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Background COVID-19 vaccines are protective against disease. Pregnant women benefit from vaccination as they are at higher risk of poor maternal and neonatal outcomes following infection. Methods Following regulatory approval of two COVID-19 vaccines in the United Kingdom, a rapid national study of vaccination in pregnancy was instituted using three existing safety surveillance platforms: UKOSS, UKTIS and VIP. This preliminary report describes the data collected up to the 15th June 2021. Results There were 971 reports of COVID-19 vaccination in the UKOSS/UKTIS ( n = 493) and VIP ( n = 478) monitoring systems describing 908 individual pregnancies. Pfizer-BioNTech mRNA vaccination was most common ( n = 501, 55.2%), most women were vaccinated in their second or third trimester ( n = 566, 62.3%), and were mainly vaccinated due to occupational infection risk ( n = 577, 63.5%). Conclusion Obstetric outcome data will be obtained by December 2021. However, women should not delay vaccination whilst awaiting further safety data to emerge.

Reinfection after primary SARS-CoV-2 infection is uncommon in adults, but little is known about the risks, characteristics, severity, or outcomes of reinfection in children. We aimed to assess the risk of SARS-CoV-2 reinfection in children and compare this with the risk in adults, by analysis of national testing data for England.In our prospective, national surveillance study to assess reinfection of SARS-CoV-2 in children in England, we used national SARS-CoV-2 testing data to estimate the risk of reinfection at least 90 days after primary infection from Jan 27, 2020, to July, 31, 2021, which encompassed the alpha (B.1.1.7) and delta (B.1.617.2) variant waves in England. Data from children up to age 16 years who met the criteria for reinfection were included. Disease severity was assessed by linking reinfection cases to national hospital admission data, intensive care admission, and death registration datasets.Reinfection rates closely followed community infection rates, with a small peak during the alpha wave and a larger peak during the delta wave. In children aged 16 years and younger, 688 418 primary infections and 2343 reinfections were identified. The overall reinfection rate was 66·88 per 100 000 population, which was higher in adults (72·53 per 100 000) than children (21·53 per 100 000). The reinfection rate after primary infection was 0·68% overall, 0·73% in adults compared with 0·18% in children age younger than 5 years, 0·24% in those aged 5-11 years, and 0·49% in those aged 12-16 years. Of the 109 children admitted to hospital with reinfection, 78 (72%) had comorbidities. Hospital admission rates were similar for the first (64 [2·7%] of 2343) and second episode (57 [2·4%] of 2343) and intensive care admissions were rare (seven children for the first episode and four for reinfections). There were 44 deaths within 28 days after primary infection (0·01%) and none after reinfection.The risk of SARS-CoV-2 reinfection is strongly related to exposure due to community infection rates, especially during the delta variant wave. Children had a lower risk of reinfection than did adults, but reinfections were not associated with more severe disease or fatal outcomes.UK Health Security Agency.

New pediatric and adult subacute sclerosing panencephalitis cases between 1996 and 2020 were reported based on an established UK registry with no evidence of under-ascertainment using a separate pediatric surveillance system. After 15 years with no pediatric UK-acquired cases, 3 cases arose from 2017 after increased measles. Modeling suggested this was in line with measles notifications, underreporting of laboratory-confirmed measles or increased subacute sclerosing panencephalitis risk.

The duration of immunity after first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the extent to which prior immunity prevents reinfection is uncertain and remains an important question within the context of new variants. This is a retrospective population-based matched observational study where we identified the first polymerase chain reaction (PCR) positive of primary SARS-CoV-2 infection case tests between 1 March 2020 and 30 September 2020. Each case was matched by age, sex, upper tier local authority of residence and testing route to one individual testing negative in the same week (controls) by PCR. After a 90-day pre-follow-up period for cases and controls, any subsequent positive tests up to 31 December 2020 and deaths within 28 days of testing positive were identified, this encompassed an essentially vaccine-free period. We used a conditional logistic regression to analyse the results. There were 517 870 individuals in the matched cohort with 2815 reinfection cases and 12 098 first infections. The protective effect of a prior SARS-CoV-2 PCR-positive episode was 78% (odds ratio (OR) 0.22, 0.21–0.23). Protection rose to 82% (OR 0.18, 0.17–0.19) after a sensitivity analysis excluded 933 individuals with a first test between March and May and a subsequent positive test between June and September 2020. Amongst individuals testing positive by PCR during follow-up, reinfection cases had 77% lower odds of symptoms at the second episode (adjusted OR 0.23, 0.20–0.26) and 45% lower odds of dying in the 28 days after reinfection (adjusted OR 0.55, 0.42–0.71). Prior SARS-CoV-2 infection offered protection against reinfection in this population. There was some evidence that reinfections increased with the alpha variant compared to the wild-type SARS-CoV-2 variant highlighting the importance of continued monitoring as new variants emerge.

Objective We aimed to look at the burden of disease caused by SARS-COV-2 reinfections and identified potential risk factors for disease severity. Methods We used national surveillance data to collect information on all SARS-CoV-2 primary infection and suspected reinfection cases between January 2020 until early May 2021. Reinfection cases were positive COVID-19 PCR or antigen test, 90 days after their first COVID-19 positive test. We collected information on case demographics, hospital and ICU admission, immunisation status and if individuals were at risk of complication for COVID-19. Results Deaths reported within 28 days of testing positive were 61% (95% confidence interval: 56% to 65%) lower in suspected COVID-19 reinfection than primary infection cases. In the unvaccinated cohort, reinfections were associated with 49% (37% to 58%) lower odds of hospital admission in cases aged 50 to 65 years in the population not identified at risk of complication for COVID-19, and 34% (17% to 48%) in those at risk. ICU admission at reinfection compared to primary infection decreased 76% (55% to 87%). Individuals at risk and those aged below 50 years, who received at least 1 dose of vaccine against COVID-19, were 62% (39% to 74%) and 58% (24% to 77%) less likely to get admitted to hospital at reinfection, respectively. Conclusion Prior SARS-CoV-2 infection was associated with lower odds of dying, and both prior infection and immunisation showed a protective effect against severe disease in selected populations. Older age, sex and underlying comorbidities appeared as principal risk factors for illness severity at reinfection. Funding PHE/UKHSA

BackgroundReinfection after primary SARS-CoV-2 infection is uncommon in adults, but little is known about the risks, characteristics, severity or outcomes of reinfection in children.MethodsWe used national SARS-CoV-2 testing data in England to estimate the risk of reinfection ≥90 days after primary infection from 01 January 2020 to 31 July 2021, which encompassed both the Alpha and Delta waves in England. Disease severity was assessed by linking reinfection cases to national hospitalisation, intensive care admission and death registrations datasets.FindingsReinfection rates closely followed community infection rates, with a small peak during the Alpha wave and a larger peak during the Delta wave. In children aged ≤16 years, there were 688,418 primary infections and 2,343 reinfections. The overall reinfection rate was 66·88/100,000 population, being higher in adults (72.53/100,000) than in children (21·53/100,000). Reinfection rates after primary infection were 0·68% overall, 0·73% in adults and 0·34% in children. Of the 109 reinfections in children admitted to hospital, 78 (72%) had underlying comorbidities. Hospitalisation rates were similar for the first (64/2343, 2·73%) and second episode (57/2343, 2·43%). Intensive care admission was rare after primary infection (n=7) or reinfection (n=4), mainly in children with comorbidities. 44 deaths occurred after primary infection within 28 days of diagnosis (44/688,418, 0·01%), none after possible reinfections.InterpretationThe risk of SARS-CoV-2 reinfection is strongly related to exposure due to community infection rates, especially during the Delta variant wave. Children had a lower risk of reinfection than adults, but reinfections were not associated with more severe disease or fatal outcomes.FundingPHE/UKHSAResearch in ContextEvidence Before this studyWe searched PubMed with the terms “COVID-19” or “SARS-CoV-2” with “reinfection” to identify publications relating to SARS-CoV-2 reinfections from 01 January until 15 November 2021. There were few publications relating to SARS-CoV-2 reinfections, and these primarily related to adults. Published studies reported very low rates of reinfection during the first few months after primary infection in adults. COVID-19 vaccines provide effective immune protection against SARS-CoV-2 infection, but recent studies have reported increasing risk of breakthrough infection with time since primary vaccination due to waning immunity. Several SARS-CoV-2 variants, including the beta, gamma and delta variants have been shown to partially evade immunity after natural infection and vaccination, potentially increasing the risk of reinfections and breakthrough infections, respectively. Data on reinfections in children are lacking and restricted mainly to case reports in immunocompromised children.Added Value of This StudyWe used national SARS-CoV-2 testing data during the first 19 months of the pandemic to estimate the risk of reinfection in children compared to adults during a period that encompassed both the Alpha and the Delta variant waves in England. We found that the risk of reinfection correlated with the risk of SARS-CoV-2 exposure and therefore, closely reflected community infection rates, with most reinfections occurring during the Delta variant wave. Whilst acknowledging the limitation of using national testing data, we found that children had a lower risk of reinfection compared to adults and that the risk of reinfection in children increased with age. Reinfections were not associated with severe disease in terms of hospitalization or intensive care admission and there were no fatalities within 28 days of the reinfection episode in children.Implications of all the Available EvidenceSARS-CoV-2 reinfections are rare in children, especially younger children, and occurred mainly during the Delta wave in England. Reinfections were not associated with more severe disease or fatal outcomes in children. COVID-19 vaccination will provide further protection against primary infections and reinfections in children.

To illustrate how data triangulation involving routine data sources can optimize data usage and provide insights into vaccine programme effectiveness by considering measles vaccination and disease incidence data in England.We obtained data on measles, mumps and rubella (MMR) vaccine coverage in birth cohorts from 1985 to 2016 from child health records and adjusted for under-ascertainment and catch-up campaigns. We assumed that the population had no natural immunity and that vaccine effectiveness was 95% for one dose and 99.75% for two doses. Vaccinations done outside the routine schedule and in people who entered England after the age of immunization were identified from primary care records. Measles susceptibility was defined as the percentage of individuals who were not immune despite all vaccination activities. We triangulated measles susceptibility and incidence data.Median susceptibility was 4.6% (range: 1.2-9.2). Among cohorts eligible for two MMR vaccine doses, those born between 1998 and 2004 were most susceptible. Measles incidence was highest in these cohorts. Data from primary care and child health records were comparable for cohorts after 2000, suggesting that little supplementary vaccination took place. For cohorts before 2000, primary care data quality was insufficient for accurately estimating coverage.Triangulating routine data on measles vaccination coverage and disease surveillance provided new insights into population immunity and helped identify vulnerable groups, which was useful for prioritizing public health actions to close gaps in immunity. This approach could be applied in any country that routinely records vaccine coverage and disease incidence.Illustrer comment la triangulation des données incluant des sources de données ordinaires peut optimiser l'utilisation des données et donner une idée de l'efficacité du programme de vaccination en considérant des données relatives à la vaccination contre la rougeole et à l'incidence de la maladie en Angleterre.Nous avons obtenu des données sur la couverture vaccinale contre la rougeole, les oreillons et la rubéole dans les cohortes de naissances de 1985 à 2016 à partir des dossiers médicaux des enfants et nous les avons ajustées en fonction de la sous-détermination et des campagnes de rattrapage. Nous sommes partis du principe que la population n'avait pas d'immunité naturelle et que l'efficacité du vaccin était de 95% pour une dose et de 99,75% pour deux doses. Les vaccinations pratiquées en dehors du calendrier habituel et chez des personnes entrées en Angleterre après l'âge de vaccination ont été identifiées à partir des dossiers relatifs aux soins primaires. La sensibilité à la rougeole a été définie comme le pourcentage d'individus qui n'étaient pas immunisés malgré toutes les activités de vaccination. Nous avons triangulé les données relatives à la sensibilité à la rougeole et à l'incidence de la rougeole.La sensibilité médiane était de 4,6% (étendue: 1,2-9,2). Parmi les cohortes pouvant bénéficier de deux doses de vaccins ROR, celles nées entre 1998 et 2004 étaient les plus sensibles. L'incidence de la rougeole était plus élevée dans ces cohortes. Les données tirées des dossiers relatifs aux soins primaires et des dossiers médicaux des enfants étaient comparables pour les cohortes ultérieures à 2000, ce qui laisse entendre que peu de vaccinations supplémentaires ont été pratiquées. Dans le cas des cohortes antérieures à 2000, la qualité des données sur les soins primaires était insuffisante pour permettre une estimation précise de la couverture.La triangulation des données ordinaires sur la couverture vaccinale antirougeoleuse et la surveillance de la maladie a jeté une lumière nouvelle sur l'immunité de la population et aidé à identifier les groupes vulnérables, ce qui a permis d'établir l'ordre de priorité des actions de santé publique destinées à combler les lacunes en matière d'immunité. Cette approche pourrait être appliquée dans tous les pays qui enregistrent systématiquement la couverture vaccinale et l'incidence de la maladie.Ilustrar cómo la triangulación de datos con fuentes rutinarias de datos puede optimizar el uso de los mismos y proporcionar información sobre la eficacia de los programas de vacunación al considerar la vacunación contra el sarampión y los datos de incidencia de la enfermedad en Inglaterra.Se obtuvieron datos sobre la cobertura de la vacuna contra el sarampión, las paperas y la rubéola (SPR) en las cohortes de nacimiento de 1985 a 2016 a partir de los registros de salud infantil y se ajustaron para tener en cuenta las campañas de recuperación y de los errores por la falta de observaciones. Se asumió que la población no tenía inmunidad natural y que la efectividad de la vacuna era del 95 % para una dosis y del 99,75 % para dos dosis. Las vacunas realizadas fuera del horario de rutina y en personas que ingresaron a Inglaterra después de la edad de vacunación fueron identificadas en los registros de atención primaria. La susceptibilidad al sarampión se definió como el porcentaje de individuos que no eran inmunes a pesar de todas las actividades de vacunación. Se triangularon los datos de susceptibilidad e incidencia del sarampión.La mediana de susceptibilidad fue de 4,6 % (rango: 1,2-9,2). Entre las cohortes elegibles para dos dosis de la vacuna triple viral, las que nacieron entre 1998 y 2004 fueron las más susceptibles. La incidencia de sarampión fue mayor en estas cohortes. Los datos de los registros de atención primaria y de salud infantil fueron comparables para las cohortes después de 2000, lo que sugiere que se realizó muy poca vacunación suplementaria. Para las cohortes anteriores a 2000, la calidad de los datos de atención primaria fue insuficiente para estimar con precisión la cobertura.La triangulación de los datos de rutina sobre la cobertura de la vacunación contra el sarampión y la vigilancia de las enfermedades proporcionó nueva información sobre la inmunidad de la población y ayudó a identificar a los grupos vulnerables, lo que resultó útil para establecer prioridades en las medidas de salud pública a fin de subsanar las deficiencias en materia de inmunidad. Este enfoque podría aplicarse en cualquier país que registre de forma rutinaria la cobertura de la vacuna y la incidencia de la enfermedad.توضيح كيف يمكن لتخطيط البيانات الذي يتضمن مصادر بيانات روتينية، أن يؤدي إلى تحسين استخدام البيانات وتوفير رؤى ثاقبة حول فعالية برنامج اللقاح عن طريق وضع بيانات لقاح الحصبة وتكرار الإصابة بالمرض بإنجلترا في الاعتبار.لقد حصلنا على بيانات حول تغطية لقاح الحصبة والنكاف والحصبة الألمانية (MMR) في مجموعات المواليد من 1985 إلى 2016، من سجلات صحة الأطفال، وقمنا بتعديلها وفقاً لعدم التحقق وحملات المتابعة. وافترضنا أن السكان لم يكن لديهم مناعة طبيعية، وأن فعالية هذا اللقاح كانت 95% لجرعة واحدة، و99.75% لجرعتين. تم التعرف من خلال سجلات الرعاية الأولية على التطعيمات التي تمت خارج المخطط الروتيني، وعلى الأشخاص الذين دخلوا إلى إنجلترا بعد سن التمنيع. تم تعريف قابلية الإصابة بالحصبة على أنها النسبة المئوية للأفراد الذين لم يكونوا محصنين على الرغم من كل أنشطة التطعيم. قمنا بتخطيط بيانات قابلية الإصابة بالحصبة، والإصابة الفعلية بها.كان متوسط قابلية الإصابة هو 4.6% (المدى: 1.2 إلى 9.2). من بين المجموعات المؤهلة للحصول على جرعات لقاح MMR، كانت المواليد بين عامي 1998 و2004 هي الأكثر عرضة للإصابة. كان معدل الإصابة بالحصبة هو الأعلى بين هذه المجموعات. كانت البيانات المستقاة من سجلات الرعاية الأولية وسجلات صحة الأطفال قابلة للمقارنة بالنسبة لمجموعات ما بعد عام 2000، مما يوضح أنه تم الحصول على تطعيم تكميلي بسيط. بالنسبة للمجموعات ما قبل عام 2000، كانت جودة بيانات الرعاية الأولية غير كافية لتقدير التغطية بشكل دقيق.أدى تخطيط البيانات الروتينية حول تغطية التطعيم ضد الحصبة ومراقبة الأمراض، إلى تقديم رؤى ثاقبة جديدة حول مناعة السكان، والمساعدة في تحديد المجموعات المعرضة للخطر، والتي كانت مفيدة لمنح الأولوية لإجراءات الصحة العامة لعلاج ثغرات المناعة. يمكن تطبيق هذا الأسلوب في أية دولة تقوم بشكل روتيني بتسجيل بيانات تغطية اللقاح ومعدل الإصابة بالمرض.通过考虑英国的麻疹疫苗接种和疾病发病率数据来说明涉及常规数据源的数据三角互证如何优化数据使用情况并提供有关疫苗计划效果的见解。.我们从 1985 年至 2016 年的儿童健康记录中获得了出生队列中麻疹、腮腺炎和风疹 (MMR) 疫苗覆盖率的相关数据并根据归因不足和弥补活动进行了调整。我们假设该人群没有天然免疫力，并且一剂疫苗有效率为 95％，两剂疫苗有效率为 99.75％。在初级保健记录中确定了在常规计划之外以及在免疫接种年龄后进入英国的人群中进行的疫苗接种。麻疹易感率是指不论各种免疫活动，非免疫人口所占的百分比。我们对麻疹易感率和发病率数据进行了三角互证。.中位数易感率为 4.6％（范围：1.2-9.2）。在符合两种 MMR 疫苗剂量的队列中，1998 年至 2004 年间出生的人群最易感染。麻疹发病率在这些队列中最高。2000 年以后，来自初级保健和儿童健康记录的数据在队列中具有可比性，表明很少进行补充疫苗接种。对于 2000 年以前的队列，初级保健数据质量不足以准确估算覆盖率。.麻疹疫苗接种覆盖率和疾病监测的三角互证常规数据针对人群免疫力提供了新的见解并有助于识别易感群体，从而有利于优先考虑公共保健措施，以缩小免疫差距。这种方法可以应用于任何经常记录疫苗覆盖率和发病率的国家。.Проиллюстрировать, как триангуляция данных с применением стандартных источников данных может оптимизировать использование данных и помогает определять наиболее эффективные способы реализации программы прививок в контексте данных о вакцинации от кори и распространенности заболевания в Англии.Авторы рассмотрели данные об охвате вакциной от кори, краснухи и свинки (MMR) младенцев, родившихся в период с 1985 по 2016 год, которые получены из медицинских карточек детей, и скорректировали их с учетом недостаточного выявления и кампаний подчищающей иммунизации. Авторы исходили из предположения, что естественный иммунитет в популяции отсутствует и что эффективность вакцинации составляла 95% после однократной дозы и 99,75% после двух доз. Случаи вакцинации с нарушением обычного графика и вакцинации лиц, попавших в Англию позже установленного возраста иммунизации, идентифицировались по первичным медицинским документам. Подверженность заболеванию корью определялась как процентная доля лиц, которые не приобрели иммунитет, несмотря на вакцинацию. Авторы провели триангуляцию данных по частоте заболевания корью и подверженности этому заболеванию.Медианная подверженность заболеванию составила 4,6% (диапазон: 1,2–9,2). Среди когорт, которым полагалось получить две дозы вакцины MMR, наиболее подвержены заболеванию были дети, рожденные в период с 1998 по 2004 год. В этих когортах распространенность кори была наивысшей. Данные первичных учреждений здравоохранения и детских медицинских карт для когорт лиц, родившихся после 2000 года, были сопоставимыми, что позволяет предположить, что дополнительная вакцинация почти не проводилась. Для когорт лиц, родившихся до 2000 года, качество данных первичных медицинских документов было недостаточным для точного определения охвата вакцинацией.Триангуляция стандартных данных об охвате вакцинацией от кори и надзоре за распространенностью заболевания позволила сделать новые выводы об иммунном статусе популяции и помогла выявить подверженные риску группы, что было важно для расстановки приоритетов в общественном здравоохранении с целью принятия мер по ликвидации пробелов в иммунизации. Такой подход применим в любой стране, которая регулярно фиксирует охват населения вакцинацией и частоту возникновения соответствующих заболеваний.

Rubella vaccination has been included in the United Kingdom’s (UK) routine childhood schedule for nearly 30 years. The UK achieved World Health Organization (WHO) elimination status in 2016 and acute rubella infections are rare. In the period 2003–16, 31 rubella infections in pregnancy (0.23 per 100,000 pregnancies) were identified through routine surveillance, of which 26 were in women who were born abroad. Five of the 31 rubella infections led to congenital rubella syndrome in the infant and three had confirmed congenital rubella infection without congenital rubella syndrome. An additional seven babies were identified with congenital rubella syndrome, although rubella infection in pregnancy had not been reported. Place of birth was known for six of these seven mothers, all of whom were born outside the UK, and in five cases maternal infection was acquired abroad. WHO Europe has set targets for measles and rubella elimination and prevention of congenital rubella syndrome by 2015. Vaccination uptake and rubella immunity is high in the UK population and most infections in pregnancy since 2003 were acquired abroad and in unvaccinated women. Every contact with a health professional should be used to check that women are fully immunised according to UK schedule.

We report 52 cases of measles linked to music and arts festivals in England and Wales, between mid-June and mid-October 2016. Nearly half were aged 15 to 19 years. Several individuals who acquired measles at one festival subsequently attended another festival while infectious, resulting in multiple interlinked outbreaks. Transmission within festivals resulted in a geographical spread of cases nationally as well as internationally, which presents particular challenges for measles control.

We analyzed data from hospital admissions and enhanced mumps surveillance to assess mumps complications during the largest mumps outbreak in England and Wales, 2004–2005, and their association with mumps vaccination. When compared with nonoutbreak periods, the outbreak was associated with a clear increase in hospitalized patients with orchitis, meningitis, and pancreatitis. Routine mumps surveillance and hospital data showed that 6.1% of estimated mumps patients were hospitalized, 4.4% had orchitis, 0.35% meningitis, and 0.33% pancreatitis. Enhanced surveillance data showed 2.9% of mumps patients were hospitalized, 6.1% had orchitis, 0.3% had meningitis, and 0.25% had pancreatitis. Risk was reduced for hospitalization (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.43–0.68), mumps orchitis (OR 0.72, 95% CI 0.56–0.93) and mumps meningitis (OR 0.28, 95% CI 0.14–0.56) when patient had received 1 dose of measles, mumps, and rubella vaccine. The protective effect of vaccination on disease severity is critical in assessing the total effects of current and future mumps control strategies.

SUMMARYBetween 3 April and 18 May 2007, 21 confirmed cases of measles were reported in members of the Irish traveller ethnic group who attended a funeral in London, England. The Health Protection Agency conducted an investigation to determine the extent of this outbreak in order to inform prevention of future outbreaks. From 23 March to 30 June, 173 outbreak-associated cases from seven regions throughout England were identified; 156 cases were in Irish travellers and 17 were epidemiologically linked to cases in that community. In total, 124 cases were laboratory confirmed (IgM or RNA); none were vaccinated against measles. MMR vaccination was offered on traveller sites. Low vaccination coverage and the movement of traveller communities present particular challenges for measles elimination in Europe. We recommend parallel approaches to improve integration of Irish travellers within routine health services whilst offering targeted interventions to increase vaccine uptake in this marginalized community.

The causes of leucodepletion failure are multifactoral and can be related to haematological variability in blood donors or donation, defective filters, poor specimen handling or ageing, and/or the presence of non-adhering leucocyte/platelets. Since refiltering removes all types of leucocytes, including the populations appearing as extra gated events, we have developed a practical method for refiltering the failed leucodepleted components on standard filters and back-flushing the second filter to assess the nature of the WBC sub-population. In practice, recovered leucocytes from red cell filters and whole blood mainly consist of neutrophils. Those from platelet and plasma filters were mainly lymphocyte with considerable differences depending on the type of leucodepletion process. Atypical leucocytes are often seen in some pre-/post-cellular leucofiltered components. These appear characteristically as small WBC with a lower affinity for filter matrix, or as cell fragment, pinched leucocyte or apoptotic cells. Different reagents in use show variable sensitivity in identifying these extra gatal events. Storage of leucodepleted samples also induces different types of abnormality in leucocyte dot plot. A useful practical approach for characterisation of the nature of leucocyte sub-populations causing failure in leucodepleted components is provided.

This exercise focused on performance of NBS quality monitoring establishments with respect to enumeration of low leucocyte and other quality indexes of platelet concentration. Paired identical leucodepleted platelet samples, spiked with WBC (20 cells/microl) in 'vacuette' or 'pouch' were assessed by participants (n = 20) on days 1, 2 and 5. For low WBC counting, all laboratories gave estimates within acceptable range (+/-25%) and good agreement between storage and assay methods was observed on days 1 and 2. Day 5 results showed greater variability. Under improved performance criteria (+/-15%), only one laboratory under-estimated at days 1 and 2. Similarly, other parameters demonstrated good agreement between storage methods on days 1 and 2. At day 5, mean results were often significantly different to previous days. Improved performance target (+/-15%) will allow identification of non-conformers.

Background Measles is a highly contagious and potentially fatal illness preventable through vaccination. Outbreaks in the UK and many other European countries have been increasing over recent years, with over 3,207 laboratory-confirmed cases reported by Public Health England from January 2012 to the end of June 2013. To aid rational decision making regarding measles control versus other use of healthcare resources, it is important to measure the severity of measles in units that are comparable to other diseases. The standard metric for this in the UK is the quality-adjust life year (QALY). To our knowledge, the impact of measles on health-related quality of life (HRQoL) in terms of QALYs has not been quantified. Methods and Findings Individuals with confirmed measles were sent questionnaires requesting information on the short-term impact of the illness on their HRQoL using the EuroQol EQ-5D-3L questionnaire. HRQoL was reported for the day the questionnaire was received, the worst day of infection and at follow-up three weeks later. 507 questionnaires were sent to individuals with confirmed measles with 203 returned (40%). The majority of respondents were not vaccinated. The mean time off work or school was 9.6 days. The mean duration of perceived illness was 13.8 days. The mean number of QALYs lost was 0.019 (equivalent to 6.9 days). The overall burden of disease in terms of QALYs lost in England based on the total number of confirmed cases in the twelve month period from 1st June 2012 was estimated to be 44.2 QALYs. Conclusion The short-term impact of measles infection on HRQoL is substantial, both at the level of the individual patient and in terms of the overall disease burden. This is the first attempt to quantify QALY-loss due to measles at a population level, and provides important parameters to guide future intervention and control measures.

In view of the increase in the number of mumps cases in 2009 and of the reports of mumps outbreaks in 2010, we report on the most recently available mumps surveillance data in England and Wales.

Background . WBC counting, an essential part of quality monitoring of WBC-reduced blood components, is carried out logistically within 48–72 h of collection. The between-laboratory variability and effects of 24–48 h storage were investigated using three major counting technologies. Study design and methods . Samples of RBC and platelets with WBC in the range 0–50/μl were transported by courier. WBC counting was performed on days 1 and 2, by IMAGN 2000, flow cytometry and Nageotte, initially using local protocols and then using a national flow protocol. Up to 15 laboratories participated in each exercise. Results . For "real failed leucodepleted" red cell products, higher levels of variability were observed for flow and Nageotte, as compared to IMAGN. For spiked RBC samples at critical decision making point (3–20 WBC/μl), between-laboratory the coefficients of variation (CVs) were low for IMAGN and were the highest for Nageotte. Flow cytometry CVs were generally high but improved subsequent to standardisation of sampling and the gating strategy. A similar pattern in the variability of results was observed for platelet concentrates. Sign tests using all samples (carried out for each method in each exercise; 25 in total) demonstrated no overall tendency for larger WBC counts to be recorded on day 1 when compared to day 2, although this difference was significant ( p Conclusions . We conclude that while a good performance is achieved using validated automated technologies for low residual leucocyte counting, the unification of reagents and standardisation of sampling and gating strategies are essential in obtaining interchangeable results. Unfixed RBC and platelet samples can generally be stored for 48 h before WBC counting.

There have recently been significant changes in diagnostic practices for detecting enterovirus (EV) infections across England and Wales. Reports of laboratory-confirmed EV infections submitted by National Health Service (NHS) hospital laboratories to Public Health England (PHE) over a 12-year period (2000–2011) were analysed. Additionally, the PHE Virus Reference Department (VRD) electronic database containing molecular typing data from 2004 onwards was interrogated. Of the 13 901 reports, there was a decline from a peak of 2254 in 2001 to 589 in 2006, and then an increase year-on-year to 1634 in 2011. This increase coincided with increasing PCR-based laboratory diagnosis, which accounted for 36% of reported cases in 2000 and 92% in 2011. The estimated annual incidence in 2011 was 3.9/100 000 overall and 238/100 000 in those aged