1406. Hepatitis B and C Prevalence in Patients with Active and Latent Tuberculosis in an Ethnically Diverse Area of London, UK

Abstract Background North West London has one of the highest tuberculosis (TB) rates in the UK, at 24.8 per 10,000. The UK prevalence of hepatitis B virus (HBV) is 0.1-0.5% and for hepatitis C virus (HCV) is 0.5-1%. Chronic infection with HBV or HCV can lead to an increased risk of adverse treatment outcomes, such as drug-induced liver injury (DILI) in patients with active or latent TB. National guidelines recommend routinely screening for HBV/HCV prior to initiating TB treatment. Our objectives were to 1) evaluate the HBV/HCV screening practice in local TB clinics, 2) establish the prevalence of HBV/HCV in patients receiving TB treatment. Methods Retrospective analysis of laboratory and medical records of patients treated for active or latent TB identified from the London TB register and clinic records from 01/01/2018 to 31/12/2020 from London North West NHS Trust. Results 1409 patients received treatment for TB during the time period of interest; 574 (40.7%) had active disease and 835 (59.3%) had latent infection. 966/1409 patients (68.56%) were screened for HBV and HCV. 55.9% of the active TB group and 77.2% of the latent infection group were tested. 66 (6.8%) patients had isolated anti-HBc positivity, 22 (2.3%) were HBV surface antigen positive and 8 (0.8%) were HCV-antibody positive. HBV surface antigens were more prevalent in active TB patients: 9/321 (2.80%) with active TB versus 13/645 (2.02%) with latent TB. 36/321 (11.21%) active TB patients had HBV core antibodies compared to 30/645 (4.65%) latent TB patients (p < 0.001). Three patients started antiviral treatment following their viral hepatitis diagnosis (one with HBV, two with HCV). Conclusion The prevalence of chronic HBV in the study population was higher than the estimated UK prevalence. Fifteen diagnoses of hepatitis were new, allowing specialist referral for monitoring of fibrosis and development of hepatocellular carcinoma. Three patients required hepatitis treatment. 6.8% of patients were positive for anti-HBc and therefore identified as being at future risk of HBV reactivation if requiring immunosuppressive therapies.TB disproportionately affects marginalised communities; screening for viral hepatitis in TB clinic represents an opportunity to target these hard-to-reach groups to maximise the impact of public health interventions. Disclosures All Authors: No reported disclosures

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Routine use of immunosuppressants is associated with mortality in hospitalised patients with COVID-19

Therapeutic Advances in Drug Safety ◽

10.1177/2042098620985690 ◽

2021 ◽

Vol 12 ◽

pp. 204209862098569

Author(s):

Phyo K. Myint ◽

Ben Carter ◽

Fenella Barlow-Pay ◽

Roxanna Short ◽

Alice G. Einarsson ◽

...

Keyword(s):

Medical Attention ◽

Close Monitoring ◽

Plain Language ◽

Discharge Data ◽

Specific Patient ◽

Risk Of Death ◽

Hospitalised Patients ◽

Increased Risk ◽

The Uk ◽

The Impact

Background: Whilst there is literature on the impact of SARS viruses in the severely immunosuppressed, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study population was drawn from the COPE Study (COVID-19 in Older People), a multicentre observational cohort study, across the UK and Italy. Data were collected between 27 February and 28 April 2020 by trained data-collectors and included all unselected consecutive admissions with COVID-19. Load (name/number of medications) and dosage of immunosuppressant were collected along with other covariate data. Primary outcome was time-to-mortality from the date of admission (or) date of diagnosis, if diagnosis was five or more days after admission. Secondary outcomes were Day-14 mortality and time-to-discharge. Data were analysed with mixed-effects, Cox proportional hazards and logistic regression models using non-users of immunosuppressants as the reference group. Results: In total 1184 patients were eligible for inclusion. The median (IQR) age was 74 (62–83), 676 (57%) were male, and 299 (25.3%) died in hospital (total person follow-up 15,540 days). Most patients exhibited at least one comorbidity, and 113 (~10%) were on immunosuppressants. Any immunosuppressant use was associated with increased mortality: aHR 1.87, 95% CI: 1.30, 2.69 (time to mortality) and aOR 1.71, 95% CI: 1.01–2.88 (14-day mortality). There also appeared to be a dose–response relationship. Conclusion: Despite possible indication bias, until further evidence emerges we recommend adhering to public health measures, a low threshold to seek medical advice and close monitoring of symptoms in those who take immunosuppressants routinely regardless of their indication. However, it should be noted that the inability to control for the underlying condition requiring immunosuppressants is a major limitation, and hence caution should be exercised in interpretation of the results. Plain Language Summary Regular Use of Immune Suppressing Drugs is Associated with Increased Risk of Death in Hospitalised Patients with COVID-19 Background: We do not have much information on how the COVID-19 virus affects patients who use immunosuppressants, drugs which inhibit or reduce the activity of the immune system. There are various conflicting views on whether immune-suppressing drugs are beneficial or detrimental in patients with the disease. Methods: This study collected data from 10 hospitals in the UK and one in Italy between February and April 2020 in order to identify any association between the regular use of immunosuppressant medicines and survival in patients who were admitted to hospital with COVID-19. Results: 1184 patients were included in the study, and 10% of them were using immunosuppressants. Any immunosuppressant use was associated with increased risk of death, and the risk appeared to increase if the dose of the medicine was higher. Conclusion: We therefore recommend that patients who take immunosuppressant medicines routinely should carefully adhere to social distancing measures, and seek medical attention early during the COVID-19 pandemic.

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'Greenfields' and 'Brownfields': automotive industrial development in the UK and in Portugal

Finisterra ◽

10.18055/finis1791 ◽

2012 ◽

Vol 31 (62) ◽

Author(s):

Andrew Pike ◽

Mário Vale

Keyword(s):

Industrial Policy ◽

Automobile Industry ◽

Industrial Development ◽

Development Strategies ◽

North West ◽

Demonstration Effect ◽

North East ◽

The North ◽

The Uk ◽

The Impact

The industrial policy in the UK and in Portugal, as in most EU countries, seeks to attract new investment capacity, to create jobs and to promote the impact of the so-called "demonstration efect" of "greenfield" development strategies pursued in the new plants of inward investors on existing or "brownfield" plants. This industrial policy focus is particularly evident in the automobile industry.This paper compares the industrial policy oriented towards the automobile industry in the UK and in Portugal. Two recent "greenfield" investments are analised: Nissan in the North-East region (UK) and Ford/VW in the Setúbal Peninsula (Portugal), as well as three "brownfield" plants: Ford Halewood and GM Vauxhall Ellesmere Port in the North-West region (UK) and Renault in Setúbal (Portugal). The first part starts with a discussion of industrial policy in the automobile sector, the role of "greenfield" development strategies and the "demonstration effect" on "brownfield" plants. Then, the limits of new inward investment are pointed out, basically their problems and restrictions. Afterwards, the structural barriers to the "demonstration effect" within "brownfield" plants are outlined and some possabilities for alternative "brownfield" development strategies are presented.

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Hepatitis B virus infection in Nigeria: a systematic review and meta-analysis of data published between 2010 and 2019

BMC Infectious Diseases ◽

10.1186/s12879-021-06800-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Busayo I. Ajuwon ◽

Isabelle Yujuico ◽

Katrina Roper ◽

Alice Richardson ◽

Meru Sheel ◽

...

Keyword(s):

Systematic Review ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Disease Surveillance ◽

Control Strategies ◽

Meta Analysis ◽

Population Based ◽

North West ◽

B Virus ◽

The Impact

Abstract Background Hepatitis B virus (HBV) is an infectious disease of global significance, causing a significant health burden in Africa due to complications associated with infection, such as cirrhosis and liver cancer. In Nigeria, which is considered a high prevalence country, estimates of HBV cases are inconsistent, and therefore additional clarity is required to manage HBV-associated public health challenges. Methods A systematic review of the literature (via PubMed, Advanced Google Scholar, African Index Medicus) was conducted to retrieve primary studies published between 1 January 2010 and 31 December 2019, with a random-effects model based on proportions used to estimate the population-based prevalence of HBV in the Nigerian population. Results The final analyses included 47 studies with 21,702 participants that revealed a pooled prevalence of 9.5%. A prevalence estimate above 8% in a population is classified as high. Sub-group analyses revealed the highest HBV prevalence in rural settings (10.7%). The North West region had the highest prevalence (12.1%) among Nigeria’s six geopolitical zones/regions. The estimate of total variation between studies indicated substantial heterogeneity. These variations could be explained by setting and geographical region. The statistical test for Egger’s regression showed no evidence of publication bias (p = 0.879). Conclusions We present an up-to-date review on the prevalence of HBV in Nigeria, which will provide critical data to optimise and assess the impact of current prevention and control strategies, including disease surveillance and diagnoses, vaccination policies and management for those infected.

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P0559AKI SEASONALITY IN ENGLAND

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa143.p0559 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Esther Wong ◽

Dorothea Nitsch

Keyword(s):

Cox Regression ◽

Winter Season ◽

Kidney Injury ◽

Seasonal Effect ◽

Winter Mortality ◽

Age Group ◽

Hospitalised Patients ◽

Increased Risk ◽

The Uk ◽

The Impact

Abstract Background and Aims Incidence of Acute Kidney Injury (AKI) is known to be seasonal, peaking in winter months among hospitalised patients. Previous studies have suggested that the seasonality of AKI is likely to be influenced by the seasonality of the underlying acute illnesses that are associated with AKI. Mortality of patients with AKI has also been reported as being higher in winter, reflecting well-described excess winter mortality associations. Here we describe the seasonal variations of AKI alerts in England and the associated mortality rate using linked national databases. Method Serum creatinine changes compatible with KDIGO AKI stage 1, 2 and 3 are sent by laboratories in England as AKI alerts to the treating clinicians and the UK Renal Registry (UKRR). We linked the electronic AKI alerts to the Hospital Episode Statistics (HES) data, to identify patients who were hospitalised. We carried out descriptive statistics, and investigate the seasonal effect to the 30-day patient mortality from date of getting AKI alert, using multivariable Cox regression and sequentially adjusting for age, sex, Index of multiple deprivation (IMD) and peak AKI stage Results Winter has the highest number of AKI episodes (N=81,276), which is 6% higher than that in summer (N=76,329) (Table 1). For patients who had an AKI episode and admitted to hospitals, the crude 30-day mortality is higher in the winter season when compared to the summer [HR 1.28 (1.25-1.31), p<0.01] (Figure 1). After adjusting season by age, peak AKI stage, IMD and sex, winter season still has significantly higher 30-day mortality than summer [HR 1.24 (1.21-1.27), p<0.01]. Winter mortality peak is confounded by age and AKI severity, which explained the drop of hazard ratio at winter peaks; whereas season is not confounded by deprivation and sex. The pattern of seasonality varies with age, in age group 18-39, there were 26.1% of AKI episodes in summer and 23.3% in winter, whereas in age group >75, there were 23.7% in summer and 27.1% in winter. Conclusion Analysis of England data confirms seasonal peak in AKI during winter months. Additionally it shows increased risk of mortality for patients with AKI in winter months. Future work will investigate the impact of comorbidities and case-mix on outcomes. By understanding the seasonal variation of AKI, we can potentially plan preventive care and improve clinical practice.

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The Perceived Impact of Suicide Bereavement on Specific Interpersonal Relationships: A Qualitative Study of Survey Data

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16101801 ◽

2019 ◽

Vol 16 (10) ◽

pp. 1801 ◽

Cited By ~ 3

Author(s):

Valeriya Azorina ◽

Nicola Morant ◽

Hedvig Nesse ◽

Fiona Stevenson ◽

David Osborn ◽

...

Keyword(s):

Interpersonal Relationships ◽

Online Survey ◽

Extended Family ◽

Social Withdrawal ◽

Free Text ◽

Increased Risk ◽

Suicide Bereavement ◽

Social Discomfort ◽

The Uk ◽

The Impact

People bereaved by suicide have an increased risk of suicide and suicide attempt, yet report receiving less support than people bereaved by other sudden deaths. Reductions in support may contribute to suicide risk, yet their nature is unclear. We explored the impact of suicide bereavement on the interpersonal relationships of young adults in the UK using an online survey to collect qualitative data. We conducted thematic analysis of free-text responses from 499 adults to questions capturing the impact of bereavement on relationships with partners, close friends, close family, extended family, and other contacts. We identified four main themes describing the changes in relationships following the suicide: (1) Social discomfort over the death (stigma and taboo; painfulness for self or others to discuss; socially prescribed grief reactions); (2) social withdrawal (loss of social confidence; withdrawal as a coping mechanism); (3) shared bereavement experience creating closeness and avoidance; (4) attachments influenced by fear of further losses (overprotectiveness towards others; avoiding attachments as protective). These findings contribute to understanding deficits in support and pathways to suicidality after suicide bereavement. Such disrupted attachments add to the burden of grief and could be addressed by public education on how to support those bereaved by suicide.

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Efficacy of contact tracing for the containment of the 2019 novel coronavirus (COVID-19)

Journal of Epidemiology & Community Health ◽

10.1136/jech-2020-214051 ◽

2020 ◽

pp. jech-2020-214051 ◽

Cited By ~ 20

Author(s):

Matt J Keeling ◽

T Deirdre Hollingsworth ◽

Jonathan M Read

Keyword(s):

Close Contact ◽

Control Measure ◽

Disease Outbreaks ◽

Contact Tracing ◽

Public Health Response ◽

Central Public Health ◽

Increased Risk ◽

Novel Coronavirus ◽

The Uk ◽

The Impact

ObjectiveContact tracing is a central public health response to infectious disease outbreaks, especially in the early stages of an outbreak when specific treatments are limited. Importation of novel coronavirus (COVID-19) from China and elsewhere into the UK highlights the need to understand the impact of contact tracing as a control measure.DesignDetailed survey information on social encounters from over 5800 respondents is coupled to predictive models of contact tracing and control. This is used to investigate the likely efficacy of contact tracing and the distribution of secondary cases that may go untraced.ResultsTaking recent estimates for COVID-19 transmission we predict that under effective contact tracing less than 1 in 6 cases will generate any subsequent untraced infections, although this comes at a high logistical burden with an average of 36 individuals traced per case. Changes to the definition of a close contact can reduce this burden, but with increased risk of untraced cases; we find that tracing using a contact definition requiring more than 4 hours of contact is unlikely to control spread.ConclusionsThe current contact tracing strategy within the UK is likely to identify a sufficient proportion of infected individuals such that subsequent spread could be prevented, although the ultimate success will depend on the rapid detection of cases and isolation of contacts. Given the burden of tracing a large number of contacts to find new cases, there is the potential the system could be overwhelmed if imports of infection occur at a rapid rate.

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Hepatitis B reactivation in patients with solid tumors: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.138 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 138-138 ◽

Cited By ~ 2

Author(s):

Lisa K. Hicks ◽

Jordan J. Feld ◽

Ronak Saluja ◽

Judy Truong ◽

Adam E. Haynes ◽

...

Keyword(s):

Systematic Review ◽

Hepatitis B ◽

Solid Tumors ◽

Solid Tumor ◽

Odds Ratio ◽

Meta Analysis ◽

Hbv Reactivation ◽

Antiviral Prophylaxis ◽

Chronic Hbv ◽

The Impact

138 Background: Hepatitis B virus (HBV) affects over 250 million people worldwide. Most people with chronic HBV (HBsAg positive) have no signs or symptoms of infection. However, when exposed to immunosuppression they are at risk of HBV reactivation which can cause hepatitis, liver failure and death. The risk of HBV reactivation in patients receiving chemotherapy for solid tumors, the efficacy of antiviral prophylaxis, and the clinical impact of HBV reactivation in this setting are uncertain. Primary Aim: To estimate the risk of clinical HBV reactivation (increased HBV DNA + transaminitis) among HBsAg-positive patients administered chemotherapy for a solid tumor. Secondary Aims: To estimate the efficacy of anti-viral prophylaxis and the risk of death from HBV reactivation in patients receiving chemotherapy for solid tumors. Methods: A systematic review and meta-analysis of the English language literature on HBV reactivation was completed (OVID Medline, 1946 to Aug 2013). All citations were reviewed by two or more authors. Data from patients with hematologic malignancies were excluded. Pooled probabilities of HBV reactivation risk, death from HBV reactivation, and odds ratio for the impact of anti-viral prophylaxis were estimated with a random effects model. Results: 2,667 citations were identified; 19 were eligible for inclusion. The pooled estimate for clinical HBV reactivation in HBsAg-positive patients receiving chemotherapy for a solid tumor was 21.9% (95% CI; 16.5% to 27.3%) in those not receiving anti-viral prophylaxis, and 2.4% (95% CI 0.7% to 4.2%) in those receiving anti-viral prophylaxis. The odds ratio for clinical HBV reactivation with antiviral prophylaxis compared to no prophylaxis was 0.12 (95% CI 0.06 to 0.25). In the absence of viral prophylaxis, the risk of dying from HBV reactivation in HBsAg-positive solid tumor patients was estimated at 1.3% with a 95% CI of 0.3% to 2.3%. Conclusions: Patients with chronic HBV who are administered chemotherapy for a solid tumor appear to be at substantial risk of clinical HBV reactivation; this risk may be mitigated by anti-viral prophylaxis. In the absence of anti-viral therapy, patients may experience a small but important risk of dying from HBV reactivation.

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Hepatitis B vaccination and changes in sexual risk behaviour among men who have sex with men in Amsterdam

Epidemiology and Infection ◽

10.1017/s0950268808000976 ◽

2008 ◽

Vol 137 (4) ◽

pp. 504-512 ◽

Cited By ~ 5

Author(s):

M. XIRIDOU ◽

J. WALLINGA ◽

N. DUKERS-MUIJERS ◽

R. COUTINHO

Keyword(s):

High Risk ◽

Hepatitis B ◽

Sexual Risk ◽

Vaccination Campaign ◽

Risk Behaviour ◽

Hepatitis B Vaccination ◽

Sexual Risk Behaviour ◽

Increased Risk ◽

Sex With Men ◽

The Impact

SUMMARYThe impact of hepatitis B vaccination in men having sex with men in Amsterdam has been marginal until now, possibly because of increases in sexual risk behaviour counterbalancing the effect of vaccination. A mathematical model is used to describe the hepatitis B epidemic. The model shows that, with the current vaccination coverage, the decrease in incidence is small in the beginning. However, the number of infections prevented per vaccine administered rises over time. Nevertheless, increased risk behaviour reduces the benefit of vaccination. Targeting high-risk men is more successful in reducing and containing the epidemic than targeting low-risk men. In conclusion, the vaccination campaign is effective and should be intensified. High-risk men should be targeted for vaccination and for risk reduction.

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Assessing the impact of projected climate change on drought vulnerability in Scotland

Hydrology Research ◽

10.2166/nh.2014.148 ◽

2014 ◽

Vol 45 (6) ◽

pp. 806-816 ◽

Cited By ~ 26

Author(s):

Richard Gosling

Keyword(s):

Water Resource ◽

Water Resource Management ◽

Water Shortage ◽

Resource Scarcity ◽

Drought Vulnerability ◽

Collaborative Project ◽

North West ◽

Ecological Implications ◽

The Uk ◽

The Impact

Although Scotland is relatively water resource rich in a UK and European context, water resource scarcity can occur during exceptional dry periods such as those experienced in North West Scotland during July 2012. Precipitation and flow anomaly indices have been recently developed and introduced operationally by the Scottish Environment Protection Agency, in order to assess the severity of dry episodes and use this information within the decision-making process when managing the ecological implications of measures required to ensure continuity of water supply. The latest projections of future climate in the UK (UKCP09) point to warmer, drier summers across much of Scotland and, as such, imply an increased frequency of periods of water shortage. This study makes use of the results from a collaborative project in which projected values of climate variables have been used to derive projected river flows at a number of catchments across the UK. These datasets have been used to evaluate the change in frequency of significant precipitation and flow deficits in Scotland. The findings suggest a marked increase in frequency of summer water resource scarcity across much of Scotland which has implications for water resource management, particularly where current storage is relatively low.

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Relevance of screening for Chagas and viral hepatitis in Bolivian migrants

10.1101/775890 ◽

2019 ◽

Author(s):

Irene Losada Galván ◽

Giuseppe Gariup ◽

Aina Casellas ◽

Carme Subirà ◽

Alex Almuedo-Riera ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Viral Hepatitis ◽

Latin American ◽

Strongyloides Stercoralis ◽

Systematic Screening ◽

Screening Programs ◽

Increased Risk ◽

B Virus ◽

Clinical Records

AbstractObjectivesgiven the scarcity of data regarding prevalence of various infectious diseases in Latin-American countries, our study aims to assess the burden of T.cruzi, S.stercoralis, HIV and viral hepatitis in Latin-American migrants, with a focus on Bolivian migrants.Methodswe performed a retrospective observational study of 565 screening evaluations on adults (≥ 18 years) carried out at our referral International Healthcare service in Barcelona. We reviewed structured clinical records and microbiological results of patients attended between February 2012 and April 2015.Resultsthe median 35 years old and 74% were women. Bolivian origin accounted for 87% of the screened population. We found a 48% prevalence of T.cruzi, 16% of S.stercoralis, 0.2% of HIV, 92% of HAV, 0.2% HBV and 0.2% HCV.Conclusionsthese results support the relevance of the screening of T. cruzi and S. stercoralis in Bolivian migrants, but challenge the pertinence of systematic screening of HBV in this population.Author summaryIn response to the challenge of detecting diseases not previously present in host countries, screening programs have been implemented for migrants based on the probability of having certain diseases depending on their country of origin and / or migratory route. This increased risk is very clearly established in some cases such as Trypanosoma cruzi infection (the cause of Chagas disease) in people from Latin America; especially from Bolivia. In recent years screening recommendations for Strongyloides stercoralis in this population was proven necessary. Current recommendations regarding systematic screening for hepatitis B establish the relevance of screening based on the probability of the disease in the 2% population of origin. Since there are no reliable and up to date data regarding prevalence of hepatitis B virus in Bolivia, we aimed to analyze data available for migrants from Bolivia in Spain.Our results support the importance of screening for T. cruzi and S.stercoralis in patients from Bolivia. However, our data show a much lower prevalence of this hepatitis B virus (0.2%) than the 2% threshold that would justify systematic screening, so we question the relevance of screening for hepatitis B virus in this population in the absence of other risk factors.

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