scholarly journals Uncovering Infant Group B Streptococcal (GBS) Disease Clusters in the United Kingdom and Ireland Through Genomic Analysis: A Population-based Epidemiological Study

2020 ◽  
Author(s):  
Simon M Collin ◽  
Natalie Groves ◽  
Catherine O’Sullivan ◽  
Elita Jauneikaite ◽  
Darshana Patel ◽  
...  
Keyword(s):  
Late Onset ◽  
Genomic Analysis ◽  
Population Based ◽  
Difference Threshold ◽  
The United Kingdom ◽  
Admission Data ◽  
True Frequency ◽  
Group B ◽  
The Uk ◽  
Record Review

Abstract Background The true frequency of hospital outbreaks of invasive group B streptococcal (iGBS; Streptococcus agalactiae) disease in infants is unknown. We used whole genome sequencing (WGS) of iGBS isolates collected during a period of enhanced surveillance of infant iGBS disease in the UK and Ireland to determine the number of clustered cases. Methods Potentially linked iGBS cases from infants with early (<7 days of life) or late-onset (7–89 days) disease were identified from WGS data (HiSeq 2500 platform, Illumina) from clinical sterile site isolates collected between 04/2014 and 04/2015. We assessed time and place of cases to determine a single-nucleotide polymorphism (SNP) difference threshold for clustered cases. Case details were augmented through linkage to national hospital admission data and hospital record review by local microbiologists. Results Analysis of sequences indicated a cutoff of ≤5 SNP differences to define iGBS clusters. Among 410 infant iGBS isolates, we identified 7 clusters (4 genetically identical pairs with 0 SNP differences, 1 pair with 3 SNP differences, 1 cluster of 4 cases with ≤1 SNP differences) of which 4 clusters were uncovered for the first time. The clusters comprised 16 cases, of which 15 were late-onset (of 192 late-onset cases with sequenced isolates) and 1 an early-onset index case. Serial intervals between cases ranged from 0 to 59 (median 12) days. Conclusions Approximately 1 in 12 late-onset infant iGBS cases were part of a hospital cluster. Over half of the clusters were previously undetected, emphasizing the importance of routine submission of iGBS isolates to reference laboratories for cluster identification and genomic confirmation.

ELFIN, the United Kingdom preterm lactoferrin trial: interpretation and future questions

2020 ◽  
Author(s):  
Janet Elizabeth Berrington ◽  
William McGuire ◽  
NIcholas David Embleton
Keyword(s):  
United Kingdom ◽  
Preterm Infants ◽  
Late Onset ◽  
Disease Onset ◽  
Intervention Group ◽  
Control Group ◽  
Bovine Lactoferrin ◽  
The United Kingdom ◽  
Late Onset Sepsis ◽  
The Uk

Previous studies suggested that supplemental bovine lactoferrin (BLF) given to preterm infants (<32 weeks gestation) may reduce late onset sepsis (LOS) and necrotising enterocolitis (NEC), but have been underpowered. The Enteral Lactoferrin in Neonates (ELFIN) study, performed in the United Kingdom (UK), aimed to further address this issue with a well powered double blinded placebo controlled trial of >2200 preterm infants. ELFIN did not demonstrate a reduction in LOS or NEC, or several other clinically important measures. 316 (29%) of 1093 infants in the intervention group developed late-onset sepsis versus 334 (31%) of 1089 in the control group with an adjusted risk ratio of 0·95 (95% CI 0·86–1·04; p=0· 233). Reasons for the differences in ELFIN trial results and other studies may include population differences, the routine use of antifungals in the UK, timing of administration of the lactoferrin in relation to disease onset, or specific properties of the lactoferrin used in different trials. Further exploration is being undertaken in the UK NIHR funded Mechanisms Affecting the Guts of Preterm Infants in Enteral feeding trials (MAGPIE) study, for which results should be available soon.

scholarly journals Severity of COVID-19 in children with cancer: Report from the United Kingdom Paediatric Coronavirus Cancer Monitoring Project

2020 ◽  
Author(s):  
Gerard C. Millen ◽  
Roland Arnold ◽  
Jean-Baptiste Cazier ◽  
Helen Curley ◽  
Richard G. Feltbower ◽  
...  
Keyword(s):  
Severe Infection ◽  
Paediatric Population ◽  
Population Based ◽  
Children With Cancer ◽  
The United Kingdom ◽  
Increased Risk ◽  
Polymerase Chain ◽  
The Uk ◽  
Active Care ◽  
Care Support

Abstract Background Children with cancer are frequently immunocompromised. While children are generally thought to be at less risk of severe SARS-CoV-2 infection than adults, comprehensive population-based evidence for the risk in children with cancer is unavailable. We aimed to produce evidence of the incidence and outcomes from SARS-CoV-2 in children with cancer attending all hospitals treating this population across the UK. Methods Retrospective and prospective observational study of all children in the UK under 16 diagnosed with cancer through data collection from all hospitals providing cancer care to this population. Eligible patients tested positive for SARS-CoV-2 on reverse transcription polymerase chain reaction (RT-PCR). The primary end-point was death, discharge or end of active care for COVID-19 for those remaining in hospital. Results Between 12 March 2020 and 31 July 2020, 54 cases were identified: 15 (28%) were asymptomatic, 34 (63%) had mild infections and 5 (10%) moderate, severe or critical infections. No patients died and only three patients required intensive care support due to COVID-19. Estimated incidence of hospital identified SARS-CoV-2 infection in children with cancer under 16 was 3%. Conclusions Children with cancer with SARS-CoV-2 infection do not appear at increased risk of severe infection compared to the general paediatric population. This is reassuring and supports the continued delivery of standard treatment.

scholarly journals Trends in the use of oral anticoagulants, antiplatelets and statins in four European countries: a population-based study

2021 ◽  
Author(s):  
Luis A. García Rodríguez ◽  
Lucía Cea Soriano ◽  
Francisco J. de Abajo ◽  
Francesca Valent ◽  
Jesper Hallas ◽  
...  
Keyword(s):  
Low Dose ◽  
Oral Anticoagulants ◽  
Population Based ◽  
European Countries ◽  
The United Kingdom ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Prevalence Proportion ◽  
The Uk ◽  
Statin Use

Abstract Purpose To evaluate time trends in the prevalence of antithrombotic and statin use in four European countries. Methods Using population-based data from the United Kingdom, Denmark, Spain and Italy between 2010 and 2018, we calculated standardized annual prevalence proportions of antithrombotics and statin use, and changes in prevalence proportions (2018 vs. 2010). Results Prevalence proportion of statins increased from 24.8% to 24.6% (UK), 21.0% to 22.3% (Region of Southern Denmark [RSD]), 12.9% to 14.3% (Udine, Italy), and 20.3% to 23.2% (Spain). Prevalence proportions of antithrombotics declined in all four countries: 18.7% to 15.9% (UK; − 2.8% points), 18.9% to 18.1% (RSD; − 0.8% points), 17.7% to 16.6% (Udine; − 1.1% points) and 15.0% to 13.6% (Spain; − 1.4% points). These declines were driven by reductions in low-dose aspirin use: 15.3% to 8.9% (UK; − 6.4% points), 16.3% to 9.5% (RSD; − 6.8% points), 13.5% to 11.6% (Udine; − 1.9% points), and 10.2% to 8.8% (Spain; − 1.4% points). In the UK, low-dose aspirin use declined from 9.1% to 4.3% (− 4.8% points) for primary CVD prevention, and from 49.6% to 36.9% (− 12.7% points) for secondary prevention. Oral anticoagulant use gradually increased but did not fully account for the decrease in low-dose aspirin use. Conclusions Antithrombotic use in the UK, RSD, Udine and Spain declined between 2010 and 2018, driven by a reduction in use of low-dose aspirin that is not completely explained by a gradual increase in OAC use. Use of statins remained constant in the UK, and increased gradually in the RSD, Udine and Spain.

Social Union

2021 ◽  
pp. 153-169
Author(s):  
Michael Keating
Keyword(s):  
United Kingdom ◽  
Health Education ◽  
Northern Ireland ◽  
Social Services ◽  
Population Based ◽  
The Other ◽  
Social Citizenship ◽  
The United Kingdom ◽  
The Uk ◽  
Undeserving Poor

Unionists have defended the United Kingdom as a social or ‘sharing’ union in which resources are distributed according to need. It is true that income support payments and pensions are largely reserved and distributed across the union according to the same criteria. Scotland, Wales and Northern Ireland are net beneficiaries. On the other hand, welfare has been detached from older understandings of social citizenship and ideas of the deserving and undeserving poor (strivers and skivers) have returned. Spending on devolved matters including health, education and social services is not equalized across the union. Instead, the Barnett Formula, based on historic spending levels and population-based adjustments, is used. Contrary to the claims of many unionists, there is no needs assessment underlying it, apart from a safeguard provision for Wales. The claim that the UK is a sharing union thus needs to be qualified.

scholarly journals The prevention of neonatal group B streptococcal disease: a report by a working group of the Medical Screening Society

2005 ◽  
Vol 12 (2) ◽  
pp. 60-68 ◽  
Author(s):  
MR Law ◽  
G Palomaki ◽  
Z Alfirevic ◽  
R Gilbert ◽  
P Heath ◽  
...  
Keyword(s):  
Late Onset ◽  
Effective Means ◽  
Group B Streptococcus ◽  
Neonatal Meningitis ◽  
Screening Performance ◽  
Alternative Means ◽  
Neonatal Group ◽  
Group B Streptococcal Disease ◽  
Group B ◽  
The Uk

Streptococcus agalactiae, or Lancefield group B streptococcus (GBS), is the most frequent cause of serious bacterial sepsis, including neonatal meningitis, in UK neonates. Early-onset neonatal GBS infection, but not late-onset, can be prevented by screening to identify high-risk pregnancies and administering penicillin during delivery. A vaccine has been developed as an alternative means of prevention but it is awaiting a randomized trial before being available for general use. In this review we examine the published literature to assess the morbidity and mortality attributable to neonatal GBS infection, quantify the screening performance of the two alternative modes of screening (microbiological and risk factor based), review the evidence on the efficacy of the vaccine, and estimate the numbers of deaths and cases of serious disability that each strategy in turn might prevent in the UK, in order to assess the most effective means of prevention for the UK.

scholarly journals Prevalence and Mortality of Individuals With X-Linked Hypophosphatemia: A United Kingdom Real-World Data Analysis

2019 ◽  
Vol 105 (3) ◽  
pp. e871-e878 ◽  
Author(s):  
Samuel Hawley ◽  
Nick J Shaw ◽  
Antonella Delmestri ◽  
Daniel Prieto-Alhambra ◽  
Cyrus Cooper ◽  
...  
Keyword(s):  
United Kingdom ◽  
Fibroblast Growth Factor 23 ◽  
Later Life ◽  
Population Based ◽  
Real World Data ◽  
The United Kingdom ◽  
Multisystemic Disease ◽  
The Uk ◽  
The Life Course

Abstract Background X-linked hypophosphatemia (XLH) is a rare multisystemic disease with a prominent musculoskeletal phenotype. We aim here to improve understanding of the prevalence of XLH across the life course and of overall survival among people with XLH. Methods This was a population-based cohort study using a large primary care database in the United Kingdom (UK) from 1995 to 2016. XLH cases were matched by age, gender, and practice to up to 4 controls. Trends in prevalence over the study period were estimated (stratified by age) and survival among cases was compared with that of controls. Findings From 522 potential cases, 122 (23.4%) were scored as at least possible XLH, while 62 (11.9%) were classified as highly likely or likely (conservative definition). In main analyses, prevalence (95% CI) increased from 3.1 (1.5–6.7) per million in 1995–1999 to 14.0 (10.8–18.1) per million in 2012–2016. Corresponding estimates using the conservative definition were 3.0 (1.4–6.5) to 8.1 (5.8–11.4). Nine (7.4%) of the possible cases died during follow-up, at median age of 64 years. Fourteen (2.9%) of the controls died at median age of 72.5 years. Mortality was significantly increased in those with possible XLH compared with controls (hazard ratio [HR] 2.93; 95% CI, 1.24–6.91). Likewise, among those with likely or highly likely XLH (HR 6.65; 1.44–30.72). Conclusions We provide conservative estimates of the prevalence of XLH in children and adults within the UK. There was an unexpected increase in mortality in later life, which may have implications for other fibroblast growth factor 23–related disorders.

scholarly journals Group B streptococcus-an update

2005 ◽  
Vol 4 (12) ◽  
pp. 356-357
Author(s):  
Mary Singh
Keyword(s):  
United Kingdom ◽  
Group B Streptococcus ◽  
Neonatal Morbidity ◽  
Neonatal Infection ◽  
Specialist Registrar ◽  
The United Kingdom ◽  
Standard Of Practice ◽  
Group B ◽  
The Uk ◽  
Developed World

Group B streptococcus (GBS) infection has long been recognised as an important cause of neonatal morbidity. It is now known to be the most common serious neonatal infection in the developed world. In the United Kingdom (UK), it is estimated that 1 in 1000 babies develops a GBS infection. A recent London study, however, estimated the incidence of culture-proven plus suspected cases of GBS infection to be significantly higher (approximately 3.6 per 1000 babies born). Despite this, there is no standard of practice in the UK for stopping GBS infections in newborn babies. Mary Singh, specialist registrar at the Royal Lancaster Infirmary, explains.

scholarly journals Characterization of Ceftazidime-Avibactam-Resistant Carbapenem-Resistant Enterobacteriaceae, United States, 2015–2017

2020 ◽  
Vol 41 (S1) ◽  
pp. s465-s466
Author(s):  
Uzma Ansari ◽  
Hannah E. Reses ◽  
Julian Grass ◽  
Joelle Nadle ◽  
Chris Bower ◽  
...  
Keyword(s):  
Public Health Problem ◽  
Population Based ◽  
International Travel ◽  
Major Public Health Problem ◽  
Convenience Sample ◽  
Carbapenem Resistant ◽  
Admission Data ◽  
Sterile Site ◽  
Record Review ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are a major public health problem. Ceftazidime-avibactam (CZA) is a treatment option for CRE approved in 2015; however, it does not have activity against isolates with metallo-β-lactamases (MBLs). Emerging resistance to CZA is a cause for concern. Our objective was to describe the microbiologic and epidemiologic characteristics of CZA-resistant (CZA-R) CRE. Methods: From 2015 to 2017, 9 states participated in laboratory- and population-based surveillance for carbapenem-resistant Escherichia coli, Klebsiella pneumoniae, K. oxytoca, K. aerogenes, and Enterobacter cloacae complex isolates from a normally sterile site or urine. A convenience sample of isolates from this surveillance were sent to the CDC for antimicrobial susceptibility testing (AST) using reference broth microdilution (BMD) including an MBL screen, species confirmation with MALDI-TOF, and real-time PCR to detect blaKPC, blaNDM, and blaOXA-48–like genes. Additional AST by BMD was performed on CZA-R isolates using meropenem-vaborbactam (MEV), imipenem-relebactam (IMR), plazomicin (PLZ), and eravacycline (ERV). Epidemiologic data were obtained from a medical record review. Community-associated cases were defined as having no healthcare exposures in the year prior to culture, no devices in place 2 days prior to culture, and culture collected before calendar day 3 after hospital admission. Data were analyzed in 3 groups: CRE that were CZA-susceptible (CZA-S), CZA-R that were due to blaNDM, and CZA-R without blaNDM. Results: Among 606 confirmed CRE tested with CZA, 33 (5.4%) were CZA-R. Of the CZA-R isolates, 16 (48.5%) harbored a blaNDM gene, of which 2 coharbored blaNDM and blaOXA-48-like genes; 9 (27.3%) harbored only a blaKPC gene. Of the 17 CZA-R isolates without blaNDM, all were MBL screen negative. CZA-R due to blaNDM were more frequently community-associated (43.8%) than CZA-S or CZA-R without blaNDM (11.0% and 5.9%, respectively); a higher percentage of CZA-R cases due to blaNDM also had recent international travel (25%) compared to the other groups (1.8% and 5.9%, respectively). CZA-R without blaNDM were more susceptible to MEV (76%), IMR (71%), PLZ (88%), and ERV (65%) compared to CZA-R due to blaNDM (19%, 6%, 56%, and 44%, respectively). Conclusions: The emergence of CZA-R isolates without blaNDM are concerning; however, these isolates are more susceptible to newer antimicrobials than those with blaNDM. In addition to high rates of resistance to newer antimicrobials, isolates with blaNDM are more frequently community-associated than other CRE. This underscores the need for more aggressive measures to stop the spread of CRE.Funding: NoneDisclosures: None

scholarly journals The changing epidemiology of diphtheria in the United Kingdom, 2009 to 2017

2020 ◽  
Vol 25 (11) ◽  
Author(s):  
Charlotte M Gower ◽  
Antonia Scobie ◽  
Norman K Fry ◽  
David J Litt ◽  
J Claire Cameron ◽  
...  
Keyword(s):  
United Kingdom ◽  
Health Management ◽  
Population Based ◽  
Toxin Gene ◽  
Reference Laboratory ◽  
Prospective Surveillance ◽  
The United Kingdom ◽  
Toxigenic Strains ◽  
The Uk ◽  
The Impact

Background Diphtheria is a potentially fatal disease caused by toxigenic strains of Corynebacterium diphtheriae, C. ulcerans or C. pseudotuberculosis. Aim Our objective was to review the epidemiology of diphtheria in the United Kingdom (UK) and the impact of recent changes in public health management and surveillance. Methods Putative human toxigenic diphtheria isolates in the UK are sent for species confirmation and toxigenicity testing to the National Reference Laboratory. Clinical, epidemiological and microbiological information for toxigenic cases between 2009 and 2017 are described in this population-based prospective surveillance study. Results There were 33 toxigenic cases of diphtheria aged 4 to 82 years. Causative species were C. diphtheriae (n = 18) and C. ulcerans (n = 15). Most C. diphtheriae cases were cutaneous (14/18) while more than half of C. ulcerans cases had respiratory presentations (8/15). Two thirds (23/33) of cases were inadequately immunised. Two cases with C. ulcerans infections died, both inadequately immunised. The major risk factor for C. diphtheriae aquisition was travel to an endemic area and for C. ulcerans, contact with a companion animal. Most confirmed C. diphtheriae or C. ulcerans isolates (441/507; 87%) submitted for toxigenicity testing were non-toxigenic, however, toxin positivity rates were higher (15/23) for C. ulcerans than C. diphtheriae (18/469). Ten non-toxigenic toxin gene-bearing (NTTB) C. diphtheriae were also detected. Conclusion Diphtheria is a rare disease in the UK. In the last decade, milder cutaneous C. diphtheriae cases have become more frequent. Incomplete vaccination status was strongly associated with the risk of hospitalisation and death.

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