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Stirrup O, Shrotri M, Adams NL, Krutikov M, Azmi B, Monakhov I, Tut G, Moss P, Hayward A, Copas A, Shallcross L. Effectiveness of successive booster vaccine doses against SARS-CoV-2 related mortality in residents of long-term care facilities in the VIVALDI study. Age Ageing 2023; 52:afad141. [PMID: 37595069 PMCID: PMC10438206 DOI: 10.1093/ageing/afad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused severe disease in unvaccinated long-term care facility (LTCF) residents. Initial booster vaccination following primary vaccination is known to provide strong short-term protection, but data are limited on duration of protection and the protective effect of further booster vaccinations. OBJECTIVE To evaluate the effectiveness of third, fourth and fifth dose booster vaccination against SARS-CoV-2 related mortality amongst older residents of LTCFs. DESIGN Prospective cohort study. SETTING LTCFs for older people in England participating in the VIVALDI study. METHODS Residents aged >65 years at participating LTCFs were eligible for inclusion if they had at least one polymerase chain reaction or lateral flow device result within the analysis period 1 January 2022 to 31 December 2022. We excluded individuals who had not received at least two vaccine doses before the analysis period. Cox regression was used to estimate relative hazards of SARS-CoV-2 related mortality following 1-3 booster vaccinations compared with primary vaccination, stratified by previous SARS-CoV-2 infection and adjusting for age, sex and LTCF size (total beds). RESULTS A total of 13,407 residents were included. Our results indicate that third, fourth and fifth dose booster vaccination provide additional short-term protection against SARS-CoV-2 related mortality relative to primary vaccination, with consistent stabilisation beyond 112 days to 45-75% reduction in risk relative to primary vaccination. CONCLUSIONS Successive booster vaccination doses provide additional short-term protection against SARS-CoV-2 related mortality amongst older LTCF residents. However, we did not find evidence of a longer-term reduction in risk beyond that provided by initial booster vaccination.
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Affiliation(s)
- Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - Madhumita Shrotri
- UCL Institute of Health Informatics, University College London, London, UK
| | - Natalie L Adams
- UCL Institute of Health Informatics, University College London, London, UK
| | - Maria Krutikov
- UCL Institute of Health Informatics, University College London, London, UK
| | - Borscha Azmi
- UCL Institute of Health Informatics, University College London, London, UK
| | | | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Andrew Hayward
- UCL Institute of Epidemiology & Healthcare, University College London, London, UK
- Health Data Research UK, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Laura Shallcross
- UCL Institute of Health Informatics, University College London, London, UK
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Stirrup O, Shrotri M, Adams NL, Krutikov M, Nacer-Laidi H, Azmi B, Palmer T, Fuller C, Irwin-Singer A, Baynton V, Tut G, Moss P, Hayward A, Copas A, Shallcross L. Clinical Effectiveness of SARS-CoV-2 Booster Vaccine Against Omicron Infection in Residents and Staff of Long-term Care Facilities: A Prospective Cohort Study (VIVALDI). Open Forum Infect Dis 2022; 10:ofac694. [PMID: 36713473 PMCID: PMC9874026 DOI: 10.1093/ofid/ofac694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/28/2022] [Indexed: 12/30/2022] Open
Abstract
Background Successive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have caused severe disease in long-term care facility (LTCF) residents. Primary vaccination provides strong short-term protection, but data are limited on duration of protection following booster vaccines, particularly against the Omicron variant. We investigated the effectiveness of booster vaccination against infections, hospitalizations, and deaths among LTCF residents and staff in England. Methods We included residents and staff of LTCFs within the VIVALDI study (ISRCTN 14447421) who underwent routine, asymptomatic testing (December 12, 2021-March 31, 2022). Cox regression was used to estimate relative hazards of SARS-CoV-2 infection, and associated hospitalization and death at 0-13, 14-48, 49-83, 84-111, 112-139, and 140+ days after dose 3 of SARS-CoV-2 vaccination compared with 2 doses (after 84+ days), stratified by previous SARS-CoV-2 infection and adjusting for age, sex, LTCF capacity, and local SARS-CoV-2 incidence. Results A total of 14 175 residents and 19 793 staff were included. In residents without prior SARS-CoV-2 infection, infection risk was reduced 0-111 days after the first booster, but no protection was apparent after 112 days. Additional protection following booster vaccination waned but was still present at 140+ days for COVID-associated hospitalization (adjusted hazard ratio [aHR], 0.20; 95% CI, 0.06-0.63) and death (aHR, 0.50; 95% CI, 0.20-1.27). Most residents (64.4%) had received primary course vaccine of AstraZeneca, but this did not impact pre- or postbooster risk. Staff showed a similar pattern of waning booster effectiveness against infection, with few hospitalizations and no deaths. Conclusions Our findings suggest that booster vaccination provided sustained protection against severe outcomes following infection with the Omicron variant, but no protection against infection from 4 months onwards. Ongoing surveillance for SARS-CoV-2 in LTCFs is crucial.
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Affiliation(s)
- Oliver Stirrup
- Correspondence: Oliver Stirrup, PhD, UCL Institute for Global Health, 222 Euston Road, London NW1 2DA, UK ()
| | | | | | - Maria Krutikov
- UCL Institute of Health Informatics, London, United Kingdom
| | | | - Borscha Azmi
- UCL Institute of Health Informatics, London, United Kingdom
| | - Tom Palmer
- Institute for Global Health, University College London, London, United Kingdom
| | | | | | - Verity Baynton
- Department of Health and Social Care, London, United Kingdom
| | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Andrew Hayward
- UCL Institute of Epidemiology & Healthcare, London, United Kingdom,Health Data Research UK, London, United Kingdom
| | - Andrew Copas
- Institute for Global Health, University College London, London, United Kingdom
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Rose TC, Adams NL, Whitehead M, Wickham S, O'Brien SJ, Hawker J, Taylor-Robinson DC, Violato M, Barr B. Neighbourhood unemployment and other socio-demographic predictors of emergency hospitalisation for infectious intestinal disease in England: A longitudinal ecological study. J Infect 2020; 81:736-742. [PMID: 32888980 PMCID: PMC7649336 DOI: 10.1016/j.jinf.2020.08.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/22/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022]
Abstract
We examined trends in infectious intestinal disease (IID) hospitalisations in England. Overall IID admission rates for children and older adults declined between 2012 & 2017. Increasing unemployment was associated with increasing IID admission rates. Healthcare access, underlying morbidity and ethnicity were also associated with IID rates. Policies should address inequalities in emergency IID hospitalisations.
Background Previous studies have observed that infectious intestinal disease (IID) related hospital admissions are higher in more deprived neighbourhoods. These studies have mainly focused on paediatric populations and are cross-sectional in nature. This study examines recent trends in emergency IID admission rates, and uses longitudinal methods to investigate the effects of unemployment (as a time varying measure of neighbourhood deprivation) and other socio-demographic characteristics on IID admissions for adults and children in England. Methods A longitudinal ecological analysis was performed using Hospital Episode Statistics on emergency hospitalisations for IID, collected over the time period 2012–17 across England. Analysis was conducted at the neighbourhood (Lower-layer Super Output Area) level for three age groups (0–14; 15–64; 65+ years). Mixed-effect Poisson regression models were used to assess the relationship between trends in neighbourhood unemployment and emergency IID admission rates, whilst controlling for measures of primary and secondary care access, underlying morbidity and the ethnic composition of each neighbourhood. Results From 2012–17, declining trends in emergency IID admission rates were observed for children and older adults overall, while rates increased for some sub-groups in the population. Each 1 percentage point increase in unemployment was associated with a 6.3, 2.4 and 4% increase in the rate of IID admissions per year for children [IRR=1.06, 95%CI 1.06–1.07], adults [IRR=1.02, 95%CI 1.02–1.03] and older adults [IRR=1.04, 95%CI 1.036–1.043], respectively. Increases in poor primary care access, the percentage of people from a Pakistani ethnic background, and the prevalence of long-term health problems, in a neighbourhood, were also associated with increases in IID admission rates. Conclusions Increasing trends in neighbourhood deprivation, as measured by unemployment, were associated with increases in emergency IID admission rates for children and adults in England, despite controlling for measures of healthcare access, underlying morbidity and ethnicity. Research is needed to improve understanding of the mechanisms that explain these inequalities, so that effective policies can be developed to reduce the higher emergency IID admission rates experienced by more disadvantaged communities.
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Affiliation(s)
- Tanith C Rose
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK.
| | - Natalie L Adams
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Sophie Wickham
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Sarah J O'Brien
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy Hawker
- National Infection Service, Public Health England, Birmingham, UK
| | - David C Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Mara Violato
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Benjamin Barr
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
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Adams NL, Rose TC, Elliot AJ, Smith G, Morbey R, Loveridge P, Lewis J, Studdard G, Violato M, O'Brien SJ, Whitehead M, Taylor-Robinson DC, Hawker JI, Barr B. Social patterning of telephone health-advice for diarrhoea and vomiting: analysis of 24 million telehealth calls in England. J Infect 2018; 78:95-100. [PMID: 30267800 PMCID: PMC6428660 DOI: 10.1016/j.jinf.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Gastrointestinal (GI) infections are common and most people do not see a physician. There is conflicting evidence of the impact of socioeconomic status (SES) on risk of GI infections. We assessed the relationship between SES and GI calls to two National Health Service (NHS) telephone advice services in England. METHODS Over 24 million calls to NHS Direct (2010-13) and NHS 111 (2013-15) were extracted from Public Health England (PHE) syndromic surveillance systems. The relationship between SES and GI calls was assessed using generalised linear models (GLM). RESULTS Adjusting for rurality and age-sex interactions, in NHS Direct, children in disadvantaged areas were at lower risk of GI calls; in NHS 111 there was a higher risk of GI calls in disadvantaged areas for all ages (0-4 years RR 1.27, 95% CI 1.25-1.29; 5-9 years RR 1.43, 95% CI 1.36-1.51; 10-14 years RR 1.36, 95% CI 1.26-1.41; 15-19 years RR 1.59, 95% CI 1.52-1.67; 20-59 years RR 1.50, 95% CI 1.47-1.53, 60 years and over RR 1.12, 95% CI 1.09-1.14). CONCLUSIONS Disadvantaged areas had higher risk of GI calls in NHS 111. This may relate to differences in exposure or vulnerability to GI infections, or propensity to call about GI infections.
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Affiliation(s)
- Natalie L Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK; National Infection Service, Public Health England, London, UK.
| | - Tanith C Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Gillian Smith
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Roger Morbey
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Paul Loveridge
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - James Lewis
- Emergency Response Department, Science and Technology, Health Protection Directorate, Public Health England, Porton Down, Salisbury, UK
| | - Gareth Studdard
- NHS England, West Midlands Integrated Urgent Care, Birmingham, UK
| | - Mara Violato
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - David C Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - Jeremy I Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; National Infection Service, Field Service, Public Health England, Birmingham, UK
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
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Adams NL, Rose TC, Hawker J, Violato M, O’Brien SJ, Whitehead M, Barr B, Taylor-Robinson DC. Socioeconomic status and infectious intestinal disease in the community: a longitudinal study (IID2 study). Eur J Public Health 2018; 28:134-138. [PMID: 29016791 PMCID: PMC5965370 DOI: 10.1093/eurpub/ckx091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Infectious intestinal diseases (IID) are common, affecting around 25% of people in UK each year at an estimated annual cost to the economy, individuals and the NHS of £1.5 billion. While there is evidence of higher IID hospital admissions in more disadvantaged groups, the association between socioeconomic status (SES) and risk of IID remains unclear. This study aims to investigate the relationship between SES and IID in a large community cohort. Methods Longitudinal analysis of a prospective community cohort in the UK following 6836 participants of all ages was undertaken. Hazard ratios for IID by SES were estimated using Cox proportional hazard, adjusting for follow-up time and potential confounding factors. Results In the fully adjusted analysis, hazard ratio of IID was significantly lower among routine/manual occupations compared with managerial/professional occupations (HR 0.74, 95% CI 0.61-0.90). Conclusion In this large community cohort, lower SES was associated with lower IID risk. This may be partially explained by the low response rate which varied by SES. However, it may be related to differences in exposure or recognition of IID symptoms by SES. Higher hospital admissions associated with lower SES observed in some studies could relate to more severe consequences, rather than increased infection risk.
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Affiliation(s)
- Natalie L Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
- National Infection Service, Public Health England, London/Birmingham,
UK
| | - Tanith C Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Jeremy Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- National Infection Service, Public Health England, London/Birmingham,
UK
| | - Mara Violato
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah J O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - David C Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
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Adams NL, Rose TC, Hawker J, Violato M, O’Brien SJ, Barr B, Howard VJK, Whitehead M, Harris R, Taylor-Robinson DC. Relationship between socioeconomic status and gastrointestinal infections in developed countries: A systematic review and meta-analysis. PLoS One 2018; 13:e0191633. [PMID: 29360884 PMCID: PMC5779704 DOI: 10.1371/journal.pone.0191633] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 12/26/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The association between socioeconomic status (SES) and health is well-documented; however limited evidence on the relationship between SES and gastrointestinal (GI) infections exists, with published studies producing conflicting results. This systematic review aimed to assess the association between SES and GI infection risk, and explore possible sources of heterogeneity in effect estimates reported in the literature. METHODS MEDLINE, Scopus, Web of Science and grey literature were searched from 1980 to October 2015 for studies reporting an association between GI infections and SES in a representative population sample from a member-country of the Organisation for Economic Co-operation and Development. Harvest plots and meta-regression were used to investigate potential sources of heterogeneity such as age; level of SES variable; GI infection measurement; and predominant mode of transmission. The protocol was registered on PROSPERO: CRD42015027231. RESULTS In total, 6021 studies were identified; 102 met the inclusion criteria. Age was identified as the only statistically significant potential effect modifier of the association between SES and GI infection risk. For children, GI infection risk was higher for those of lower SES versus high (RR 1.51, 95% CI;1.26-1.83), but there was no association for adults (RR 0.79, 95% CI;0.58-1.06). In univariate analysis, the increased risk comparing low and high SES groups was significantly higher for pathogens spread by person-to-person transmission, but lower for environmental pathogens, as compared to foodborne pathogens. CONCLUSIONS Disadvantaged children, but not adults, have greater risk of GI infection compared to their more advantaged counterparts. There was high heterogeneity and many studies were of low quality. More high quality studies are needed to investigate the association between SES and GI infection risk, and future research should stratify analyses by age and pathogen type. Gaining further insight into this relationship will help inform policies to reduce inequalities in GI illness in children.
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Affiliation(s)
- Natalie L. Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- National Infection Service, Public Health England, London, United Kingdom
| | - Tanith C. Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Jeremy Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- National Infection Service, Public Health England, London, United Kingdom
| | - Mara Violato
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
| | - Sarah J. O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Victoria J. K. Howard
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Ross Harris
- National Infection Service, Public Health England, London, United Kingdom
| | - David C. Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
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Rose TC, Adams NL, Barr B, Hawker J, O'Brien SJ, Violato M, Whitehead M, Taylor-Robinson DC. Socioeconomic status is associated with symptom severity and sickness absence in people with infectious intestinal disease in the UK. BMC Infect Dis 2017. [PMID: 28645256 PMCID: PMC5481911 DOI: 10.1186/s12879-017-2551-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of infectious intestinal disease (IID) in the UK is substantial. Negative consequences including sickness absence are common, but little is known about the social patterning of these outcomes, or the extent to which they relate to disease severity. METHODS We performed a cross-sectional analysis using IID cases identified from a large population-based survey, to explore the association between socioeconomic status (SES) and symptom severity and sickness absence; and to assess the role of symptom severity on the relationship between SES and absence. Regression modelling was used to investigate these associations, whilst controlling for potential confounders such as age, sex and ethnicity. RESULTS Among 1164 cases, those of lower SES versus high had twice the odds of experiencing severe symptoms (OR 2.2, 95%CI;1.66-2.87). Lower SES was associated with higher odds of sickness absence (OR 1.8, 95%CI;1.26-2.69), however this association was attenuated after adjusting for symptom severity (OR 1.4, 95%CI;0.92-2.07). CONCLUSIONS In a large sample of IID cases, those of low SES versus high were more likely to report severe symptoms, and sickness absence; with greater severity largely explaining the higher absence. Public health interventions are needed to address the unequal consequences of IID identified.
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Affiliation(s)
- Tanith C Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK. .,Department of Public Health and Policy, University of Liverpool, Liverpool, UK. .,Department of Public Health and Policy Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool, L69 3GB, UK.
| | - Natalie L Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK.,National Infection Service, Public Health England, London/Birmingham, UK
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Jeremy Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,National Infection Service, Public Health England, London/Birmingham, UK
| | - Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Mara Violato
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - David C Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Adams NL, Byrne L, Smith GA, Elson R, Harris JP, Salmon R, Smith R, O'Brien SJ, Adak GK, Jenkins C. Shiga Toxin-Producing Escherichia coli O157, England and Wales, 1983-2012. Emerg Infect Dis 2016; 22:590-7. [PMID: 26982243 PMCID: PMC4806951 DOI: 10.3201/eid2204.151485] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Although incidence remained constant, outbreaks from contaminated meat and milk declined and those from petting farms and schools and nurseries increased. We evaluated clinical Shiga toxin–producing Escherichia coli O157 infections in England and Wales during 1983–2012 to describe changes in microbiological and surveillance methods. A strain replacement event was captured; phage type (PT) 2 decreased to account for just 3% of cases by 2012, whereas PT8 and PT21/28 strains concurrently emerged, constituting almost two thirds of cases by 2012. Despite interventions to control and reduce transmission, incidence remained constant. However, sources of infection changed over time; outbreaks caused by contaminated meat and milk declined, suggesting that interventions aimed at reducing meat cross-contamination were effective. Petting farm and school and nursery outbreaks increased, suggesting the emergence of other modes of transmission and potentially contributing to the sustained incidence over time. Studies assessing interventions and consideration of policies and guidance should be undertaken to reduce Shiga toxin–producing E. coli O157 infections in England and Wales in line with the latest epidemiologic findings.
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Lane CR, LeBaigue S, Esan OB, Awofisyo AA, Adams NL, Fisher IST, Grant KA, Peters TM, Larkin L, Davies RH, Adak GK. Salmonella enterica serovar Enteritidis, England and Wales, 1945-2011. Emerg Infect Dis 2015; 20:1097-104. [PMID: 24960614 PMCID: PMC4073836 DOI: 10.3201/eid2007.121850] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A focus on eliminating phage type 4 in egg and poultry production has greatly reduced foodborne disease among humans. In England and Wales, the emergence of Salmonella enterica serovar Enteritidis resulted in the largest and most persistent epidemic of foodborne infection attributable to a single subtype of any pathogen since systematic national microbiological surveillance was established. We reviewed 67 years of surveillance data to examine the features, underlying causes, and overall effects of S. enterica ser. Enteritidis. The epidemic was associated with the consumption of contaminated chicken meat and eggs, and a decline in the number of infections began after the adoption of vaccination and other measures in production and distribution of chicken meat and eggs. We estimate that >525,000 persons became ill during the course of the epidemic, which caused a total of 6,750,000 days of illness, 27,000 hospitalizations, and 2,000 deaths. Measures undertaken to control the epidemic have resulted in a major reduction in foodborne disease in England and Wales.
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Allen DJ, Adams NL, Aladin F, Harris JP, Brown DWG. Emergence of the GII-4 Norovirus Sydney2012 strain in England, winter 2012-2013. PLoS One 2014; 9:e88978. [PMID: 24551201 PMCID: PMC3923861 DOI: 10.1371/journal.pone.0088978] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 01/16/2014] [Indexed: 12/19/2022] Open
Abstract
Norovirus is the commonest cause of acute gastrointestinal disease and is the main aetiological agent of outbreaks of gastroenteritis, particularly in semi-closed environments. Norovirus infections in England typically peak between December and March each year. The most commonly detected norovirus strains belong to the genetically diverse genogroup-II genotype-4 (GII-4) genocluster and in the previous two norovirus winter seasons the majority of GII-4 strains in circulation worldwide have been genetically similar to the GII-4 strain New Orleans 1805/2009/USA. At the beginning of the 2012/13 season a genetically distinct GII-4 strain (Sydney 2012/NSW0514/2012/AU) was described which emerged worldwide during the winter of 2012/13. Here we describe the emergence of norovirus strains genetically related to Sydney2012 in England during the 2012/13 season to replace NewOrleans2009 strains as the most commonly detected variant of GII-4 norovirus in England. Furthermore, we demonstrate that whilst the emergence of Sydney2012 coincided with an early peak in the number of norovirus outbreaks, there was not an overall increase in norovirus activity compared to the previous season. Finally, we show that the Sydney2012 strain is associated with distinct genetic changes compared to the NewOrleans2009 strain, and these changes may have contributed to the emergence of the Sydney2012 strain.
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Affiliation(s)
- David J. Allen
- Virus Reference Department, Microbiology Services, Public Health England, London, United Kingdom
- * E-mail:
| | - Natalie L. Adams
- Gastrointestinal, Emerging and Zoonotic Infections Department, Heath Protection Services, Public Health England, London, United Kingdom
| | - Farah Aladin
- Virus Reference Department, Microbiology Services, Public Health England, London, United Kingdom
| | - John P. Harris
- Gastrointestinal, Emerging and Zoonotic Infections Department, Heath Protection Services, Public Health England, London, United Kingdom
- Institute of Infection and Global Health and National Consortium for Zoonosis Research, University of Liverpool, Liverpool, United Kingdom
| | - David W. G. Brown
- Virus Reference Department, Microbiology Services, Public Health England, London, United Kingdom
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Abstract
Solar ultraviolet radiation (UVR, 290-400 nm) penetrates into seawater and can harm shallow-dwelling and planktonic marine organisms. Studies dating back to the 1930s revealed that echinoids, especially sea urchin embryos, are powerful models for deciphering the effects of UVR on embryonic development and how embryos defend themselves against UV-induced damage. In addition to providing a large number of synchronously developing embryos amenable to cellular, biochemical, molecular, and single-cell analyses, the purple sea urchin, Strongylocentrotus purpuratus, also offers an annotated genome. Together, these aspects allow for the in-depth study of molecular and biochemical signatures of UVR stress. Here, we review the effects of UVR on embryonic development, focusing on the early-cleavage stages, and begin to integrate data regarding single-protein responses with comprehensive proteomic assessments. Proteomic studies reveal changes in levels of post-translational modifications to proteins that respond to UVR, and identify proteins that can then be interrogated as putative targets or components of stress-response pathways. These responsive proteins are distributed among systems upon which targeted studies can now begin to be mapped. Post-transcriptional and translational controls may provide early embryos with a rapid, fine-tuned response to stress during early stages, especially during pre-blastula stages that rely primarily on maternally derived defenses rather than on responses through zygotic gene transcription.
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Affiliation(s)
- N L Adams
- California Polytechnic State University, San Luis Obispo, CA, USA.
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12
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Abstract
Equivalent versions of the Complex Figure Test (CFT) are useful for assessing change over time in constructional skills, planning, spatial organization, and visual-spatial memory while minimizing practice effects. To address the need for an equivalent version of the CFT to the Rey, the present study compared copy and 45 min-delayed recall accuracy scores of the Rey and Mack CFTs obtained from 245 adults involved in a study of the neuropsychological correlates of sleep apnea and its treatment. Accuracy scores did not significantly differ between individuals with and without sleep apnea. Also, there was no significant difference between copy or recall accuracy scores obtained on the Rey and Mack CFTs. Similar correlations were found between relevant demographic factors, estimated IQ, and accuracy scores for both CFTs. These data suggest that the Mack figure may be a useful alternative to the Rey CFT.
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Affiliation(s)
- T W Frazier
- Department of Psychology, Case Western Reserve University, Cleveland, OH 44106-7123, USA.
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13
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Belton RJ, Adams NL, Foltz KR. Isolation and characterization of sea urchin egg lipid rafts and their possible function during fertilization. Mol Reprod Dev 2001; 59:294-305. [PMID: 11424215 DOI: 10.1002/mrd.1034] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Specialized membrane microdomains called rafts are thought to play a role in many types of cell-cell interactions and signaling. We have investigated the possibility that sea urchin eggs contain these specialized membrane microdomains and if they play a role in signal transduction at fertilization. A low density, TX-100 insoluble membrane fraction, typical of lipid rafts, was isolated by equilibrium gradient centrifugation. This raft fraction contained proteins distinct from cytoskeletal complexes. The fraction was enriched in tyrosine phosphorylated proteins and contained two proteins known to be involved in signaling during egg activation (an egg Src-type kinase and PLC gamma). This fraction was further characterized as a prototypical raft fraction by the release of proteins in response to in vitro treatment of the rafts with the cholesterol binding drug, methyl-beta-cyclodextrin (M beta CD). Furthermore, treatment of eggs with M beta CD inhibited fertilization, suggesting that egg lipid rafts play a physiological role in fertilization. Mol. Reprod. Dev. 59:294-305, 2001.
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Affiliation(s)
- R J Belton
- Department of Molecular, Cellular and Developmental Biology and the Marine Science Institute, University of California Santa Barbara, Santa Barbara, California 93106, USA
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14
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Pettee AD, Wasserman BA, Adams NL, McMullen W, Smith HR, Woods SL, Ratnoff OD. Familial Sneddon's syndrome: clinical, hematologic, and radiographic findings in two brothers. Neurology 1994; 44:399-405. [PMID: 8145905 DOI: 10.1212/wnl.44.3_part_1.399] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We present the clinical, hematologic, and radiographic findings in two brothers with Sneddon's syndrome (stroke and livedo reticularis) and antiphospholipid antibodies. Patient 1 had anticardiolipin antibody and patient 2 had lupus anticoagulant, which we detected only upon repeated blood testing. One should test for both anticardiolipin antibody and lupus anticoagulant and repeat the screenings before determining a Sneddon's syndrome patient's antiphospholipid antibody status. Both Sneddon's syndrome and the primary antiphospholipid antibody syndrome are potentially familial causes of stroke. In familial cases, an inherited predisposition to antiphospholipid antibody production may be involved in disease pathogenesis.
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Affiliation(s)
- A D Pettee
- Department of Neurology, University Hospitals of Cleveland, OH 44106
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15
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von Bredow JD, Adams NL, Groff WA, Vick JA. Effectiveness of oral pyridostigmine pretreatment and cholinolytic-oxime therapy against soman intoxication in nonhuman primates. Fundam Appl Toxicol 1991; 17:761-70. [PMID: 1778362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Nonhuman primates which were fed Mestinon (pyridostigmine) syrup-impregnated food biscuits (40 mg per animal) exhibited a reproducible inhibition of whole blood cholinestrase activity of 40 to 50% for a period of 1 to 6 hr. Pyridostigmine pretreatment was supplemented by therapy with two doses of an antidotal combination (A,TM,B) consisting of 0.05 mg/kg atropine, 2.24 mg/kg TMB-4, and 0.4 mg/kg benactyzine which assured survival in five of six animals following three separate exposures to 10 LD50 soman. The protective period of this oral dose of pyridostigmine supported by A,TM,B therapy was between 1/2 and 8 hr. Oral pyridostigmine pretreatment in combination with atropine therapy (three doses of 0.07 or 1.00 mg/kg im) also saved monkeys exposed to 10 LD50 soman; however, the period of recovery was prolonged. Oral pyridostigmine pretreatment did not alter the lethality of soman in the absence of A,TM,B or atropine therapy.
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Affiliation(s)
- J D von Bredow
- Pharmacology Division, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010
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Abstract
We report behavioral and cognitive characteristics of 12 patients with caudate nuclei lesions, 11 unilateral and one bilateral. These patients developed an acute behavioral change characterized by apathy, disinhibition, or a major affective disturbance. The pattern of personality change correlated with size and location of lesion within the caudate but not the laterality. Seven patients were further compared with matched controls on a series of neuropsychological tests. Their performance was impaired on tasks requiring planning and sequencing. They had short attention spans and decreased free recall of episodic and semantic items with good recognition memory scores. Similar behavioral and cognitive changes also occur in early Huntington's disease, frontal-lesioned patients, and caudate-lesioned animals, and correspond to disturbances of specific frontal-caudate circuits. These results implicate the caudate nuclei in mediating prefrontal behaviors and possibly in the conceptual integration of memories.
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Affiliation(s)
- M F Mendez
- Case Western Reserve University, Cleveland, OH
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Abstract
An injury report from designed for use in a large strip and sheet steel processing plant incorporated check lists intended to yield detailed ergonomics data. Analyses of almost 10 000 injuries reported upon over five consecutive years are the subject of this report. It is clear that the injury rate was almost halved over the five years. A number of other relationships are revealed by the data, notably the frequency of injury according to: day of week; hour of day; and time between the employee's last work break and the occurrence of injury. It is concluded that the categorical approach to reporting utilised in this study is of real value and suggestions are made for its more widespread application.
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Affiliation(s)
- N L Adams
- The University of Wollongong, NSW, Australia
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Bay E, Adams NL, von Bredow JK, Nelson JD. Respiratory phase shift of pattern in the medullary reticular formation after soman in the cat. Brain Res 1973; 60:526-32. [PMID: 4587291 DOI: 10.1016/0006-8993(73)90816-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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