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Boudou M, ÓhAiseadha C, Garvey P, O’Dwyer J, Hynds P. An ecological study of the spatiotemporal dynamics and drivers of domestically acquired campylobacteriosis in Ireland, 2011-2018. PLoS One 2023; 18:e0291739. [PMID: 37976287 PMCID: PMC10655977 DOI: 10.1371/journal.pone.0291739] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/05/2023] [Indexed: 11/19/2023] Open
Abstract
In 2021, Campylobacteriosis was the main gastrointestinal disease in the European Union since 2007 according to the European Centre for Disease Prevention and Control. In the Republic of Ireland, the incidence of the disease is particularly high with approximately 3,000 cases per annum, raising significant concerns for national health authorities with an expected increase in the number of cases in the light of climate change. The current study sought to assess the spatio-temporal patterns of campylobacteriosis in the Republic of Ireland using 20,391 cases from January 2011 to December 2018. An ensemble of spatial statistics techniques including seasonal decomposition, spatial clustering and space-time scanning, were used to elucidate the main individual and spatio-temporal characteristics of the disease in the country. Findings revealed that cases from the paediatric age group (i.e., under 5 years old) were more likely to occur in rural areas (aOR: 1.1.27, CI 95% 1.14-1.41) while cases from the intermediate age group (i.e., >5 & <65 years old) were associated with urban living (aOR: 1.30, CI 95% 1.21-1.4). The disease exhibited a peak during Irish summer, with a stronger seasonal signal reported in counties located on the Western part of the country. Infection hotspots were more likely to occur in urban areas, and more particularly on the Southern part of the island and around the main metropolitan areas. Overall, research findings pointed out the influence of local and spatio-temporally specific socio-demographic and environmental risk factors (i.e., cooking habits, local weather, dietary types) therefore highlighting the need for initiating spatio-temporally targeted health management and surveillance strategies.
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Affiliation(s)
- Martin Boudou
- Environmental Sustainability & Health Institute (ESHI), Dublin, Republic of Ireland
| | - Coilín ÓhAiseadha
- Department of Public Health, Health Service Executive (HSE), Dr. Steevens’ Hospital, Dublin, Republic of Ireland
| | - Patricia Garvey
- Health Protection Surveillance Centre, Dublin, Republic of Ireland
| | - Jean O’Dwyer
- School of Biological, Earth and Environmental Sciences, Environmental Research Institute (ERI), University College Cork, Cork, Republic of Ireland
- Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin, Republic of Ireland
| | - Paul Hynds
- Environmental Sustainability & Health Institute (ESHI), Dublin, Republic of Ireland
- Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin, Republic of Ireland
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2
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McKeown D, McCourt A, Hendrick L, O’Farrell A, Donohue F, Grabowsky L, Kavanagh P, Garvey P, O’Donnell J, O’Connor L, Cuddihy J, Robinson M, O’Reilly D, Staines A, Johnson H. COVID-19 incidence and outcome by affluence/deprivation across three pandemic waves in Ireland: A retrospective cohort study using routinely collected data. PLoS One 2023; 18:e0287636. [PMID: 37478117 PMCID: PMC10361474 DOI: 10.1371/journal.pone.0287636] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 06/11/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Since the pandemic onset, deprivation has been seen as a significant determinant of COVID-19 incidence and mortality. This study explores outcomes of COVID-19 in the context of material deprivation across three pandemic waves in Ireland. METHODS Between 1st March 2020 and 13th May 2021, 252,637 PCR-confirmed COVID-19 cases were notified in Ireland. Cases were notified to the national Computerised Infectious Disease Reporting (CIDR) system. Each case was geo-referenced and assigned a deprivation category according to the Haase-Pratschke (HP) Deprivation Index. Regression modelling examined three outcomes: admission to hospital; admission to an intensive care unit (ICU) and death. RESULTS Deprivation increased the likelihood of contracting COVID-19 in all age groups and across all pandemic waves, except for the 20-39 age group. Deprivation, age, comorbidity and male gender carried increased risk of hospital admission. Deprivation was not a factor in predicting ICU admission or death, and diagnosis in wave 2 was associated with the lowest risk of all three outcomes. CONCLUSIONS Our study suggests that COVID-19 spreads easily through all strata of society and particularly in the more deprived population; however this was not a consistent finding. Ireland is ethnically more homogenous than other countries reporting a larger deprivation gradient, and in such societies, structural racial differences may contribute more to poor COVID outcomes than elements of deprivation.
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Affiliation(s)
- Declan McKeown
- National Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Angela McCourt
- National Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Louise Hendrick
- National Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Anne O’Farrell
- National Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Fionnuala Donohue
- National Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Laurin Grabowsky
- National Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Paul Kavanagh
- National Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Patricia Garvey
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - Joan O’Donnell
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - Lois O’Connor
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - John Cuddihy
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - Matt Robinson
- National Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Declan O’Reilly
- National Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Anthony Staines
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Howard Johnson
- National Health Intelligence Unit, Health Service Executive, Dublin, Ireland
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3
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Larkin L, Pardos de la Gandara M, Hoban A, Pulford C, Jourdan-Da Silva N, de Valk H, Browning L, Falkenhorst G, Simon S, Lachmann R, Dryselius R, Karamehmedovic N, Börjesson S, van Cauteren D, Laisnez V, Mattheus W, Pijnacker R, van den Beld M, Mossong J, Ragimbeau C, Vergison A, Thorstensen Brandal L, Lange H, Garvey P, Nielsen CS, Herrera León S, Varela C, Chattaway M, Weill FX, Brown D, McKeown P. Investigation of an international outbreak of multidrug-resistant monophasic Salmonella Typhimurium associated with chocolate products, EU/EEA and United Kingdom, February to April 2022. Euro Surveill 2022; 27. [PMID: 35426359 PMCID: PMC9012091 DOI: 10.2807/1560-7917.es.2022.27.15.2200314] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
An extensive multi-country outbreak of multidrug-resistant monophasic Salmonella Typhimurium infection in 10 countries with 150 reported cases, predominantly affecting young children, has been linked to chocolate products produced by a large multinational company. Extensive withdrawals and recalls of multiple product lines have been undertaken. With Easter approaching, widespread product distribution and the vulnerability of the affected population, early and effective real-time sharing of microbiological and epidemiological information has been of critical importance in effectively managing this serious food-borne incident.
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Affiliation(s)
- Lesley Larkin
- Gastrointestinal Infections and Food Safety (One Health Unit), UK Health Security Agency, London, United Kingdom
| | - Maria Pardos de la Gandara
- Institut Pasteur, Université Paris Cité, Centre National de Référence des E. coli, Shigella et Salmonella, Unité des Bactéries pathogènes entériques, Paris, France
| | - Ann Hoban
- Gastrointestinal Infections and Food Safety (One Health Unit), UK Health Security Agency, London, United Kingdom
| | - Caisey Pulford
- Gastrointestinal Infections and Food Safety (One Health Unit), UK Health Security Agency, London, United Kingdom
| | | | - Henriette de Valk
- Sante Publique France, Direction des Maladies Infectieuses Unité EAZ, Paris, France
| | - Lynda Browning
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, United Kingdom
| | - Gerhard Falkenhorst
- Robert Koch Institute, Department of Infectious Disease Epidemiology FG 35 - Gastrointestinal Infections, Zoonoses and Tropical Infections, Berlin, Germany
| | - Sandra Simon
- Robert Koch Institute, Department of Infectious Diseases, Unit for Enteropathogenic Bacteria and Legionella / National Reference Centre for Salmonella and other Bacterial Enterics, Wernigerode, Germany
| | - Raskit Lachmann
- Robert Koch Institute, Department of Infectious Disease Epidemiology FG 35 - Gastrointestinal Infections, Zoonoses and Tropical Infections, Berlin, Germany
| | - Rikard Dryselius
- Public Health Agency of Sweden, Unit for Zoonoses and Antibiotic Resistance, Stockholm, Sweden
| | - Nadja Karamehmedovic
- Public Health Agency of Sweden, Unit for laboratory surveillance of bacterial pathogens, Stockholm, Sweden
| | - Stefan Börjesson
- Public Health Agency of Sweden, Unit for Zoonoses and Antibiotic Resistance, Stockholm, Sweden
| | - Dieter van Cauteren
- Epidemiology of infectious diseases, Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Valeska Laisnez
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Epidemiology of infectious diseases, Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Wesley Mattheus
- National Reference Centre for Salmonella and Shigella, Sciensano, Brussels, Belgium
| | - Roan Pijnacker
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, Netherlands
| | - Maaike van den Beld
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, Netherlands
| | - Joël Mossong
- Health Inspection, Health Directorate, Luxembourg
| | - Catherine Ragimbeau
- Laboratoire National de Santé, Epidemiology and Microbial Genomics, Dudelange, Luxembourg
| | | | - Lin Thorstensen Brandal
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Heidi Lange
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Charlotte Salgaard Nielsen
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- HSE -Health Protection Surveillance Centre, Dublin, Ireland
| | - Silvia Herrera León
- Instituto de Salud Carlos III. Centro Nacional de Microbiología, Madrid, Spain
| | - Carmen Varela
- Instituto de Salud Carlos III. CIBER epidemiología y salud pública. Madrid, Spain
| | - Marie Chattaway
- Specialist Scientific Reference Service (Salmonella), Gastrointestinal Bacteria Reference Unit, UK Health Security Agency, London, United Kingdom
| | - François-Xavier Weill
- Institut Pasteur, Université Paris Cité, Centre National de Référence des E. coli, Shigella et Salmonella, Unité des Bactéries pathogènes entériques, Paris, France
| | - Derek Brown
- Scottish Microbiology Reference Laboratories, Glasgow, United Kingdom
| | - Paul McKeown
- HSE -Health Protection Surveillance Centre, Dublin, Ireland
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4
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Heavey L, Garvey P, Colgan AM, Thornton L, Connell J, Roux T, Hunt M, O'Callaghan F, Culkin F, Keogan M, O'Connor N, O'Sullivan MB, O'Sullivan S, Tait M, De Gascun CF, Igoe D. The Study to Investigate COVID-19 Infection in People Living in Ireland (SCOPI): A seroprevalence study, June to July 2020. Euro Surveill 2021; 26. [PMID: 34857067 PMCID: PMC8641066 DOI: 10.2807/1560-7917.es.2021.26.48.2001741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BackgroundRobust data on SARS-CoV-2 population seroprevalence supplement surveillance data in providing evidence for public health action.AimTo conduct a SARS-CoV-2 population-based seroprevalence survey in Ireland.MethodsUsing a cross-sectional study design, we selected population samples from individuals aged 12-69 years in counties Dublin and Sligo using the Health Service Executive Primary Care Reimbursement Service database as a sampling frame. Samples were selected with probability proportional to the general population age-sex distribution, and by simple random sampling within age-sex strata. Antibodies to SARS-CoV-2 were detected using the Abbott Architect SARS-CoV-2 IgG Assay and confirmed using the Wantai Assay. We estimated the population SARS-CoV-2 seroprevalence weighted for age, sex and geographic area.ResultsParticipation rates were 30% (913/3,043) and 44% (820/1,863) in Dublin and Sligo. Thirty-three specimens had detectable SARS-CoV-2 antibodies (1.9%). We estimated weighted seroprevalences of 3.12% (95% confidence interval (CI): 2.05-4.53) and 0.58% (95% CI: 0.18-1.38) for Dublin and Sligo, and 1.69% (95% CI: 1.13-2.41) nationally. This equates to an estimated 59,482 (95% CI: 39,772-85,176) people aged 12-69 years nationally having had infection with SARS-CoV-2, 3.0 (95% CI: 2.0-4.3) times higher than confirmed notifications. Ten participants reported a previous laboratory-confirmed SARS-CoV-2 -infection; eight of these were antibody-positive. Twenty-five antibody-positive participants had not reported previous laboratory-confirmed infection.ConclusionThe majority of people in Ireland are unlikely to have been infected with SARS-CoV-2 by June-July 2020. Non-pharmaceutical public health measures remained key pending widespread availability of vaccination, and effective treatments.
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Affiliation(s)
- Laura Heavey
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - Patricia Garvey
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - Aoife M Colgan
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - Lelia Thornton
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - Jeff Connell
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Thomas Roux
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - Meadhbh Hunt
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | | | - Fiona Culkin
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - Mary Keogan
- Department of Clinical Immunology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Siobhán O'Sullivan
- Office of the Chief Medical Officer, Department of Health, Dublin, Ireland
| | - Michele Tait
- Office of the Chief Operations Officer, Health Service Executive, Dublin, Ireland
| | - Cillian F De Gascun
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Derval Igoe
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
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5
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Suetens C, Kinross P, Gallego Berciano P, Arroyo Nebreda V, Hassan E, Calba C, Fernandes E, Peralta-Santos A, Casaca P, Shodu N, Dequeker S, Kontopidou F, Pappa L, Kacelnik O, Børseth AW, O'Connor L, Garvey P, Liausedienė R, Valintelienė R, Ernst C, Mossong J, Štefkovičová M, Prostináková Z, Danielsen AC, Mougkou A, Lamb F, Cenciarelli O, Monnet DL, Plachouras D. Increasing risk of breakthrough COVID-19 in outbreaks with high attack rates in European long-term care facilities, July to October 2021. Euro Surveill 2021; 26. [PMID: 34886946 PMCID: PMC8662803 DOI: 10.2807/1560-7917.es.2021.26.49.2101070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We collected data from 10 EU/EEA countries on 240 COVID-19 outbreaks occurring from July−October 2021 in long-term care facilities with high vaccination coverage. Among 17,268 residents, 3,832 (22.2%) COVID-19 cases were reported. Median attack rate was 18.9% (country range: 2.8–52.4%), 17.4% of cases were hospitalised, 10.2% died. In fully vaccinated residents, adjusted relative risk for COVID-19 increased with outbreak attack rate. Findings highlight the importance of early outbreak detection and rapid containment through effective infection prevention and control measures.
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Affiliation(s)
- Carl Suetens
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Pete Kinross
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | | | | | - Clémentine Calba
- Santé publique France, Regional Unit Provence-Alps-French Riviera and Corsica, Marseille, France
| | | | | | | | | | | | - Flora Kontopidou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases NPHO, Athens, Greece
| | - Lamprini Pappa
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases NPHO, Athens, Greece
| | | | | | - Lois O'Connor
- Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Rasa Liausedienė
- National Public Health Centre under The Ministry of Health, Vilnius, Lithuania
| | | | | | | | - Mária Štefkovičová
- Alexander Dubcek University, Trenčin, Slovakia.,Regional Public Health Authority, Trenčin, Slovakia
| | | | | | - Aikaterini Mougkou
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Orlando Cenciarelli
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Dominique L Monnet
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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6
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McCormick CA, Domegan L, Carty PG, Drew R, McAuliffe FM, O'Donohoe O, White N, Garvey P, O'Grady M, De Gascun CF, McCormick PA. Routine screening for hepatitis C in pregnancy is cost-effective in a large urban population in Ireland: a retrospective study. BJOG 2021; 129:322-327. [PMID: 34706147 DOI: 10.1111/1471-0528.16984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/16/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate whether risk factor-based screening in pregnancy is failing to identify women with hepatitis C virus (HCV) infection and to assess the cost-effectiveness of universal screening. DESIGN Retrospective study and model-based economic evaluation. SETTING Two urban tertiary referral maternity units, currently using risk factor-based screening for HCV infection. POPULATION Pregnant women who had been tested for hepatitis B, HIV but not HCV. METHODS Anonymised sera were tested for HCV antibody. Positive sera were tested for HCV antigen. A cost-effectiveness analysis of a change to universal screening was performed using a Markov model to simulate disease progression and Monte Carlo simulations for probabilistic sensitivity analysis. MAIN OUTCOME MEASURES Presence of HCV antigen and cost per quality-adjusted life year (QALY). RESULTS In all, 4655 samples were analysed. Twenty had HCV antibodies and five HCV antigen. This gives an active infection rate of 5/4655, or 0.11%, compared with a rate of 0.15% in the risk-factor group. This prevalence is 65% lower than a previous study in the same hospitals from 2001 to 2005. The calculated incremental cost-effectiveness ratio (ICER) for universal screening was €3,315 per QALY gained. CONCLUSION This study showed that the prevalence of HCV infection in pregnant women in the Dublin region has declined by 65% over the past two decades. Risk factor-based screening misses a significant proportion of infections. A change to universal maternal screening for hepatitis C would be cost-effective in our population. TWEETABLE ABSTRACT Universal maternal screening for hepatitis C is cost-effective in this urban Irish population.
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Affiliation(s)
- C A McCormick
- National Maternity Hospital, Dublin, Ireland.,St Vincent's University Hospital, Dublin, Ireland
| | - L Domegan
- Health Protection Surveillance Centre, Dublin, Ireland
| | - P G Carty
- RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Health Information and Quality Authority, Dublin, Ireland
| | - R Drew
- Rotunda Hospital, Dublin, Ireland
| | - F M McAuliffe
- National Maternity Hospital, Dublin, Ireland.,UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | - O O'Donohoe
- National Virus Reference Laboratory, UCD, Dublin, Ireland
| | - N White
- National Virus Reference Laboratory, UCD, Dublin, Ireland
| | - P Garvey
- Health Protection Surveillance Centre, Dublin, Ireland
| | - M O'Grady
- National Hepatitis C Treatment Programme, Health Service Executive, Dublin, Ireland
| | - C F De Gascun
- National Virus Reference Laboratory, UCD, Dublin, Ireland
| | - P A McCormick
- St Vincent's University Hospital, Dublin, Ireland.,National Hepatitis C Treatment Programme, Health Service Executive, Dublin, Ireland
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7
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Domegan L, Garvey P, McEnery M, Fiegenbaum R, Brabazon E, Quintyne KI, O'Connor L, Cuddihy J, O'Donnell J. Establishing a COVID-19 pandemic severity assessment surveillance system in Ireland. Influenza Other Respir Viruses 2021; 16:172-177. [PMID: 34609049 PMCID: PMC8652866 DOI: 10.1111/irv.12890] [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: 04/26/2021] [Revised: 07/02/2021] [Accepted: 07/11/2021] [Indexed: 11/27/2022] Open
Abstract
We developed a COVID-19 pandemic severity assessment (PSA) monitoring system in Ireland, in order to inform and improve public health preparedness, response and recovery. The system based on the World Health Organization (WHO) Pandemic Influenza Severity Assessment (PISA) project included a panel of surveillance parameters for the following indicators: transmissibility, impact and disease severity. Age-specific thresholds were established for each parameter and data visualised using heat maps. The findings from the first pandemic wave in Ireland have shown that the WHO PISA system can be adapted for COVID-19, providing a standardised tool for early warning and monitoring pandemic severity.
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Affiliation(s)
- Lisa Domegan
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Patricia Garvey
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Maeve McEnery
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Rachel Fiegenbaum
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Elaine Brabazon
- Department of Public Health, Health Service Executive North-East, Navan, Ireland
| | - Keith Ian Quintyne
- Department of Public Health, Health Service Executive North-East, Navan, Ireland
| | - Lois O'Connor
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - John Cuddihy
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Joan O'Donnell
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland
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8
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Boudou M, ÓhAiseadha C, Garvey P, O'Dwyer J, Hynds P. Modelling COVID-19 severity in the Republic of Ireland using patient co-morbidities, socioeconomic profile and geographic location, February to November 2020. Sci Rep 2021; 11:18474. [PMID: 34531478 PMCID: PMC8446039 DOI: 10.1038/s41598-021-98008-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/01/2021] [Indexed: 12/23/2022] Open
Abstract
Understanding patient progression from symptomatic COVID-19 infection to a severe outcome represents an important tool for improved diagnoses, surveillance, and triage. A series of models have been developed and validated to elucidate hospitalization, admission to an intensive care unit (ICU) and mortality in patients from the Republic of Ireland. This retrospective cohort study of patients with laboratory-confirmed symptomatic COVID-19 infection included data extracted from national COVID-19 surveillance forms (i.e., age, gender, underlying health conditions, occupation) and geographically-referenced potential predictors (i.e., urban/rural classification, socio-economic profile). Generalised linear models and recursive partitioning and regression trees were used to elucidate COVID-19 progression. The incidence of symptomatic infection over the study-period was 0.96% (n = 47,265), of whom 3781 (8%) required hospitalisation, 615 (1.3%) were admitted to ICU and 1326 (2.8%) died. Models demonstrated an increasingly efficacious fit for predicting hospitalization [AUC 0.816 (95% CI 0.809, 0.822)], admission to ICU [AUC 0.885 (95% CI 0.88 0.89)] and death [AUC of 0.955 (95% CI 0.951 0.959)]. Severe obesity (BMI ≥ 40) was identified as a risk factor across all prognostic models; severely obese patients were substantially more likely to receive ICU treatment [OR 19.630] or die [OR 10.802]. Rural living was associated with an increased risk of hospitalization (OR 1.200 (95% CI 1.143-1.261)]. Urban living was associated with ICU admission [OR 1.533 (95% CI 1.606-1.682)]. Models provide approaches for predicting COVID-19 prognoses, allowing for evidence-based decision-making pertaining to targeted non-pharmaceutical interventions, risk-based vaccination priorities and improved patient triage.
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Affiliation(s)
- M Boudou
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - C ÓhAiseadha
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
- Department of Public Health, Health Service Executive, (HSE), Dublin, Ireland
| | - P Garvey
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - J O'Dwyer
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
- Environmental Research Institute, University College Cork, Cork, Ireland
- Irish Centre for Research in Applied Geoscience, University College Dublin, Dublin, Ireland
| | - P Hynds
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland.
- Irish Centre for Research in Applied Geoscience, University College Dublin, Dublin, Ireland.
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9
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Boudou M, Cleary E, ÓhAiseadha C, Garvey P, McKeown P, O'Dwyer J, Hynds P. Spatiotemporal epidemiology of cryptosporidiosis in the Republic of Ireland, 2008-2017: development of a space-time "cluster recurrence" index. BMC Infect Dis 2021; 21:880. [PMID: 34454462 PMCID: PMC8401175 DOI: 10.1186/s12879-021-06598-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/01/2021] [Accepted: 08/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Ireland frequently reports the highest annual Crude Incidence Rates (CIRs) of cryptosporidiosis in the EU, with national CIRs up to ten times the EU average. Accordingly, the current study sought to examine the spatiotemporal trends associated with this potentially severe protozoan infection. Methods Overall, 4509 cases of infection from January 2008 to December 2017 were geo-referenced to a Census Small Area (SA), with an ensemble of geo-statistical approaches including seasonal decomposition, Local Moran’s I, and space–time scanning used to elucidate spatiotemporal patterns of infection. Results One or more confirmed cases were notified in 3413 of 18,641 Census SAs (18.3%), with highest case numbers occurring in the 0–5-year range (n = 2672, 59.3%). Sporadic cases were more likely male (OR 1.4) and rural (OR 2.4), with outbreak-related cases more likely female (OR 1.4) and urban (OR 1.5). Altogether, 55 space–time clusters (≥ 10 confirmed cases) of sporadic infection were detected, with three “high recurrence” regions identified; no large urban conurbations were present within recurrent clusters. Conclusions Spatiotemporal analysis represents an important indicator of infection patterns, enabling targeted epidemiological intervention and surveillance. Presented results may also be used to further understand the sources, pathways, receptors, and thus mechanisms of cryptosporidiosis in Ireland. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06598-3.
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Affiliation(s)
- M Boudou
- Environmental Sustainability and Health Institute (ESHI), Technological University Dublin, Greenway Hub, Grangegorman, Dublin 7, D07 H6K8, Republic of Ireland.
| | - E Cleary
- Environmental Sustainability and Health Institute (ESHI), Technological University Dublin, Greenway Hub, Grangegorman, Dublin 7, D07 H6K8, Republic of Ireland
| | - C ÓhAiseadha
- Department of Public Health, Health Service Executive (HSE), Dr. Steevens' Hospital, Dublin 8, Republic of Ireland
| | - P Garvey
- Health Protection Surveillance Centre, 25 Middle Gardiner Street, Dublin 1, Republic of Ireland
| | - P McKeown
- Health Protection Surveillance Centre, 25 Middle Gardiner Street, Dublin 1, Republic of Ireland
| | - J O'Dwyer
- School of Biological, Earth and Environmental Sciences, Environmental Research Institute (ERI), University College Cork, Cork, Republic of Ireland.,Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin 4, Republic of Ireland
| | - Paul Hynds
- Environmental Sustainability and Health Institute (ESHI), Technological University Dublin, Greenway Hub, Grangegorman, Dublin 7, D07 H6K8, Republic of Ireland. .,Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin 4, Republic of Ireland.
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10
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Cleary E, Boudou M, Garvey P, Aiseadha CO, McKeown P, O'Dwyer J, Hynds P. Spatiotemporal Dynamics of Sporadic Shiga Toxin-Producing Escherichia coli Enteritis, Ireland, 2013-2017. Emerg Infect Dis 2021; 27:2421-2433. [PMID: 34424163 PMCID: PMC8386769 DOI: 10.3201/eid2709.204021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/19/2022] Open
Abstract
The Republic of Ireland regularly reports the highest annual crude incidence rates of Shiga toxin–producing Escherichia coli (STEC) enteritis in the European Union, ≈10 times the average. We investigated spatiotemporal patterns of STEC enteritis in Ireland using multiple statistical tools. Overall, we georeferenced 2,755 cases of infection during January 2013–December 2017; we found >1 case notified in 2,340 (12.6%) of 18,641 Census Small Areas. We encountered the highest case numbers in children 0–5 years of age (n = 1,101, 39.6%) and associated with serogroups O26 (n = 800, 29%) and O157 (n = 638, 23.2%). Overall, we identified 17 space-time clusters, ranging from 2 (2014) to 5 (2017) clusters of sporadic infection per year; we detected recurrent clustering in 3 distinct geographic regions in the west and mid-west, all of which are primarily rural. Our findings can be used to enable targeted epidemiologic intervention and surveillance.
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11
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Boudou M, ÓhAiseadha C, Garvey P, O'Dwyer J, Hynds P. Breakpoint modelling of temporal associations between non-pharmaceutical interventions and symptomatic COVID-19 incidence in the Republic of Ireland. PLoS One 2021; 16:e0255254. [PMID: 34324566 PMCID: PMC8321012 DOI: 10.1371/journal.pone.0255254] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background To constrain propagation and mitigate the burden of COVID-19, most countries initiated and continue to implement several non-pharmaceutical interventions (NPIs), including national and regional lockdowns. In the Republic of Ireland, the first national lockdown was decreed on 23rd of March 2020, followed by a succession of restriction increases and decreases (phases) over the following year. To date, the effects of these interventions remain unclear, and particularly within differing population subsets. The current study sought to assess the impact of individual NPI phases on COVID-19 transmission patterns within delineated population subgroups in the Republic of Ireland. Methods and findings Confirmed, anonymised COVID-19 cases occurring between the 29th of February 2020 and 30th November 2020 (n = 72,654) were obtained. Segmented modelling via breakpoint regression with multiple turning points was employed to identify structural breaks across sub-populations, including primary/secondary infections, age deciles, urban/commuter/rural areas, patients with underlying health conditions, and socio-demographic profiles. These were subsequently compared with initiation dates of eight overarching NPI phases. Five distinct breakpoints were identified. The first breakpoint, associated with a decrease in the daily COVID-19 incidence, was reported within 14 days of the first set of restrictions in mid-March 2020 for most population sub-groups. Results suggest that moderately strict NPIs were more effective than the strictest Phase 5 (National Lockdown). Divergences were observed across population sub-groups; lagged response times were observed among populations >80 years, residents of rural/ commuter regions, and cases associated with a below-median deprivation score. Conclusions Study findings suggest that many NPIs have been successful in decreasing COVID-19 incidence rates, however the strictest Phase 5 NPI was not. Moreover, NPIs were not equally successful across all sub-populations, with differing response times noted. Future strategies and interventions may need to be increasingly bespoke, based on sub-population profiles and required responses.
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Affiliation(s)
- Martin Boudou
- SpatioTemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
| | - Coilin ÓhAiseadha
- SpatioTemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
- Health Service Executive, (HSE), Dublin, Ireland
| | - Patricia Garvey
- SpatioTemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Jean O'Dwyer
- SpatioTemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland
- Irish Centre for Research in Applied Geoscience, University College Dublin, Dublin, Ireland
| | - Paul Hynds
- SpatioTemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
- Irish Centre for Research in Applied Geoscience, University College Dublin, Dublin, Ireland
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12
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Domegan L, Garvey P, McKeown P, Johnson H, Hynds P, O'Dwyer J, ÓhAiseadha C. Geocoding cryptosporidiosis cases in Ireland (2008-2017)-development of a reliable, reproducible, multiphase geocoding methodology. Ir J Med Sci 2021; 190:1497-1507. [PMID: 33464478 PMCID: PMC7813664 DOI: 10.1007/s11845-020-02468-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/17/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
Background Geocoding (the process of converting a text address into spatial data) quality may affect geospatial epidemiological study findings. No national standards for best geocoding practice exist in Ireland. Irish postcodes (Eircodes) are not routinely recorded for infectious disease notifications and > 35% of dwellings have non-unique addresses. This may result in incomplete geocoding and introduce systematic errors into studies. Aims This study aimed to develop a reliable and reproducible methodology to geocode cryptosporidiosis notifications to fine-resolution spatial units (Census 2016 Small Areas), to enhance data validity and completeness, thus improving geospatial epidemiological studies. Methods A protocol was devised to utilise geocoding tools developed by the Health Service Executive’s Health Intelligence Unit. Geocoding employed finite-string automated and manual matching, undertaken sequentially in three additive phases. The protocol was applied to a cryptosporidiosis notification dataset (2008–2017) from Ireland’s Computerised Infectious Disease Reporting System. Outputs were validated against devised criteria. Results Overall, 92.1% (4266/4633) of cases were successfully geocoded to one Small Area, and 95.5% (n = 4425) to larger spatial units. The proportion of records geocoded increased by 14% using the multiphase approach, with 5% of records re-assigned to a different spatial unit. Conclusions The developed multiphase protocol improved the completeness and validity of geocoding, thus increasing the power of subsequent studies. The authors recommend capturing Eircodes ideally using application programming interface for infectious disease or other health-related datasets, for more efficient and reliable geocoding. Where Eircodes are not recorded/available, for best geocoding practice, we recommend this (or a similar) quality driven protocol.
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Affiliation(s)
- Lisa Domegan
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. .,Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland.
| | - Patricia Garvey
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Paul McKeown
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Howard Johnson
- Health Service Executive-Health Intelligence Unit, Dublin, Ireland
| | - Paul Hynds
- Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland.,Irish Centre for Research in Applied Geosciences, University College Dublin, Dublin, Ireland
| | - Jean O'Dwyer
- Irish Centre for Research in Applied Geosciences, University College Dublin, Dublin, Ireland.,School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland.,Water and Environment Research Group, Environmental Research Institute, University College Cork, Cork, Ireland
| | - Coilín ÓhAiseadha
- Health Service Executive-Department of Public Health-East, Dublin, Ireland.
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13
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O'Connor L, McKeown P, Barrasa A, Garvey P. Epidemiology of Campylobacter infections in Ireland 2004–2016: What has changed? Zoonoses Public Health 2020; 67:362-369. [DOI: 10.1111/zph.12695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 12/23/2019] [Accepted: 01/22/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Lois O'Connor
- European Programme for Intervention Epidemiology Training (EPIET) European Centre for Disease Prevention and Control (ECDC) Stockholm Sweden
- Health Protection Surveillance Centre Dublin Ireland
| | - Paul McKeown
- Health Protection Surveillance Centre Dublin Ireland
| | - Alicia Barrasa
- European Programme for Intervention Epidemiology Training (EPIET) European Centre for Disease Prevention and Control (ECDC) Stockholm Sweden
- Instituto de Salud Carlos III Madrid Spain
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14
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O'Brien S, Garvey P, Baker K, Brennan M, Cormican M, Cuddihy J, De Lappe N, Ellard R, Fallon Ú, Irvine N, Murphy S, O'Brien D, O'Connor M, O'Hare C, O'Sullivan MB, Part AM, Rooney P, Ryan A, Waldron G, Ward M, McKeown PJ. Investigation of a foodborne outbreak of Shigella sonnei in Ireland and Northern Ireland, December 2016: the benefits of cross-border collaboration and commercial sales data. Public Health 2020; 182:19-25. [PMID: 32120067 DOI: 10.1016/j.puhe.2020.01.008] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe a cross-border foodborne outbreak of Shigella sonnei that occurred in Ireland and Northern Ireland (NI) in December 2016 whilst also highlighting the valuable roles of sales data and international collaboration in the investigation and control of this outbreak. STUDY DESIGN A cross-border outbreak control team was established to investigate the outbreak. METHODS Epidemiological, microbiological, and environmental investigations were undertaken. Traditional analytical epidemiological studies were not feasible in this investigation. The restaurant chain provided sales data, which allowed assessment of a possible increased risk of illness associated with exposure to a particular type of heated food product (product A). RESULTS Confirmed cases demonstrated sole trimethoprim resistance: an atypical antibiogram for Shigella isolates in Ireland. Early communication and the sharing of information within the outbreak control team facilitated the early detection of the international dimension of this outbreak. A joint international alert using the European Centre for Disease Control's confidential Epidemic Intelligence Information System for Food- and Waterborne Diseases and Zoonoses (EPIS-FWD) did not reveal further cases outside of the island of Ireland. The outbreak investigation identified that nine of thirteen primary case individuals had consumed product A from one of multiple branches of a restaurant chain located throughout the island of Ireland. Product A was made specifically for this chain in a food production facility in NI. S. sonnei was not detected in food samples from the food production facility. Strong statistical associations were observed between visiting a branch of this restaurant chain between 5 and 9 December 2016 and eating product A and developing shigellosis. CONCLUSIONS This outbreak investigation highlights the importance of international collaboration in the efficient identification of cross-border foodborne outbreaks and the value of using sales data as the analytical component of such studies.
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Affiliation(s)
- S O'Brien
- HSE-Health Protection Surveillance Centre, Dublin, Ireland; Department of Public Health HSE-NW, Sligo, Ireland.
| | - P Garvey
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | - K Baker
- Food Standards Agency Northern Ireland, Belfast, Northern Ireland, Ireland
| | - M Brennan
- Food Safety Authority of Ireland, Dublin, Ireland
| | - M Cormican
- National Salmonella, Shigella and Listeria Reference Laboratory, Galway, Ireland
| | - J Cuddihy
- Department of Public Health HSE-SE, Kilkenny, Ireland
| | - N De Lappe
- National Salmonella, Shigella and Listeria Reference Laboratory, Galway, Ireland
| | - R Ellard
- Food Safety Authority of Ireland, Dublin, Ireland
| | - Ú Fallon
- Department of Public Health HSE-Midlands, Co Offaly, Ireland
| | - N Irvine
- Public Health Agency Northern Ireland, Belfast, Northern Ireland, UK
| | - S Murphy
- Environmental Health Department, Newry, Mourne & Down District Council, Northern Ireland, UK
| | - D O'Brien
- HSE Environmental Health Service Dublin Specialist Section, Dublin, Ireland
| | - M O'Connor
- Department of Public Health HSE-E, Dublin, Ireland
| | - C O'Hare
- Department of Public Health HSE-SE, Kilkenny, Ireland
| | | | - A M Part
- HSE Environmental Health Service Dublin Mid Leinster, Dublin, Ireland
| | - P Rooney
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - A Ryan
- Department of Public Health HSE-NW, Sligo, Ireland
| | - G Waldron
- Public Health Agency Northern Ireland, Belfast, Northern Ireland, UK
| | - M Ward
- Department of Public Health HSE-E, Dublin, Ireland
| | - P J McKeown
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
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15
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Pijnacker R, Dallman TJ, Tijsma ASL, Hawkins G, Larkin L, Kotila SM, Amore G, Amato E, Suzuki PM, Denayer S, Klamer S, Pászti J, McCormick J, Hartman H, Hughes GJ, Brandal LCT, Brown D, Mossong J, Jernberg C, Müller L, Palm D, Severi E, Gołębiowska J, Hunjak B, Owczarek S, Le Hello S, Garvey P, Mooijman K, Friesema IHM, van der Weijden C, van der Voort M, Rizzi V, Franz E. An international outbreak of Salmonella enterica serotype Enteritidis linked to eggs from Poland: a microbiological and epidemiological study. Lancet Infect Dis 2019; 19:778-786. [PMID: 31133519 DOI: 10.1016/s1473-3099(19)30047-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Salmonella spp are a major cause of food-borne outbreaks in Europe. We investigated a large multi-country outbreak of Salmonella enterica serotype Enteritidis in the EU and European Economic Area (EEA). METHODS A confirmed case was defined as a laboratory-confirmed infection with the outbreak strains of S Enteritidis based on whole-genome sequencing (WGS), occurring between May 1, 2015, and Oct 31, 2018. A probable case was defined as laboratory-confirmed infection with S Enteritidis with the multiple-locus variable-number tandem repeat analysis outbreak profile. Multi-country epidemiological, trace-back, trace-forward, and environmental investigations were done. We did a case-control study including confirmed and probable cases and controls randomly sampled from the population registry (frequency matched by age, sex, and postal code). Odds ratios (ORs) for exposure rates between cases and controls were calculated with unmatched univariable and multivariable logistic regression. FINDINGS 18 EU and EEA countries reported 838 confirmed and 371 probable cases. 509 (42%) cases were reported in 2016, after which the number of cases steadily increased. The case-control study results showed that cases more often ate in food establishments than did controls (OR 3·4 [95% CI 1·6-7·3]), but no specific food item was identified. Recipe-based food trace-back investigations among cases who ate in food establishments identified eggs from Poland as the vehicle of infection in October, 2016. Phylogenetic analysis identified two strains of S Enteritidis in human cases that were subsequently identified in salmonella-positive eggs and primary production premises in Poland, confirming the source of the outbreak. After control measures were implemented, the number of cases decreased, but increased again in March, 2017, and the increase continued into 2018. INTERPRETATION This outbreak highlights the public health value of multi-country sharing of epidemiological, trace-back, and microbiological data. The re-emergence of cases suggests that outbreak strains have continued to enter the food chain, although changes in strain population dynamics and fewer cases indicate that control measures had some effect. Routine use of WGS in salmonella surveillance and outbreak response promises to identify and stop outbreaks in the future. FUNDING European Centre for Disease Prevention and Control; Directorate General for Health and Food Safety, European Commission; and National Public Health and Food Safety Institutes of the authors' countries (see Acknowledgments for full list).
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Affiliation(s)
- Roan Pijnacker
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, Netherlands.
| | | | - Aloys S L Tijsma
- Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht, Netherlands
| | | | | | - Saara M Kotila
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Giusi Amore
- European Food Safety Authority, Parma, Italy
| | - Ettore Amato
- Rapid Alert System for Food and Feed, Directorate-General for Health and Food Safety, European Commission, Brussels, Belgium
| | - Pamina M Suzuki
- Crisis Management in Food, Directorate-General for Health and Food Safety, European Commission, Brussels, Belgium
| | - Sarah Denayer
- National Institute for Public Health (Sciensano), Elsene, Belgium
| | - Sofieke Klamer
- National Institute for Public Health (Sciensano), Elsene, Belgium
| | - Judit Pászti
- National Centre for Epidemiology, Budapest, Hungary
| | | | | | | | | | - Derek Brown
- Scottish Salmonella, Shigella, and Clostridium difficile Reference Laboratory, Glasgow, UK
| | - Joël Mossong
- National Health Laboratory, Dudelange, Luxembourg
| | | | | | - Daniel Palm
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Ettore Severi
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | | | | | | | | | - Kirsten Mooijman
- European Union Reference Laboratory for Salmonella, Bilthoven, Netherlands
| | - Ingrid H M Friesema
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, Netherlands
| | - Coen van der Weijden
- Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht, Netherlands
| | - Menno van der Voort
- Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht, Netherlands
| | | | - Eelco Franz
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, Netherlands
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16
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Garvey P, O'Grady B, Franzoni G, Bolger M, Irwin Crosby K, Connell J, Burke D, De Gascun C, Thornton L. Hepatitis C virus seroprevalence and prevalence of chronic infection in the adult population in Ireland: a study of residual sera, April 2014 to February 2016. ACTA ACUST UNITED AC 2018; 22:30579. [PMID: 28797323 PMCID: PMC5553053 DOI: 10.2807/1560-7917.es.2017.22.30.30579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/26/2016] [Accepted: 05/17/2017] [Indexed: 01/09/2023]
Abstract
Robust data on hepatitis C virus (HCV) population prevalence are essential to inform national HCV services. In 2016, we undertook a survey to estimate HCV prevalence among the adult population in Ireland. We used anonymised residual sera available at the National Virus Reference Laboratory. We selected a random sample comprising persons ≥ 18 years with probability proportional to the general population age-sex distribution. Anti-HCV and HCV Ag were determined using the Architect anti-HCV and HCV Ag assays. Fifty-three of 3,795 specimens were seropositive (age-sex-area weighted seroprevalence 0.98% (95% confidence interval (CI): 0.73–1.3%)). Thirty-three specimens were HCV-antigen and antibody-positive (age-sex-area weighted prevalence of chronic infection 0.57% (95% CI: 0.40–0.81%)). The prevalence of chronic infection was higher in men (0.91%; 95% CI: 0.61–1.4%), in specimens from the east of the country (1.4%; 95%CI: 0.99–2.0%), and among persons aged 30–39 years and 40–49 years (1.1% (95% CI: 0.59–2.0%) and 1.1% (95% CI: 0.64–1.9%) respectively). Ireland ranks at the lower end of the spectrum of prevalence of chronic HCV infection internationally. Men born between 1965 and 1984 from the east of the country have the highest rate of chronic HCV infection.
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Affiliation(s)
- Patricia Garvey
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Brian O'Grady
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Geraldine Franzoni
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Maeve Bolger
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Katie Irwin Crosby
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Jeff Connell
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Deirdre Burke
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Cillian De Gascun
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Lelia Thornton
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
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17
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Garvey P, Murphy N, Flanagan P, Brennan A, Courtney G, Crosbie O, Crowe J, Hegarty J, Lee J, McIver M, McNulty C, Murray F, Nolan N, O'Farrelly C, Stewart S, Tait M, Norris S, Thornton L. Disease outcomes in a cohort of women in Ireland infected by hepatitis C-contaminated anti-D immunoglobulin during 1970s. J Hepatol 2017; 67:1140-1147. [PMID: 28843656 DOI: 10.1016/j.jhep.2017.07.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/21/2017] [Accepted: 07/15/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIM In the mid-1990s, a group of Rh negative women was diagnosed with hepatitis C virus (HCV) genotype 1b infection, following administration of contaminated anti-D immunoglobulin in 1977-79. We aimed to describe their disease history and estimate the effect of selected host and treatment factors on disease progression. METHODS We conducted a cohort study on the women infected with HCV. Information was collected from records at seven HCV treatment centres on demographics, treatment and health outcomes up to the 31st December 2013. We calculated cumulative incidence, case fatality, and sub hazard ratios (SHR) for disease progression using competing risks regression. RESULTS Six hundred and eighty-two patients were included in the study. Among the chronically infected patients (n=374), 35% completed interferon-based antiviral treatment; 42% of whom had a sustained virological response. At the end of 2013, 19%, 1.9%, and 4.9% of chronically infected patients had developed cirrhosis, hepatocellular carcinoma, and liver-related death, respectively, compared with 10%, 0.8%, and 2.4% at the end of 2008. At the end of 2013, 321 (86%) of the chronically infected patients remained alive, 247 (77%) of whom were still chronically infected. Factors associated with increased cirrhosis rates included high alcohol intake (aSHR=4.9 [2.5-9.5]) and diabetes mellitus (aSHR=5.0 [2.9-8.8]). CONCLUSIONS Development of liver-related outcomes accelerated with time, with the risk of cirrhosis, hepatocellular carcinoma, and liver-related death doubling in the last five years of follow-up, particularly in women with high alcohol consumption and diabetes mellitus. We recommend that patients with chronic HCV infection be advised of the additive harmful effect of alcohol, and that data be collected on this cohort after a further five years to analyse the effect of subsequent antiviral treatment during this rapidly evolving period in HCV treatment history. LAY SUMMARY In the mid-1990s, a group of women were diagnosed with chronic hepatitis C virus (HCV) infection following receipt of contaminated anti-D immunoglobulin between 1977 and 1979 in Ireland. Seventy-two (19%) developed cirrhosis and 18 had died from liver-related causes (5%) after 36years of infection. Disease progression accelerated in the last five years of follow-up, particularly in women with diabetes mellitus and high alcohol consumption. We recommend that patients with chronic HCV infection be advised of the additive harmful effect of high alcohol consumption.
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Affiliation(s)
- Patricia Garvey
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden.
| | - Niamh Murphy
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Paula Flanagan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Aline Brennan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - John Crowe
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - John Hegarty
- St Vincent's University Hospital, Dublin, Ireland
| | - John Lee
- University College Hospital, Galway, Ireland
| | - Margaret McIver
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - Niamh Nolan
- St Vincent's University Hospital, Dublin, Ireland
| | | | | | - Michele Tait
- Health Service Executive, Dr. Steevens Hospital, Dublin, Ireland
| | | | - Lelia Thornton
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
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18
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Garvey P, Thornton L, Lyons F. Knowledge of HIV PEP Among Healthcare Workers in Ireland, 2016: Room for Improvement. Ir Med J 2017; 110:502. [PMID: 28657279] [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: 06/07/2023]
Abstract
Post-exposure prophylaxis (PEP) is an important aspect of HIV prevention following potential exposure. We conducted a survey to assess knowledge of HIV PEP, and awareness of HIV PEP resources, among key healthcare professionals, using an anonymous online questionnaire. Twelve (18%) of 68 respondents answered five or more of six knowledge questions correctly; 49 (72%) cited the Emergency Management of Injuries (EMI) toolkit as a resource. Although most respondents were aware of the EMI Toolkit for HIV PEP, the low number of respondents correctly answering knowledge questions suggests a need for training to avoid potential suboptimal HIV PEP use.
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Affiliation(s)
- P Garvey
- Health Protection Surveillance Centre - Health Service Executive, Dublin 1, Ireland
- European Programme for Intervention Epidemiology Training, European Centre for Disease Control and Prevention, Stockholm, Sweden
| | - L Thornton
- Health Protection Surveillance Centre - Health Service Executive, Dublin 1, Ireland
| | - F Lyons
- The Health Service Executive Sexual Health and Crisis Pregnancy Programme, Dublin 1, Ireland
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Fitzgerald M, Thornton L, O'Gorman J, O'Connor L, Garvey P, Boland M, Part AM, Rogalska J, Coughlan H, MacDiarmada J, Heslin J, Canny M, Finnegan P, Moran J, O'Flanagan D. Outbreak of hepatitis A infection associated with the consumption of frozen berries, Ireland, 2013--linked to an international outbreak. ACTA ACUST UNITED AC 2014; 19. [PMID: 25375902 DOI: 10.2807/1560-7917.es2014.19.43.20942] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In May 2013, a European alert was issued regarding a hepatitis A virus (HAV) outbreak in Italy. In June 2013, HAV subgenotype IA with an identical sequence was identified in Ireland in three cases who had not travelled to Italy. The investigation consisted of descriptive epidemiology, a case-control study, microbiological testing of human and food specimens, molecular typing of positive specimens and food traceback. We identified 21 outbreak cases (14 confirmed primary cases) with symptom onset between 31 January and 11 October 2013. For the case-control study, we recruited 11 confirmed primary cases and 42 matched controls. Cases were more likely than controls to have eaten berry cheesecake (matched odds ratio (mOR): 12; 95% confidence interval (CI): 1.3-114), whole frozen berries (mOR: 9.5; 95% CI: 1.0-89), yoghurt containing frozen berries (mOR: 6.6, 95% CI: 1.2-37) or raw celery (mOR: 4; 95% CI: 1.2-16). Among cases, 91% had consumed at least one of four products containing frozen berries (mOR: 12; 95% CI: 1.5-94). Sixteen food samples tested were all negative for HAV. As products containing frozen berries were implicated in the outbreak, the public were advised to heat-treat frozen berries before consumption.
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Affiliation(s)
- M Fitzgerald
- Health Service Executive (HSE) - Health Protection Surveillance Centre (HPSC), Dublin, Ireland
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Kelly TA, O'Lorcain P, Moran J, Garvey P, McKeown P, Connell J, Cotter S. Underreporting of viral encephalitis and viral meningitis, Ireland, 2005-2008. Emerg Infect Dis 2014; 19:1428-36. [PMID: 23965781 PMCID: PMC3810922 DOI: 10.3201/eid1909.130201] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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] [Indexed: 11/19/2022] Open
Abstract
Viral encephalitis (VE) and viral meningitis (VM) have been notifiable infectious diseases under surveillance in the Republic of Ireland since 1981. Laboratories have reported confirmed cases by detection of viral nucleic acid in cerebrospinal fluid since 2004. To determine the prevalence of these diseases in Ireland during 2005–2008, we analyzed 3 data sources: Hospital In-patient Enquiry data (from hospitalized following patients discharge) accessed through Health Intelligence Ireland, laboratory confirmations from the National Virus Reference Laboratory, and events from the Computerised Infectious Disease Reporting surveillance system. We found that the national surveillance system underestimates the incidence of these diseases in Ireland with a 10-fold higher VE hospitalization rate and 3-fold higher VM hospitalization rate than the reporting rate. Herpesviruses were responsible for most specified VE and enteroviruses for most specified VM from all 3 sources. Recommendations from this study have been implemented to improve the surveillance of these diseases in Ireland.
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Affiliation(s)
- Tara A Kelly
- Health Services Executive–Health Protection Surveillance Centre, Dublin, Ireland.
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Garvey P, McKeown P, Kelly P, Cormican M, Anderson W, Flack A, Barron S, De Lappe N, Buckley J, Cosgrove C, Molloy D, O' Connor J, O' Sullivan P, Matthews J, Ward M, Breslin A, O' Sullivan MB, Kelleher K, McNamara A, Foley-Nolan C, Pelly H, Cloak F. Investigation and management of an outbreak of Salmonella Typhimurium DT8 associated with duck eggs, Ireland 2009 to 2011. Euro Surveill 2013; 18:20454. [PMID: 23611032] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Salmonella Typhimurium DT8 was a very rare cause of human illness in Ireland between 2000 and 2008, with only four human isolates from three patients being identified. Over a 19-month period between August 2009 and February 2011, 34 confirmed cases and one probable case of Salmonella Typhimurium DT8 were detected, all of which had an MLVA pattern 2-10-NA-12-212 or a closely related pattern. The epidemiological investigations strongly supported a linkbetween illness and exposure to duck eggs. Moreover, S. Typhimurium with an MLVA pattern indistinguishable (or closely related) to the isolates from human cases, was identified in 22 commercial and backyard duck flocks, twelve of which were linked with known human cases. A range of control measures were taken at farm level, and advice was provided to consumers on the hygienic handling and cooking of duck eggs. Although no definitive link was established with a concurrent duck egg-related outbreak of S. Typhimurium DT8 in the United Kingdom, it seems likely that the two events were related. It may be appropriate for other countries with a tradition of consuming duck eggs to consider the need for measures to reduce the risk of similar outbreaks.
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Affiliation(s)
- P Garvey
- Health Protection Surveillance Centre, Dublin, Ireland.
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Garvey P, McKeown P, Kelly P, Cormican M, Anderson W, Flack A, Barron S, De Lappe N, Buckley J, Cosgrove C, Molloy D, O’Connor J, O’Sullivan P, Matthews J, Ward M, Breslin A, O’Sullivan MB, Kelleher K, McNamara A, Foley-Nolan C, Pelly H, Cloak F, Outbreak control team C. Investigation and management of an outbreak of Salmonella Typhimurium DT8 associated with duck eggs, Ireland 2009 to 2011. Euro Surveill 2013. [DOI: 10.2807/ese.18.16.20454-en] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
>Salmonella Typhimurium DT8 was a very rare cause of human illness in Ireland between 2000 and 2008, with only four human isolates from three patients being identified. Over a 19-month period between August 2009 and February 2011, 34 confirmed cases and one probable case of Salmonella Typhimurium DT8 were detected, all of which had an MLVA pattern 2-10-NA-12-212 or a closely related pattern. The epidemiological investigations strongly supported a link between illness and exposure to duck eggs. Moreover, S. Typhimurium with an MLVA pattern indistinguishable (or closely related) to the isolates from human cases, was identified in 22 commercial and backyard duck flocks, twelve of which were linked with known human cases. A range of control measures were taken at farm level, and advice was provided to consumers on the hygienic handling and cooking of duck eggs. Although no definitive link was established with a concurrent duck egg-related outbreak of S. Typhimurium DT8 in the United Kingdom, it seems likely that the two events were related. It may be appropriate for other countries with a tradition of consuming duck eggs to consider the need for measures to reduce the risk of similar outbreaks.
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Affiliation(s)
- P Garvey
- Health Protection Surveillance Centre, Dublin, Ireland
| | - P McKeown
- Health Protection Surveillance Centre, Dublin, Ireland
| | - P Kelly
- Irish Department of Agriculture, Food and the Marine, Dublin, Ireland
| | - M Cormican
- National Salmonella, Shigella and Listeria Reference Laboratory, Medical Microbiology Department, University Hospital Galway, Galway, Ireland
| | - W Anderson
- Food Safety Authority of Ireland, Dublin, Ireland
| | - A Flack
- Irish Department of Agriculture, Food and the Marine, Dublin, Ireland
| | - S Barron
- Irish Department of Agriculture, Food and the Marine, Dublin, Ireland
| | - N De Lappe
- National Salmonella, Shigella and Listeria Reference Laboratory, Medical Microbiology Department, University Hospital Galway, Galway, Ireland
| | - J Buckley
- Veterinary Department, Cork County Council, Cork, Ireland
| | - C Cosgrove
- Health Service Executive, Communicable Disease Unit of the Environmental Health Service, Blanchardstown Dublin, Ireland
| | - D Molloy
- Health Service Executive, Communicable Disease Unit of the Environmental Health Service, Blanchardstown Dublin, Ireland
| | - J O’Connor
- National Salmonella, Shigella and Listeria Reference Laboratory, Medical Microbiology Department, University Hospital Galway, Galway, Ireland
| | - P O’Sullivan
- Department of Public Health, Health Service Executive Mid-West, Department of Public Health, HSE West, Limerick, Ireland
| | - J Matthews
- Food Safety Authority of Ireland, Dublin, Ireland
| | - M Ward
- Department of Public Health, Health Service Executive East, Dr Steeven's Hospital, Dublin, Irelan
| | - A Breslin
- Department of Public Health Medicine, Health Service Executive North West, Sligo, Ireland
| | - M B O’Sullivan
- Department of Public Health, Health Service Executive South, Wilton, Cork, Ireland
| | - K Kelleher
- National Office for Health Protection, Health Service Executive Offices, Limerick, Ireland
| | - A McNamara
- Department of Public Health, Health Service Executive Dublin/Mid-Leinster, Tullamore Co. Offaly, Ireland
| | | | - H Pelly
- Department of Public Health, Health Service Executive West, Merlin Park Hospital, Galway, Ireland
| | - F Cloak
- Health Protection Surveillance Centre, Dublin, Ireland
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Fox EM, deLappe N, Garvey P, McKeown P, Cormican M, Leonard N, Jordan K. PFGE analysis of Listeria monocytogenes isolates of clinical, animal, food and environmental origin from Ireland. J Med Microbiol 2012; 61:540-547. [DOI: 10.1099/jmm.0.036764-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Edward M. Fox
- Veterinary Sciences Centre, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- Teagasc, Moorepark Food Reaserch Centre, Cork, Ireland
| | - Niall deLappe
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Paul McKeown
- Health Protection Surveillance Centre, Dublin, Ireland
| | - Martin Cormican
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Nola Leonard
- Veterinary Sciences Centre, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Kieran Jordan
- Teagasc, Moorepark Food Reaserch Centre, Cork, Ireland
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Tilson L, Jit M, Schmitz S, Walsh C, Garvey P, McKeown P, Barry M. Cost-effectiveness of universal rotavirus vaccination in reducing rotavirus gastroenteritis in Ireland. Vaccine 2011; 29:7463-73. [DOI: 10.1016/j.vaccine.2011.07.056] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 07/08/2011] [Accepted: 07/17/2011] [Indexed: 12/31/2022]
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Nicolay N, Garvey P, Delappe N, Cormican M, McKeown P. Completeness and timeliness of Salmonella notifications in Ireland in 2008: a cross sectional study. BMC Public Health 2010; 10:568. [PMID: 20860803 PMCID: PMC2955005 DOI: 10.1186/1471-2458-10-568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 09/22/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Ireland, salmonellosis is the second most common cause of bacterial gastroenteritis. A new electronic system for reporting (Computerised Infectious Disease Reporting--CIDR) of Salmonella cases was established in 2004. It collates clinical (and/or laboratory) data on confirmed and probable Salmonella cases. The authors studied the completeness and the timeliness of Salmonella notifications in 2008. METHODS This analysis was based upon laboratory confirmed cases of salmonella gastroenteritis. Using data contained in CIDR, we examined completeness for certain non-mandatory fields (country of infection, date of onset of illness, organism, outcome, patient type, and ethnicity). We matched the CIDR data with the dataset provided by the national Salmonella reference laboratory (NSRL) to which all Salmonella spp. isolates are referred for definitive typing. We calculated the main median time intervals in the flow of events of the notification process. RESULTS In total, 416 laboratory confirmed Salmonella cases were captured by the national surveillance system and the NSRL and were included in the analysis. Completeness of non mandatory fields varied considerably. Organism was the most complete field (98.8%), ethnicity the least (11%). The median time interval between sample collection (first contact of the patient with the healthcare professional) to the first notification to the regional Department of Public Health (either a clinical or a laboratory notification) was 6 days (Interquartile 4-7 days). The median total identification time interval, time between sample collections to availability of serotyping and phage-typing results on the system was 25 days (Interquartile 19-32 days). Timeliness varied with respect to Salmonella species. Clinical notifications occurred more rapidly than laboratory notifications. CONCLUSIONS Further feedback and education should be given to health care professionals to improve completeness of reporting of non-mandatory fields. The efficiency of reporting was similar to that published elsewhere. Delays in the reporting system at present mean that although the system is of value in facilitating comprehensive reporting it is unlikely it can be relied upon for rapid detection of outbreaks at an early stage. Direct person-to-person, communication between clinical and reference laboratories and public health practitioners remains a critical element of the surveillance system for rapid outbreak detection.
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Affiliation(s)
- Nathalie Nicolay
- European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
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Abstract
Cryptosporidium is a protozoal parasite which is of public health interest primarily due to its frequent association with drinking water. Since cryptosporidiosis became a notifiable human disease in 2004 in Ireland, evidence has been growing as to the national burden of illness caused by this pathogen. Nationally, crude incidence rates of between 8.7 and 13.4 per 100,000 were reported annually in the period 2004-2006. Rural areas reported more cases, with regional incidence rates as high as 31.4/100,000 per year. Over this time period, there has consistently been a peak in the number of notifications in springtime, contrasting with the reported seasonal distribution of cases elsewhere in Europe. Outbreak surveillance data suggest that drinking water is an important transmission route for general outbreaks, with person-to-person spread more common in family outbreaks. Cryptosporidium is an important gastrointestinal pathogen in Ireland, with much still to be learned about its epidemiology here.
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Affiliation(s)
- P Garvey
- Health Protection Surveillance Centre, Dublin, Ireland
| | - P McKeown
- Health Protection Surveillance Centre, Dublin, Ireland
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Garvey P, McKeown P. Epidemiology of human cryptosporidiosis in Ireland, 2004-2006: analysis of national notification data. Euro Surveill 2009; 14:19128. [PMID: 19250622] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Since cryptosporidiosis became a notifiable human disease in 2004 in Ireland, evidence has been growing as to the national burden of illness caused by this pathogen. Nationally, crude incidence rates of between 8.7 and 13.4 per 100,000 were reported annually in the period 2004-2006.
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Affiliation(s)
- P Garvey
- Health Protection Surveillance Centre, Dublin, Ireland
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O'Sullivan MB, Garvey P, O'Riordan M, Coughlan H, McKeown P, Brennan A, McNamara E. Increase in VTEC cases in the south of Ireland: link to private wells? Euro Surveill 2008; 13:18991. [PMID: 18822242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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O’Sullivan MB, Garvey P, O’Riordan M, Coughlan H, McKeown P, Brennan A, McNamara E. Increase in VTEC cases in the south of Ireland: link to private wells? Euro Surveill 2008. [DOI: 10.2807/ese.13.39.18991-en] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
High levels of verotoxigenic Escherichia coli (VTEC) have been recorded to date in 2008 in the Republic of Ireland. One hundred and forty-eight VTEC cases were notified up to the end of August 2008 (Figure 1), compared to 70-90 confirmed cases reported in the equivalent time period in 2006 and 2007. Thirty three percent of cases notified in Ireland in 2008 indicated that their usual drinking water supply was a private well.
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Affiliation(s)
- M B O’Sullivan
- Department of Public Health, Health Service Executive - South, Cork, Ireland
| | - P Garvey
- Health Protection Surveillance Centre, Dublin, Ireland
| | - M O’Riordan
- Department of Public Health, Health Service Executive - South, Cork, Ireland
| | - H Coughlan
- Department of Public Health, Health Service Executive - South, Cork, Ireland
| | - P McKeown
- Health Protection Surveillance Centre, Dublin, Ireland
| | - A Brennan
- Department of Public Health, Health Service Executive - South, Cork, Ireland
| | - E McNamara
- Public Health Laboratory, HSE Dublin Mid-Leinster, Cherry Orchard Hospital, Dublin, Ireland
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Kane RC, Farrell AT, Saber H, Tang S, Williams G, Jee JM, Liang C, Booth B, Chidambaram N, Morse D, Sridhara R, Garvey P, Justice R, Pazdur R. Sorafenib for the treatment of advanced renal cell carcinoma. Clin Cancer Res 2007; 12:7271-8. [PMID: 17189398 DOI: 10.1158/1078-0432.ccr-06-1249] [Citation(s) in RCA: 350] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This report describes the U.S. Food and Drug Administration (FDA) review and approval of sorafenib (Nexavar, BAY43-9006), a new small-molecule, oral, multi-kinase inhibitor for the treatment of patients with advanced renal cell carcinoma (RCC). EXPERIMENTAL DESIGN After meeting with sponsors during development studies of sorafenib, the FDA reviewed the phase 3 protocol under the Special Protocol Assessment mechanism. Following new drug application submission, FDA independently analyzed the results of two studies in advanced RCC: a large, randomized, double-blinded, phase 3 international trial of single-agent sorafenib and a supportive phase 2 study. RESULTS In the phase 3 trial, 902 patients with advanced progressive RCC after one prior systemic therapy were randomized to 400 mg sorafenib twice daily plus best supportive care or to a matching placebo plus best supportive care. Primary study end points included overall survival and progression-free survival (PFS). A PFS analysis, pre-specified and conducted after a total of 342 events, showed statistically significant superiority for the sorafenib group (median = 167 days) compared with that for the controls (median = 84 days, log-rank P < 0.000001); the sorafenib/placebo hazard ratio was 0.44 (95% confidence interval, 0.35-0.55). Results were similar regardless of patient risk score, performance status, age, or prior therapy. The (partial) response rate to sorafenib was 2.1%. Overall survival results are preliminary. The principal toxicities in the sorafenib patients included reversible skin rashes in 40% and hand-foot skin reaction in 30%; diarrhea was reported in 43%, treatment-emergent hypertension was reported in 17%, and sensory neuropathic changes were reported in 13%. Grade 4 adverse events were uncommon. Grade 3 adverse events were hand-foot skin reaction (6%), fatigue (5%), and hypertension (3%). Laboratory findings included asymptomatic hypophosphatemia in 45% of sorafenib patients versus 11% in the placebo arm and elevation of serum lipase in 41% of sorafenib patients versus 30% in the placebo arm. Grade 4 pancreatitis was reported in two sorafenib patients, although both patients subsequently resumed sorafenib, with one at full dose. CONCLUSIONS Sorafenib received FDA regular approval on December 20, 2005 for the treatment of advanced RCC based on the persuasive magnitude of improvement in PFS with acceptable safety. The recommended dose is 400 mg (two 200-mg tablets) twice daily taken either 1 h before or 2 h after meals. Adverse events were accommodated by temporary dose interruptions or reductions.
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Affiliation(s)
- Robert C Kane
- Division of Drug Oncology Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20993-0004, USA.
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McKeown P, O'Connor M, McDonnell G, Di Renzi M, Foley B, Garvey P, McNamara E, Codd S, Cosgove C, de la Harpe D. Outbreak of shigellosis in Irish holidaymakers associated with travel to Egypt. Euro Surveill 2005; 10:E050630.4. [PMID: 16783111 DOI: 10.2807/esw.10.26.02737-en] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
An outbreak of gastrointestinal illness associated with travel to Egypt is being investigated in Ireland. An aeroplane arrived in Dublin on 1 June 2005, carrying holidaymakers returning from Luxor in Egypt
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Affiliation(s)
- Paul McKeown
- Health Protection Surveillance Centre, Dublin, Ireland.
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Hazarika M, White RM, Booth BP, Wang YC, Ham DYL, Liang CY, Rahman A, Gobburu JVS, Li N, Sridhara R, Morse DE, Lostritto R, Garvey P, Johnson JR, Pazdur R. Pemetrexed in malignant pleural mesothelioma. Clin Cancer Res 2005; 11:982-92. [PMID: 15709163] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
PURPOSE This report describes the data and analysis leading to the approval of pemetrexed (LY 231514, MTA, Alimta, Eli Lilly and Co., Indianapolis, IN) by the U.S. Food and Drug Administration (FDA) of a New Drug Application for the treatment of malignant pleural mesothelioma (MPM). EXPERIMENTAL DESIGN The FDA review of the efficacy and safety of pemetrexed assessed in a randomized clinical trial of 448 patients with unresectable MPM comparing pemetrexed plus cisplatin with cisplatin alone, as well as preclinical pharmacology and chemistry data, are described. The basis for marketing approval is discussed. RESULTS In one randomized, single-blind, multicenter international trial, 226 patients were randomized to the pemetrexed and cisplatin arm and 222 patients were randomized to cisplatin alone. Median survival times were 12.1 months for pemetrexed and cisplatin and 9.3 months for cisplatin (P = 0.021; hazard ratio, 0.766; 95% confidence interval, 0.61-0.96). Myelosuppression, predominantly neutropenia, was the most common toxicity of pemetrexed plus cisplatin. Other common adverse events were fatigue, leucopenia, nausea, dyspnea, vomiting, chest pain, anemia, thrombocytopenia, and anorexia. CONCLUSIONS Pemetrexed in combination with cisplatin was approved by the FDA on February 4, 2004 for the treatment of patients with MPM whose disease is either unresectable or who are otherwise not candidates for curative surgery. The recommended dose of pemetrexed is 500 mg/m(2) intra venous infusion over 10 minutes on day 1 of each 21-day cycle in combination with 75 mg/m(2) cisplatin infused over 2 hours beginning 30 minutes after the pemetrexed infusion. Patients must receive oral folic acid and vitamin B(12) injections before the start and during therapy to reduce severe toxicities. Patients should also receive corticosteroids with the chemotherapy to decrease the incidence of skin rash. Approval was based on a demonstration of survival improvement in a single randomized trial. Response rates and time to tumor progression were not included in product labeling because of inconsistencies in assessments among the investigators, independent radiologic reviewers, and the FDA, reflecting the difficulty of radiographic assessments in malignant mesothelioma. Complete prescribing information is available on the FDA Web site at http://www.fda.gov/cder/approval/index.htm.
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Affiliation(s)
- Maitreyee Hazarika
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 5600 Fishers Lane, Rockville, MD 20857, USA.
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35
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Hazarika M, White RM, Booth BP, Wang YC, Lee Ham DY, Liang CY, Rahman A, Gobburu JV, Li N, Sridhara R, Morse DE, Lostritto R, Garvey P, Johnson JR, Pazdur R. Pemetrexed in Malignant Pleural Mesothelioma. Clin Cancer Res 2005. [DOI: 10.1158/1078-0432.982.11.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
Purpose: This report describes the data and analysis leading to the approval of pemetrexed (LY 231514, MTA, Alimta, Eli Lilly and Co., Indianapolis, IN) by the U.S. Food and Drug Administration (FDA) of a New Drug Application for the treatment of malignant pleural mesothelioma (MPM).
Experimental Design: The FDA review of the efficacy and safety of pemetrexed assessed in a randomized clinical trial of 448 patients with unresectable MPM comparing pemetrexed plus cisplatin with cisplatin alone, as well as preclinical pharmacology and chemistry data, are described. The basis for marketing approval is discussed.
Results: In one randomized, single-blind, multicenter international trial, 226 patients were randomized to the pemetrexed and cisplatin arm and 222 patients were randomized to cisplatin alone. Median survival times were 12.1 months for pemetrexed and cisplatin and 9.3 months for cisplatin (P = 0.021; hazard ratio, 0.766; 95% confidence interval, 0.61-0.96). Myelosuppression, predominantly neutropenia, was the most common toxicity of pemetrexed plus cisplatin. Other common adverse events were fatigue, leucopenia, nausea, dyspnea, vomiting, chest pain, anemia, thrombocytopenia, and anorexia.
Conclusions: Pemetrexed in combination with cisplatin was approved by the FDA on February 4, 2004 for the treatment of patients with MPM whose disease is either unresectable or who are otherwise not candidates for curative surgery. The recommended dose of pemetrexed is 500 mg/m2 intra venous infusion over 10 minutes on day 1 of each 21-day cycle in combination with 75 mg/m2 cisplatin infused over 2 hours beginning 30 minutes after the pemetrexed infusion. Patients must receive oral folic acid and vitamin B12 injections before the start and during therapy to reduce severe toxicities. Patients should also receive corticosteroids with the chemotherapy to decrease the incidence of skin rash. Approval was based on a demonstration of survival improvement in a single randomized trial. Response rates and time to tumor progression were not included in product labeling because of inconsistencies in assessments among the investigators, independent radiologic reviewers, and the FDA, reflecting the difficulty of radiographic assessments in malignant mesothelioma. Complete prescribing information is available on the FDA Web site at http://www.fda.gov/cder/approval/index.htm.
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Affiliation(s)
- Maitreyee Hazarika
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Robert M. White
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Brian P. Booth
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Yong-Cheng Wang
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Doo Y. Lee Ham
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Cheng Yi Liang
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Atiqur Rahman
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Jogarao V.S. Gobburu
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Ning Li
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Rajeshwari Sridhara
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - David E. Morse
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Richard Lostritto
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Patricia Garvey
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - John R. Johnson
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
| | - Richard Pazdur
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
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McEvoy JM, Doherty AM, Sheridan JJ, Thomson-Carter FM, Garvey P, McGuire L, Blair IS, McDowell DA. The prevalence and spread of Escherichia coli O157:H7 at a commercial beef abattoir. J Appl Microbiol 2003; 95:256-66. [PMID: 12859756 DOI: 10.1046/j.1365-2672.2003.01981.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To investigate the prevalence and virulence characteristics of Escherichia coli O157:H7 after a number of beef process operations at a commercial Irish abattoir. METHODS AND RESULTS Two 12-month studies were carried out. The first study (study 1) examined the prevalence of E. coli O157:H7 at up to six sites on carcasses at eight stages of the dressing, washing, chilling and boning process. The second study (study 2) examined the prevalence of E. coli O157:H7 in bovine faeces and rumen contents post-slaughter and on dressed, washed carcasses. Isolates from both studies were phage-typed and the presence of genes encoding verocytotoxin, enterohaemolysin and intimin production was determined. E. coli O157:H7 was isolated from four of 36 carcasses in study 1. E. coli O157:H7 was detected during hide removal and was detected at multiple carcass sites and multiple process stages, including boning. On two carcasses, contamination was first detected at the bung following its freeing and tying. All isolates from study 1 were phage type (PT) 2, eaeAO157 and ehlyA positive, but were verocytotoxin 1 (VT1) and verocytotoxin 2 (VT2) negative. In study 2, E. coli O157:H7 was isolated from 2.4% of faecal, 0.8% of rumen and 3.2% of carcass samples. In some cases, isolates recovered from the faeces of a particular animal, the resulting carcass and adjacent carcasses on the line had the same phage typing and virulence characteristic profile patterns. All isolates from study 2 were eaeAO157 and ehlyA positive and only one isolate was VT1 and VT2 negative. Most isolates were PT 32. A higher frequency of positive isolations was noted from samples taken during spring and late summer. CONCLUSION These studies show that in a typical Irish beef abattoir, carcass contamination with E. coli O157:H7 can occur during hide removal and bung tying and this contamination can remain on the carcass during subsequent processing. SIGNIFICANCE AND IMPACT OF THE STUDY This study provides data that is necessary for the understanding of how E. coli O157:H7 contamination of beef occurs.
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Affiliation(s)
- J M McEvoy
- Teagasc, The National Food Centre, Ashtown, Dublin, UK
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Affiliation(s)
- P Garvey
- Department of Obstetrics and Gynecology, New York Hospital-Cornell University Medical College, New York, USA
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Garvey P, Rince A, Hill C, Fitzgerald GF. Identification of a recA homolog (recALP) on the conjugative lactococcal phage resistance plasmid pNP40: evidence of a role for chromosomally encoded recAL in abortive infection. Appl Environ Microbiol 1997; 63:1244-51. [PMID: 9097419 PMCID: PMC168416 DOI: 10.1128/aem.63.4.1244-1251.1997] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The determinants for two bacteriophage resistance mechanisms, AbiE and AbiF, are separated by approximately 3,300 nucleotides on the lactococcal plasmid pNP40 (P. Garvey, G.F. Fitzgerald, and C. Hill, Appl. Environ. Microbiol. 61:4321-4328, 1995). DNA sequence analysis of the intervening region led to the identification of two open reading frames (ORFs) which are transcribed in the opposite direction to the Abi determinants. One of these ORFs encodes a recA homolog (designated recALP). This is the first report of a recA-like determinant located to a plasmid. The second ORF (orfU) shares homology with the umuC gene of the SOS response. Analysis of a number of lactococcal strains confirmed the presence of recALP-like sequences in at least two other lactococcal strains. The proximity of the recA and umuC homologs suggested a possible role in the phase resistance encoded by the Abi determinants. However, no evidence was obtained to demonstrate a function for either ORF in the expression of either AbiE or AbiF. Nor could the recALP gene restore resistance to mitomycin in a recA-deficient lactococcal strain, VEL1122. Interestingly, it was shown that the chromosomally encoded recA is necessary for complete expression of the AbiF phenotype, confirming a role for RecA in this abortive infection system.
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Affiliation(s)
- P Garvey
- Department of Microbiology, University College, Cork, Ireland
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Garvey P, Hill C, Fitzgerald GF. The Lactococcal Plasmid pNP40 Encodes a Third Bacteriophage Resistance Mechanism, One Which Affects Phage DNA Penetration. Appl Environ Microbiol 1996; 62:676-9. [PMID: 16535245 PMCID: PMC1388783 DOI: 10.1128/aem.62.2.676-679.1996] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The lactococcal plasmid pNP40 mediates insensitivity to (phi)c2 by an early-acting phage resistance mechanism in addition to the previously identified abortive infection system, AbiF, in the Lactococcus lactis subsp. lactis MG1614 background. A second abortive infection determinant on pNP40, AbiE, does not confer resistance to (phi)c2. The early-acting mechanism on pNP40 does not prevent phage adsorption nor does it appear to operate by restriction/modification. Phage DNA was not detected in pNP40-containing cells until 30 min following exposure to (phi)c2 compared with 5 min in a sensitive host; however, electroporation of phage DNA into resistant hosts resulted in the release of phage progeny from a dramatically elevated number of cells compared with conventionally infected hosts. It appears therefore that pNP40 encodes a novel phage resistance mechanism which blocks DNA penetration specifically for (phi)c2.
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Hill C, Garvey P, Fitzgerald GF. Bacteriophage-host interactions and resistance mechanisms, analysis of the conjugative bacteriophage resistance plasmid pNP40. ACTA ACUST UNITED AC 1996. [DOI: 10.1051/lait:19961-27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Garvey P, Fitzgerald GF, Hill C. Cloning and DNA sequence analysis of two abortive infection phage resistance determinants from the lactococcal plasmid pNP40. Appl Environ Microbiol 1995; 61:4321-8. [PMID: 8534099 PMCID: PMC167743 DOI: 10.1128/aem.61.12.4321-4328.1995] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The lactococcal plasmid pNP40, from Lactococcus lactis subsp. lactis biovar diacetylactis DRC3, confers complete resistance to the prolate-headed phage phi c2 and the small isometric-headed phage phi 712 in L. lactis subsp. lactis MG1614. A 6.0-kb NcoI fragment of pNP40 cloned in the lactococcal Escherichia coli shuttle vector pAM401 was found to confer partial resistance to phi 712. Subcloning and deletion analysis of the recombinant plasmid pPG01 defined a 2.5-kb ScaIHpaI fragment as conferring phage insensitivity. Sequence analysis of this region confirmed the presence of two overlapping open reading frames (ORFs). Further subcloning of pNP40 to characterize the resistance determinant active against phi c2 identified a 5.6-kb EcoRV fragment of pNP40 which, when cloned in pAM401, conferred partial resistance to both phi c2 and phi 712. Subcloning and deletion analysis of the recombinant plasmid pCG1 defined a 3.7-kb EcoRV-XbaI fragment as encoding phage insensitivity. DNA sequence analysis of this region revealed the presence of a single complete ORF. The introduction of a frameshift mutation at the unique BglII site within this ORF disrupted the phage resistance phenotype, confirming that this ORF is responsible for the observed phage insensitivity. The mechanisms encoded by pPG01 and pCG1 in L. lactis subsp. lactis MG1614 conformed to the criteria defining abortive infection and were designated AbiE and AbiF, respectively. Analysis of the phage DNA content of phi 712-infected hosts containing AbiF demonstrated that it inhibited the rate of phage DNA replication, while AbiE had little effect on phage DNA replication, suggesting a later target of inhibition. The predicted protein product of abiF shows significant homology to the products of two other lactococcal abortive infection genes, abiD and abiD1.
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Affiliation(s)
- P Garvey
- Department of Microbiology, University College, Cork, Ireland
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Garvey P, van Sinderen D, Twomey D, Hill C, Fitzgerald G. Molecular genetics of bacteriophage and natural phage defence systems in the genus Lactococcus. Int Dairy J 1995. [DOI: 10.1016/0958-6946(95)00038-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quigley C, Garvey P. Promoting sexual health. BMJ 1992; 305:363-4. [PMID: 1392896 PMCID: PMC1882999 DOI: 10.1136/bmj.305.6849.363-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Cameron A, Nicholson S, Nimrod C, Harder J, Davies D, Dempster C, Garvey P. Duplex ultrasonography of the fetal aorta, umbilical artery, and placental arcuate artery throughout normal human pregnancy. Can Assoc Radiol J 1989; 40:145-9. [PMID: 2660959] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A cross-sectional duplex study of blood flow in the fetal aorta, umbilical artery, and arcuate arteries of 111 normal subjects was performed once at between 20 and 42 weeks gestation. Peak systolic velocity, end-diastolic velocity, mean velocity, and volume flow were measured in the fetal aorta, and systolic to diastolic (S/D) ratios were measured in all three vessels. Velocities show an inverse exponential (Y = Exp [1/X x B + C]) increase with gestational age, reaching a plateau just before term, while S/D ratios in the aorta and umbilical arteries show a linear decrease. Such findings are at variance with some published data. Our results suggest a reduction in fetal placental resistance at term and provide useful data concerning normal fetal and placental circulations.
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Affiliation(s)
- A Cameron
- Department of Obstetrics and Gynecology, University of Calgary, Alberta
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Abstract
Laryngotracheobronchial lesions were carefully documented in 26 neonatal autopsies and were classified into two main types. Type I lesions were focal desquamative or ulcerative, asynchronous, and variable in severity involving areas exposed to contact with endotracheal tube or suction catheter. These lesions are most likely due to trauma of artificial ventilation. Type II lesions were diffuse, necrotizing, more synchronous and uniform in severity involving tissues distal to the endotracheal tube and extending to second or third generation bronchi. The early or mild type II lesions consisted of coagulative necrosis of epithelial cells and mucosal oedema. The late or severe type II lesions showed features similar to those of necrotizing tracheobronchitis described by Metley et al. All the cases with type II lesions had been ventilated with 100 per cent oxygen continuously for at least 3 h during life. The use of pure oxygen may be an important factor leading to necrotizing tracheobronchitis.
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Affiliation(s)
- W S Hwang
- Department of Pathology, University of Calgary, Alberta, Canada
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