Communicable Disease Surveillance Center

Cardiff, United Kingdom

Communicable Disease Surveillance Center

Cardiff, United Kingdom
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Keramarou M.,Centers for Disease Control and Prevention | Keramarou M.,Communicable Disease Surveillance Center | Evans M.R.,Communicable Disease Surveillance Center | Evans M.R.,University of Cardiff
Journal of Infection | Year: 2012

Objectives: Infectious disease legislation in the United Kingdom has recently changed. Our aim was to provide a baseline against which to assess the impact of these changes by synthesising current knowledge on completeness of notification and on factors associated with better reporting rates. Methods: We systematically reviewed the literature for studies reporting completeness of reporting of notifiable infectious diseases in the United Kingdom over the past 35 years. Results: Altogether, 46 studies met our search criteria. Reporting completeness varied from 3% to 95% and was most strongly correlated with the disease being reported. Median reporting completeness was 73% (range 6%-93%) for tuberculosis, 65% (range 40%-95%) for meningococcal disease, and 40% (range 3%-87%) for other diseases (Kruskal-Wallis test, p < 0.05). Reporting completeness did not change for either tuberculosis or meningococcal disease over the period studied. In multivariate analysis, none of the factors examined (study size, study time period, number of data sources used to assess completeness, uncorrected or corrected study design) were significantly associated with reporting completeness. Conclusion: Reporting completeness has not improved over the past three decades. It remains sub-optimal even for diseases which are under enhanced surveillance or are of significant public health importance. © 2012 The British Infection Association.

Roberts J.R.,Public Health NHS Bristol | Mason B.W.,Communicable Disease Surveillance Center | Paranjothy S.,University of Cardiff | Palmer S.R.,University of Cardiff
Pediatric Infectious Disease Journal | Year: 2012

Little is known about the risk of tuberculosis transmission from children. We reviewed the published literature on the transmission of tuberculosis during outbreaks involving children 3 to 11 years of age and report that transmission rates among close contacts in school outbreaks are on average higher (weighted average 69.8% vs. 39.3%) if the index case is a child than an adult. © 2012 Lippincott Williams & Wilkins.

Wyer M.D.,Aberystwyth University | Wyn-Jones A.P.,Aberystwyth University | Kay D.,Aberystwyth University | Au-Yeung H.K.C.,Communicable Disease Surveillance Center | And 5 more authors.
Water Research | Year: 2012

Human adenoviruses (HAdV) may be implicated in some disease outbreaks associated with recreational water exposures, typically in swimming pools. Modern molecular methods can be used to detect HAdV in environmental water samples. During the EU FP6 Project VIROBATHE a database of over 290 HAdV analyses with corresponding faecal indicator organism (FIO) determinations was gathered and used to explore statistical associations between HAdV and FIO results. The FIOs measured were Escherichia coli, intestinal enterococci and somatic coliphage. Statistically significant trends of increasing proportions of HAdV-positive results in categories of increasing FIO concentration were found in freshwater but not seawater samples. The analysis of these trends in freshwater samples was refined, the trends remaining statistically significant when using categories of 0.5 log10 intervals of FIO concentration. Logistic regression models were then developed to predict the probability of a HAdV-positive outcome from FIO concentration. Potential applications of these models to predict the probability of HAdV-positive outcomes from routine FIO determinations used to describe recreational water quality exposures and to classify recreational water quality are discussed. © 2012 Elsevier Ltd.

Lale A.S.,University of Cardiff | Temple J.M.F.,Communicable Disease Surveillance Center
Journal of the Royal Society of Medicine | Year: 2016

Objectives: To determine if NHS reforms affect population mortality. Design: Retrospective study using routinely published data. Setting & participants: Resident population of England and Wales 1948 to 2012 Main outcome measure: All cause age sex directly standardised mortality England and Wales 1948 to 2012. Methods: Using the CuSum technique and Change-Point Analysis to identify sustained changes in the improving age-standardised mortality rates for the period 1948-2012, and comparing the time of these changes with periods of NHS reform. Where observed changes did not fit with NHS reform, changes external to the NHS were sought as a possible explanation of changes observed. Results: CuSum plotting and CPA showed no significant changes in female mortality trend between 1948 and 2012. However, this analysis identified a sustained improvement in the male mortality trend, occurring in the mid-1970s. A further change in the rate of male mortality decline was found around the Millennium. Conclusion: The 1974 NHS reorganisation, changing service arrangements predominantly for women and children, is considered an unlikely explanation of the improved rate of male mortality decline. Thus, centrally led NHS reorganisation has never had any detectable effect on either male or female mortality and must be considered ineffective for this purpose. But some evidence supporting the view that increased funding improves outcomes is found. © 2016, © The Royal Society of Medicine.

Meader E.,Norwich University | Thomas D.,Communicable Disease Surveillance Center | Salmon R.,Communicable Disease Surveillance Center | Sillis M.,Norwich University
Zoonoses and Public Health | Year: 2010

Hepatitis E is a zoonosis that can be acquired by the consumption of contaminated food or water, or via person-to-person spread. However, little is known about the transmission of hepatitis E virus (HEV) in the UK. We investigated the epidemiology of indigenous hepatitis E infection using the PHLS Farm Cohort, a sentinel group with a history of close contact with a range of domestic animals. Ten of the 413 subjects tested were positive for hepatitis E IgG antibodies (2.4%). Seroprevalence peaked in those aged 51 to 60 years (relative risk 3.3, 95% CI: 1.0-10.5). Male participants (relative risk 3.6, 95% CI: 0.6-21.2) and those from farms in the Hereford area of the United Kingdom (relative risk 2.7, 95% CI: 0.8-8.4), an area of mixed livestock farming, were more likely to have serological evidence of previous HEVs exposure, although these findings were not statistically significant. Exposure to pigs, or water from a private supply, was not identified as a significant risk factor. The results of this study suggest that UK farming populations are exposed to HEV, but the predominant route of transmission remains elusive. © 2009 The Authors. Journal compilation © 2009 Blackwell Verlag GmbH.

Jebbari H.,Public Health England | Simms I.,Public Health England | Conti S.,Public Health England | Marongiu A.,Public Health England | And 5 more authors.
Sexually Transmitted Infections | Year: 2011

Objective: To investigate factors associated with variations in diagnoses of primary, secondary and early latent syphilis in England and Wales. Methods: Data were derived from two sources: diagnoses made in genitourinary medicine clinics reported on form KC60, and information collected through National Enhanced Syphilis Surveillance (NESS). Multinomial regression modelling was used for data analysis. Results: Between 1999 and 2008, 12 021 NESS reports were received, 54% of KC60 reports. The dominant profile of the epidemic was one of white men who have sex with men aged 35-44, often co-infected with HIV, centred in larger cities. During this period, the proportion of primary cases increased over time, while the proportion of secondary cases fell. Primary cases exceeded secondary cases by 2004. The proportion of early latent cases remained relatively stable over time and tended to be lower than that of primary and secondary infection. Patients who attended because they had symptoms of infection, had been identified through partner notification, were HIV positive, and were UK born were more likely to present with primary or secondary infection than with early latent infection. A higher proportion of early latent cases were seen among patients who were Asian, had contacted sexual partners through saunas, bars and the internet, had untraceable partners, and had acquired infection in Manchester. Conclusions: The continuing syphilis epidemic indicates that control has only been partially effective, with ongoing transmission being sustained. Intensive and targeted efforts delivered locally are required to interrupt further transmission.

Tomkinson A.,University of Wales | Harrison W.,Public Health Service | Owens D.,University of Wales | Fishpool S.,University of Wales | Temple M.,Communicable Disease Surveillance Center
Laryngoscope | Year: 2012

Objectives/Hypothesis: To examine postoperative hemorrhage following adenoidectomy. Study Design: Prospective multicenter observational study. Methods: The Surgical Instrument Surveillance Programme (SISP) was established in 2003 to monitor tonsil and adenoid surgery in all hospitals in Wales. Data were examined between April 1, 2003 and June 30, 2008, for risk factors that may contribute to primary (R1) or secondary (R2) postoperative hemorrhage from the adenoid bed, of a severity sufficient to require a return to the operating room. Results: There were 5,588 procedures included, of which 4,225 included simultaneous tonsillectomy. The study included 2,903 (52%) males with a median age of 5.8 years (interquartile range [IQR], 4.5-7.7 years) and 2,685 (48%) females with a median age of 6.5 years (IQR, 5.0-9.1 years). There were 22 patients (0.4%; confidence interval [CI], 0.2-0.6) who returned to the operating room with a postoperative hemorrhage arising from the adenoid bed. These were exclusively R1 hemorrhage; there were no instances of R2 hemorrhage (0.0%; CI, 0.0-0.1). No specific risk factors for R1 hemorrhage could be identified. There were 38 patients in the adenotonsillectomy group who returned to operating room with a postoperative hemorrhage arising from the tonsil bed (0.5%; CI, 0.3-0.8). R1 was seen in 22 patients (0.5%; CI, 0.3-0.8) and R2 in 16 patients (0.4%; CI, 0.2-0.6). Conclusions: Adenoidectomy appears to be primarily a procedure performed in childhood. The rate of R1 hemorrhage following adenoidectomy is one in 200 (0.5%) and is similar to the R1 hemorrhage rate for tonsillectomy. R2 hemorrhage following an adenoidectomy appears to be extremely rare. In children, the risk of a serious primary hemorrhage following an adenotonsillectomy is double that of either procedure when performed alone. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Mason B.W.,Communicable Disease Surveillance Center | Chalmers R.M.,Singleton Hospital | Carnicer-Pont D.,National Public Health Service for Wales | Casemore D.P.,Aberystwyth University
Journal of Water and Health | Year: 2010

An outbreak in the autumn of 2005 resulted in 218 confirmed cases of Cryptosporidium hominis. The attack rate (relative risk 4.1, 95%CI 2.8-9.1) was significantly higher in the population supplied by Cwellyn Water Treatment Works (WTW). A case-control study demonstrated a statistically significant association (odds ratio 6.1, 95% CI 1.8-23.8) between drinking unboiled tap water and C. hominis infection. The association remained significant in a logistic regression analysis, with an adjusted odds ratio of 1.30 (95 CI 1.05-1.61) per glass of unboiled tap water consumed per day. This evidence together with environmental and associated microbiological investigations, and the absence of effective treatment to remove Cryptosporidium oocysts at the WTW, led to the conclusion that the outbreak was waterborne. Oocyst counts in final treated water at the WTW and at different points in the distribution system were consistently very low, maximum count in continuous monitoring 0.08 oocysts per 10 litres. Data from continuous monitoring and the epidemic curve is consistent with the hypothesis that low numbers of oocysts of C hominis were present in treated water continuously during the outbreak and these were of sufficient infectivity to cause illness. All surface water derived water supplies present a potential risk to human health and appropriate control measures should be in place to minimise these risks. © IWA Publishing 2010.

Cann K.F.,Communicable Disease Surveillance Center | Thomas D.R.,Communicable Disease Surveillance Center | Salmon R.L.,Communicable Disease Surveillance Center | Wyn-Jones A.P.,Aberystwyth University | Kay D.,Aberystwyth University
Epidemiology and Infection | Year: 2013

SUMMARY Global climate change is expected to affect the frequency, intensity and duration of extreme water-related weather events such as excessive precipitation, floods, and drought. We conducted a systematic review to examine waterborne outbreaks following such events and explored their distribution between the different types of extreme water-related weather events. Four medical and meteorological databases (Medline, Embase, GeoRef, PubMed) and a global electronic reporting system (ProMED) were searched, from 1910 to 2010. Eighty-seven waterborne outbreaks involving extreme water-related weather events were identified and included, alongside 235 ProMED reports. Heavy rainfall and flooding were the most common events preceding outbreaks associated with extreme weather and were reported in 55.2% and 52.9% of accounts, respectively. The most common pathogens reported in these outbreaks were Vibrio spp. (21.6%) and Leptospira spp. (12.7%). Outbreaks following extreme water-related weather events were often the result of contamination of the drinking-water supply (53.7%). Differences in reporting of outbreaks were seen between the scientific literature and ProMED. Extreme water-related weather events represent a risk to public health in both developed and developing countries, but impact will be disproportionate and likely to compound existing health disparities. Copyright © Cambridge University Press 2012.

Tomkinson A.,University of Wales | Harrison W.,Communicable Disease Surveillance Center | Owens D.,University of Wales | Harris S.,Communicable Disease Surveillance Center | And 2 more authors.
Laryngoscope | Year: 2011

Objectives/Hypothesis: To identify the main risk factors associated with postoperative hemorrhage following tonsillectomy. Study Design: Prospective multicenter observational study. Methods: The Surgical Instrument Surveillance Programme (SISP) was established in 2003 to monitor tonsil and adenoid surgery and the associated complications in all hospitals in Wales. Data were examined between April 1, 2003, and June 30, 2008, by using binary logistic regression, for risk factors that may contribute to primary (R1) or secondary (R2) postoperative hemorrhage of a severity sufficient to require a return to the operating theater. Results: A total of 17,480 procedures were included. Patients aged â12 years were 1.5 (1.0-2.1; P <.05) and 3 times (2.2-4.9; P <.0001) more likely to experience R1 and R2 complications, respectively. There were 2.5 times as many females as males aged â12 years who underwent tonsillectomy, but males were almost twice as likely to experience R1 (1.4-2.8), P <.0001, or R2 (1.2-2.5), P <.001, postoperative hemorrhage. There was a 1.9-fold increased likelihood of R1 (1.1-3.3), P <.05, with the most junior surgeon, and no relationship with R2. All techniques that used heat had a significantly greater adjusted odds of R2 as compared with cold dissection, with odds ranging from 2.7 (1.5-4.7), P <.001, for dissection plus bipolar diathermy and ties, to 13.0 (5.8-29.1), P <.0001, with coblation when used with other techniques. No additional risk was associated with specified single-use instruments. Conclusions: Patient age and sex and operative technique were the most significant factors affecting the risk and timing of serious postoperative hemorrhage, with no additional risk associated with the use of specified single-use instruments. © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.

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