stable isotope (δ 15 N and δ 13 C) normalized data of Greenland halibut (GH) (Reinhardtius hippoglossoides) showed that Hg bioaccumulation in fillet tissue decreased by ~35-50 %, over a ten-year period from 2006 to 2015 (n = 7 individual sampling years). Hg was predominantly in the methylmercury form (>77 %). Results from a Bayesian information theoretic model showed that GH Hg concentrations decreased with time and its associated declines in Hg air emissions, estimated trophic position, and a potentially lower degree of demersal prey use as indicated by temporal trend shifts in nitrogen (δ 15 N) and carbon (δ 13 C) stable isotope values. GH trophic shifts accounted for about one third of the observed temporal reduction in Hg. Our study demonstrates the importance of simultaneously considering Hg emissions, food web dynamics and trophic shifts as important drivers of Hg bioaccumulation in a marine, deep water fish species and highlights the effectiveness of Hg regulations on ocean apex predator Hg concentrations and overall seafood safety., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: In October 2012, a maternal pertussis vaccination program was introduced in England for women between 28 and 32 weeks of pregnancy. In April 2016, the recommended optimal window was extended to 20-32 weeks to improve vaccine coverage and protect preterm infants. This study assesses the impact of offering maternal pertussis vaccination earlier in pregnancy on hospitalized infant pertussis cases., Methods: Hospitalized pertussis cases ≤60 days old in England were extracted from Hospital Episode Statistics pre- and post-policy change. Data were linked to laboratory-confirmed cases, and clinical records were reviewed where cases were not matched. Maternal vaccine status of identified cases was established. Median hospital duration was calculated, and a competing risk survival analysis was undertaken to assess multiple factors., Results: A total of 201 cases were included in the analysis. Of the 151 cases with reported gestational age, the number of hospitalizations among full-term infants was 60 cases pre-policy and 62 cases post-policy, respectively, while preterm cases declined from 20 to 9 (P = .06). Length of hospital stay did not differ significantly after the policy change. Significantly longer hospital stays were seen in cases aged 0-4 weeks (median of 3 more days than infants aged 5-8 weeks), premature infants (median of 4 more days than term infants), and cases with coinfections (median of 1 more day than those without coinfection)., Conclusions: The number of preterm infants hospitalized with pertussis in England was halved after the policy change and preterm infants were no longer overrepresented among hospitalized cases., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.)

The present study aims to explore the bioaccumulation and biotic transformations of inorganic (iHg) and monomethyl mercury (MMHg) by natural pico-nanoplankton community from eutrophic lake Soppen, Switzerland. Pico-nanoplankton encompass mainly bacterioplankton, mycoplankton and phytoplankton groups with size between 0.2 and 20 μm. Species-specific enriched isotope mixture of 199 iHg and 201 MMHg was used to explore the accumulation, the subcellular distribution and transformations occurring in natural pico-nanoplankton sampled at 2 different depths (6.6 m and 8.3 m). Cyanobacteria, diatoms, cryptophyta, green algae and heterotrophic microorganisms were identified as the major groups of pico-nanoplankton with diatoms prevailing at deeper samples. Results showed that pico-nanoplankton accumulated both iHg and MMHg preferentially in the cell membrane/organelles, despite observed losses. The ratios between the iHg and MMHg concentrations measured in the membrane/organelles and cytosol were comparable for iHg and MMHg. Pico-nanoplankton demethylate added 201 MMHg (~4 and 12% per day depending on cellular compartment), although the involved pathways are to further explore. Comparison of the concentrations of 201 iHg formed from 201 MMHg demethylation in whole system, medium and whole cells showed that 82% of the demethylation was biologically mediated by pico-nanoplankton. No significant methylation of iHg by pico-nanoplankton was observed. The accumulation of iHg and MMHg and the percentage of demethylated MMHg correlated positively with the relative abundance of diatoms and heterotrophic microorganisms in the pico-nanoplankton, the concentrations of TN, Mg 2+ , NO 3 - , NO 2 - , NH 4 + and negatively with the concentrations of DOC, K + , Na + , Ca 2+ , SO 4 2- . Taken together the results of the present field study confirm the role of pico-nanoplankton in Hg bioaccumulation and demethylation, however further research is needed to better understand the underlying mechanisms and interconnection between heterotrophic and autotrophic microorganisms., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Understanding of mercury (Hg) complexation with low molecular weight (LMW) bioligands will help elucidate its speciation. In natural waters, the rate of this complexation is governed by physicochemical, geochemical, and biochemical parameters. However, the role of bioligands involved in Hg intracellular handling by aquatic microorganisms is not well documented. Here, we combine the use of isotopically labeled Hg species (inorganic and monomethylmercury, iHg and MeHg) with gas or liquid chromatography coupling to elemental and molecular mass spectrometry to explore the role of intracellular biogenic ligands involved in iHg and MeHg speciation in cyanobacterium Synechocystis sp. PCC 6803, a representative phytoplankton species. This approach allowed to track resulting metabolic and newly found intracellular Hg biocomplexes (e.g., organic thiols) in Synechocystis sp. PCC 6803 finding different intracellular Hg species binding affinities with both high and low molecular weight (HMW and LMW) bioligands in the exponential and stationary phase. Furthermore, the parallel detection with both elemental and molecular ionization sources allowed the sensitive detection and molecular identification of glutathione (GSH) as the main low molecular weight binding ligand to iHg ((GS) 2 -Hg) and MeHg (GS-MeHg) in the cytosolic fraction. Such a novel experimental approach expands our knowledge on the role of biogenic ligands involved in iHg and MeHg intracellular handling in cyanobacteria.

The Hg isotopic composition of 1-year-old Norway spruce (Picea abies) shoots collected from Saarland cornurbation Warndt, Germany, since 1985 by the German Environmental Specimen Bank, were measured for a better understanding of the temporal trends of Hg sources. The isotopic data showed that Hg was mainly taken up as gaseous element mercury (GEM) and underwent oxidation in the spruce needles; this led to a significant decrease in the δ 202 Hg compared with the atmospheric Hg isotopic composition observed for deciduous leaves and epiphytic lichens. Observation of the odd mass-independent isotopic fractionation (MIF) indicated that Δ 199 Hg and Δ 201 Hg were close to but slightly lower than the actual values recorded from the atmospheric measurement of the GEM isotopic composition in non-contaminated sites in U.S. and Europe, whereas observation of the even-MIF indicated almost no differences for Δ 200 Hg. This confirmed that GEM is a major source of Hg accumulation in spruce shoots. Interestingly, the Hg isotopic composition in the spruce shoots did not change very significantly during the study period of >30 years, even as the Hg concentration decreased significantly. Even-MIF (Δ 200 Hg) and mass-dependent fractionation (MDF) (δ 202 Hg) of the Hg isotopes exhibited slight decrease with time, whereas odd-MIF did not show any clear trend. These results suggest a close link between the long-term evolution of GEM isotopic composition in the air and the isotopic composition of bioaccumulated Hg altered by mass-dependent fraction in the spruce shoots., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The impact of SARS-CoV-2 alongside influenza is a major concern in the northern hemisphere as winter approaches., Methods: Test data for influenza and SARS-CoV-2 from national surveillance systems between 20 January 2020 and 25 April 2020 were used to estimate influenza infection on the risk of SARS-CoV-2 infection. A test-negative design was used to assess the odds of SARS-CoV-2 in those who tested positive for influenza compared with those who tested negative. The severity of SARS-CoV-2 was also assessed using univariable and multivariable analyses., Results: The risk of testing positive for SARS-CoV-2 was 58% lower among influenza-positive cases and patients with a coinfection had a risk of death of 5.92 (95% confidence interval: 3.21-10.91) times greater than among those with neither influenza nor SARS-CoV-2. The odds of ventilator use or death and intensive care unit admission or death were greatest among coinfected patients., Conclusions: Coinfection of these viruses could have a significant impact on morbidity, mortality and health-service demand., (© The Author(s) 2021. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Background: The B.1.617.2 (delta) variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), has contributed to a surge in cases in India and has now been detected across the globe, including a notable increase in cases in the United Kingdom. The effectiveness of the BNT162b2 and ChAdOx1 nCoV-19 vaccines against this variant has been unclear., Methods: We used a test-negative case-control design to estimate the effectiveness of vaccination against symptomatic disease caused by the delta variant or the predominant strain (B.1.1.7, or alpha variant) over the period that the delta variant began circulating. Variants were identified with the use of sequencing and on the basis of the spike ( S ) gene status. Data on all symptomatic sequenced cases of Covid-19 in England were used to estimate the proportion of cases with either variant according to the patients' vaccination status., Results: Effectiveness after one dose of vaccine (BNT162b2 or ChAdOx1 nCoV-19) was notably lower among persons with the delta variant (30.7%; 95% confidence interval [CI], 25.2 to 35.7) than among those with the alpha variant (48.7%; 95% CI, 45.5 to 51.7); the results were similar for both vaccines. With the BNT162b2 vaccine, the effectiveness of two doses was 93.7% (95% CI, 91.6 to 95.3) among persons with the alpha variant and 88.0% (95% CI, 85.3 to 90.1) among those with the delta variant. With the ChAdOx1 nCoV-19 vaccine, the effectiveness of two doses was 74.5% (95% CI, 68.4 to 79.4) among persons with the alpha variant and 67.0% (95% CI, 61.3 to 71.8) among those with the delta variant., Conclusions: Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses. Absolute differences in vaccine effectiveness were more marked after the receipt of the first dose. This finding would support efforts to maximize vaccine uptake with two doses among vulnerable populations. (Funded by Public Health England.)., (Copyright © 2021 Massachusetts Medical Society.)

Background: We report here the case of two coworkers infected by the same SARS-CoV-2 strain, presenting two different immunological outcomes., Case: One patient presented a strong IgG anti-receptor-binding domain immune response correlated with a low and rapidly decreasing titer of neutralizing antibodies. The other patient had a similar strong IgG anti-receptor-binding domain immune response but high neutralizing antibody titers., Discussion and Conclusion: Thus, host individual factors may be the main drivers of the immune response varying with age and clinical severity., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: An unexpected resurgence of pertussis cases and infant deaths was observed in some countries that had switched to acellular pertussis vaccines in the primary immunisation schedule. In response to the outbreaks, maternal pertussis vaccination programmes in pregnant women have been adopted worldwide, including the USA in 2011 and the UK in 2012. Following the success of the programme in England, we evaluated the health and economic impact of stopping versus continuing the maternal pertussis immunisation to inform public health policy making., Methods: We used a mathematical model to estimate the number of infant hospitalisations and deaths related to pertussis in England over 2019-2038. Losses in quality-adjusted life years, QALYs, were considered for infants (aged 0-2 months) who survived or died from pertussis, bereaved parents (of infants who died from pertussis), and women with pertussis (aged 20-44 years). Direct medical costs to the National Health Service included infant hospitalisations, maternal vaccinations, and disease in women. Costs and QALYs were discounted at 3.5%. Changes in the incremental cost-effectiveness ratio, ICER, were explored in sensitivity analyses., Results: The model supports continuing the maternal pertussis immunisation programme as a cost-effective intervention at an ICER of £14,500/QALY (2.5% and 97.5%-quantile: £7,300/QALY to £32,400/QALY). Stopping versus continuing the maternal programme results in an estimated mean of 972 (range 582 to 1489) versus 308 (184 to 471) infant hospitalisations annually. Results were most sensitive to the number of hospitalisations and deaths when stopping the maternal programme. At a cost-effectiveness threshold of £30,000/QALY, the probability of the maternal programme being cost-effective was 96.2%., Conclusion: Our findings support continuing the maternal pertussis vaccination programme as otherwise higher levels of disease activity and infant mortality are expected to return. These results have led policy makers to decide to continue the maternal programme in the UK routine immunisation schedule., (Copyright © 2021. Published by Elsevier Ltd.)

Endogenous RNA interference (RNAi) pathways regulate a wide range of cellular processes in diverse eukaryotes, yet in the ciliated eukaryote, Tetrahymena thermophila , the cellular purpose of RNAi pathways that generate ∼23-24 nucleotide (nt) small (s)RNAs has remained unknown. Here, we investigated the phenotypic and gene expression impacts on vegetatively growing cells when genes involved in ∼23-24 nt sRNA biogenesis are disrupted. We observed slower proliferation and increased expression of genes involved in DNA metabolism and chromosome organization and maintenance in sRNA biogenesis mutants RSP1 Δ, RDN2 Δ, and RDF2 Δ. In addition, RSP1 Δ and RDN2 Δ cells frequently exhibited enlarged chromatin extrusion bodies, which are nonnuclear, DNA-containing structures that may be akin to mammalian micronuclei. Expression of homologous recombination factor Rad51 was specifically elevated in RSP1 Δ and RDN2 Δ strains, with Rad51 and double-stranded DNA break marker γ-H2A.X localized to discrete macronuclear foci. In addition, an increase in Rad51 and γ-H2A.X foci was also found in knockouts of TWI8, a macronucleus-localized PIWI protein. Together, our findings suggest that an evolutionarily conserved role for RNAi pathways in maintaining genome integrity may be extended even to the early branching eukaryotic lineage that gave rise to Tetrahymena thermophila .

Hg accumulation in marine organisms depends strongly on in situ water or sediment biogeochemistry and levels of Hg pollution. To predict the rates of Hg exposure in human communities, it is important to understand Hg assimilation and processing within commercially harvested marine fish, like the European seabass Dicentrarchus labrax. Previously, values of Δ 199 Hg and δ 202 Hg in muscle tissue successfully discriminated between seven populations of European seabass. In the present study, a multi-tissue approach was developed to assess the underlying processes behind such discrimination. We determined total Hg content (THg), the proportion of monomethyl-Hg (%MeHg), and Hg isotopic composition (e.g. Δ 199 Hg and δ 202 Hg) in seabass liver. We compared this to the previously published data on muscle tissue and local anthropogenic Hg inputs. The first important finding of this study showed an increase of both %MeHg and δ 202 Hg values in muscle compared to liver in all populations, suggesting the occurrence of internal MeHg demethylation in seabass. This is the first evidence of such a process occurring in this species. Values for mass-dependent (MDF, δ 202 Hg) and mass-independent (MIF, Δ 199 Hg) isotopic fractionation in liver and muscle accorded with data observed in estuarine fish (MDF, 0-1‰ and MIF, 0-0.7‰). Black Sea seabass stood out from other regions, presenting higher MIF values (≈1.5‰) in muscle and very low MDF (≈-1‰) in liver. This second finding suggests that under low Hg bioaccumulation, Hg isotopic composition may allow the detection of a shift in the habitat use of juvenile fish, such as for first-year Black Sea seabass. Our study supports the multi-tissue approach as a valid tool for refining the analysis of Hg sourcing and metabolism in a marine fish. The study's major outcome indicates that Hg levels of pollution and fish foraging location are the main factors influencing Hg species accumulation and isotopic fractionation in the organisms., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: In England, the reopening of universities in September 2020 coincided with a rapid increase in SARS-CoV-2 infection rates in university aged young adults. This study aimed to estimate SARS-CoV-2 antibody prevalence in students attending universities that had experienced a COVID-19 outbreak after reopening for the autumn term in September 2020., Methods: A cross-sectional serosurvey was conducted during 02-11 December 2020 in students aged ≤ 25 years across five universities in England. Blood samples for SARS-CoV-2 antibody testing were obtained using a self-sampling kit and analysed using the Abbott SARS-CoV-2 N antibody and/or an in-house receptor binding domain (RBD) assay., Findings: SARS-CoV-2 seroprevalence in 2,905 university students was 17.8% (95%CI, 16.5-19.3), ranging between 7.6%-29.7% across the five universities. Seropositivity was associated with being younger likely to represent first year undergraduates (aOR 3.2, 95% CI 2.0-4.9), living in halls of residence (aOR 2.1, 95% CI 1.7-2.7) and sharing a kitchen with an increasing number of students (shared with 4-7 individuals, aOR 1.43, 95%CI 1.12-1.82; shared with 8 or more individuals, aOR 1.53, 95% CI 1.04-2.24). Seropositivity was 49% in students living in halls of residence that reported high SARS-CoV-2 infection rates (>8%) during the autumn term., Interpretation: Despite large numbers of cases and outbreaks in universities, less than one in five students (17.8%) overall had SARS-CoV-2 antibodies at the end of the autumn term in England. In university halls of residence affected by a COVID-19 outbreak, however, nearly half the resident students became infected and developed SARS-CoV-2 antibodies., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

In March 2019, a pertussis outbreak occurred in children in a junior school (7-11 years) in England who had been offered pertussis-containing booster vaccine at 40 months of age. In a case-control investigation, we assessed the extent of transmission and any difference in protection afforded to those who had previously received a booster 3- or 5-component acellular pertussis vaccine (aP). We took oral fluid specimens from the students to determine IgG antibodies against pertussis toxin (anti-PT). Parents of students attending the school were sent a questionnaire on pertussis symptoms and vaccination status was retrieved from general practitioner records for all students. Of 381 students, 134 (35.2%) were classified as pertussis cases, 133 by demonstration of significant anti-PT IgG titres and one clinically. There was no significant difference in the risk of pertussis between students receiving 3-component (33.7%) or 5-component (32.3%) aP boosters. However, pertussis infection differed significantly in school year 4, with 22.9%, 50.0%, 23.7% and 38.1% pertussis cases in years 3, 4, 5 and 6, respectively. The proportion of students with incomplete vaccinations recorded was higher than the proportion of those not covered according to the national reported coverage, possibly contributing to sustained transmission within the school.

BackgroundA multi-tiered surveillance system based on influenza surveillance was adopted in the United Kingdom in the early stages of the coronavirus disease (COVID-19) epidemic to monitor different stages of the disease. Mandatory social and physical distancing measures (SPDM) were introduced on 23 March 2020 to attempt to limit transmission.AimTo describe the impact of SPDM on COVID-19 activity as detected through the different surveillance systems.MethodsData from national population surveys, web-based indicators, syndromic surveillance, sentinel swabbing, respiratory outbreaks, secondary care admissions and mortality indicators from the start of the epidemic to week 18 2020 were used to identify the timing of peaks in surveillance indicators relative to the introduction of SPDM. This timing was compared with median time from symptom onset to different stages of illness and levels of care or interactions with healthcare services.ResultsThe impact of SPDM was detected within 1 week through population surveys, web search indicators and sentinel swabbing reported by onset date. There were detectable impacts on syndromic surveillance indicators for difficulty breathing, influenza-like illness and COVID-19 coding at 2, 7 and 12 days respectively, hospitalisations and critical care admissions (both 12 days), laboratory positivity (14 days), deaths (17 days) and nursing home outbreaks (4 weeks).ConclusionThe impact of SPDM on COVID-19 activity was detectable within 1 week through community surveillance indicators, highlighting their importance in early detection of changes in activity. Community swabbing surveillance may be increasingly important as a specific indicator, should circulation of seasonal respiratory viruses increase.

The four largest freshwater lakes in southwestern France are of both ecological and economic importance. However, some of them are subjected to mercury (Hg) contamination, resulting in the ban of human consumption of piscivorous fish. Moreover, beyond predatory fish, little information exist regarding Hg levels in other species of these ecosystems. In this context, we used a food web analytical approach to investigate Hg bioaccumulation and biomagnification in relation to the trophic structure of these four lakes. More specifically, various organisms (macrophytes, epiphyton, invertebrates and fish) were collected at the four lakes and analysed for carbon and nitrogen stable isotopes as well as for total Hg (THg) and methylmercury (MeHg). A spatial variability of bioaccumulation in organisms was observed, particularly in carnivorous fish, with higher Hg levels being found in the two more northern lakes (median±SE: 3491 ± 474 and 1113 ± 209 ng THg.g -1 dw in lakes HC and L, respectively) than in the southern pair (600 ± 117 and 911 ± 117 ng THg.g -1 dw in lakes CS and PB, respectively). Methylmercury biomagnification was observed through the food webs of all four lakes, with different trophic magnification slopes (HC = 0.16; L = 0.33; CS = 0.27; PB = 0.27), even though the length of the food chains was similar between the lakes. Our results suggest that rather than the food web structure, anthropogenic inputs (sulfate in northern lakes and phosphorus inputs in southern ones) may have a strong impact, more or less directly, on Hg methylation in freshwater environments, and lead to concentrations exceeding environmental recommendations despite low Hg backgrounds in sediment and water., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The occurrence of severe limb trauma is a brutal event for all patients in any context. Many questions quickly arise, with a very broad scope - from the course of the intervention to family and social reintegration. The nurse has an essential role in listening, educating and supporting the patient before and after the operation. In addition to reassurance, she plays a central role in organising the return home and helping the patient to resume socio-professional activities., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Since mercury (Hg) biogeochemistry in the Southern Ocean is minimally documented, we investigated Hg stable isotopes in the blood of seabirds breeding at different latitudes in the Antarctic, Subantarctic and Subtropical zones. Hg isotopic composition was determined in adult penguins (5 species) and skua chicks (2 species) from Adélie Land (66°39'S, Antarctic) to Crozet (46°25'S, Subantarctic) and Amsterdam Island (37°47'S, Subtropical). Mass-dependent (MDF, δ 202 Hg) and mass-independent (MIF, Δ 199 Hg) Hg isotopic values separated populations geographically. Antarctic seabirds exhibited lower δ 202 Hg values (-0.02 to 0.79 ‰, min-max) than Subantarctic (0.88 to 2.12 ‰) and Subtropical (1.44 to 2.37 ‰) seabirds. In contrast, Δ 199 Hg values varied slightly from Antarctic (1.31 to 1.73 ‰) to Subtropical (1.69 to 2.04 ‰) waters. The extent of methylmercury (MeHg) photodemethylation extrapolated from Δ 199 Hg values was not significantly different between locations, implying that most of the bioaccumulated MeHg was of mesopelagic origin. The larger increase of MDF between the three latitudes co-varies with MeHg concentrations. This supports an increasing effect of specific biogenic Hg pathways from Antarctic to Subtropical waters, such as Hg biological transformations and accumulations. This "biogenic effect" among different productive southern oceanic regions can also be related to different mixed layer depth dynamics and biological productivity turnover that specifically influence the vertical transport between the mesopelagic and the photic zones. This study shows the first Hg isotopic data of the Southern Ocean at large scale and reveals how regional Southern Ocean dynamics and productivity control marine MeHg biogeochemistry and the exposure of seabirds to Hg contamination., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

In October 2012, a maternal pertussis vaccination program was implemented in England following an increased incidence and mortality in infants. We evaluated the cost-effectiveness of the program by comparing pertussis-related infant hospitalizations and deaths in 2012-2017 with nonvaccination scenarios. Despite considerable uncertainties, findings support the cost-effectiveness of the program., (© Crown copyright 2020.)

Despite the limited direct anthropogenic mercury (Hg) inputs in the circumpolar Arctic, elevated concentrations of methylmercury (MeHg) are accumulated in Arctic marine biota. However, the MeHg production and bioaccumulation pathways in these ecosystems have not been completely unraveled. We measured Hg concentrations and stable isotope ratios of Hg, carbon, and nitrogen in the feathers and blood of geolocator-tracked little auk Alle alle from five Arctic breeding colonies. The wide-range spatial mobility and tissue-specific Hg integration times of this planktivorous seabird allowed the exploration of their spatial (wintering quarters/breeding grounds) and seasonal (nonbreeding/breeding periods) MeHg exposures. An east-to-west increase of head feather Hg concentrations (1.74-3.48 μg·g -1 ) was accompanied by significant spatial trends of Hg isotope (particularly Δ 199 Hg: 0.96-1.13‰) and carbon isotope (δ 13 C: -20.6 to -19.4‰) ratios. These trends suggest a distinct mixing/proportion of MeHg sources between western North Atlantic and eastern Arctic regions. Higher Δ 199 Hg values (+0.4‰) in northern colonies indicate an accumulation of more photochemically impacted MeHg, supporting shallow MeHg production and bioaccumulation in high Arctic waters. The combination of seabird tissue isotopic analysis and spatial tracking helps in tracing the MeHg sources at various spatio-temporal scales.

Microorganisms are key players in the transformation of mercury into neurotoxic methylmercury (MeHg). Nevertheless, this mechanism and the opposite MeHg demethylation remain poorly understood. Here, we explored the impact of inorganic mercury (IHg) and MeHg concentrations from 0.05 to 50 μM on the production and degradation of MeHg in two sulfate-reducing bacteria, Pseudodesulfovibrio hydrargyri BerOc1 able to methylate and demethylate mercury and Desulfovibrio desulfuricans G200 only able to demethylate MeHg. MeHg produced by BerOc1 increased with increasing IHg concentration with a maximum attained for 5 μM, and suggested a saturation of the process. MeHg was mainly found in the supernatant suggesting its export from the cell. Hg L 3 -edge High- Energy-Resolution-Fluorescence-Detected-X-ray-Absorption-Near-Edge-Structure spectroscopy (HERFD-XANES) identified MeHg produced by BerOc1 as MeHg-cysteine 2 form. A dominant tetracoordinated βHgS form was detected for BerOc1 exposed to the lowest IHg concentrations where methylation was detected. In contrast, at the highest exposure (50 μM) where Hg methylation was abolished, Hg species drastically changed suggesting a role of Hg speciation in the production of MeHg. The tetracoordinated βHgS was likely present as nano-particles as suggested by transmission electron microscopy combined to X-ray energy dispersive spectroscopy (TEM-X-EDS) and nano-X ray fluorescence (nano-XRF). When exposed to MeHg, the production of IHg, on the contrary, increased with the increase of MeHg exposure until 50 μM for both BerOc1 and G200 strains, suggesting that demethylation did not require intact biological activity. The formed IHg species were identified as various tetracoordinated Hg-S forms. These results highlight the important role of thiol ligands and Hg coordination in Hg methylation and demethylation processes., (Copyright © 2020 Isaure, Albertelli, Kieffer, Tucoulou, Petrel, Gontier, Tessier, Monperrus and Goñi-Urriza.)

An interlaboratory study on the National Institute for Environmental Studies (NIES) certified reference material (CRM) No. 28 Urban Aerosols, collected on the filters of a central ventilating system in a building in Beijing city center, was performed to obtain informative values of Hg isotopic composition and total Hg (THg) mass fraction. The THg mass fraction was determined by four organizations using atomic absorption spectrometry; it resulted in the mean value of 1.19 ± 0.12 mg/kg (2SD, n = 24). The Hg isotopic composition of the CRM was measured and intercompared at two different institutions by cold vapor generation system coupled to multicollector inductively coupled plasma mass spectrometry. Subsequently, a conventional dissolution method that uses a mixture of HNO 3 /HCl/H 2 O 2 in Hotblock® and two different dissolution methods that use a mixture of HNO 3 /HCl with a microwave and a digestion bomb were applied. The Hg isotopic compositions were δ 202 Hg = - 1.26 ± 0.17‰, Δ 199 Hg = - 0.23 ± 0.06‰, Δ 200 Hg = 0.01 ± 0.07‰, and Δ 201 Hg = - 0.22 ± 0.09‰ (2SD, n = 18) for the conventional method, which agree well with those obtained using microwave and bomb digestion. Our results indicate that, for the quality control of particulate matter analyses, this CRM is appropriate for use in environmental and geochemical studies. Graphical abstract.

Mercury (Hg) pollution threatens ecosystems and human health. Wastewater treatment plants (WWTPs) play a key role in limiting Hg discharges from wastewaters to rivers and lakes, but large-scale studies to estimate Hg loads and discharge at national levels are scarce. We assessed the concentration, flux, speciation, and removal of Hg in municipal wastewater throughout Switzerland by investigating 64 WWTPs in a pre-study and a subset of 28 WWTPs in the main study. We also studied the behavior and pathways of Hg along the various treatment steps in a state-of-the-art WWTP. The resulting dataset, representative of industrialized countries, provides an overview of (i) current Hg concentration ranges, (ii) average per capita loads, and (iii) wastewater Hg inputs into surface waters. The results allowed estimation of a total Hg (THg) load in Swiss wastewater of 130 ± 30 kg THg/year (15.7 mg/capita/y), of which 96 ± 4% is retained in sewage sludge. About 4.7 ± 0.5 kg THg/year (0.57 mg/capita/y) is discharged with the treated wastewater into surface waters. This corresponds to only 1.5-3% of the THg load carried by the major Swiss rivers, indicating that >95% of riverine Hg originates from other sources. Extrapolation to the population of Europe would yield a total amount of 11,700 kg THg/year in raw wastewater, with some 480 kg THg/year discharged to surface waters. Monomethyl mercury on average accounted for 0.23% of THg, and its fraction remained constant along the different treatment steps., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Using electronic health records, we assessed the early impact of coronavirus disease (COVID-19) on routine childhood vaccination in England by 26 April 2020. Measles-mumps-rubella vaccination counts fell from February 2020, and in the 3 weeks after introduction of physical distancing measures were 19.8% lower (95% confidence interval: -20.7 to -18.9) than the same period in 2019, before improving in mid-April. A gradual decline in hexavalent vaccination counts throughout 2020 was not accentuated by physical distancing.

Peatlands are globally important ecosystems where inorganic mercury is converted to bioaccumulating and highly toxic methylmercury, resulting in high risks of methylmercury exposure in adjacent aquatic ecosystems. Although biological mercury methylation has been known for decades, there is still a lack of knowledge about the organisms involved in mercury methylation and the drivers controlling their methylating capacity. In order to investigate the metabolisms responsible for mercury methylation and methylmercury degradation as well as the controls of both processes, we studied a chronosequence of boreal peatlands covering fundamentally different biogeochemical conditions. Potential mercury methylation rates decreased with peatland age, being up to 53 times higher in the youngest peatland compared to the oldest. Methylation in young mires was driven by sulfate reduction, while methanogenic and syntrophic metabolisms became more important in older systems. Demethylation rates were also highest in young wetlands, with a gradual shift from biotic to abiotic methylmercury degradation along the chronosequence. Our findings reveal how metabolic shifts drive mercury methylation and its ratio to demethylation as peatlands age., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Schools are increasingly being used to deliver vaccines. In 2015/16 three school-based vaccination programmes were delivered to adolescents in England: human papillomavirus (HPV), meningococcal groups A, C, W and Y disease (MenACWY) and tetanus, diphtheria and polio (Td/IPV). We assessed how school delivery models impact vaccine coverage and how a delivery model for one programme may impact another. Routinely collected national data were analysed to ascertain the school grade achieving highest coverage within each one-dose programme and to compare two-dose delivery models (within year vs across years) for the HPV vaccine. We also assessed whether the HPV delivery model was associated with coverage in other programmes. MenACWY and Td/IPV coverage was highest in younger school grades. Overall similar HPV coverage was achieved with both models (86.7% two doses within one year, 85.8% two doses across two years, p = 0.20). High two-dose HPV coverage in 2015/16 was reported in areas that achieved high HPV coverage in 2013/14 when three doses were required. Areas with high three-dose coverage in 2013/14 achieved higher coverage with a within-one-year approach (92.0% vs 85.2%, p < 0.001), whilst areas reporting low coverage in 2013/14 achieved lower but similar coverage in 2015/16 with both models (79.2% vs 80.9% p = 0.29). MenACWY and Td/IPV coverage were higher in areas with high HPV coverage in 2013/14. Among high HPV coverage areas, MenACWY coverage was higher when HPV doses were delivered within year. School-based programmes should be offered as early as feasible and acceptable to optimise coverage. The choice of delivery model for HPV should take into account local performance and provider experience. Single providers may delivery multiple vaccines and the delivery for one programme may affect the performance of other programmes. Providers should consider local circumstances including past and current vaccine coverage and factors influencing coverage when deciding what delivery model to adopt., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Neuroangiostrongyliasis is a parasitic disease caused by the accidental ingestion of the nematode Angiostrongylus cantonensis in its larval form. Human infection can lead to eosinophilic meningitis, sometimes complicated by life-threatening radiculomyelitis or encephalitis. Although some cases have been reported from other Caribbean Islands, no cases have been diagnosed in Martinique so far. Here, we report the first eight laboratory-confirmed cases of neuroangiostrongyliasis on the island of Martinique, French West Indies, between 1 January 2002 and 31 December 2017. One case was fatal and five resulted in neurological sequelae. The medical community should consider the risk of A. cantonensis infection in patients living in or returning from Martinique., (© C. Dard et al., published by EDP Sciences, 2020.)

Objective: To describe school-level and area-level factors that influence coverage of the school-delivered human papillomavirus (HPV) and meningococcal A, C, W and Y (MenACWY) programmes among adolescents., Design: Ecological study., Setting and Participants: Aggregated 2016/2017 data from year 9 pupils were received from 1407 schools for HPV and 1432 schools for MenACWY. The unit of analysis was the school., Primary and Secondary Outcome Measures: Outcome measures were percentage point (pp) difference in vaccine coverage by schools' religious affiliation, school type, urban/rural, single sex/mixed and region. A subanalysis of mixed-sex, state-funded secondary schools also included deprivation, proportion of population from black and ethnic minorities, and school size., Results: Muslim and Jewish schools had significantly lower coverage than schools of no religious character for HPV (24.0 (95% CI -38.2 to -9.8) and 20.5 (95% CI -30.7 to -10.4) pp lower, respectively) but not for MenACWY. Independent, special schools and pupil referral units had increasingly lower vaccine coverage compared with state-funded secondary schools for both HPV and MenACWY. For both vaccines, coverage was 2 pp higher in rural schools than in urban schools and lowest in London. Compared with mixed schools, HPV coverage was higher in male-only (3.7 pp, 95% CI 0.2 to 7.2) and female-only (4.8 pp, 95% CI 2 to 7.6) schools. In the subanalysis, schools located in least deprived areas had the highest coverage for both vaccines (3.8 (95% CI 0.9 to 6.8) and 10.4 (95% CI 7.0 to 13.8) pp for HPV and MenACWY, respectively), and the smallest schools had the lowest coverage (-10.4 (95% CI -14.1 to -6.8) and -7.9 (95% CI -12 to -3.8) for HPV and MenACWY, respectively)., Conclusions: Tailored approaches are required to improve HPV vaccine coverage in Muslim and Jewish schools. In addition, better ways of reaching pupils in smaller specialist schools are needed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Submarine canyons are important stocks of commercial interest fish, whose consumption is one of the main monomethymercury (MeHg) exposure to humans. Currently, biogeochemistry of mercury in those biologically productive system is unknown. In this work, inorganic mercury (Hg(II)) and organic mercury (MeHg) distributions were measured in sedimentary accumulative zones (slopes and terraces) against adjacent continental shelf sediments. Hg compound concentrations in these sediments show a huge range of concentrations (Hg(II) ranging from 18 to 973 ng g -1 and MeHg ranging from 0.07 to 2.03 ng g -1 ) exhibiting factors 50 and 20 fold, respectively. Higher values of mercury compounds were observed in canyon locations suggesting a high accumulation of mercury associated with higher values of clay fraction and organic matter content. The reactivity of mercury was investigated in sediment of three locations along Capbreton submarine canyon axis using slurry incubations experiments and isotopic tracers. Specific methylation and demethylation rate constants (k M and k D ) were calculated. Results clearly showed that MeHg concentrations in these sediments are controlled by competing and simultaneous methylation and demethylation reactions mainly mediated by biotic process. Mercury reactivity was found higher in coastal stations compared to the offshore station due to more labile organic matter which may stimulate microbial activities. However, higher net MeHg production was estimated for the offshore station due to high Hg(II) concentrations suggesting a potential MeHg source for such marine environments., (Copyright © 2019. Published by Elsevier B.V.)

The human risk following exposure to the European reassortant avian influenza A(H5N6) is unknown. We used routine data collected as part of public health follow-up to assess outcomes of individuals exposed to H5N6-infected wild birds in England. There were 19 separate incidents of confirmed H5N6 among wild birds in the first quarter of 2018 in England and 69 individuals exposed to infected birds during these incidents. Five exposed individuals developed respiratory symptoms. However, no H5N6 infection was detected among those individuals with respiratory symptoms who underwent diagnostic testing, indicating that the human risk from this strain remains low., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Chlor-alkali plants (CAP) are recognized as major sources of mercury (Hg) in the environment. In this work, Hg concentration, speciation and isotopic signature were determined in sediments and biota (fish and oyster) from Sagua La Grande River (SG River) and the adjacent coastal zone in the vicinity of a CAP (Cuba). High Hg concentrations in surface sediments (up to 5072 ng g -1 ), mainly occurring as inorganic Hg, decrease with the distance from the CAP along the SG River and seaward. Meanwhile, Hg concentration and speciation in riverine catfish (Claria gariepinus) muscle (1093 ± 319 ng g -1 , ˜70% as MeHg) and coastal oysters (Crassostrea rizophorae) (596 ± 233 ng g -1 , ˜50% as MeHg) indicate a direct impact from CAP. Hg isotopic signature in sediments, following both mass dependent (MDF) and mass independent fractionation (MIF), exhibits a clear binary mixing between CAP pollution (+0.42‰, δ 202 Hg; -0.18‰, Δ 201 Hg) and regional background end-member (˜ -0.49‰, δ 202 Hg; +0.01‰, Δ 201 Hg). The combination of speciation and isotopic information in biota and sediments allows to trace Hg contamination pathways from contaminated sediments to the biota, establishing the importance of both methylation and demethylation extent in both river and coastal sites before Hg species bioaccumulation., (Copyright © 2019. Published by Elsevier B.V.)

Hardangerfjord is one of the longest fjords in the world and has historical mercury (Hg) contamination from a zinc plant in its inner sector. In order to investigate the extent of Hg transferred to abiotic and biotic ecosystem compartments, Hg and monomethylmercury (MeHg) concentrations were measured in seawater, sediment, and seafood commonly consumed by humans. Although total mercury in seawater has been described previously, this investigation reports novel MeHg data for seawater from Norwegian fjords. Total Hg and MeHg concentrations in seawater, sediment, and biota increased towards the point source of pollution (PSP) and multiple lines of evidence show a clear PSP effect in seawater and sediment concentrations. In fish, however, similar high concentrations were found in the inner part of another branch adjacent to the PSP. We postulate that, in addition to PSP, atmospheric Hg, terrestrial run-off and hydroelectric power stations are also important sources of Hg in this fjord ecosystem. Hg contamination gradually increased towards the inner part of the fjord for most fish species and crustaceans. Since the PSP and the atmospheric Hg pools were greater towards the inner part of the fjord, it is not entirely possible to discriminate the full extent of the PSP and the atmospheric Hg contribution to the fjord food web. The European Union (EU) Hg maximum level for consumption was exceeded in demersal fish species including tusk (Brosme brosme), blue ling (Molva dypterygia) and common ling (Molva molva) from the inner fjord (1.08 to 1.89 mg kg -1 ww) and from the outer fjord (0.49 to 1.07 mg kg -1 ww). Crustaceans were less contaminated and only European lobster (Homarus gammarus) from inner fjord exceeded the EU limit (0.62 mg kg -1 ww). Selenium (Se) concentrations were also measured in seafood species and Se-Hg co-exposure dynamics are also discussed., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The denial of pregnancy is the non-recognition of the state of the current pregnancy by a pregnant woman. It lasts for a few months or for the whole pregnancy, with generally few physical transformations. In this study, we will consider the denial of pregnancy as a late declaration of pregnancy (beyond 20 weeks of gestation) as well as a lack of objective perceptions of this pregnancy. The main objective of this study is to explore the relationship between pregnancy denial and the development of the infant (attachment pattern of the infant, early interactions of mother-infant dyads, and early development of the infant)., Methods: The design is a case-control prospective study, which will compare two groups of mother-infant dyads: a "case" group with maternal denials of pregnancy and a "control" group without denials of pregnancy. A total of 140 dyads (mother + infant) will be included in this study (70 cases and 70 controls) and followed for 18 months. The setting is a national recruitment setting with 10 centers distributed all over France. The follow-up of the "cases" and the "controls" will be identical and will occur over 5 visits. It will include measures of the infant attachment pattern, the quality of early mother-infant interaction and infant development., Discussion: This study aims to examine the pathogenesis of pregnancy denial as well as its consequences on early infant development and early mother-infant interaction., Trial Registration: Clinical Trial Number: NCT02867579 on the date of 16 August 2016 (retrospectively registered).

The concentrations of inorganic mercury (IHg) and methylmercury (MeHg) in surface sediments from the contaminated Aveiro Lagoon (Portugal) were determined by species-specific isotope dilution analysis. Different behaviour of IHg and MeHg was observed based upon multiple regression analysis, including geochemical characteristics of the surface sediments (fine fraction, concentrations of organic matter and metals) and non-Euclidean distances between sampling points. This data treatment method was valid over the entire concentration range of IHg and MeHg, allowing robust quantitative evaluation with respect to extrapolation. For IHg, there was statistical separation of the dispersion away from the contamination source and of Al concentration in the sediments. The MeHg concentrations followed those of IHg at high concentrations. The geochemical variables, such as concentrations of Ca (marine influence proxy), Mn and organic matter, were necessary to describe the behaviour of MeHg across the whole concentration range. The models for MeHg demonstrated that, close to the mouth of the lagoon, net production of MeHg was higher. In future, multiple regression analysis could be applied to separate and to evaluate quantitatively the effects of geochemistry and dispersion away from the contamination source in sediments contaminated with other substances., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background & Aims: Iodine deficiency inhibits the normal development of human beings and is the leading cause of preventable mental retardation. Our study aims to update the urinary iodine concentrations and the intake of iodized salt in children in Madrid (Spain)., Methods: A cross-sectional study was designed where 217 children aged 3-14 years old were studied. A nutritional survey including the intake of iodized salt and other iodine-rich foods was performed. In addition, the urinary concentration of iodine was determined in each patient., Results: Near 60% of the surveyed households routinely used iodized salt. Significant differences in age, sex, country of birth, or country of birth and parents educational levels and iodized salt consumption were not found. The median of the urinary iodine level (120 μg/L; interquartile range 80-184) was significantly higher in boys than girls and more elevated in younger children. Iodized salt and milk consumption significantly increased the concentration of urinary iodine. Children who drank less than two glasses of milk per day and did not consume iodized salt have four times the risk of iodine deficiency compared to children who daily drank at least two glasses of milk and consumed iodized salt (P < 0.001)., Conclusions: The nutritional level of iodine in the children studied is appropriate despite the low consumption of iodized salt. This is due to the consumption of dairy products and milk. The younger the child, the better his/her iodine nutritional level. Teenagers studied are at higher risk of iodine deficiency., (Copyright © 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)