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Lopez Bernal J, Panagiotopoulos N, Byers C, Garcia Vilaplana T, Boddington N, Zhang XS, Charlett A, Elgohari S, Coughlan L, Whillock R, Logan S, Bolt H, Sinnathamby M, Letley L, MacDonald P, Vivancos R, Edeghere O, Anderson C, Paranthaman K, Cottrell S, McMenamin J, Zambon M, Dabrera G, Ramsay M, Saliba V. Transmission dynamics of COVID-19 in household and community settings in the United Kingdom, January to March 2020. Euro Surveill 2022; 27. [PMID: 35426357 DOI: 10.1101/2020.08.19.20177188] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
BackgroundHouseholds appear to be the highest risk setting for COVID-19 transmission. Large household transmission studies in the early stages of the pandemic in Asia reported secondary attack rates ranging from 5 to 30%.AimWe aimed to investigate the transmission dynamics of COVID-19 in household and community settings in the UK.MethodsA prospective case-ascertained study design based on the World Health Organization FFX protocol was undertaken in the UK following the detection of the first case in late January 2020. Household contacts of cases were followed using enhanced surveillance forms to establish whether they developed symptoms of COVID-19, became confirmed cases and their outcomes. We estimated household secondary attack rates (SAR), serial intervals and individual and household basic reproduction numbers. The incubation period was estimated using known point source exposures that resulted in secondary cases.ResultsWe included 233 households with two or more people with 472 contacts. The overall household SAR was 37% (95% CI: 31-43%) with a mean serial interval of 4.67 days, an R0 of 1.85 and a household reproduction number of 2.33. SAR were lower in larger households and highest when the primary case was younger than 18 years. We estimated a mean incubation period of around 4.5 days.ConclusionsRates of COVID-19 household transmission were high in the UK for ages above and under 18 years, emphasising the need for preventative measures in this setting. This study highlights the importance of the FFX protocol in providing early insights on transmission dynamics.
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Affiliation(s)
- Jamie Lopez Bernal
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Chloe Byers
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Nicki Boddington
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Xu-Sheng Zhang
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Andre Charlett
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Suzanne Elgohari
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Laura Coughlan
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Rosie Whillock
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Sophie Logan
- Field Services Division, Public Health England, London, United Kingdom
| | - Hikaru Bolt
- Field Services Division, Public Health England, London, United Kingdom
| | - Mary Sinnathamby
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Louise Letley
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Pauline MacDonald
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Roberto Vivancos
- Field Services Division, Public Health England, London, United Kingdom
| | - Obaghe Edeghere
- Field Services Division, Public Health England, London, United Kingdom
| | | | | | | | | | - Maria Zambon
- TARGET Department, Public Health England, London, United Kingdom
| | - Gavin Dabrera
- TARGET Department, Public Health England, London, United Kingdom
| | - Mary Ramsay
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Vanessa Saliba
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
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Lopez Bernal J, Panagiotopoulos N, Byers C, Garcia Vilaplana T, Boddington N, Zhang XS, Charlett A, Elgohari S, Coughlan L, Whillock R, Logan S, Bolt H, Sinnathamby M, Letley L, MacDonald P, Vivancos R, Edeghere O, Anderson C, Paranthaman K, Cottrell S, McMenamin J, Zambon M, Dabrera G, Ramsay M, Saliba V. Transmission dynamics of COVID-19 in household and community settings in the United Kingdom, January to March 2020. Euro Surveill 2022; 27:2001551. [PMID: 35426357 PMCID: PMC9012093 DOI: 10.2807/1560-7917.es.2022.27.15.2001551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/20/2022] [Indexed: 12/23/2022] Open
Abstract
BackgroundHouseholds appear to be the highest risk setting for COVID-19 transmission. Large household transmission studies in the early stages of the pandemic in Asia reported secondary attack rates ranging from 5 to 30%.AimWe aimed to investigate the transmission dynamics of COVID-19 in household and community settings in the UK.MethodsA prospective case-ascertained study design based on the World Health Organization FFX protocol was undertaken in the UK following the detection of the first case in late January 2020. Household contacts of cases were followed using enhanced surveillance forms to establish whether they developed symptoms of COVID-19, became confirmed cases and their outcomes. We estimated household secondary attack rates (SAR), serial intervals and individual and household basic reproduction numbers. The incubation period was estimated using known point source exposures that resulted in secondary cases.ResultsWe included 233 households with two or more people with 472 contacts. The overall household SAR was 37% (95% CI: 31-43%) with a mean serial interval of 4.67 days, an R0 of 1.85 and a household reproduction number of 2.33. SAR were lower in larger households and highest when the primary case was younger than 18 years. We estimated a mean incubation period of around 4.5 days.ConclusionsRates of COVID-19 household transmission were high in the UK for ages above and under 18 years, emphasising the need for preventative measures in this setting. This study highlights the importance of the FFX protocol in providing early insights on transmission dynamics.
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Affiliation(s)
- Jamie Lopez Bernal
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Chloe Byers
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Nicki Boddington
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Xu-Sheng Zhang
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Andre Charlett
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Suzanne Elgohari
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Laura Coughlan
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Rosie Whillock
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Sophie Logan
- Field Services Division, Public Health England, London, United Kingdom
| | - Hikaru Bolt
- Field Services Division, Public Health England, London, United Kingdom
| | - Mary Sinnathamby
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Louise Letley
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Pauline MacDonald
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Roberto Vivancos
- Field Services Division, Public Health England, London, United Kingdom
| | - Obaghe Edeghere
- Field Services Division, Public Health England, London, United Kingdom
| | | | | | | | | | - Maria Zambon
- TARGET Department, Public Health England, London, United Kingdom
| | - Gavin Dabrera
- TARGET Department, Public Health England, London, United Kingdom
| | - Mary Ramsay
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Vanessa Saliba
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
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Mitchell HD, Vilaplana TG, Mandal S, Ratna N, Glancy M, Shah A, Simmons R, Penman C, Kirsebom F, Costella A, Brown AE, Mohammed H, Delpech V, Sinka K, Hughes G. Effects of COVID-19 Pandemic Response on Service Provision for Sexually Transmitted Infections, HIV, and Viral Hepatitis, England. Emerg Infect Dis 2022; 28:739-742. [PMID: 35202537 PMCID: PMC8888218 DOI: 10.3201/eid2803.211998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Since the coronavirus disease pandemic response began in March 2020, tests, vaccinations, diagnoses, and treatment initiations for sexual health, HIV, and viral hepatitis in England have declined. The shift towards online and outreach services happened rapidly during 2020 and highlights the need to evaluate the effects of these strategies on health inequalities.
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Garcia Vilaplana T, Leeman D, Balogun K, Ngui SL, Phipps E, Khan WM, Balasegaram S. Hepatitis A outbreak associated with consumption of dates, England and Wales, January 2021 to April 2021. Euro Surveill 2021; 26:2100432. [PMID: 34018484 PMCID: PMC8138963 DOI: 10.2807/1560-7917.es.2021.26.20.2100432] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We report a national hepatitis A virus (HAV) outbreak linked to the consumption of Medjool dates. Twenty-nine cases of three genetically related sequences have been identified. Epidemiological investigations identified a suspected product (adjusted odds ratio: 47.36; 95% confidence interval: 1.79-1,256.07; p = 0.021). Microbiological testing has confirmed the presence of HAV on dates recovered from two cases and the product has been recalled. Date consumption is currently likely to be increased in connection with Ramadan, with potential ongoing contamination risk.
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Affiliation(s)
- Tatiana Garcia Vilaplana
- These authors contributed equally to this article and share first authorship,Immunisations and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - David Leeman
- These authors contributed equally to this article and share first authorship,Field Epidemiology Training Programme, National Infection Service, Public Health England, London, United Kingdom
| | - Koye Balogun
- Immunisations and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom,Blood Safety, Hepatitis, STI and HIV Department, National Infection Service, Public Health England, London, United Kingdom
| | - Siew Lin Ngui
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Emily Phipps
- Blood Safety, Hepatitis, STI and HIV Department, National Infection Service, Public Health England, London, United Kingdom
| | - Wazirzada M Khan
- South London Health Protection Team, Public Health England, London, United Kingdom
| | - Incident Team
- Public Health England and Food Standards Agency, London, United Kingdom
| | - Sooria Balasegaram
- South East and London Field Service, National Infection Service, Public Health England, London, United Kingdom
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Boddington NL, Charlett A, Elgohari S, Byers C, Coughlan L, Vilaplana TG, Whillock R, Sinnathamby M, Panagiotopoulos N, Letley L, MacDonald P, Vivancos R, Edeghere O, Shingleton J, Bennett E, Cottrell S, McMenamin J, Zambon M, Ramsay M, Dabrera G, Saliba V, Bernal JL. Epidemiological and clinical characteristics of early COVID-19 cases, United Kingdom of Great Britain and Northern Ireland. Bull World Health Organ 2021; 99:178-189. [PMID: 33716340 PMCID: PMC7941108 DOI: 10.2471/blt.20.265603] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 05/15/2020] [Revised: 09/11/2020] [Accepted: 10/06/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To describe the clinical presentation, course of disease and health-care seeking behaviour of the first few hundred cases of coronavirus disease 2019 (COVID-19) in the United Kingdom of Great Britain and Northern Ireland. METHODS We implemented the World Health Organization's First Few X cases and contacts investigation protocol for COVID-19. Trained public health professionals collected information on 381 virologically confirmed COVID-19 cases from 31 January 2020 to 9 April 2020. We actively followed up cases to identify exposure to infection, symptoms and outcomes. We also collected limited data on 752 symptomatic people testing negative for COVID-19, as a control group for analyses of the sensitivity, specificity and predictive value of symptoms. FINDINGS Approximately half of the COVID-19 cases were imported (196 cases; 51.4%), of whom the majority had recent travel to Italy (140 cases; 71.4%). Of the 94 (24.7%) secondary cases, almost all reported close contact with a confirmed case (93 cases; 98.9%), many through household contact (37 cases; 39.8%). By age, a lower proportion of children had COVID-19. Most cases presented with cough, fever and fatigue. The sensitivity and specificity of symptoms varied by age, with nonlinear relationships with age. Although the proportion of COVID-19 cases with fever increased with age, for those with other respiratory infections the occurrence of fever decreased with age. The occurrence of shortness of breath also increased with age in a greater proportion of COVID-19 cases. CONCLUSION The study has provided useful evidence for generating case definitions and has informed modelling studies of the likely burden of COVID-19.
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Affiliation(s)
| | - Andre Charlett
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Suzanne Elgohari
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Chloe Byers
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Laura Coughlan
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | | | - Rosie Whillock
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Mary Sinnathamby
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | | | - Louise Letley
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Pauline MacDonald
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | | | | | | | | | | | | | - Maria Zambon
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Mary Ramsay
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Gavin Dabrera
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
| | - Vanessa Saliba
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, England
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