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Rodwell EV, Vishram B, Smith R, Browning L, Smith-Palmer A, Allison L, Holmes A, Godbole G, McCarthy N, Dallman TJ, Jenkins C. Epidemiology and genomic analysis of Shiga toxin-producing Escherichia coli clonal complex 165 in the UK. J Med Microbiol 2021; 70. [PMID: 34919511 PMCID: PMC8744276 DOI: 10.1099/jmm.0.001471] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Shiga toxin-producing Escherichia coli (STEC) is a zoonotic, foodborne gastrointestinal pathogen that has the potential to cause severe clinical outcomes, including haemolytic uraemic syndrome (HUS). STEC-HUS is the leading cause of renal failure in children and can be fatal. Over the last decade, STEC clonal complex 165 (CC165) has emerged as a cause of STEC-HUS.Gap Statement. There is a need to understand the pathogenicity and prevalence of this emerging STEC clonal complex in the UK, to facilitate early diagnosis, improve clinical management, and prevent and control outbreaks.Aim. The aim of this study was to characterize CC165 through identification of virulence factors (VFs) and antimicrobial resistance (AMR) determinants in the genome and to integrate the genome data with the available epidemiological data to better understand the incidence and pathogenicity of this clonal complex in the UK.Methodology. All isolates belonging to CC165 in the archives at the UK public health agencies were sequenced and serotyped, and the virulence gene and AMR profiles were derived from the genome using PHE bioinformatics pipelines and the Centre for Genomic Epidemiology virulence database.Results. There were 48 CC165 isolates, of which 43 were STEC, four were enteropathogenic E. coli (EPEC) and one E. coli. STEC serotypes were predominately O80:H2 (n=28), and other serotypes included O45:H2 (n=9), O55:H9 (n=4), O132:H2 (n=1) and O180:H2 (n=1). All but one STEC isolate had Shiga toxin (stx) subtype stx2a or stx2d and 47/48 isolates had the eae gene encoding intimin involved in the intimate attachment of the bacteria to the human gut mucosa. We detected extra-intestinal virulence genes including those associated with iron acquisition (iro) and serum resistance (iss), indicating that this pathogen has the potential to translocate to extra-intestinal sites. Unlike other STEC clonal complexes, a high proportion of isolates (93%, 40/43) were multidrug-resistant, including resistance to aminoglycosides, beta-lactams, chloramphenicol, sulphonamides, tetracyclines and trimethoprim.Conclusion. The clinical significance of this clonal complex should not be underestimated. Exhibiting high levels of AMR and a combination of STEC and extra-intestinal pathogenic E. coli (ExPEC) virulence profiles, this clonal complex is an emerging threat to public health.
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Affiliation(s)
- Ella V Rodwell
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5AT, UK.,Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
| | - Bhavita Vishram
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Robert Smith
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, Wales, UK
| | | | | | - Lesley Allison
- Scottish E. coli O157/STEC Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Anne Holmes
- Scottish E. coli O157/STEC Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Gauri Godbole
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Noel McCarthy
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK.,Public Health and Primary Care, Trinity College, Dublin, Ireland
| | - Timothy J Dallman
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5AT, UK.,NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
| | - Claire Jenkins
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5AT, UK.,NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
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Vishram B, Jenkins C, Greig DR, Godbole G, Carroll K, Balasegaram S, Byrne L. The emerging importance of Shiga toxin-producing Escherichia coli other than serogroup O157 in England. J Med Microbiol 2021; 70. [PMID: 34309502 PMCID: PMC8493422 DOI: 10.1099/jmm.0.001375] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Shiga toxin-producing Escherichia coli (STEC) can cause severe disease and large outbreaks. In England, the incidence and clinical significance of STEC serogroups other than O157 (non-O157) is unknown due to a testing bias for detection of STEC O157. Since 2013, the implementation of PCR to detect all STEC serogroups by an increasing number of diagnostic laboratories has led to an increase in the detection of non-O157 STEC. Hypothesis/Gap statement Due to a bias in testing methodologies to select for STEC serogroup O157 in frontline diagnostic laboratories in most countries, very little surveillance data have been previously generated on non-O157 STEC. Aim Five years (2014–2018) of STEC national surveillance data were extracted and descriptive analysis undertaken to assess disease severity of non-O157 STEC strains. Methods Data from 1 January 2014 to 31 December 2018 were extracted from the National Enhanced Surveillance System for STEC and analysed. Results The implementation of Gastrointestinal Polymerase Chain Reaction (GI-PCR) has resulted in a four-fold increase in the detection of non-O157 STEC cases between 2014 and 2018. There were 2579 cases infected with 97 different non-O157 serogroups. The gender distribution was similar amongst STEC O157 and non-O157 STEC cases with 57 and 56 % of cases being female respectively, but a significantly higher proportion of cases (P <0.001) under 5 years of age was observed among STEC O157 (22 %) cases compared to non-O157 STEC (14 %). The most common non-O157 serogroups were O26 (16 %), O146 (11 %), O91 (10 %), O128 (7 %), O103 (5 %) and O117 (3 %). Overall, rates of bloody diarrhoea were highest in O26 (44 %) and O103 (48 %) cases and lowest in STEC O117 cases (17 %). Strains harbouring Shiga toxin stx1a caused the highest proportion of diarrhoea (93 %) and caused the same level of bloody diarrhoea as stx2a (39 %). However, stx2a caused the highest proportion of vomiting (46 %), hospitalisation (49 %) and considerably more HUS (29 %) than other stx profiles. Conclusion The implementation of PCR targeting stx at diagnostic laboratories has shown that non-O157 STEC, most notably STEC O26, are an emerging risk to public health.
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Affiliation(s)
- Bhavita Vishram
- National Infection Service, Public Health England, London, UK
| | - Claire Jenkins
- National Infection Service, Public Health England, London, UK
| | - David R Greig
- National Infection Service, Public Health England, London, UK.,Division of Infection and Immunity, The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, EH25 9RG, UK
| | - Gauri Godbole
- National Infection Service, Public Health England, London, UK
| | - Kevin Carroll
- PHE South East, Surrey and Sussex HPT, Parkside, Chart Way, Horsham RH12 1XA, UK
| | | | - Lisa Byrne
- National Infection Service, Public Health England, London, UK
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Jenkins C, Byrne L, Vishram B, Sawyer C, Balasegaram S, Ahyow L, Johnson S. Shiga toxin-producing Escherichia coli haemolytic uraemic syndrome (STEC-HUS): diagnosis, surveillance and public-health management in England. J Med Microbiol 2020; 69:1034-1036. [PMID: 32552986 PMCID: PMC7481745 DOI: 10.1099/jmm.0.001215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/20/2020] [Indexed: 01/30/2023] Open
Affiliation(s)
- Claire Jenkins
- National Infection Service, Public Health England, London NW9 5HT, UK
| | - Lisa Byrne
- National Infection Service, Public Health England, London NW9 5HT, UK
| | - Bhavita Vishram
- National Infection Service, Public Health England, London NW9 5HT, UK
| | - Clare Sawyer
- Public Health Wales, Cardiff CF10 4BZ, UK
- Field Services – South East and London, Public Health England, London SE1 6LH, UK
| | - Sooria Balasegaram
- Field Services – South East and London, Public Health England, London SE1 6LH, UK
| | - Laura Ahyow
- East Midlands Health Protection Team, Public Health England, Nottingham NG2 4LA, UK
| | - Sally Johnson
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle NE1 4LP, UK
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Vishram B, Reynolds C, Brailsford SR, Hewitt P. In the NAT era, is routine lookback to recipients still required when donors seroconvert for HIV infection? Vox Sang 2019; 114:394-396. [PMID: 30820949 DOI: 10.1111/vox.12767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/29/2018] [Revised: 12/28/2018] [Accepted: 12/31/2018] [Indexed: 01/20/2023]
Abstract
Human immuno virus screening assays have improved in sensitivity over the last 20 years and our data demonstrates that there is no evidence of missed HIV positive window period donations since the introduction of pooled HIV NAT screening. Here we recommend that extensive lookback investigations are not routinely required if the most recent negative donation is negative on individual sample HIV PCR testing.
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Affiliation(s)
- Bhavita Vishram
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
| | - Claire Reynolds
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
| | - Susan R Brailsford
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
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Furegato M, Fifer H, Mohammed H, Simms I, Vanta P, Webb S, Foster K, Kingston M, Charlett A, Vishram B, Reynolds C, Gill N, Hughes G. Factors associated with four atypical cases of congenital syphilis in England, 2016 to 2017: an ecological analysis. ACTA ACUST UNITED AC 2018; 22. [PMID: 29233254 PMCID: PMC5727590 DOI: 10.2807/1560-7917.es.2017.22.49.17-00750] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Four isolated cases of congenital syphilis born to mothers who screened syphilis negative in the first trimester were identified between March 2016 and January 2017 compared with three cases between 2010 and 2015. The mothers were United Kingdom-born and had no syphilis risk factors. Cases occurred in areas with recent increases in sexually-transmitted syphilis among women and men who have sex with men, some behaviourally bisexual, which may have facilitated bridging between sexual networks.
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Affiliation(s)
- Martina Furegato
- HIV & STI Department, Public Health England, Colindale, London, United Kingdom
| | - Helen Fifer
- Bacteriology Reference Department, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Hamish Mohammed
- HIV & STI Department, Public Health England, Colindale, London, United Kingdom
| | - Ian Simms
- HIV & STI Department, Public Health England, Colindale, London, United Kingdom
| | - Paul Vanta
- HIV & STI Department, Public Health England, Colindale, London, United Kingdom
| | - Sharon Webb
- NHS Infectious Diseases in Pregnancy Screening Programme, PHE Screening, London, United Kingdom
| | - Kirsty Foster
- HIV & STI Department, Public Health England, Colindale, London, United Kingdom
| | - Margaret Kingston
- The Northern Integrated Contraception, Sexual Health & HIV Service, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - André Charlett
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Bhavita Vishram
- NHS Blood & Transplant/PHE Epidemiology Unit, Public Health England, Colindale, London, United Kingdom
| | - Claire Reynolds
- NHS Blood & Transplant/PHE Epidemiology Unit, Public Health England, Colindale, London, United Kingdom
| | - Noel Gill
- HIV & STI Department, Public Health England, Colindale, London, United Kingdom
| | - Gwenda Hughes
- HIV & STI Department, Public Health England, Colindale, London, United Kingdom
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Vishram B, Letley L, Jan Van Hoek A, Silverton L, Donovan H, Adams C, Green D, Edwards A, Yarwood J, Bedford H, Amirthalingam G, Campbell H. Vaccination in pregnancy: Attitudes of nurses, midwives and health visitors in England. Hum Vaccin Immunother 2017; 14:179-188. [PMID: 29048989 DOI: 10.1080/21645515.2017.1382789] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 10/18/2022] Open
Abstract
OBJECTIVE To examine amongst healthcare professionals in England; knowledge of vaccinations in pregnancy, their perceived roles in these programmes and whether they recommend scheduled vaccines to pregnant women. DESIGN Cross sectional survey (online questionnaire) Setting: Healthcare workers in contact with pregnant women in England. PARTICIPANTS The survey analysis included 3441 healthcare workers who had been surveyed during May to August 2015. The participants were midwives, practice nurses and health visitors, working in England who were members of the Royal College of Midwives, Royal College of Nursing and the Institute of Health Visiting. RESULTS We found that knowledge of vaccination in pregnancy was high in all professional groups. Seventy three percent of all respondents would recommend the influenza vaccine and 74% would recommend the pertussis vaccine to pregnant women. They were more likely to recommend vaccination in pregnancy if they would personally have the influenza and pertussis vaccines themselves and/or if they had the influenza vaccine as a healthcare worker. Practice nurses were significantly more likely to recommend the pertussis and influenza vaccines to pregnant women than midwives and health visitors. Health professionals who had received immunisation training were more confident in giving advice to pregnant women. CONCLUSION Immunisation training is essential if healthcare workers are to be informed and confident in effectively delivering the maternal immunisation programme and thus improving uptake of vaccines in pregnancy. These findings are important in tailoring educational programmes and addressing the training needs of different healthcare professional groups.
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Affiliation(s)
- Bhavita Vishram
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Louise Letley
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Albert Jan Van Hoek
- b Department of Infectious Disease Epidemiology , London School of Hygiene and Tropical Medicine , London , UK
| | | | | | | | - David Green
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Angela Edwards
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Joanne Yarwood
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Helen Bedford
- f University College London, Institute of Child health , London , UK
| | - Gayatri Amirthalingam
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Helen Campbell
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
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