Search

ObjectiveIn September 2020, records of 15,861 SARS-CoV-2 cases failed to upload from the Second Generation Laboratory Surveillance System (SGSS) to the Contact Tracing Advisory Service (CTAS) tool, resulting in a delay in the contact tracing of these cases. This study used CTAS data to determine the impact of this delay on health outcomes: transmission events, hospitalisations, and mortality. Previously, a modelling study had suggested a substantial impact.DesignObservational studySettingEngland.PopulationIndividuals testing positive for SARS-CoV-2 and their reported contacts.Main outcome measuresSecondary attack rates (SARs), hospitalisations, and deaths amongst primary and secondary contacts were calculated, compared to all other concurrent, unaffected cases. SGSS records affected by the event were matched to CTAS records and successive contacts and cases were identified.ResultsThe initiation of contact tracing was delayed by 3 days on average in the primary cases in the delay group (6 days) compared to the control group (3 days). This was associated with lower completion of contact tracing of primary cases in the delay group: 80% (95%CI: 79-81%) in the delay group and 83% (95%CI: 83-84%) in the control group. There was some evidence to suggest an increase in transmission to non-household contacts amongst those affected by the delay. The SAR for non-household contacts was higher amongst secondary contacts in the delay group than the control group (delay group: 7.9%, 95%CI:6.4% to 9.2%; control group: 5.9%, 95%CI: 5.3% to 6.6%). There was no evidence of a difference between the delay and control groups in the odds of hospitalisation (crude odds ratio: 1.1 (95%CI: 0.9 to 1.2) or death (crude odds ratio: 0.7 (0.1 to 4.0)) amongst secondary contacts.ConclusionsThe delay in contact tracing had a limited impact on population health outcomes.Strengths and limitations of the studyShows empirical data on the health impact of an event leading to a delay in contact tracing so can test hypotheses generated by models of the potential impact of a delay in contact tracingEstimates the extent of further transmission and odds of increased mortality or hospitalisation in up to the third generation of cases affected by the eventThe event acts as a natural experiment to describe the possible impact of contact tracing, comparing a group affected by chance by delayed contact tracing to a control group who experienced no delayContact tracing was not completed for all individuals, so the study might not capture all affected contacts or transmissions

In November 2019, an outbreak of Shiga toxin-producing Escherichia coli O157:H7 was detected in South Yorkshire, England. Initial investigations established consumption of milk from a local dairy as a common exposure. A sample of pasteurised milk tested the next day failed the phosphatase test, indicating contamination of the pasteurised milk by unpasteurised (raw) milk. The dairy owner agreed to immediately cease production and initiate a recall. Inspection of the pasteuriser revealed a damaged seal on the flow divert valve. Ultimately, there were 21 confirmed cases linked to the outbreak, of which 11 (52%) were female, and 12/21 (57%) were either 65 years of age. Twelve (57%) patients were treated in hospital, and three cases developed haemolytic uraemic syndrome. Although the outbreak strain was not detected in the milk samples, it was detected in faecal samples from the cattle on the farm. Outbreaks of gastrointestinal disease caused by milk pasteurisation failures are rare in the UK. However, such outbreaks are a major public health concern as, unlike unpasteurised milk, pasteurised milk is marketed as ‘safe to drink’ and sold to a larger, and more dispersed, population. The rapid, co-ordinated multi-agency investigation initiated in response to this outbreak undoubtedly prevented further cases.

Despite a sizeable evidence base for the risk of campylobacteriosis associated with eating chicken liver pâté, associated outbreaks continue to occur. In January 2017, six cases of campylobacteriosis reported having eaten a Christmas set-menu meal at the same hotel in North Yorkshire, England on the same day. A retrospective cohort study was undertaken to test the null hypothesis that consumption of individual food items was not associated with an increased risk of illness. There were 19 cases of campylobacteriosis linked to the outbreak; seven confirmed and 12 probable cases. Chicken liver pâté was the food item most strongly associated with illness (P < 0.001) with a corresponding high crude relative risk (12.95). This relationship was supported by multivariable analysis, sensitivity analyses and a clear dose–response relationship. Three cases reported an incubation period of

We report key learning from the public health management of the first two confirmed cases of COVID-19 identified in the UK. The first case imported, and the second associated with probable person-to-person transmission within the UK. Contact tracing was complex and fast-moving. Potential exposures for both cases were reviewed, and 52 contacts were identified. No further confirmed COVID-19 cases have been linked epidemiologically to these two cases. As steps are made to enhance contact tracing across the UK, the lessons learned from earlier contact tracing during the country's containment phase are particularly important and timely.

Between November 2014 and May 2018, 118 laboratory-confirmed cases of high-level azithromycin resistant Neisseria gonorrhoeae were identified in England. Cases emerged among heterosexuals in Leeds but spread across England and into sexual networks of men who have sex with men as the outbreak progressed. The few epidemiological links identified indicate substantial under-diagnosis of cases and this, along with the upturn in cases in 2017, highlights the difficulties in controlling the outbreak.

SUMMARYPertussis is a vaccine-preventable respiratory infection caused by Bordetella pertussis which can be fatal in infants. Although high vaccine coverage led to prolonged disease control in England, a national outbreak of pertussis in 2011 led to the largest increase in over two decades, including a marked increase in cases aged ⩾15 years. A case-control study in four regions of England was undertaken to investigate risk factors for pertussis in adolescents and adults, specifically employment type and professional and household contact with children. Pertussis cases were laboratory-confirmed and aged ⩾15 years. Controls were recruited through general practitioner nomination. Demographic and risk factor information were collected using an online survey. Multivariable logistic regression was used to estimate independent associations with outcome. Two hundred and thirty-one cases and 190 controls were recruited. None of the four employment variables (social care, education, health sector, patient contact) were significantly associated with pertussis. Professional contact with children aged < 1 year was associated with a significantly reduced odds of pertussis [odds ratio (OR) 0·25, 95% confidence interval (CI) 0·08–0·78, P = 0·017]. Household contact with ⩾1 child aged 10–14 years was associated with significantly increased odds of pertussis (OR 2·61, 95% CI 1·47–4·64, P = 0·001). Occupational contact with very young children was associated with reduced odds of pertussis, probably due to immune boosting by low-level exposures to B. pertussis. Sharing a household with a young adolescent was a significant risk factor for pertussis in adults and older teenagers. The primary focus of the childhood pertussis vaccination programmes is to prevent infant disease. Although evidence is emerging that adolescent vaccination does not provide indirect protection to infants, our results highlight the importance of children aged 10–14 years in pertussis transmission to older adolescents and adults.

Background This study aims to estimate pertussis vaccine uptake in pregnant women in England, describe timing of vaccine delivery and examine variations in uptake. Methods Cross-sectional survey of vaccine uptake in women delivering in maternity units in England. Variation in uptake described according to geography, maternal age, ethnicity and parity as reported by the midwife completing the survey. Results A total of 1325 surveys were returned, 85% of which (1128) contained information about vaccination. Vaccine uptake was 61.8% (95% CI: 56.8-66.5) and was higher in the White British ethnic group than any other (67.7%, 95% CI: 63.5 to 71.5). Uptake was higher outside London (65.3%, 95% CI: 61.1-69.3) than within London (31.0%, 95% CI: 24.9-38.0). Reported uptake was lower in areas of high deprivation, and in women of higher parity, observations that were not statistically significant in the multivariable model. Overall, 74% of women were vaccinated between 28 and 32 weeks. Conclusions Pertussis vaccine uptake in pregnant women varies significantly across the country and is affected by ethnicity, deprivation and parity. Variations should be addressed through service delivery models designed to reduce potential inequalities in infant protection.

In October 2009, a dual-pathogen outbreak of Campylobacter and Salmonella occurred in which 59 cases were identified among guests attending a regional conference in the North of England. The mean symptomatic period was 5.4 days ( confidence intervals: 4.4-6.4), and over 84% of the cases had abdominal pain and diarrhoea.A retrospective cohort study was used to investigate the outbreak, and active case-finding was performed through the conference organizers and environmental health officers. A focused questionnaire was distributed to all guests via the event organizers 10 days after the conference.Response rate among guests was 61% (107/175). A cohort study was undertaken, and a strong association was found between illness and consumption of chicken liver pâté, supporting the hypothesis that chicken liver pâté was the most likely cause of the outbreak.This is the first mixed pathogen outbreak documented associated with the consumption of chicken liver pâté and adds to the evidence of potential hazards associated with the undercooking of poultry livers. A rapid outbreak investigation with collaboration between several organizations and the venue led to identification of the most probable source.

BACKGROUND: During the 'containment' phase of the influenza A (H1N1) pandemic 2009, antivirals were used for treatment and prophylaxis. This audit aimed to review the speed of the process involved in delivering antivirals and to assess whether this was likely to have occurred fast enough to be in keeping with the aims of reducing transmission. METHODS: Flu Response Centres in each region were tasked with co-ordinating local delivery and all case data were entered into Fluzone (an electronic case management system). All data between 1 June and 2 July in the Yorkshire and Humber region were reviewed. Forty-eight hours from the onset of illness to treatment and prophylaxis were used as reference standards. RESULTS: The median estimate for the earliest point cases could have received treatment was 2 days (95% CI 2-3 days) and the earliest point contacts of cases could have received prophylaxis was 4 days (95% CI 4-5 days). CONCLUSIONS: The logistical difficulties of delivering 'containment' according to the national algorithms meant there were significant time delays involved and that this was likely to have reduced the effectiveness of the strategy. This would be important to consider if a 'containment' strategy was to be employed in any future emergency.

Pneumococcal surface protein A (PspA) Protective aganist multiple pneumococcal serotypes in mice models of invasive disease pneumonia, and colonization. Vaccination of healthy volunteers with PspA generated antibodies aganist multiple strains that protected mice aganist invasive disease. Human studies in progess. Pneumolysins.Pneumolysoids Protection aganist Pneuminia and increased survival after intraperitoneal challenge. human studies in progress Neuraminidases (Nan) Protection aganist colonization and otitis media Pneumococcal surface protein C (PspC) Protection aganist colonization. Protection aganist sepsis Pneumococcal protective protein A (PppA) Protection aganist lung infection. Protective aganist nasopharyngeal colonization. Pneumococcal Histidine Trial Protein D Protective aganist animal models of invasive disease and pneumonia phase II trial reports awaited. IC4 antigens Protection aganist sepsis, pneumonia, nasopharyngeal carriage.