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Jones CR, Guy RL, Mirfenderesky M, Brown CS, Lamagni T. Tonsillectomy for recurrent tonsillitis: the NATTINA trial. Lancet 2024; 403:1632. [PMID: 38677855 DOI: 10.1016/s0140-6736(24)00191-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/29/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Christopher R Jones
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London NW9 5EQ, UK.
| | - Rebecca L Guy
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London NW9 5EQ, UK
| | - Mariyam Mirfenderesky
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London NW9 5EQ, UK
| | - Colin S Brown
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London NW9 5EQ, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Theresa Lamagni
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London NW9 5EQ, UK
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Lamagni T, McGregor C, Guy RL, Whitworth J, Efstratiou A. Seizing opportunities for prevention of group A streptococcal infection. Lancet Microbe 2024:S2666-5247(23)00404-4. [PMID: 38278164 DOI: 10.1016/s2666-5247(23)00404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/28/2024]
Affiliation(s)
- Theresa Lamagni
- Healthcare-Associated Infection & Antimicrobial Resistance Division, UK Health Security Agency, London NW9 5EQ, UK.
| | - Calum McGregor
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca L Guy
- Healthcare-Associated Infection & Antimicrobial Resistance Division, UK Health Security Agency, London NW9 5EQ, UK
| | - James Whitworth
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Androulla Efstratiou
- Reference Services Division, UK Health Security Agency, London NW9 5EQ, UK; WHO Collaborating Centre for Diphtheria and Streptococcal Infections, UK Health Security Agency, London NW9 5EQ, UK
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Wrenn K, Blomquist PB, Inzoungou-Massanga C, Olufon O, Guy RL, Hatziioanou D, Findlater L, Smith I, Mirfenderesky M, Luyt K, Williams T, Stoianova S, Dickinson M, Pietzsch M, Jarvis CI, Brown C, Lamagni T, Kumar D. Surge of lower respiratory tract group A streptococcal infections in England in winter 2022: epidemiology and clinical profile. Lancet 2023; 402 Suppl 1:S93. [PMID: 37997140 DOI: 10.1016/s0140-6736(23)02095-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Following low incidence of invasive group A streptococcal (iGAS) infections during the COVID-19 pandemic, marked increases were noted in many countries during 2022, particularly in children. In November 2022, severe presentations of lower respiratory tract infections (LRTIs), including empyema, were notified by clinicians across the UK. UKHSA investigated this rise with the aim of informing clinical management and public health response. METHODS We undertook a case-series analysis using multiple routine data sources, exempted from ethics approval or patient consent. We identified iGAS cases in England in children younger than 15 years with an LRTI reported between Oct 1 and Dec 21, 2022, using UKHSA laboratory surveillance data (GAS detected in LRT specimens) and notifications by clinicians and Health Protection Teams (HPTs). Symptoms, diagnoses, health-care interactions, and outcome (death or recovery) data were obtained from HPT case management notes, the National Child Mortality Database, and the NHS Digital Emergency Care Dataset. FINDINGS We identified 147 cases of LRTI iGAS in children across England (77 [52%] male, 70 [48%] female; median age 4 years [IQR 2-6]). Predominant ethnicities were White (74 [65%] of 113 with known ethnicity) and Asian (18 [16%] of 113). Most reported symptoms were fever (90 [75%] of 120 children with ≥1 symptom) and cough (60 [50%] of 120), and 71 (48%) of all 147 children had a diagnosed respiratory viral coinfection (most commonly hMPV and RSV). 127 (86%) of children attended an emergency department, 31% (n=36/114 with onset date) at least twice within 21 days after symptom onset. 37 (25%) of 147 children died, with a median time from symptom onset to death of 4 days (IQR 3-7). Of 32 children with sample dates, 16 (84%) were tested for GAS on or after the day they died. Over half of deaths (21 [57%] of 37 deaths) occurred in the community after rapid deterioration, of whom 18 had previous contact with health-care services documented. INTERPRETATION The UK saw an unusual rise in iGAS LRTIs in children in late 2022. One in four cases died, over half in the community. Non-specific symptoms, viral symptoms, or positive virology might have lowered suspicion of bacterial infection. Although the use of multiple available data sources expedited the analysis, varying data completeness limited interpretation. Our study highlights the need for earlier detection and identification of effective measures to prevent death. FUNDING None.
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Affiliation(s)
- Katie Wrenn
- Rapid Investigation Team, UK Health Security Agency, London, UK
| | | | | | | | - Rebecca L Guy
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
| | - Diane Hatziioanou
- Rapid Investigation Team, UK Health Security Agency, London, UK; Data Release and Acquisitions, Information Management and Privacy, UK Health Security Agency, London, UK
| | - Lucy Findlater
- South West Field Service, UK Health Security Agency, Bristol, UK
| | - Iona Smith
- UK Field Epidemiology Training Programme, UKHSA, UK
| | - Mariyam Mirfenderesky
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK; Microbiology Department, North Middlesex University Hospital NHS Trust, London, UK
| | - Karen Luyt
- National Child Mortality Database, University of Bristol, Bristol, UK
| | - Tom Williams
- National Child Mortality Database, University of Bristol, Bristol, UK
| | - Sylvia Stoianova
- National Child Mortality Database, University of Bristol, Bristol, UK
| | | | - Maaike Pietzsch
- Rapid Investigation Team, UK Health Security Agency, London, UK
| | | | - Colin Brown
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Theresa Lamagni
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
| | - Deepti Kumar
- Rapid Investigation Team, UK Health Security Agency, London, UK
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Tanner J, Brierley Jones L, Rochon M, Westwood N, Wloch C, Vaja R, Rogers L, Dearling J, Wilson K, Magboo R, Aujla H, Page S, Whiting P, Murphy G, Brown C, Lamagni T, Harrington P. Barriers and facilitators for surgical site infection surveillance for adult cardiac surgery in a high-income setting: an in-depth exploration. J Hosp Infect 2023; 141:112-118. [PMID: 37734675 DOI: 10.1016/j.jhin.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Surgical site infection (SSI) surveillance aims to facilitate a reduction in SSIs through identifying infection rates, benchmarking, triggering clinical review and instituting infection control measures. Participation in surveillance is, however, variable suggesting opportunities to improve wider adoption. AIM To gain an in-depth understanding of the barriers and facilitators for SSI surveillance in a high-income European setting. METHODS Key informant interviews with 16 surveillance staff, infection prevention staff, nurses and surgeons from nine cardiac hospitals in England. Data were analysed thematically. FINDINGS SSI surveillance was reported to be resource intensive. Barriers to surveillance included challenges associated with data collection: data being located in numerous places, multiple SSI data reporting schemes, difficulty in finding denominator data, lack of interface between computerized systems, 'labour intensive' or 'antiquated' methods to collect data (e.g., using postal systems for patient questionnaires). Additional reported concerns included: relevance of definitions, perceived variability in data reporting, lack of surgeon engagement, unsupportive managers, low priority of SSIs among staff, and a 'blame culture' around high SSI rates. Facilitators were increased resources, better use of digital technologies (e.g., remote digital wound monitoring), integrating surveillance within routine clinical work, having champions, mandating surveillance, ensuring a closer relationship between surveillance and improved patient outcomes, increasing the focus on post-discharge surveillance, and integration with primary care data. CONCLUSION Using novel interviews with 'front-line' staff, identified opportunities for improving participation in SSI surveillance. Translating these findings into action will increase surveillance activity and bring patient safety benefits to a larger pool of surgical patients.
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Affiliation(s)
- J Tanner
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - L Brierley Jones
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - M Rochon
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - C Wloch
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - R Vaja
- Department of Cardiothoracic Surgery, Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Rogers
- Department of Cardiothoracic Surgery, University Hospitals of Bristol and Weston NHS Foundation Trust
| | | | - K Wilson
- Patient and Public Representative, UK
| | - R Magboo
- Critical Care, Barts Health NHS Trust, London, UK
| | - H Aujla
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - S Page
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - P Whiting
- Bristol Medical School, University of Bristol, Bristol, UK
| | - G Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - C Brown
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - T Lamagni
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - P Harrington
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
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Flannagan J, Chudasama DY, Hope R, Collin SM, Bhattacharya A, Merrick R, Aziz NA, Hopkins S, Dabrera G, Lamagni T. Attribution of nosocomial seeding to long-term care facility COVID-19 outbreaks. Epidemiol Infect 2023; 151:e191. [PMID: 37876042 PMCID: PMC10728972 DOI: 10.1017/s0950268823001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 10/26/2023] Open
Abstract
Residents of long-term care facilities (LTCFs) were disproportionately affected by the COVID-19 pandemic. We assessed the extent to which hospital-associated infections contributed to COVID-19 LTCF outbreaks in England. We matched addresses of cases between March 2020 and June 2021 to reference databases to identify LTCF residents. Linkage to health service records identified hospital-associated infections, with the number of days spent in hospital before positive specimen date used to classify these as definite or probable. Of 149,129 cases in LTCF residents during the study period, 3,748 (2.5%) were definite or probable hospital-associated and discharged to an LTCF. Overall, 431 (0.3%) were identified as index cases of potentially nosocomial-seeded outbreaks (2.7% (431/15,797) of all identified LTCF outbreaks). These outbreaks involved 4,521 resident cases and 1,335 deaths, representing 3.0% and 3.6% of all cases and deaths in LTCF residents, respectively. The proportion of outbreaks that were potentially nosocomial-seeded peaked in late June 2020, early December 2020, mid-January 2021, and mid-April 2021. Nosocomial seeding contributed to COVID-19 LTCF outbreaks but is unlikely to have accounted for a substantial proportion. The continued identification of such outbreaks after the implementation of preventative policies highlights the challenges of preventing their occurrence.
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Affiliation(s)
| | | | - Russell Hope
- United Kingdom Health Security Agency, London, UK
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Lamagni T, Guy RL, Sriskandan S, Decraene V, Brown CS. Improving maternal outcomes through early recognition, rapid notification, and investigation of invasive GAS infection. Lancet Microbe 2023; 4:e766. [PMID: 37392752 DOI: 10.1016/s2666-5247(23)00186-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Theresa Lamagni
- Healthcare-Associated Infection & Antimicrobial Resistance Division, UK Health Security Agency, London, UK.
| | - Rebecca L Guy
- Healthcare-Associated Infection & Antimicrobial Resistance Division, UK Health Security Agency, London, UK
| | - Shiranee Sriskandan
- Faculty of Medicine, Department of Infectious Disease, Imperial College, London, UK; National Institute for Health and Care Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London
| | | | - Colin S Brown
- Healthcare-Associated Infection & Antimicrobial Resistance Division, UK Health Security Agency, London, UK; National Institute for Health and Care Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London
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Piyasena C, Galu S, Yoshida R, Thakkar D, O'Sullivan J, Longley C, Evans K, Sweeney S, Kendall G, Ben-Sasi K, Richards J, Harris C, Jagodzinski J, Demirjian A, Lamagni T, Le Doare K, Heath PT, Battersby C. Comparison of diagnoses of early-onset sepsis associated with use of Sepsis Risk Calculator versus NICE CG149: a prospective, population-wide cohort study in London, UK, 2020-2021. BMJ Open 2023; 13:e072708. [PMID: 37500270 PMCID: PMC10387649 DOI: 10.1136/bmjopen-2023-072708] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE We sought to compare the incidence of early-onset sepsis (EOS) in infants ≥34 weeks' gestation identified >24 hours after birth, in hospitals using the Kaiser Permanente Sepsis Risk Calculator (SRC) with hospitals using the National Institute for Health and Care Excellence (NICE) guidance. DESIGN AND SETTING Prospective observational population-wide cohort study involving all 26 hospitals with neonatal units colocated with maternity services across London (10 using SRC, 16 using NICE). PARTICIPANTS All live births ≥34 weeks' gestation between September 2020 and August 2021. OUTCOME MEASURES EOS was defined as isolation of a bacterial pathogen in the blood or cerebrospinal fluid (CSF) culture from birth to 7 days of age. We evaluated the incidence of EOS identified by culture obtained >24 hours to 7 days after birth. We also evaluated the rate empiric antibiotics were commenced >24 hours to 7 days after birth, for a duration of ≥5 days, with negative blood or CSF cultures. RESULTS Of 99 683 live births, 42 952 (43%) were born in SRC hospitals and 56 731 (57%) in NICE hospitals. The overall incidence of EOS (<72 hours) was 0.64/1000 live births. The incidence of EOS identified >24 hours was 2.3/100 000 (n=1) for SRC vs 7.1/100 000 (n=4) for NICE (OR 0.5, 95% CI (0.1 to 2.7)). This corresponded to (1/20) 5% (SRC) vs (4/45) 8.9% (NICE) of EOS cases (χ=0.3, p=0.59). Empiric antibiotics were commenced >24 hours to 7 days after birth in 4.4/1000 (n=187) for SRC vs 2.9/1000 (n=158) for NICE (OR 1.5, 95% CI (1.2 to 1.9)). 3111 (7%) infants received antibiotics in the first 24 hours in SRC hospitals vs 8428 (15%) in NICE hospitals. CONCLUSION There was no significant difference in the incidence of EOS identified >24 hours after birth between SRC and NICE hospitals. SRC use was associated with 50% fewer infants receiving antibiotics in the first 24 hours of life.
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Affiliation(s)
| | - Sorana Galu
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Rie Yoshida
- Imperial College Healthcare NHS Trust, London, UK
| | - Devangi Thakkar
- The Hillingdon University Hospitals NHS Foundation Trust, Harrow, London, UK
| | - Joanna O'Sullivan
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, London, UK
| | | | - Katie Evans
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Giles Kendall
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Chris Harris
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Alicia Demirjian
- Evelina London Children's Hospital, London, UK
- United Kingdom Health Security Agency, London, UK
| | | | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
| | - Paul T Heath
- Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Imperial College London Faculty of Medicine, London, UK
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Sinnathamby MA, Warburton F, Guy R, Andrews N, Lamagni T, Watson C, Bernal JL. Epidemiological Impact of the Pediatric Live Attenuated Influenza Vaccine (LAIV) Program on Group A Streptococcus (GAS) Infection in England. Open Forum Infect Dis 2023; 10:ofad270. [PMID: 37383247 PMCID: PMC10296055 DOI: 10.1093/ofid/ofad270] [Citation(s) in RCA: 1] [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: 03/13/2023] [Accepted: 05/16/2023] [Indexed: 06/30/2023] Open
Abstract
Background Influenza is known to predispose to secondary bacterial infections including invasive group A streptococcal (iGAS) disease. The universal pediatric live attenuated influenza vaccine (LAIV) program introduced in England from the 2013/2014 influenza season was implemented incrementally, introducing cohorts of children annually to 2-16 years of coverage. Additionally, from the beginning of the program, discrete pilot areas offered LAIV vaccination to all primary school-age children, allowing for a unique comparison of infection rates between pilot and nonpilot areas during the program rollout. Methods Cumulative incidence rate ratios (IRRs) of GAS infections (all), scarlet fever (SF), and iGAS infection within each season by age group were compared for pilot and nonpilot areas using Poisson regression. The overall effect of the pilot program in the pre- (2010/2011-2012/2013 seasons) and postintroduction (2013/2014-2016/2017 seasons) periods was assessed using negative binomial regression by comparing changes in incidence between pilot/nonpilot areas (ratio of IRR [rIRR]). Results Reductions in IRRs of GAS and SF were observed within most post-LAIV program seasons, among the age groups 2-4 and 5-10 years. Significant reductions were seen among 5-10 years (rIRR, 0.57; 95% CI, 0.45-0.71; P < .001), 2-4 years (rIRR, 0.62; 95% CI, 0.43-0.90; P = .011), and 11-16 years (rIRR, 0.63; 95% CI, 0.43-0.90; P = .018) for GAS infections when assessing the overall effect of the program. Conclusions Our findings suggest that vaccination with LAIV may be associated with a reduced risk of GAS infection and support attaining high uptake of childhood influenza vaccination.
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Affiliation(s)
- Mary A Sinnathamby
- Correspondence: Mary A. Sinnathamby, BSc, MPH, 61 Colindale Avenue, London NW9 5EQ, UK ()
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Jamrozy D, Gopal Rao G, Feltwell T, Lamagni T, Khanna P, Efstratiou A, Parkhill J, Bentley SD. Population genetics of group B Streptococcus from maternal carriage in an ethnically diverse community in London. Front Microbiol 2023; 14:1185753. [PMID: 37275158 PMCID: PMC10233156 DOI: 10.3389/fmicb.2023.1185753] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Maternal immunization against Group B Streptococcus (GBS) has the potential to significantly reduce the burden of neonatal GBS infections. Population genetics of GBS from maternal carriage can offer key insights into vaccine target distribution. Methods In this study we characterized the population structure of GBS isolates from maternal carriage (n = 535) in an ethnically diverse community in London, using whole genome sequencing. Results The isolates clustered into nine clonal complexes (CCs) but the majority (95%) belonged to five lineages: CC1 (26%), CC19 (26%), CC23 (20%), CC17 (13%) and CC8/10 (10%). Nine serotypes were identified, the most common were serotypes III (26%), V (21%), II (19%) and Ia (19%). Other serotypes (Ib, IV, VI, VII, IX) represented less than 10% of all isolates each. Intra-lineage serotype diversity was observed in all major CCs but was highest in CC1, which revealed nine serotypes. Nearly all isolates (99%) carried at least one of the four alpha family protein genes (alpha, alp1, alp23, and rib). All isolates were susceptible to penicillin. We found 21% and 13% of isolates to be resistant to clarithromycin and clindamycin, respectively. Prevalence of macrolide-lincosamide-streptogramin B (MLSB) resistance genes was 22% and they were most common in CC19 (37%) and CC1 (28%), and isolates with serotypes V (38%) and IV (32%). We identified some associations between maternal ethnicity and GBS population structure. Serotype Ib was significantly less common among the South Asian compared to Black women (S. Asian: 3/142, Black: 15/135, p = 0.03). There was also a significantly lower proportion of CC1 isolates among the White other (24/142) in comparison to Black (43/135) and S. Asian (44/142) women (p = 0.04). We found a significantly higher proportion of CC17 isolates among the White other compared to S. Asian women (White other: 32/142, S. Asian: 10/142, p = 0.004). Conclusion Our study showed high prevalence of GBS vaccine targets among isolates from pregnant women in London. However, the observed serotype diversity in CC1 and high prevalence of MLSB resistance genes in CC19 demonstrates presence of high risk lineages, which might act as a reservoir of non-vaccine strains and antimicrobial resistance determinants.
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Affiliation(s)
- Dorota Jamrozy
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Guduru Gopal Rao
- Department of Microbiology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, United Kingdom
- Faculty of Medicine, Imperial College, London, United Kingdom
| | - Theresa Feltwell
- Cambridge Institute for Medical Research, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Theresa Lamagni
- World Health Organization Collaborating Centre for Diphtheria and Streptococcal Infections, UK Health Security Agency, London, United Kingdom
| | - Priya Khanna
- Department of Microbiology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, United Kingdom
| | - Androulla Efstratiou
- World Health Organization Collaborating Centre for Diphtheria and Streptococcal Infections, UK Health Security Agency, London, United Kingdom
| | - Julian Parkhill
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Stephen D. Bentley
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, United Kingdom
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10
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Zhi X, Li HK, Li H, Loboda Z, Charles S, Vieira A, Huse K, Jauneikaite E, Reeves L, Mok KY, Coelho J, Lamagni T, Sriskandan S. Emerging Invasive Group A Streptococcus M1 UK Lineage Detected by Allele-Specific PCR, England, 2020 1. Emerg Infect Dis 2023; 29:1007-1010. [PMID: 37019153 PMCID: PMC10124639 DOI: 10.3201/eid2905.221887] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Increasing reports of invasive Streptococcus pyogenes infections mandate surveillance for toxigenic lineage M1UK. An allele-specific PCR was developed to distinguish M1UK from other emm1 strains. The M1UK lineage represented 91% of invasive emm1 isolates in England in 2020. Allele-specific PCR will permit surveillance for M1UK without need for genome sequencing.
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11
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McGuire E, Li A, Collin SM, Decraene V, Cook M, Padfield S, Sriskandan S, Van Beneden C, Lamagni T, Brown CS. Time to negative throat culture following initiation of antibiotics for pharyngeal group A Streptococcus: a systematic review and meta-analysis up to October 2021 to inform public health control measures. Euro Surveill 2023; 28. [PMID: 37052678 PMCID: PMC10103550 DOI: 10.2807/1560-7917.es.2023.28.15.2200573] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BackgroundPublic health guidance recommending isolation of individuals with group A streptococcal (GAS) infection or carriage for 12-24 h from antibiotic initiation to prevent onward transmission requires a strong evidence base.AimTo estimate the pooled proportion of individuals who remain GAS culture-positive at set intervals after initiation of antibiotics through a systematic literature review (PROSPERO CRD42021290364) and meta-analysis.MethodsWe searched Ovid MEDLINE (1946-), EMBASE (1974-) and Cochrane library. We included interventional or observational studies with ≥ 10 participants reporting rates of GAS throat culture positivity during antibiotic treatment for culture-confirmed GAS pharyngitis, scarlet fever and asymptomatic pharyngeal GAS carriage. We did not apply age, language or geographical restrictions.ResultsOf 5,058 unique records, 43 were included (37 randomised controlled studies, three non-randomised controlled trials and three before-and-after studies). The proportion of individuals remaining culture-positive on day 1, day 2 and days 3-9 were 6.9% (95% CI: 2.7-16.8%), 5.4% (95% CI: 2.1-13.3%) and 2.6% (95% CI: 1.6-4.2%). For penicillins and cephalosporins, day 1 positivity was 6.5% (95% CI: 2.5-16.1%) and 1.6% (95% CI: 0.04-42.9%), respectively. Overall, for 9.1% (95% CI: 7.3-11.3), throat swabs collected after completion of therapy were GAS culture-positive. Only six studies had low risk of bias.ConclusionsOur review provides evidence that antibiotics for pharyngeal GAS achieve a high rate of culture conversion within 24 h but highlights the need for further research given methodological limitations of published studies and imprecision of pooled estimates. Further evidence is needed for non-beta-lactam antibiotics and asymptomatic individuals.
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Affiliation(s)
- Emma McGuire
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Ang Li
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Simon M Collin
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Valerie Decraene
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Michael Cook
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Simon Padfield
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Shiranee Sriskandan
- NIHR Health Protection Research Unit in Healthcare-associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | | | - Theresa Lamagni
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Colin S Brown
- NIHR Health Protection Research Unit in Healthcare-associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
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12
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Tessier E, Webster H, Aziz NA, Flannagan J, Zaidi A, Charlett A, Dabrera G, Lamagni T. The impact of COVID-19 on residents of long-term care facilities with learning disabilities and/or autism. Influenza Other Respir Viruses 2023; 17:e13139. [PMID: 37123814 PMCID: PMC10133727 DOI: 10.1111/irv.13139] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023] Open
Abstract
Background The COVID-19 pandemic has had disproportionate impact on vulnerable populations including those with learning disabilities. Assessing the incidence and risk of death in such settings can improve the prevention of COVID-19. We describe individuals who tested positive for SARS-CoV-2 while residing in care homes for learning disabilities and/or autism and investigate the risk of death compared with individuals living in their own homes. Methods Surveillance records for COVID-19 infections in England from 02 February 2020 to 31 March 2022 were extracted. Data on property type, variant wave, vaccination, hospitalisation and death were derived through data linkage and enrichment. Care home residents with learning disabilities and/or autism and diagnosed with COVID-19 were identified and analysed, and logistic regression analyses compared the risk of death of individuals living in private residence. We assessed interaction parameters by post-estimation analyses. Results A total of 3501 individuals were identified as diagnosed with SARS-CoV-2 whilst living in 632 care home properties for learning disabilities and/or autism. Of the 3686 episodes of infection, 80.4% were part of an outbreak. The crude case fatality rate was 2.6% and 0.6% among care home residents with autism and/or learning disabilities and their counterparts in households, respectively.The post-estimation analyses found over eight times the odds of death among care home residents in 60 years old compared with their counterparts living in private homes. Conclusions Care home residents with learning disabilities and/or autism have a greater risk of death from COVID-19. Optimising guidance to meet their needs is of great importance.
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Affiliation(s)
- Elise Tessier
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Harriet Webster
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Nurin Abdul Aziz
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Joe Flannagan
- All Hazards and Intelligence DivisionUK Health Security AgencyLondonUK
| | - Asad Zaidi
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Andre Charlett
- Statistics, Modelling and Economic DivisionUK Health Security AgencyLondonUK
| | - Gavin Dabrera
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Theresa Lamagni
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
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13
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Li HK, Zhi X, Vieira A, Whitwell HJ, Schricker A, Jauneikaite E, Li H, Yosef A, Andrew I, Game L, Turner CE, Lamagni T, Coelho J, Sriskandan S. Characterization of emergent toxigenic M1 UK Streptococcus pyogenes and associated sublineages. Microb Genom 2023; 9:mgen000994. [PMID: 37093716 PMCID: PMC10210942 DOI: 10.1099/mgen.0.000994] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/23/2023] [Indexed: 04/25/2023] Open
Abstract
Streptococcus pyogenes genotype emm1 is a successful, globally distributed epidemic clone that is regarded as inherently virulent. An emm1 sublineage, M1UK, that produces increased levels of SpeA toxin was associated with increased scarlet fever and invasive infections in England in 2015/2016. Defined by 27 SNPs in the core genome, M1UK is now dominant in England. To more fully characterize M1UK, we undertook comparative transcriptomic and proteomic analyses of M1UK and contemporary non-M1UK emm1 strains (M1global). Just seven genes were differentially expressed by M1UK compared with contemporary M1global strains. In addition to speA, five genes in the operon that includes glycerol dehydrogenase were upregulated in M1UK (gldA, mipB/talC, pflD, and phosphotransferase system IIC and IIB components), while aquaporin (glpF2) was downregulated. M1UK strains have a stop codon in gldA. Deletion of gldA in M1global abrogated glycerol dehydrogenase activity, and recapitulated upregulation of gene expression within the operon that includes gldA, consistent with a feedback effect. Phylogenetic analysis identified two intermediate emm1 sublineages in England comprising 13/27 (M113SNPs) and 23/27 SNPs (M123SNPs), respectively, that had failed to expand in the population. Proteomic analysis of invasive strains from the four phylogenetic emm1 groups highlighted sublineage-specific changes in carbohydrate metabolism, protein synthesis and protein processing; upregulation of SpeA was not observed in chemically defined medium. In rich broth, however, expression of SpeA was upregulated ~10-fold in both M123SNPs and M1UK sublineages, compared with M113SNPs and M1global. We conclude that stepwise accumulation of SNPs led to the emergence of M1UK. While increased expression of SpeA is a key indicator of M1UK and undoubtedly important, M1UK strains have outcompeted M123SNPs and other emm types that produce similar or more superantigen toxin. We speculate that an accumulation of adaptive SNPs has contributed to a wider fitness advantage in M1UK on an inherently successful emm1 streptococcal background.
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Affiliation(s)
- Ho Kwong Li
- Department of Infectious Disease, Imperial College London, London, UK
- MRC Centre for Molecular Bacteriology & Infection (CMBI), Imperial College London, London, UK
| | - Xiangyun Zhi
- Department of Infectious Disease, Imperial College London, London, UK
- MRC Centre for Molecular Bacteriology & Infection (CMBI), Imperial College London, London, UK
| | - Ana Vieira
- Department of Infectious Disease, Imperial College London, London, UK
- MRC Centre for Molecular Bacteriology & Infection (CMBI), Imperial College London, London, UK
| | - Harry J. Whitwell
- National Phenome Centre and Imperial Clinical Phenotyping Centre, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Amelia Schricker
- UK Dementia Research Institute, Department of Brain Sciences, Imperial College London, London, UK
| | - Elita Jauneikaite
- NIHR Health Protection Unit in Healthcare-associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Hanqi Li
- Department of Infectious Disease, Imperial College London, London, UK
| | - Ahmed Yosef
- Department of Infectious Disease, Imperial College London, London, UK
| | - Ivan Andrew
- Genomics Facility, UKRI-MRC London Institute for Medical Sciences (LMS), Imperial College London, London, UK
| | - Laurence Game
- Genomics Facility, UKRI-MRC London Institute for Medical Sciences (LMS), Imperial College London, London, UK
| | - Claire E. Turner
- The Florey Institute, School of Biosciences, University of Sheffield, South Yorkshire, UK
| | - Theresa Lamagni
- NIHR Health Protection Unit in Healthcare-associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
- Centre for Infections, UK Health Security Agency, London, UK
| | - Juliana Coelho
- NIHR Health Protection Unit in Healthcare-associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
- Centre for Infections, UK Health Security Agency, London, UK
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London, UK
- MRC Centre for Molecular Bacteriology & Infection (CMBI), Imperial College London, London, UK
- NIHR Health Protection Unit in Healthcare-associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
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14
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Ladhani SN, Guy R, Hughes HE, Elliot AJ, Bhopal SS, Brown C, Lamagni T. Paediatric group A streptococcal disease in England: a primary care perspective - Authors' reply. Lancet Child Adolesc Health 2023; 7:e9. [PMID: 36774928 DOI: 10.1016/s2352-4642(23)00021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/11/2023]
Affiliation(s)
| | - Rebecca Guy
- UK Health Security Agency, London, NW9 5EQ, UK
| | | | | | | | - Colin Brown
- UK Health Security Agency, London, NW9 5EQ, UK
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15
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Capelastegui F, Flannagan J, Augarde E, Tessier E, Chudasama D, Dabrera G, Lamagni T, Campos-Matos I. Making the invisible visible: using national surveillance data to identify people experiencing homelessness in England with COVID-19. Epidemiol Infect 2023; 151:e51. [PMID: 36852580 PMCID: PMC10063863 DOI: 10.1017/s095026882300033x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Persons experiencing homelessness (PEH) or rough sleeping are a vulnerable population, likely to be disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. The impact of COVID-19 infection on this population is yet to be fully described in England. We present a novel method to identify COVID-19 cases in this population and describe its findings. A phenotype was developed and validated to identify PEH or rough sleeping in a national surveillance system. Confirmed COVID-19 cases in England from March 2020 to March 2022 were address-matched to known homelessness accommodations and shelters. Further cases were identified using address-based indicators, such as NHS pseudo postcodes. In total, 1835 cases were identified by the phenotype. Most were <39 years of age (66.8%) and male (62.8%). The proportion of cases was highest in London (29.8%). The proportion of cases of a minority ethnic background and deaths were disproportionality greater in this population, compared to all COVID-19 cases in England. This methodology provides an approach to track the impact of COVID-19 on a subset of this population and will be relevant to policy making. Future surveillance systems and studies may benefit from this approach to further investigate the impact of COVID-19 and other diseases on select populations.
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Affiliation(s)
- Fernando Capelastegui
- National COVID-19 Epidemiology Cell, UK Health Security Agency, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Joe Flannagan
- National COVID-19 Epidemiology Cell, UK Health Security Agency, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Elizabeth Augarde
- Department of Health and Social Care, Office of Health Improvement and Disparities, 39 Victoria Street, London, SW1H 0EU, UK
| | - Elise Tessier
- National COVID-19 Epidemiology Cell, UK Health Security Agency, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Dimple Chudasama
- National COVID-19 Epidemiology Cell, UK Health Security Agency, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Gavin Dabrera
- National COVID-19 Epidemiology Cell, UK Health Security Agency, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Theresa Lamagni
- National COVID-19 Epidemiology Cell, UK Health Security Agency, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Ines Campos-Matos
- National COVID-19 Epidemiology Cell, UK Health Security Agency, 61 Colindale Ave, London, NW9 5EQ, UK
- Department of Health and Social Care, Office of Health Improvement and Disparities, 39 Victoria Street, London, SW1H 0EU, UK
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16
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Guy R, Henderson KL, Coelho J, Hughes H, Mason EL, Gerver SM, Demirjian A, Watson C, Sharp A, Brown CS, Lamagni T. Increase in invasive group A streptococcal infection notifications, England, 2022. Euro Surveill 2023; 28:2200942. [PMID: 36695450 PMCID: PMC9817207 DOI: 10.2807/1560-7917.es.2023.28.1.2200942] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Increases in invasive group A streptococcal (iGAS) infection and associated deaths, particularly in children, above seasonally expected levels are being seen this season (772 notifications reported in weeks 37 to 48 in 2022) across England. Diagnoses of iGAS infection from lower respiratory tract specimens in children under 15 years increased to 28% in November 2022. Medical practitioners have been alerted to the exceptional increase in incidence, including unusual numbers of children presenting with pulmonary empyema.
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Affiliation(s)
- Rebecca Guy
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, United Kingdom
| | - Katherine L Henderson
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, United Kingdom
| | - Juliana Coelho
- Staphylococcus and Streptococcus Reference Section, AMRHAI, UK Health Security Agency, London, United Kingdom
| | - Helen Hughes
- Real-time Syndromic Surveillance Team, Field Services Division, UK Health Security Agency, London, United Kingdom
| | - Emily L Mason
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, United Kingdom
| | - Sarah M Gerver
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, United Kingdom
| | - Alicia Demirjian
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, United Kingdom,Department of Paediatric Infectious Diseases & Immunology, Evelina London Children’s Hospital, London, United Kingdom,Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Conall Watson
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Ashley Sharp
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, United Kingdom
| | - Colin S Brown
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, United Kingdom
| | - Theresa Lamagni
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, United Kingdom
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17
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Cavallaro M, Coelho J, Ready D, Decraene V, Lamagni T, McCarthy ND, Todkill D, Keeling MJ. Cluster detection with random neighbourhood covering: Application to invasive Group A Streptococcal disease. PLoS Comput Biol 2022; 18:e1010726. [PMID: 36449515 PMCID: PMC9744322 DOI: 10.1371/journal.pcbi.1010726] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/12/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
The rapid detection of outbreaks is a key step in the effective control and containment of infectious diseases. In particular, the identification of cases which might be epidemiologically linked is crucial in directing outbreak-containment efforts and shaping the intervention of public health authorities. Often this requires the detection of clusters of cases whose numbers exceed those expected by a background of sporadic cases. Quantifying exceedances rapidly is particularly challenging when only few cases are typically reported in a precise location and time. To address such important public health concerns, we present a general method which can detect spatio-temporal deviations from a Poisson point process and estimate the odds of an isolate being part of a cluster. This method can be applied to diseases where detailed geographical information is available. In addition, we propose an approach to explicitly take account of delays in microbial typing. As a case study, we considered invasive group A Streptococcus infection events as recorded and typed by Public Health England from 2015 to 2020.
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Affiliation(s)
- Massimo Cavallaro
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, United Kingdom
- School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
- UK Health Security Agency, United Kingdom
| | | | - Derren Ready
- UK Health Security Agency, United Kingdom
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol, Bristol, United Kingdom
| | | | | | - Noel D. McCarthy
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Institute of Population Health, School of Medicine, Trinity College Dublin, University of Dublin, 2 Dublin, Ireland
| | - Dan Todkill
- UK Health Security Agency, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Matt J. Keeling
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, United Kingdom
- School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
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18
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Merrick R, Chudasama D, Flannagan J, Campos-Matos I, Howard A, Bindra R, Gill ON, Dabrera G, Lamagni T. Differential impact of quarantine policies for recovered COVID-19 cases in England: a case cohort study of surveillance data, June to December 2020. BMC Public Health 2022; 22:1915. [PMID: 36241977 PMCID: PMC9562076 DOI: 10.1186/s12889-022-14254-x] [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: 02/21/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background From 12th March 2020, individuals in England were advised to quarantine in their home if a household member tested positive for SARS-CoV-2. A mandatory isolation period of 10 days was introduced on 28th September 2020 and applied to all individuals with COVID-19. We assessed the frequency, timing, and characteristics of recovered COVID-19 cases requiring subsequent quarantine episodes due to household re-exposure. Methods In this case cohort study, all laboratory-confirmed COVID-19 cases notified in England (29th June to 28th December 2020) were analysed to identify consecutive household case(s). Multivariable logistic regression was used to determine associations between case characteristics and need to quarantine following recent infection (within 28 days of diagnosis). Results Among 1,651,550 cases resident in private dwellings and Houses of Multiple Occupancy (HMOs), 744,548 (45.1%) were the only case in their home and 56,179 (3.4%) were succeeded by further household cases diagnosed within 11–28 days of their diagnosis. Of 1,641,412 cases arising in private homes, the likelihood of further household cases was highest for Bangladeshi (aOR = 2.20, 95% CI = 2.10–2.31) and Pakistani (aOR = 2.15, 95% CI = 2.08–2.22) individuals compared to White British, as well as among young people (17-24y vs. 25-64y; aOR = 1.19, 95% CI = 1.16–1.22), men (vs. women; aOR = 1.06, 95% CI = 1.04–1.08), London residents (vs. Yorkshire and Humber; aOR = 1.57, 95% CI = 1.52–1.63) and areas of high deprivation (IMD 1 vs. 10; aOR = 1.13, 95% CI = 1.09–1.19). Conclusion Policies requiring quarantine on re-exposure differentially impact some of the most disadvantaged populations. Quarantine exemption for recently recovered individuals could mitigate the socioeconomic impact of responses to COVID-19 or similar infectious disease outbreaks.
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Affiliation(s)
- Rachel Merrick
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK.
| | - Dimple Chudasama
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Joe Flannagan
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Ines Campos-Matos
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Annabelle Howard
- COVID-19 International Cell, UK Health Security Agency, London, UK
| | - Renu Bindra
- COVID-19 National Guidance Cell, UK Health Security Agency, London, UK
| | - O Noël Gill
- COVID-19 National Guidance Cell, UK Health Security Agency, London, UK
| | - Gavin Dabrera
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Theresa Lamagni
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
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19
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Miller KM, Lamagni T, Hay R, Cannon JW, Marks M, Bowen AC, Kaslow DC, Cherian T, Seale AC, Pickering J, Daw JN, Moore HC, Van Beneden C, Carapetis JR, Manning L. Standardization of Epidemiological Surveillance of Group A Streptococcal Cellulitis. Open Forum Infect Dis 2022; 9:S25-S30. [PMID: 36128406 PMCID: PMC9474943 DOI: 10.1093/ofid/ofac267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Cellulitis is an acute bacterial infection of the dermis and subcutaneous tissue usually found complicating a wound, ulcer, or dermatosis. This article provides guidelines for the surveillance of cellulitis. The primary objectives of cellulitis surveillance are to (1) monitor trends in rates of infection, (2) describe the demographic and clinical characteristics of patients with cellulitis, (3) estimate the frequency of complications, and (4) describe the risk factors associated with primary and recurrent cellulitis. This article includes case definitions for clinical cellulitis and group A streptococcal cellulitis, based on clinical and laboratory evidence, and case classifications for an initial and recurrent case. It is expected that surveillance for cellulitis will be for all-cause cellulitis, rather than specifically for Strep A cellulitis. Considerations of the type of surveillance are also presented, including identification of data sources and surveillance type. Minimal surveillance necessary for cellulitis is facility-based, passive surveillance. Prospective, active, facility-based surveillance is recommended for estimates of pathogen-specific cellulitis burden. Participant eligibility, surveillance population, and additional surveillance considerations such as active follow-up of cases, the use of International Classification of Disease diagnosis codes, and microbiological sampling of cases are discussed. Finally, the core data elements to be collected on case report forms are presented.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | | | - Roderick Hay
- St John’s Institute of Dermatology, King’s College London , London , United Kingdom
| | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine , London , United Kingdom
- Hospital for Tropical Diseases and Division of Infection and Immunity, University College London Hospitals , London , United Kingdom
- Division of Infection and Immunity, University College London , London , United Kingdom
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Department of Infectious Diseases, Perth Children’s Hospital , Nedlands, Western Australia , Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia , Australia
| | | | | | - Anna C Seale
- UK Health Security Agency , London , United Kingdom
- London School of Hygiene & Tropical Medicine , London , United Kingdom
- University of Warwick , Coventry , United Kingdom
| | - Janessa Pickering
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | - Jessica N Daw
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | | | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia , Australia
| | - Laurens Manning
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Infectious Diseases Department, Fiona Stanley Hospital , Perth, Western Australia , Australia
- School of Medicine and Pharmacology, Harry Perkins Research Institute, Fiona Stanley Hospital, University of Western Australia , Perth, Western Australia , Australia
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20
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Miller KM, Tanz RR, Shulman ST, Carapetis JR, Cherian T, Lamagni T, Bowen AC, Pickering J, Fulurija A, Moore HC, Cannon JW, Barnett TC, Van Beneden CA, Carapetis J, Van Beneden C, Kaslow DC, Cherian T, Lamagni T, Engel M, Cannon J, Moore HC, Bowen A, Seale A, Kang G, Watkins D, Kariuki S. Standardization of Epidemiological Surveillance of Group A Streptococcal Pharyngitis. Open Forum Infect Dis 2022; 9:S5-S14. [PMID: 36128410 PMCID: PMC9474939 DOI: 10.1093/ofid/ofac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pharyngitis, more commonly known as sore throat, is caused by viral and/or bacterial infections. Group A Streptococcus (Strep A) is the most common bacterial cause of pharyngitis. Strep A pharyngitis is an acute, self-limiting disease but if undertreated can lead to suppurative complications, nonsuppurative poststreptococcal immune-mediated diseases, and toxigenic presentations. We present a standardized surveillance protocol, including case definitions for pharyngitis and Strep A pharyngitis, as well as case classifications that can be used to differentiate between suspected, probable, and confirmed cases. We discuss the current tests used to detect Strep A among persons with pharyngitis, including throat culture and point-of-care tests. The type of surveillance methodology depends on the resources available and the objectives of surveillance. Active surveillance and laboratory confirmation is the preferred method for case detection. Participant eligibility, the surveillance population and additional considerations for surveillance of pharyngitis are addressed, including baseline sampling, community engagement, frequency of screening and season. Finally, we discuss the core elements of case report forms for pharyngitis and provide guidance for the recording of severity and pain associated with the course of an episode.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Robert R Tanz
- Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children’s Hospital of Chicago , Chicago, Illinois , USA
| | - Stanford T Shulman
- Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children’s Hospital of Chicago , Chicago, Illinois , USA
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
- Perth Children’s Hospital , Perth , Australia
| | | | - Theresa Lamagni
- United Kingdom Health Security Agency , London , United Kingdom
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
- Perth Children’s Hospital , Perth , Australia
| | - Janessa Pickering
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Alma Fulurija
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Timothy C Barnett
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Chris A Van Beneden
- CDC Foundation, Centers for Disease Control and Prevention , Atlanta, Georgia , USA
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21
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Miller KM, Van Beneden C, McDonald M, Hla TK, Wong W, Pedgrift H, Kaslow DC, Cherian T, Carapetis JR, Scheel A, Seale A, Bowen AC, Moore HC, Lamagni T, Rodriguez-Iturbe B. Standardization of Epidemiological Surveillance of Acute Poststreptococcal Glomerulonephritis. Open Forum Infect Dis 2022; 9:S57-S64. [PMID: 36128411 PMCID: PMC9474944 DOI: 10.1093/ofid/ofac346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
Acute poststreptococcal glomerulonephritis (APSGN) is an immune complex-induced glomerulonephritis that develops as a sequela of streptococcal infections. This article provides guidelines for the surveillance of APSGN due to group A Streptococcus (Strep A). The primary objectives of APSGN surveillance are to monitor trends in age- and sex-specific incidence, describe the demographic and clinical characteristics of patients with APSGN, document accompanying risk factors, then monitor trends in frequency of complications, illness duration, hospitalization rates, and mortality. This document provides surveillance case definitions for APSGN, including clinical and subclinical APSGN based on clinical and laboratory evidence. It also details case classifications that can be used to differentiate between confirmed and probable cases, and it discusses the current investigations used to provide evidence of antecedent Strep A infection. The type of surveillance recommended depends on the burden of APSGN in the community and the objectives of surveillance. Strategies for minimal surveillance and enhanced surveillance of APSGN are provided. Furthermore, a discussion covers the surveillance population and additional APSGN-specific surveillance considerations such as contact testing, active follow up of cases and contacts, frequency of reporting, surveillance visits, period of surveillance, and community engagement. Finally, the document presents core data elements to be collected on case report forms, along with guidance for documenting the course and severity of APSGN.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | | | | | - Thel K Hla
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- University of Western Australia , Perth, Western Australia , Australia
- Fiona Stanley Hospital , Murdoch, Western Australia , Australia
| | - William Wong
- Starship Children’s Hospital , Auckland , New Zealand
| | | | | | | | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
| | - Amy Scheel
- Emory University School of Medicine , Atlanta, Georgia , USA
| | - Anna Seale
- London School of Hygiene & Tropical Medicine , London , United Kingdom
- University of Warwick , Coventry , United Kingdom
- UK Health Security Agency , London , United Kingdom
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
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22
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Miller KM, Carapetis JR, Cherian T, Hay R, Marks M, Pickering J, Cannon JW, Lamagni T, Romani L, Moore HC, Van Beneden CA, Barth DD, Bowen AC, Carapetis J, Van Beneden C, Kaslow D, Cherian T, Lamagni T, Engel M, Cannon J, Moore H, Bowen A, Seale A, Kang G, Watkins D, Kariuki S. Standardization of Epidemiological Surveillance of Group A Streptococcal Impetigo. Open Forum Infect Dis 2022; 9:S15-S24. [PMID: 36128409 PMCID: PMC9474945 DOI: 10.1093/ofid/ofac249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Impetigo is a highly contagious bacterial infection of the superficial layer of skin. Impetigo is caused by group A Streptococcus (Strep A) and Staphylococcus aureus, alone or in combination, with the former predominating in many tropical climates. Strep A impetigo occurs mainly in early childhood, and the burden varies worldwide. It is an acute, self-limited disease, but many children experience frequent recurrences that make it a chronic illness in some endemic settings. We present a standardized surveillance protocol including case definitions for impetigo including both active (purulent, crusted) and resolving (flat, dry) phases and discuss the current tests used to detect Strep A among persons with impetigo. Case classifications that can be applied are detailed, including differentiating between incident (new) and prevalent (existing) cases of Strep A impetigo. The type of surveillance methodology depends on the burden of impetigo in the community. Active surveillance and laboratory confirmation is the preferred method for case detection, particularly in endemic settings. Participant eligibility, surveillance population and additional considerations for surveillance of impetigo, including examination of lesions, use of photographs to document lesions, and staff training requirements (including cultural awareness), are addressed. Finally, the core elements of case report forms for impetigo are presented and guidance for recording the course and severity of impetigo provided.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
- Perth Children’s Hospital , Perth, Western Australia , Australia
| | | | - Roderick Hay
- St John’s Institute of Dermatology, King’s College London , United Kingdom
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine , London , United Kingdom
- Hospital for Tropical Diseases, University College , London , United Kingdom
- Division of Infection and Immunity, University College London , London , United Kingdom
| | - Janessa Pickering
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Theresa Lamagni
- United Kingdom Health Security Agency , London , United Kingdom
| | - Lucia Romani
- The Kirby Institute, University of New South Wales Sydney , Sydney , Australia
- Murdoch Children’s Research Group , Melbourne , Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Chris A Van Beneden
- CDC Foundation, Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Dylan D Barth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
- Perth Children’s Hospital , Perth, Western Australia , Australia
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23
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Miller KM, Lamagni T, Cherian T, Cannon JW, Parks T, Adegbola RA, Pickering J, Barnett T, Engel ME, Manning L, Bowen AC, Carapetis JR, Moore HC, Barth DD, Kaslow DC, Van Beneden CA. Standardization of Epidemiological Surveillance of Invasive Group A Streptococcal Infections. Open Forum Infect Dis 2022; 9:S31-S40. [PMID: 36128405 PMCID: PMC9474937 DOI: 10.1093/ofid/ofac281] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/13/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Invasive group A streptococcal (Strep A) infections occur when Streptococcus pyogenes, also known as beta-hemolytic group A Streptococcus, invades a normally sterile site in the body. This article provides guidelines for establishing surveillance for invasive Strep A infections. The primary objective of invasive Strep A surveillance is to monitor trends in rates of infection and determine the demographic and clinical characteristics of patients with laboratory-confirmed invasive Strep A infection, the age- and sex-specific incidence in the population of a defined geographic area, trends in risk factors, and the mortality rates and rates of nonfatal sequelae caused by invasive Strep A infections.
This article includes clinical descriptions followed by case definitions, based on clinical and laboratory evidence, and case classifications (confirmed or probable, if applicable) for invasive Strep A infections and for 3 Strep A syndromes: streptococcal toxic shock syndrome, necrotizing fasciitis, and pregnancy-associated Strep A infection.
Considerations of the type of surveillance are also presented, noting that most people who have invasive Strep A infections will present to hospital and that invasive Strep A is a notifiable disease in some countries. Minimal surveillance necessary for invasive Strep A infection is facility-based, passive surveillance. A resource-intensive but more informative approach is active case finding of laboratory-confirmed Strep A invasive infections among a large (eg, state-wide) and well defined population.
Participant eligibility, surveillance population, and additional surveillance components such as the use of International Classification of Disease diagnosis codes, follow-up, period of surveillance, seasonality, and sample size are discussed. Finally, the core data elements to be collected on case report forms are presented.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | | | | | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Tom Parks
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital , London , United Kingdom
| | | | - Janessa Pickering
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Tim Barnett
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Mark E Engel
- AFROStrep Research Initiative, Department of Medicine, University of Cape Town , Cape Town , South Africa
| | - Laurens Manning
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Infectious Diseases Department, Fiona Stanley Hospital , Perth, Western Australia , Australia
- Medical School, University of Western Australia , Perth, Western Australia , Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Perth Children’s Hospital , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Dylan D Barth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
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24
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Collin SM, Demirjian A, Swann C, Lamagni T. Race and Ethnicity in Neonatal Group B Streptococcal Disease in England: 2016-2020. Pediatrics 2022; 150:188785. [PMID: 35979728 DOI: 10.1542/peds.2021-056080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Simon M Collin
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency, London, United Kingdom
| | - Alicia Demirjian
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency, London, United Kingdom.,Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom.,Faculty of Life Sciences & Medicine, King's College London, United Kingdom
| | - Catherine Swann
- Office for Health Improvement and Disparities, Department of Health & Social Care, London, United Kingdom
| | - Theresa Lamagni
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency, London, United Kingdom
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25
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Naylor NR, Evans S, Pouwels KB, Troughton R, Lamagni T, Muller-Pebody B, Knight GM, Atun R, Robotham JV. Quantifying the primary and secondary effects of antimicrobial resistance on surgery patients: Methods and data sources for empirical estimation in England. Front Public Health 2022; 10:803943. [PMID: 36033764 PMCID: PMC9413182 DOI: 10.3389/fpubh.2022.803943] [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: 10/28/2021] [Accepted: 07/04/2022] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial resistance (AMR) may negatively impact surgery patients through reducing the efficacy of treatment of surgical site infections, also known as the "primary effects" of AMR. Previous estimates of the burden of AMR have largely ignored the potential "secondary effects," such as changes in surgical care pathways due to AMR, such as different infection prevention procedures or reduced access to surgical procedures altogether, with literature providing limited quantifications of this potential burden. Former conceptual models and approaches for quantifying such impacts are available, though they are often high-level and difficult to utilize in practice. We therefore expand on this earlier work to incorporate heterogeneity in antimicrobial usage, AMR, and causative organisms, providing a detailed decision-tree-Markov-hybrid conceptual model to estimate the burden of AMR on surgery patients. We collate available data sources in England and describe how routinely collected data could be used to parameterise such a model, providing a useful repository of data systems for future health economic evaluations. The wealth of national-level data available for England provides a case study in describing how current surveillance and administrative data capture systems could be used in the estimation of transition probability and cost parameters. However, it is recommended that such data are utilized in combination with expert opinion (for scope and scenario definitions) to robustly estimate both the primary and secondary effects of AMR over time. Though we focus on England, this discussion is useful in other settings with established and/or developing infectious diseases surveillance systems that feed into AMR National Action Plans.
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Affiliation(s)
- Nichola R. Naylor
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, Antimicrobial Resistance (AMR) Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom,Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom,*Correspondence: Nichola R. Naylor
| | - Stephanie Evans
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
| | - Koen B. Pouwels
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, United Kingdom,The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, United Kingdom
| | - Rachael Troughton
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom
| | - Theresa Lamagni
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
| | - Berit Muller-Pebody
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
| | - Gwenan M. Knight
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, Antimicrobial Resistance (AMR) Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Julie V. Robotham
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom,Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
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26
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Naylor NR, Evans S, Pouwels KB, Troughton R, Lamagni T, Muller-Pebody B, Knight GM, Atun R, Robotham JV. Quantifying the primary and secondary effects of antimicrobial resistance on surgery patients: Methods and data sources for empirical estimation in England. Front Public Health 2022. [DOI: 10.5210.3389/fpubh.2022.803943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) may negatively impact surgery patients through reducing the efficacy of treatment of surgical site infections, also known as the “primary effects” of AMR. Previous estimates of the burden of AMR have largely ignored the potential “secondary effects,” such as changes in surgical care pathways due to AMR, such as different infection prevention procedures or reduced access to surgical procedures altogether, with literature providing limited quantifications of this potential burden. Former conceptual models and approaches for quantifying such impacts are available, though they are often high-level and difficult to utilize in practice. We therefore expand on this earlier work to incorporate heterogeneity in antimicrobial usage, AMR, and causative organisms, providing a detailed decision-tree-Markov-hybrid conceptual model to estimate the burden of AMR on surgery patients. We collate available data sources in England and describe how routinely collected data could be used to parameterise such a model, providing a useful repository of data systems for future health economic evaluations. The wealth of national-level data available for England provides a case study in describing how current surveillance and administrative data capture systems could be used in the estimation of transition probability and cost parameters. However, it is recommended that such data are utilized in combination with expert opinion (for scope and scenario definitions) to robustly estimate both the primary and secondary effects of AMR over time. Though we focus on England, this discussion is useful in other settings with established and/or developing infectious diseases surveillance systems that feed into AMR National Action Plans.
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27
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Moore HL, Battersby C, Piyasena C, Demirjian A, Lamagni T. Assessing variation in neonatal sepsis screening across England. Arch Dis Child Fetal Neonatal Ed 2022:archdischild-2022-324380. [PMID: 35790345 DOI: 10.1136/archdischild-2022-324380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Hannah L Moore
- UK Field Epidemiology Training Program, UK Health Security Agency, Leeds, UK
| | | | | | - Alicia Demirjian
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK.,Neonatal Medicine, Evelina London Children's Hospital, London, UK
| | - Theresa Lamagni
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
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28
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Leeman D, Flannagan J, Chudasama D, Dack K, Anderson C, Dabrera G, Lamagni T. Effect of Returning University Students on COVID-19 Infections in England, 2020. Emerg Infect Dis 2022; 28:1366-1374. [PMID: 35642474 PMCID: PMC9239898 DOI: 10.3201/eid2807.212332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/28/2022] Open
Abstract
Each September in England, ≈1 million students relocate to study at universities. To determine COVID-19 cases and outbreaks among university students after their return to university during the COVID pandemic in September 2020, we identified students with COVID-19 (student case-patients) by reviewing contact tracing records identifying attendance at university and residence in student accommodations identified by matching case-patients’ residential addresses with national property databases. We determined COVID-19 rates in towns/cities with and without a university campus. We identified 53,430 student case-patients during September 1–December 31, 2020, which accounted for 2.7% of all cases during this period. Student case-patients increased rapidly after the start of the term, driven initially by cases and outbreaks in student accommodations. Case rates among students 18–23 years of age doubled at the start of term in towns with universities. Our findings highlight the need for face-to-face and control measures to reduce virus transmission.
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29
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Flannagan J, Twohig KA, Carter E, Chudasama DY, Lamagni T, Dabrera G. Increased Residential Clustering of COVID-19 Cases Associated With SARS-CoV-2 Variant of Concern B.1.1.7. Epidemiology 2022; 33:465-469. [PMID: 35512232 PMCID: PMC9148639 DOI: 10.1097/ede.0000000000001497] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.1.7 variant in England in 2020 and subsequent global spread emphasized the need to understand epidemiologic characteristics of SARS-CoV-2 variants. A diagnostic proxy for this variant, referred to as S-gene target failure, provided a rich dataset to assess transmissibility of the variant in an analysis of clustering in residential settings. METHODS We used a pair-matched case-control study design to estimate odds of onward transmission within households with S-gene target failure index cases versus nontarget failure index cases. We defined cases as the index in a household cluster (clustered case) and controls as a case with no subsequent household cluster (sporadic). We matched clustered and sporadic cases one-to-one on specimen week, geography, and property type. We used conditional logistic regression, adjusting for age, sex, ethnicity, and symptom status, to assess odds of residential clustering. RESULTS Our study population comprised 57,244 individuals with specimen dates from 23 November 2020 to 4 January 2021. Crude analysis yielded 54% increased odds (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.5, 1.6) of residential clustering associated with S-gene target failure; the association remained in the fully adjusted model (OR = 1.6, 95% CI = 1.5, 1.6). Stratified analyses by region showed increased odds of residential clustering associated with target failure in all regions apart from the Southwest, where we observed lower precision. Similar adjusted odds ratios with precise confidence intervals remained in stratified analyses by property category. CONCLUSION We observed increased odds in all property types, consistent with greater transmissibility of the B.1.1.7 variant in this high-risk setting.
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Affiliation(s)
- Joe Flannagan
- From the National COVID-19 Epidemiology Cell, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Katherine A. Twohig
- From the National COVID-19 Epidemiology Cell, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Emma Carter
- From the National COVID-19 Epidemiology Cell, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Dimple Y. Chudasama
- From the National COVID-19 Epidemiology Cell, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Theresa Lamagni
- From the National COVID-19 Epidemiology Cell, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Gavin Dabrera
- From the National COVID-19 Epidemiology Cell, National Infection Service, Public Health England, Colindale, London, United Kingdom
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30
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Sherwood E, Vergnano S, Kakuchi I, Bruce MG, Chaurasia S, David S, Dramowski A, Georges S, Guy R, Lamagni T, Levy-Bruhl D, Lyytikäinen O, Naus M, Okaro JO, Oppegaard O, Vestrheim DF, Zulz T, Steer AC, Van Beneden CA, Seale AC. Invasive group A streptococcal disease in pregnant women and young children: a systematic review and meta-analysis. Lancet Infect Dis 2022; 22:1076-1088. [PMID: 35390294 PMCID: PMC9217756 DOI: 10.1016/s1473-3099(21)00672-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The incidence of invasive disease caused by group A streptococcus (GAS) has increased in multiple countries in the past 15 years. However, despite these reports, to the best of our knowledge, no systematic reviews and combined estimates of the incidence of invasive GAS have been done in key high-risk groups. To address this, we estimated the incidence of invasive GAS disease, including death and disability outcomes, among two high-risk groups-namely, pregnant women and children younger than 5 years. METHODS We did a systematic review and meta-analyses on invasive GAS outcomes, including incidence, case fatality risks, and neurodevelopmental impairment risk, among pregnant women, neonates (younger than 28 days), infants (younger than 1 year), and children (younger than 5 years) worldwide and by income region. We searched several databases for articles published from Jan 1, 2000, to June 3, 2020, for publications that reported invasive GAS outcomes, and we sought unpublished data from an investigator group of collaborators. We included studies with data on invasive GAS cases, defined as laboratory isolation of Streptococcus pyogenes from any normally sterile site, or isolation of S pyogenes from a non-sterile site in a patient with necrotising fasciitis or streptococcal toxic shock syndrome. For inclusion in pooled incidence estimates, studies had to report a population denominator, and for inclusion in pooled estimates of case fatality risk, studies had to report aggregate data on the outcome of interest and the total number of cases included as a denominator. We excluded studies focusing on groups at very high risk (eg, only preterm infants). We assessed heterogeneity with I2. FINDINGS Of the 950 published articles and 29 unpublished datasets identified, 20 studies (seven unpublished; 3829 cases of invasive GAS) from 12 countries provided sufficient data to be included in pooled estimates of outcomes. We did not identify studies reporting invasive GAS incidence among pregnant women in low-income and middle-income countries (LMICs) nor any reporting neurodevelopmental impairment after invasive GAS in LMICs. In nine studies from high-income countries (HICs) that reported invasive GAS in pregnancy and the post-partum period, invasive GAS incidence was 0·12 per 1000 livebirths (95% CI 0·11 to 0·14; I2=100%). Invasive GAS incidence was 0·04 per 1000 livebirths (0·03 to 0·05; I2=100%; 11 studies) for neonates, 0·13 per 1000 livebirths (0·10 to 0·16; I2=100%; ten studies) for infants, and 0·09 per 1000 person-years (95% CI 0·07 to 0·10; I2=100%; nine studies) for children worldwide; 0·12 per 1000 livebirths (95% CI 0·00 to 0·24; I2=100%; three studies) in neonates, 0·33 per 1000 livebirths (-0·22 to 0·88; I2=100%; two studies) in infants, and 0·22 per 1000 person-years (0·13 to 0·31; I2=100%; two studies) in children in LMICs; and 0·02 per 1000 livebirths (0·00 to 0·03; I2=100%; eight studies) in neonates, 0·08 per 1000 livebirths (0·05 to 0·11; I2=100%; eight studies) in infants, and 0·05 per 1000 person-years (0·03 to 0·06; I2=100%; seven studies) in children for HICs. Case fatality risks were high, particularly among neonates in LMICs (61% [95% CI 33 to 89]; I2=54%; two studies). INTERPRETATION We found a substantial burden of invasive GAS among young children. In LMICs, little data were available for neonates and children and no data were available for pregnant women. Incidences of invasive GAS are likely to be underestimates, particularly in LMICs, due to low GAS surveillance. It is essential to improve available data to inform development of prevention and management strategies for invasive GAS. FUNDING Wellcome Trust.
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Affiliation(s)
- Emma Sherwood
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Stefania Vergnano
- Paediatric Infectious Diseases, Bristol Royal Hospital for Children, University Hospitals Bristol NHS, Bristol, UK
| | - Isona Kakuchi
- Paediatric Infectious Diseases, Bristol Royal Hospital for Children, University Hospitals Bristol NHS, Bristol, UK
| | - Michael G Bruce
- Centers for Disease Control and Prevention, Arctic Investigations Program, Anchorage, Alaska, USA
| | - Suman Chaurasia
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Samara David
- British Columbia Centre for Disease Control, University of British Columbia, BC, Canada
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Scarlett Georges
- Infectious Diseases Department, Santé Publique France, French National Public Health Agency, St Maurice, France
| | - Rebecca Guy
- National Infection Service, UK Health Security Agency, London, UK
| | - Theresa Lamagni
- National Infection Service, UK Health Security Agency, London, UK
| | - Daniel Levy-Bruhl
- Infectious Diseases Department, Santé Publique France, French National Public Health Agency, St Maurice, France
| | - Outi Lyytikäinen
- National Institute for Health and Welfare, Department of Health Security, Infectious Disease Control and Vaccinations Unit, Helsinki, Finland
| | - Monika Naus
- British Columbia Centre for Disease Control, University of British Columbia, BC, Canada
| | | | - Oddvar Oppegaard
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Didrik F Vestrheim
- Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Tammy Zulz
- Centers for Disease Control and Prevention, Arctic Investigations Program, Anchorage, Alaska, USA
| | - Andrew C Steer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Anna C Seale
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Hallmaier-Wacker LK, Andrews A, Nsonwu O, Demirjian A, Hope RJ, Lamagni T, Collin SM. Incidence and aetiology of infant Gram-negative bacteraemia and meningitis: systematic review and meta-analysis. Arch Dis Child 2022; 107:archdischild-2022-324047. [PMID: 35710719 PMCID: PMC9606543 DOI: 10.1136/archdischild-2022-324047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND One in six infant deaths worldwide are caused by invasive bacterial infections, of which a substantial but unquantified proportion are caused by Gram-negative bacteria. METHODS We conducted a systematic review of studies published from 31 May 2010 to 1 June 2020 indexed in MEDLINE, Embase and Global Health databases. We performed meta-analyses of the incidence of Gram-negative bacteraemia and of individual Gram-negative species as proportions of all infant bacteraemia, stratified by onset (early vs late) and country income (low/middle vs high). RESULTS 152 studies from 54 countries were included, 60 in high-income countries (HIC) and 92 in low-income/middle-income countries (LMIC). Gram-negatives represented a higher proportion (53%, 95% CI 49% to 57%) of all infant bacteraemia in LMIC compared with HIC (28%, 95% CI 25% to 32%). Incidence of infant Gram-negative bacteraemia was 2.01 (95% CI 1.15 to 3.51) per 1000 live births; it was five times higher in LMIC (4.35, 95% CI 2.94 to 6.43) compared with HIC (0.73, 95% CI 0.39 to 7.5). In HIC, Escherichia coli was the leading Gram-negative pathogen, representing 19.2% (95% CI 15.6% to 23.4%) of early and 7.3% (95% CI 5.3% to 10.1%) of all late-onset bacteraemia; Klebsiella spp were the next most common cause (5.3%) of late-onset bacteraemia. In LMIC, Klebsiella spp caused 16.4% (95% CI 11.5% to 22.7%) of early and 15.0% (95% CI 10.1% to 21.8%) of late-onset bacteraemia, followed by E. coli (early-onset 7.50%, 95% CI 4.98% to 11.1%; late-onset 6.53%, 95% CI 4.50% to 9.39%) and Pseudomonas spp (early-onset 3.93%, 95% CI 2.04% to 7.44%; late-onset 2.81%, 95% CI 1.99% to 3.95%). CONCLUSION E. coli, Klebsiella and Pseudomonas spp cause 20%-28% of early-onset infant bacteraemia and 14% cases of infant meningitis worldwide. Implementation of preventive measures could reduce the high incidence of Gram-negative bacteraemia in LMIC. PROSPERO REGISTRATION NUMBER CRD42020191618.
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Affiliation(s)
- Luisa K Hallmaier-Wacker
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
| | - Amelia Andrews
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
| | - Olisaeloka Nsonwu
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
| | - Alicia Demirjian
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
- Evelina London Children's Hospital, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Russell J Hope
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
| | - Theresa Lamagni
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
| | - Simon M Collin
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, UK Health Security Agency (UKHSA), London, UK
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32
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Dabrera G, Allen H, Zaidi A, Flannagan J, Twohig K, Thelwall S, Marchant E, Aziz NA, Lamagni T, Myers R, Charlett A, Capelastegui F, Chudasama D, Clare T, Coukan F, Sinnathamby M, Ferguson N, Hopkins S, Chand M, Hope R, Kall M. Assessment of mortality and hospital admissions associated with confirmed infection with SARS-CoV-2 Alpha variant: a matched cohort and time-to-event analysis, England, October to December 2020. Euro Surveill 2022; 27:2100377. [PMID: 35593163 PMCID: PMC9121661 DOI: 10.2807/1560-7917.es.2022.27.20.2100377] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BackgroundThe emergence of the SARS-CoV-2 Alpha variant in England coincided with a rapid increase in the number of PCR-confirmed COVID-19 cases in areas where the variant was concentrated.AimOur aim was to assess whether infection with Alpha was associated with more severe clinical outcomes than the wild type.MethodsLaboratory-confirmed infections with genomically sequenced SARS-CoV-2 Alpha and wild type between October and December 2020 were linked to routine healthcare and surveillance datasets. We conducted two statistical analyses to compare the risk of hospital admission and death within 28 days of testing between Alpha and wild-type infections: a matched cohort study and an adjusted Cox proportional hazards model. We assessed differences in disease severity by comparing hospital admission and mortality, including length of hospitalisation and time to death.ResultsOf 63,609 COVID-19 cases sequenced in England between October and December 2020, 6,038 had the Alpha variant. In the matched cohort analysis, we matched 2,821 cases with Alpha to 2,821 to cases with wild type. In the time-to-event analysis, we observed a 34% increased risk in hospitalisation associated with Alpha compared with wild type, but no significant difference in the risk of mortality.ConclusionWe found evidence of increased risk of hospitalisation after adjusting for key confounders, suggesting increased infection severity associated with the Alpha variant. Rapid assessments of the relative morbidity in terms of clinical outcomes and mortality associated with emerging SARS-CoV-2 variants compared with dominant variants are required to assess overall impact of SARS-CoV-2 mutations.
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Affiliation(s)
- Gavin Dabrera
- National Infection Service, Public Health England, London, United Kingdom
| | - Hester Allen
- National Infection Service, Public Health England, London, United Kingdom
| | - Asad Zaidi
- National Infection Service, Public Health England, London, United Kingdom
| | - Joe Flannagan
- National Infection Service, Public Health England, London, United Kingdom
| | - Katherine Twohig
- National Infection Service, Public Health England, London, United Kingdom
| | - Simon Thelwall
- National Infection Service, Public Health England, London, United Kingdom
| | - Elizabeth Marchant
- National Infection Service, Public Health England, London, United Kingdom
| | - Nurin Abdul Aziz
- National Infection Service, Public Health England, London, United Kingdom
| | - Theresa Lamagni
- National Infection Service, Public Health England, London, United Kingdom
| | - Richard Myers
- National Infection Service, Public Health England, London, United Kingdom
| | - André Charlett
- National Infection Service, Public Health England, London, United Kingdom
| | | | - Dimple Chudasama
- National Infection Service, Public Health England, London, United Kingdom
| | - Tom Clare
- National Infection Service, Public Health England, London, United Kingdom
| | - Flavien Coukan
- National Infection Service, Public Health England, London, United Kingdom
| | - Mary Sinnathamby
- National Infection Service, Public Health England, London, United Kingdom
| | - Neil Ferguson
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute for Disease and Emergency Analytics, Imperial College London, St Mary's Campus, London, United Kingdom
| | - Susan Hopkins
- National Infection Service, Public Health England, London, United Kingdom
| | - Meera Chand
- National Infection Service, Public Health England, London, United Kingdom
| | - Russell Hope
- National Infection Service, Public Health England, London, United Kingdom
| | - Meaghan Kall
- National Infection Service, Public Health England, London, United Kingdom
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- https://www.cogconsortium.uk
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33
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Cordery R, Purba AK, Begum L, Mills E, Mosavie M, Vieira A, Jauneikaite E, Leung RCY, Siggins MK, Ready D, Hoffman P, Lamagni T, Sriskandan S. Frequency of transmission, asymptomatic shedding, and airborne spread of Streptococcus pyogenes in schoolchildren exposed to scarlet fever: a prospective, longitudinal, multicohort, molecular epidemiological, contact-tracing study in England, UK. Lancet Microbe 2022; 3:e366-e375. [PMID: 35544097 PMCID: PMC9042792 DOI: 10.1016/s2666-5247(21)00332-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite recommendations regarding prompt treatment of cases and enhanced hygiene measures, scarlet fever outbreaks increased in England between 2014 and 2018. We aimed to assess the effects of standard interventions on transmission of Streptococcus pyogenes to classroom contacts, households, and classroom environments to inform future guidance. METHODS We did a prospective, longitudinal, multicohort, molecular epidemiological, contact-tracing study in six settings across five schools in Greater London, UK. Schools and nurseries were eligible to participate if they had reported two cases of scarlet fever within 10 days of each other among children aged 2-8 years from the same class, with the most recent case arising in the preceding 48 h. We cultured throat swabs from children with scarlet fever, classroom contacts, and household contacts at four timepoints. We also cultured hand swabs and cough plates from all cases in years 1 and 2 of the study, and from classroom contacts in year 2. Surface swabs from toys and other fomites in classrooms were cultured in year 1, and settle plates from classrooms were collected in year 2. Any sample with S pyogenes detected was recorded as positive and underwent emm genotyping and genome sequencing to compare with the outbreak strain. FINDINGS Six classes, comprising 12 cases of scarlet fever, 17 household contacts, and 278 classroom contacts were recruited between March 1 and May 31, 2018 (year 1), and between March 1 and May 31, 2019 (year 2). Asymptomatic throat carriage of the outbreak strains increased from 11 (10%) of 115 swabbed children in week 1, to 34 (27%) of 126 in week 2, to 26 (24%) of 108 in week 3, and then five (14%) of 35 in week 4. Compared with carriage of outbreak S pyogenes strains, colonisation with non-outbreak and non-genotyped S pyogenes strains occurred in two (2%) of 115 swabbed children in week 1, five (4%) of 126 in week 2, six (6%) of 108 in week 3, and in none of the 35 children in week 4 (median carriage for entire study 2·8% [IQR 0·0-6·6]). Genome sequencing showed clonality of outbreak isolates within each of six classes, confirming that recent transmission accounted for high carriage. When transmissibility was tested, one (9%) of 11 asymptomatic carriers of emm4 and five (36%) of 14 asymptomatic carriers of emm3.93 had a positive cough plate. The outbreak strain was identified in only one (2%) of 60 surface swabs taken from three classrooms; however, in the two classrooms with settle plates placed in elevated locations, two (17%) of 12 and six (50%) of 12 settle plates yielded the outbreak strain. INTERPRETATION Transmission of S pyogenes in schools is intense and might occur before or despite reported treatment of cases, underlining a need for rapid case management. Despite guideline adherence, heavy shedding of S pyogenes by few classroom contacts might perpetuate outbreaks, and airborne transmission has a plausible role in its spread. These findings highlight the need for research to improve understanding and to assess effectiveness of interventions to reduce airborne transmission of S pyogenes. FUNDING Action Medical Research, UK Research Innovation, and National Institute for Health Research.
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Affiliation(s)
- Rebecca Cordery
- London Health Protection Teams, Public Health England, London, UK
| | - Amrit K Purba
- London Health Protection Teams, Public Health England, London, UK
| | - Lipi Begum
- London Health Protection Teams, Public Health England, London, UK
| | - Ewurabena Mills
- Department of Infectious Disease, Imperial College London, London, UK
| | - Mia Mosavie
- Department of Infectious Disease, Imperial College London, London, UK,NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Ana Vieira
- Department of Infectious Disease, Imperial College London, London, UK,NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK,MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK
| | - Elita Jauneikaite
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK,MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK,Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Rhoda C Y Leung
- Department of Infectious Disease, Imperial College London, London, UK
| | - Matthew K Siggins
- Department of Infectious Disease, Imperial College London, London, UK,MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK
| | - Derren Ready
- National Infection Service, Public Health England, London, UK,NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Peter Hoffman
- National Infection Service, Public Health England, London, UK
| | - Theresa Lamagni
- National Infection Service, Public Health England, London, UK,NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK.
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Nabarro LE, Brown CS, Balasegaram S, Decraene V, Elston J, Kapadia S, Harrington P, Hoffman P, Mearkle R, Patel B, Ready D, Robinson E, Lamagni T. Invasive Group A Streptococcus Outbreaks Associated with Home Healthcare, England, 2018-2019. Emerg Infect Dis 2022; 28. [PMID: 35451366 PMCID: PMC9045425 DOI: 10.3201/eid2805.211497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
emm typing and whole-genome sequencing can help identify case clusters. Healthcare-associated invasive group A Streptococcus (iGAS) outbreaks are common worldwide, but only England has reported outbreaks associated with home healthcare (HHC). We describe 10 outbreaks during 2018–2019 in England. A total of 96 iGAS cases (range 2–39 per outbreak) and 28 deaths (case-fatality rate 29%) occurred. Outbreak duration ranged from 3–517 days; median time between sequential cases was 20.5 days (range 1–225 days). Outbreak identification was difficult, but emm typing and whole-genome sequencing improved detection. Network analyses indicated multiple potential transmission routes. Screening of 366 HHC workers from 9 outbreaks identified group A Streptococcus carriage in just 1 worker. Outbreak control required multiple interventions, including improved infection control, equipment decontamination, and antimicrobial prophylaxis for staff. Transmission routes and effective interventions are not yet clear, and iGAS outbreaks likely are underrecognized. To improve patient safety and reduce deaths, public health agencies should be aware of HHC-associated iGAS.
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35
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Davies HG, O'Sullivan CP, Al Janabi H, Rattue H, Trotter C, Mary Ramsay KG, Ladhani S, Lamagni T, Okike IO, Le Doare K, Heath PT. Comparison of neurodevelopmental outcomes in children with GBS Sepsis and Meningitis. Clin Infect Dis 2022; 75:922-923. [PMID: 35443067 DOI: 10.1093/cid/ciac318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hannah G Davies
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Catherine P O'Sullivan
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Hareth Al Janabi
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Hilary Rattue
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Caroline Trotter
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | | | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Theresa Lamagni
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Ifeanyichukwu O Okike
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St. George's, University of London, London, U.K
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36
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Moore HC, Cannon JW, Kaslow DC, Lamagni T, Bowen AC, Miller KM, Cherian T, Carapetis J, Van Beneden C. A systematic framework for prioritising burden of disease data required for vaccine development and implementation: the case for group A streptococcal diseases. Clin Infect Dis 2022; 75:1245-1254. [PMID: 35438130 PMCID: PMC9525082 DOI: 10.1093/cid/ciac291] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/16/2021] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
Vaccine development and implementation decisions need to be guided by accurate and robust burden of disease data. We developed an innovative systematic framework outlining the properties of such data that are needed to advance vaccine development and evaluation, and prioritize research and surveillance activities. We focus on 4 objectives—advocacy, regulatory oversight and licensure, policy and post-licensure evaluation, and post-licensure financing—and identify key stakeholders and specific requirements for burden of disease data aligned with each objective. We apply this framework to group A Streptococcus, a pathogen with an underrecognized global burden, and give specific examples pertinent to 8 clinical endpoints. This dynamic framework can be adapted for any disease with a vaccine in development and can be updated as vaccine candidates progress through clinical trials. This framework will also help with research and innovation priority setting of the Immunization Agenda 2030 (IA2030) and accelerate development of future vaccines.
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Affiliation(s)
- Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Western Australia, Australia
| | - Kate M Miller
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Western Australia, Australia
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37
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Vusirikala A, Flannagan J, Czachorowski M, Zaidi A, Twohig KA, Plugge E, Ellaby N, Rice W, Dabrera G, Chudasama DY, Lamagni T. Impact of SARS-CoV-2 Alpha variant (B.1.1.7) on prisons, England. Public Health 2022; 204:21-24. [PMID: 35131679 PMCID: PMC8712265 DOI: 10.1016/j.puhe.2021.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Amoolya Vusirikala
- National Infection Service, UK Health Security Agency, Colindale, London NW9 5EQ, UK.
| | - Joe Flannagan
- National Infection Service, UK Health Security Agency, Colindale, London NW9 5EQ, UK
| | - Maciej Czachorowski
- National Health and Justice Team, UK Health Security Agency, Wellington House, London SE1 8UG, UK
| | - Asad Zaidi
- National Infection Service, UK Health Security Agency, Colindale, London NW9 5EQ, UK
| | - Kate A Twohig
- National Infection Service, UK Health Security Agency, Colindale, London NW9 5EQ, UK
| | - Emma Plugge
- National Health and Justice Team, UK Health Security Agency, Wellington House, London SE1 8UG, UK
| | - Nicholas Ellaby
- National Infection Service, UK Health Security Agency, Colindale, London NW9 5EQ, UK
| | - Wendy Rice
- National Infection Service, UK Health Security Agency, Colindale, London NW9 5EQ, UK
| | - Gavin Dabrera
- National Infection Service, UK Health Security Agency, Colindale, London NW9 5EQ, UK
| | - Dimple Y Chudasama
- National Infection Service, UK Health Security Agency, Colindale, London NW9 5EQ, UK
| | - Theresa Lamagni
- National Infection Service, UK Health Security Agency, Colindale, London NW9 5EQ, UK
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38
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Chudasama DY, Milbourn H, Nsonwu O, Senyah F, Florence I, Cook B, Marchant E, Blomquist PB, Flannagan J, Dabrera G, Lewis J, Lamagni T. Penetration and impact of COVID-19 in long term care facilities in England: population surveillance study. Int J Epidemiol 2022; 50:1804-1813. [PMID: 34999883 DOI: 10.1093/ije/dyab176] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Long-term care facilities (LTCF) worldwide have suffered high rates of COVID-19, reflecting the vulnerability of the persons who live there and the institutional nature of care delivered. This study describes the impact of the pandemic on incidences and deaths in LTCF across England. METHODS Laboratory-confirmed SARS-CoV-2 cases in England, notified to Public Health England from 01 Jan to 25 Dec 2020, were address-matched to an Ordnance Survey reference database to identify residential property classifications. Data were analysed to characterize cases and identify clusters. Associated deaths were defined as death within 60 days of diagnosis or certified as cause of death. RESULTS Of 1 936 315 COVID-19 cases, 81 275 (4.2%) and 10 050 (0.52%) were identified as resident or staff in an LTCF, respectively, with 20 544 associated deaths in residents, accounting for 31.3% of all COVID-19 deaths. Cases were identified in 69.5% of all LTCFs in England, with 33.1% experiencing multiple outbreaks. Multivariable analysis showed a 67% increased odds of death in residents [adjusted odds ratio (aOR): 1.67, 95% confidence interval (CI): 1.63-1.72], compared with those not residing in LTCFs. A total of 10 321 outbreaks were identified at these facilities, of which 8.2% identified the first case as a staff member. CONCLUSIONS Over two-thirds of LTCFs have experienced large and widespread outbreaks of COVID-19, and just under one-third of all COVID-19 deaths occurring in this setting in spite of early policies. A key implication of our findings is upsurges in community incidences seemingly leading to increased outbreaks in LTCFs; thus, identifying and shielding residents from key sources of infection are vital to reduce the number of future outbreaks.
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Affiliation(s)
- Dimple Y Chudasama
- Epidemiology Cell, National Infection Service, Public Health England, London, UK
| | - Hannah Milbourn
- Epidemiology Cell, National Infection Service, Public Health England, London, UK
| | - Olisaeloka Nsonwu
- Epidemiology Cell, National Infection Service, Public Health England, London, UK
| | - Francis Senyah
- Geospatial Information Systems (GIS), National Infection Service, Public Health England, London, UK
| | - Isaac Florence
- Epidemiology Cell, National Infection Service, Public Health England, London, UK
| | - Bryony Cook
- Geospatial Information Systems (GIS), National Infection Service, Public Health England, London, UK
| | - Elizabeth Marchant
- Epidemiology Cell, National Infection Service, Public Health England, London, UK
| | | | - Joe Flannagan
- Epidemiology Cell, National Infection Service, Public Health England, London, UK
| | - Gavin Dabrera
- Epidemiology Cell, National Infection Service, Public Health England, London, UK
| | - James Lewis
- Geospatial Information Systems (GIS), National Infection Service, Public Health England, London, UK
| | - Theresa Lamagni
- Epidemiology Cell, National Infection Service, Public Health England, London, UK
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39
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Allen H, Vusirikala A, Flannagan J, Twohig KA, Zaidi A, Chudasama D, Lamagni T, Groves N, Turner C, Rawlinson C, Lopez-Bernal J, Harris R, Charlett A, Dabrera G, Kall M. Household transmission of COVID-19 cases associated with SARS-CoV-2 delta variant (B.1.617.2): national case-control study. Lancet Reg Health Eur 2022; 12:100252. [PMID: 34729548 PMCID: PMC8552812 DOI: 10.1016/j.lanepe.2021.100252] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The SARS-CoV-2 Delta variant (B.1.617.2), first detected in India, has rapidly become the dominant variant in England. Early reports suggest this variant has an increased growth rate suggesting increased transmissibility. This study indirectly assessed differences in transmissibility between the emergent Delta variant compared to the previously dominant Alpha variant (B.1.1.7). METHODS A matched case-control study was conducted to estimate the odds of household transmission (≥ 2 cases within 14 days) for Delta variant index cases compared with Alpha cases. Cases were derived from national surveillance data (March to June 2021). One-to-two matching was undertaken on geographical location of residence, time period of testing and property type, and a multivariable conditional logistic regression model was used for analysis. FINDINGS In total 5,976 genomically sequenced index cases in household clusters were matched to 11,952 sporadic index cases (single case within a household). 43.3% (n=2,586) of cases in household clusters were confirmed Delta variant compared to 40.4% (n= 4,824) of sporadic cases. The odds ratio of household transmission was 1.70 among Delta variant cases (95% CI 1.48-1.95, p <0.001) compared to Alpha cases after adjusting for age, sex, ethnicity, index of multiple deprivation (IMD), number of household contacts and vaccination status of index case. INTERPRETATION We found evidence of increased household transmission of SARS-CoV-2 Delta variant, potentially explaining its success at displacing Alpha variant as the dominant strain in England. With the Delta variant now having been detected in many countries worldwide, the understanding of the transmissibility of this variant is important for informing infection prevention and control policies internationally.
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Affiliation(s)
| | | | - Joe Flannagan
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Katherine A. Twohig
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Asad Zaidi
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Dimple Chudasama
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Theresa Lamagni
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Natalie Groves
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Charlie Turner
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | | | - Jamie Lopez-Bernal
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Ross Harris
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Andre Charlett
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Gavin Dabrera
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Meaghan Kall
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
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Herdman MT, Cordery R, Karo B, Purba AK, Begum L, Lamagni T, Kee C, Balasegaram S, Sriskandan S. Clinical management and impact of scarlet fever in the modern era: findings from a cross-sectional study of cases in London, 2018-2019. BMJ Open 2021; 11:e057772. [PMID: 34952887 PMCID: PMC9066343 DOI: 10.1136/bmjopen-2021-057772] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/25/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In response to increasing incidence of scarlet fever and wider outbreaks of group A streptococcal infections in London, we aimed to characterise the epidemiology, symptoms, management and consequences of scarlet fever, and to identify factors associated with delayed diagnosis. DESIGN AND SETTING Cross-sectional community-based study of children with scarlet fever notified to London's three Health Protection Teams, 2018-2019. PARTICIPANTS From 2575 directly invited notified cases plus invitations via parental networks at 410 schools/nurseries with notified outbreaks of confirmed/probable scarlet fever, we received 477 responses (19% of those directly invited), of which 412 met the case definition. Median age was 4 years (range <1 to 16), 48% were female, and 70% were of white ethnicity. OUTCOME MEASURES Preplanned measures included quantitative description of case demographics, symptoms, care-seeking, and clinical, social, and economic impact on cases and households. After survey completion, secondary analyses of factors associated with delayed diagnosis (by logistic regression) and consequences of delayed diagnosis (by Cox's regression), and qualitative analysis of free text comments were added. RESULTS Rash was reported for 89% of cases, but followed onset of other symptoms for 71%, with a median 1-day delay. Pattern of onset varied with age: sore throat was more common at onset among children 5 years and older (OR3.1, 95% CI 1.9 to 5.0). At first consultation, for 28%, scarlet fever was not considered: in these cases, symptoms were frequently attributed to viral infection (60%, 64/106). Delay in diagnosis beyond first consultation occurred more frequently among children aged 5+ who presented with sore throat (OR 2.8 vs 5+without sore throat; 95% CI 1.3 to 5.8). Cases with delayed diagnosis took, on average, 1 day longer to return to baseline activities. CONCLUSIONS Scarlet fever may be initially overlooked, especially among older children presenting with sore throat. Raising awareness among carers and practitioners may aid identification and timely treatment.
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Affiliation(s)
- Michael Trent Herdman
- National Infection Service, Public Health England (now UK Health Security Agency), London, UK
- UK Field Epidemiology Training Programme, Public Health England (now UK Health Security Agency), London, UK
| | - Rebecca Cordery
- South London Health Protection Team, Public Health England (now UK Health Security Agency), London, UK
| | - Basel Karo
- National Infection Service, Public Health England (now UK Health Security Agency), London, UK
| | - Amrit Kaur Purba
- South London Health Protection Team, Public Health England (now UK Health Security Agency), London, UK
| | - Lipi Begum
- South London Health Protection Team, Public Health England (now UK Health Security Agency), London, UK
| | - Theresa Lamagni
- National Infection Service, Public Health England (now UK Health Security Agency), London, UK
| | - Chuin Kee
- Oak Lodge Medical Centre, Barnet, North Central London CCG, London, UK
| | - Sooria Balasegaram
- National Infection Service, Public Health England (now UK Health Security Agency), London, UK
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Healthcare-associated infection and AMR, Imperial College London, London, UK
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK
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Chudasama DY, Tessier E, Flannagan J, Leeman D, Webster H, Demirjian A, Falconer C, Thelwall S, Kall M, Saliba V, Ramsay M, Dabrera G, Lamagni T. Surge in SARS-CoV-2 transmission in school-aged children and household contacts, England, August to October 2021. Euro Surveill 2021; 26. [PMID: 34857070 PMCID: PMC8641067 DOI: 10.2807/1560-7917.es.2021.26.48.2101019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Easing of COVID-19 restrictions in England in the summer of 2021 was followed by a sharp rise in cases among school-aged children. Weekly rates of SARS-CoV-2 infection in primary and secondary school children reached 733.3 and 1,664.7/100,000 population, respectively, by week 39 2021. A surge in household clusters with school-aged index cases was noted at the start of the school term, with secondary cases predominantly in children aged 5–15 years and adults aged 30–49 years.
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Affiliation(s)
- Dimple Y Chudasama
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Elise Tessier
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Joe Flannagan
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - David Leeman
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Harriet Webster
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Alicia Demirjian
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom.,Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, United Kingdom.,Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Catherine Falconer
- Clinical & Public Health, Young People Cell, UK Health Security Agency, London, United Kingdom
| | - Simon Thelwall
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Meaghan Kall
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Vanessa Saliba
- Surveillance Cell, UK Health Security Agency, London, United Kingdom
| | - Mary Ramsay
- Surveillance Cell, UK Health Security Agency, London, United Kingdom
| | - Gavin Dabrera
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Theresa Lamagni
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
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42
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Lamagni T, Wloch C, Broughton K, Collin SM, Chalker V, Coelho J, Ladhani SN, Brown CS, Shetty N, Johnson AP. Assessing the added value of group B Streptococcus maternal immunisation in preventing maternal infection and fetal harm: population surveillance study. BJOG 2021; 129:233-240. [PMID: 34324252 PMCID: PMC9291181 DOI: 10.1111/1471-0528.16852] [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: 02/04/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the incidence of maternal group B Streptococcus (GBS) infection in England. DESIGN Population surveillance augmented through data linkage. SETTING England. POPULATION All pregnant women accessing the National Health Service (NHS) in England. METHODS Invasive GBS (iGBS) infections during pregnancy or within 6 weeks of childbirth were identified by linking Public Health England (PHE) national microbiology surveillance data for 2014 to NHS hospital admission records. Capsular serotypes of GBS were determined by reference laboratory typing of clinical isolates from women aged 15-44 years. Post-caesarean section surgical site infection (SSI) caused by GBS was identified in 21 hospitals participating in PHE SSI surveillance (2009-2015). MAIN OUTCOME MEASURES iGBS rate per 1000 maternities; risk of GBS SSI per 1000 caesarean sections. RESULTS Of 1601 patients diagnosed with iGBS infections in England in 2014, 185 (12%) were identified as maternal infections, a rate of 0.29 (95% CI 0.25-0.33) per 1000 maternities and representing 83% of all iGBS cases in women aged 18-44 years. Seven (3.8%) were associated with miscarriage. Fetal outcome identified excess rates of stillbirth (3.4 versus 0.5%) and extreme prematurity (<28 weeks of gestation, 3.7 versus 0.5%) compared with national averages (P < 0.001). Caesarean section surveillance in 27 860 women (21 hospitals) identified 47 cases of GBS SSI, with an estimated 4.24 (3.51-5.07) per 1000 caesarean sections, a median time-to-onset of 10 days (IQR 7-13 days) and ten infections that required readmission. Capsular serotype analysis identified a diverse array of strains with serotype III as the most common (43%). CONCLUSIONS Our assessment of maternal GBS infection in England indicates the potential additional benefit of GBS vaccination in preventing adverse maternal and fetal outcomes.
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Affiliation(s)
- T Lamagni
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - C Wloch
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - K Broughton
- Respiratory and Vaccine Preventable Reference Unit, Bacteriology Reference Department, National Infection Service, Public Health England, London, UK
| | - S M Collin
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - V Chalker
- Respiratory and Vaccine Preventable Reference Unit, Bacteriology Reference Department, National Infection Service, Public Health England, London, UK
| | - J Coelho
- Respiratory and Vaccine Preventable Reference Unit, Bacteriology Reference Department, National Infection Service, Public Health England, London, UK
| | - S N Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - C S Brown
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - N Shetty
- Respiratory and Vaccine Preventable Reference Unit, Bacteriology Reference Department, National Infection Service, Public Health England, London, UK
| | - A P Johnson
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
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43
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Rice WM, Chudasama DY, Lewis J, Senyah F, Florence I, Thelwall S, Glaser L, Czachorowski M, Plugge E, Kirkbride H, Dabrera G, Lamagni T. Epidemiology of COVID-19 in Prisons, England, 2020. Emerg Infect Dis 2021; 27:2183-2186. [PMID: 34287123 PMCID: PMC8314811 DOI: 10.3201/eid2708.204920] [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: 12/01/2022] Open
Abstract
Using laboratory data and a novel address matching methodology, we identified 734 cases of coronavirus disease in 88 prisons in England during March 16–October 12, 2020. An additional 412 cases were identified in prison staff and household members. We identified 84 prison outbreaks involving 86% of all prison-associated cases.
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44
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Newton JN, Griffiths C, Fitzpatrick J, Lamagni T, Campos-Matos I. Sex-disaggregated data is reported by Public Health England. Lancet Glob Health 2021; 9:e1059. [PMID: 34174186 PMCID: PMC8443002 DOI: 10.1016/s2214-109x(21)00249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
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45
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Brown AE, Heinsbroek E, Kall MM, Allen H, Beebeejaun K, Blomquist P, Campos-Matos I, Campbell CNJ, Mohammed H, Sinka K, Lamagni T, Phin N, Dabrera G. Epidemiology of Confirmed COVID-19 Deaths in Adults, England, March-December 2020. Emerg Infect Dis 2021; 27:1468-1471. [PMID: 33900176 PMCID: PMC8084521 DOI: 10.3201/eid2705.203524] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/21/2022] Open
Abstract
Of the 58,186 coronavirus deaths among adults in England during March–December 2020, 77% occurred in hospitals, 93% were in patients >60 years, and 91% occurred within 28 days of positive specimen. Cumulative mortality rates were highest among persons of Black, Asian, other, or mixed ethnicities and in socioeconomically deprived areas.
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46
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Abstract
During 2015–2016, a total of 3,156 episodes of invasive group B Streptococcus (iGBS) infection in adults (>15 years of age) were recorded in England, corresponding to an annual incidence of 3.48/100,000 population. iGBS incidence was highest in older patients and women of childbearing age. The 493 pregnancy-related iGBS episodes correspond to a rate of 1.34/10,000 live births. In adults up to 60–69 years of age and in pregnant women, iGBS incidence increased with higher levels of socioeconomic deprivation. Hospital admissions associated with iGBS were predominantly emergency admissions (73% [2,260/3,099]); only 7% of nonpregnancy iGBS diagnoses were made >48 hours after admission. Underlying conditions were highly prevalent in nonpregnant adult case-patients, including cardiovascular (57%), lung (43%), and kidney (45%) disease and diabetes (40%). Post-iGBS episode 30-day and 12-month all-cause mortality rates in nonpregnant adults were 12% and 24%, respectively. No pregnancy-related iGBS deaths were identified.
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47
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Freudenhammer M, Karampatsas K, Le Doare K, Lander F, Armann J, Acero Moreno D, Boyle M, Buxmann H, Campbell R, Chalker V, Cunney R, Doherty L, Davies E, Efstratiou A, Elling R, Endmann M, Essers J, Hentschel R, Jones CE, Kallsen S, Kapatai G, Krüger M, Ladhani S, Lamagni T, Lindsay D, Meehan M, O'Sullivan CP, Patel D, Reynolds AJ, Roll C, Schulzke S, Smith A, Stein A, von der Wense A, Voss E, Wieg C, Härtel C, Heath PT, Henneke P. Invasive Group B Streptococcus Disease With Recurrence and in Multiples: Towards a Better Understanding of GBS Late-Onset Sepsis. Front Immunol 2021; 12:617925. [PMID: 34149682 PMCID: PMC8208644 DOI: 10.3389/fimmu.2021.617925] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/15/2020] [Accepted: 05/04/2021] [Indexed: 01/30/2023] Open
Abstract
Group B Streptococcus (GBS) is a common intestinal colonizer during the neonatal period, but also may cause late-onset sepsis or meningitis in up to 0.5% of otherwise healthy colonized infants after day 3 of life. Transmission routes and risk factors of this late-onset form of invasive GBS disease (iGBS) are not fully understood. Cases of iGBS with recurrence (n=25) and those occurring in parallel in twins/triplets (n=32) from the UK and Ireland (national surveillance study 2014/15) and from Germany and Switzerland (retrospective case collection) were analyzed to unravel shared (in affected multiples) or fixed (in recurrent disease) risk factors for GBS disease. The risk of iGBS among infants from multiple births was high (17%), if one infant had already developed GBS disease. The interval of onset of iGBS between siblings was 4.5 days and in recurrent cases 12.5 days. Disturbances of the individual microbiome, including persistence of infectious foci are suggested e.g. by high usage of perinatal antibiotics in mothers of affected multiples, and by the association of an increased risk of recurrence with a short term of antibiotics [aOR 4.2 (1.3-14.2), P=0.02]. Identical GBS serotypes in both recurrent infections and concurrently infected multiples might indicate a failed microbiome integration of GBS strains that are generally regarded as commensals in healthy infants. The dynamics of recurrent GBS infections or concurrent infections in multiples suggest individual patterns of exposure and fluctuations in host immunity, causing failure of natural niche occupation.
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Affiliation(s)
- Mirjam Freudenhammer
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,IMM-PACT Clinician Scientist Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Konstantinos Karampatsas
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Fabian Lander
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany
| | - Jakob Armann
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany
| | - Daniel Acero Moreno
- Department of Neonatology, Kinderkrankenhaus Amsterdamer Straße, Cologne, Germany
| | - Margaret Boyle
- Department of Health Northern Ireland, Belfast, United Kingdom
| | - Horst Buxmann
- Department of Pediatric and Adolescent Medicine, Division for Neonatology at the University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Ruth Campbell
- Public Health Agency Northern Ireland, Belfast, United Kingdom
| | - Victoria Chalker
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
| | - Robert Cunney
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland.,Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland
| | | | | | | | - Roland Elling
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Endmann
- Department of Pediatric and Adolescent Medicine, St. Franziskus Hospital Ahlen, Ahlen, Germany
| | - Jochen Essers
- Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Roland Hentschel
- Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Steffen Kallsen
- Department of Paediatrics and Youth Medicine, Klinikum Friedrichshafen, Friedrichshafen, Germany
| | - Georgia Kapatai
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
| | - Marcus Krüger
- Department of Neonatology, München Klinik Harlaching and Schwabing, Munich, Germany
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom.,Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Theresa Lamagni
- National Infection Service, Public Health England, London, United Kingdom
| | - Diane Lindsay
- Scottish Microbiology Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Mary Meehan
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland
| | - Catherine P O'Sullivan
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Darshana Patel
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | | | - Claudia Roll
- Department of Neonatology, Vest Children's Hospital Datteln, University Witten-Herdecke, Witten-Herdecke, Germany
| | - Sven Schulzke
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Andrew Smith
- Scottish Microbiology Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom.,Glasgow Dental Hospital and School, University of Glasgow, Glasgow, United Kingdom
| | - Anja Stein
- Department of Pediatrics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Axel von der Wense
- Neonatology and Pediatric Intensive Care, Altonaer Children's Hospital, Altonaer Kinderkrankenhaus, Hamburg, Germany
| | - Egbert Voss
- Klinik Hallerwiese-Cnopfsche Kinderklinik, Nürnberg, Germany
| | - Christian Wieg
- Department of Neonatology, Klinikum Aschaffenburg, Aschaffenburg, Germany
| | - Christoph Härtel
- Department of Pediatrics, University of Würzburg, Würzburg, Germany.,PRIMAL (Priming Immunity at the Beginning of Life) Consortium, Freiburg/Lübeck, Germany
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Philipp Henneke
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,PRIMAL (Priming Immunity at the Beginning of Life) Consortium, Freiburg/Lübeck, Germany
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48
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Collin SM, Groves N, O'Sullivan C, Jauneikaite E, Patel D, Cunney R, Meehan M, Reynolds A, Smith A, Lindsay D, Doherty L, Davies E, Chalker V, Lamb P, Afshar B, Balasegaram S, Coelho J, Ready D, Brown CS, Efstratiou A, Le Doare K, Sriskandan S, Heath PT, Lamagni T. Uncovering Infant Group B Streptococcal (GBS) Disease Clusters in the United Kingdom and Ireland Through Genomic Analysis: A Population-based Epidemiological Study. Clin Infect Dis 2021; 72:e296-e302. [PMID: 32766850 DOI: 10.1093/cid/ciaa1087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 04/23/2020] [Accepted: 07/28/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The true frequency of hospital outbreaks of invasive group B streptococcal (iGBS; Streptococcus agalactiae) disease in infants is unknown. We used whole genome sequencing (WGS) of iGBS isolates collected during a period of enhanced surveillance of infant iGBS disease in the UK and Ireland to determine the number of clustered cases. METHODS Potentially linked iGBS cases from infants with early (<7 days of life) or late-onset (7-89 days) disease were identified from WGS data (HiSeq 2500 platform, Illumina) from clinical sterile site isolates collected between 04/2014 and 04/2015. We assessed time and place of cases to determine a single-nucleotide polymorphism (SNP) difference threshold for clustered cases. Case details were augmented through linkage to national hospital admission data and hospital record review by local microbiologists. RESULTS Analysis of sequences indicated a cutoff of ≤5 SNP differences to define iGBS clusters. Among 410 infant iGBS isolates, we identified 7 clusters (4 genetically identical pairs with 0 SNP differences, 1 pair with 3 SNP differences, 1 cluster of 4 cases with ≤1 SNP differences) of which 4 clusters were uncovered for the first time. The clusters comprised 16 cases, of which 15 were late-onset (of 192 late-onset cases with sequenced isolates) and 1 an early-onset index case. Serial intervals between cases ranged from 0 to 59 (median 12) days. CONCLUSIONS Approximately 1 in 12 late-onset infant iGBS cases were part of a hospital cluster. Over half of the clusters were previously undetected, emphasizing the importance of routine submission of iGBS isolates to reference laboratories for cluster identification and genomic confirmation.
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Affiliation(s)
- Simon M Collin
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI & AMR) Division, National Infection Service, Public Health England, London, United Kingdom
| | - Natalie Groves
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Catherine O'Sullivan
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom
| | - Elita Jauneikaite
- NIHR Health Protection Unit in Healthcare-associated Infections and Antimicrobial Resistance, Imperial College, London, United Kingdom.,Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, United Kingdom
| | - Darshana Patel
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Robert Cunney
- Health Service Executive Health Protection Surveillance Centre, Dublin, Ireland.,Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Mary Meehan
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland
| | | | - Andrew Smith
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, United Kingdom.,Scottish Microbiology Reference Laboratory, Glasgow, United Kingdom
| | - Diane Lindsay
- Scottish Microbiology Reference Laboratory, Glasgow, United Kingdom
| | | | | | - Victoria Chalker
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom.,NIHR Health Protection Unit in Healthcare-associated Infections and Antimicrobial Resistance, Imperial College, London, United Kingdom
| | - Peter Lamb
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI & AMR) Division, National Infection Service, Public Health England, London, United Kingdom
| | - Baharak Afshar
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Sooria Balasegaram
- Field Service, National Infection Service, Public Health England, London, United Kingdom
| | - Juliana Coelho
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Derren Ready
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Colin S Brown
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI & AMR) Division, National Infection Service, Public Health England, London, United Kingdom
| | - Androulla Efstratiou
- NIHR Health Protection Unit in Healthcare-associated Infections and Antimicrobial Resistance, Imperial College, London, United Kingdom.,WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections, National Infection Service, Public Health England, London, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom.,Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Pathogen Immunity Group, Public Health England, Porton Down, United Kingdom
| | - Shiranee Sriskandan
- NIHR Health Protection Unit in Healthcare-associated Infections and Antimicrobial Resistance, Imperial College, London, United Kingdom.,MRC Centre for Molecular Bacteriology & Infection, Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom
| | - Theresa Lamagni
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI & AMR) Division, National Infection Service, Public Health England, London, United Kingdom.,NIHR Health Protection Unit in Healthcare-associated Infections and Antimicrobial Resistance, Imperial College, London, United Kingdom
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Chudasama DY, Flannagan J, Collin SM, Charlett A, Twohig KA, Lamagni T, Dabrera G. Household clustering of SARS-CoV-2 variant of concern B.1.1.7 (VOC-202012-01) in England. J Infect 2021; 83:e26-e28. [PMID: 33933529 PMCID: PMC8085110 DOI: 10.1016/j.jinf.2021.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Dimple Y Chudasama
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK.
| | - Joe Flannagan
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Simon M Collin
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - André Charlett
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Katherine A Twohig
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Theresa Lamagni
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Gavin Dabrera
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
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50
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Aktuerk D, Ali J, Badran A, Balmforth D, Bleetman D, Brown C, Suelo-Calanao R, Cartwright J, Casey L, Chiwera L, Fudulu D, Garner M, Gradinariu G, Harky A, Hussain A, Hutton S, Kew E, Loubani M, Mani K, Martin J, Rochon M, Moawad N, Mohamed S, Muretti M, Murphy G, Olivieri G, Paglinawan I, Quijano-Campos J, Rizzo V, Robertson S, Rogers L, Roman M, Salmon K, Sanders J, Talukder S, Tanner J, Vaja R, Zientara A, Green S, Miles R, Lamagni T, Harrington P. National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland. J Hosp Infect 2020; 106:812-819. [DOI: 10.1016/j.jhin.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
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