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Didcot, United Kingdom

O'Connell S.,Public Health England
Current Opinion in Infectious Diseases | Year: 2010

PURPOSE OF REVIEW: Lyme borreliosis is the most common vector-borne bacterial infection in temperate areas of the northern hemisphere. It has been perceived as difficult to diagnose and treat, but much is now known about its clinical presentations, which largely fall into well defined categories in both adults and children. This review features recent publications on clinical diagnosis and management. RECENT FINDINGS: The reported incidence of Lyme borreliosis has increased markedly in many countries. Many recent publications have focused on clinical and laboratory aspects of paediatric and adult neuroborreliosis, and there is now strong evidence for the efficacy of oral doxycycline for most presentations of neuroborreliosis. Serological tests have improved significantly. Several studies have confirmed that patients treated for early Lyme borreliosis have good overall long-term outcomes. Studies of patients with persistent symptoms following treatment have not shown evidence for active infection or for sustained benefit from prolonged antibiotic treatment. SUMMARY: Greater efforts are needed to provide education for prevention and early diagnosis to avoid late complications. Further improvements in diagnostic tests would be welcomed. More research is required to assess the causes and management of post-Lyme symptoms. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


We investigated the effect of the 7-valent pneumococcal conjugate vaccine (PCV7) programme in England on serotype-specific carriage and invasive disease to help understand its role in serotype replacement and predict the impact of higher valency vaccines. Nasopharyngeal swabs were taken from children <5 y old and family members (n=400) 2 y after introduction of PCV7 into routine immunization programs. Proportions carrying Streptococcus pneumoniae and serotype distribution among carried isolates were compared with a similar population prior to PCV7 introduction. Serotype-specific case carrier ratios (CCRs) were estimated using national data on invasive disease. In vaccinated children and their contacts vaccine-type (VT) carriage decreased, but was offset by an increase in non-VT carriage, with no significant overall change in carriage prevalence, odds ratio 1.06 (95% confidence interval 0.76-1.49). The lower CCRs of the replacing serotypes resulted in a net reduction in invasive disease in children. The additional serotypes covered by higher valency vaccines had low carriage but high disease prevalence. Serotype 11C emerged as predominant in carriage but caused no invasive disease whereas 8, 12F, and 22F emerged in disease but had very low carriage prevalence. Because the additional serotypes included in PCV10/13 have high CCRs but low carriage prevalence, vaccinating against them is likely to significantly reduce invasive disease with less risk of serotype replacement. However, a few serotypes with high CCRs could mitigate the benefits of higher valency vaccines. Assessment of the effect of PCV on carriage as well as invasive disease should be part of enhanced surveillance activities for PCVs. Please see later in the article for the Editors' Summary.


Minor P.D.,Public Health England
Clinical Infectious Diseases | Year: 2010

Influenza virus changes constantly, making vaccine production challenging. Changing the growth substrate from eggs to cell culture raises issues at all stages of the process, from surveillance to the assay of vaccines. The pandemic threat-first H5N1, then HlNl-encouraged a review of methods and brought issues into sharp relief. © 2010 by the Infectious Diseases Society of America. All rights reserved.


Brown K.E.,Public Health England
Reviews in Medical Virology | Year: 2010

The first human parvoviruses to be described (1960s) were the adeno-associated viruses (AAVs, now classed as dependoviruses), originally identified as contaminants of cell cultures, followed by parvovirus B19 (B19V) in 1974, the first parvovirus to be definitively shown to be pathogenic. More recently two new groups of parvoviruses, the human bocaviruses (HuBoV) and the Parv4 viruses have been identified. These four groups of human viruses are all members of different genera within the Parvovirus family, and have very different biology, epidemiology and disease associations from each other. This review will provide an overview of the virological, pathogenic and clinical features of the different human paroviruses, and how these new viruses and their variants fit into the current understanding of parvovirus infection. Copyright © 2010 John Wiley & Sons, Ltd.


Gillespie I.A.,Public Health England
American journal of epidemiology | Year: 2012

Case-control studies are important in infectious disease epidemiology for rapidly identifying and controlling risks, but challenges, including the need for speed, can place practical restrictions on control selection and recruitment. The biased comparisons that result can hamper or, worse, mislead investigators. Following a 2009 outbreak of Shiga-like toxin-producing Escherichia coli O157 infection associated with a petting farm in southeast England, it was hypothesized that case behavior alone could be used to identify risks. Case-patients' exposures were randomized on a case-by-case basis, and the resulting permuted data were compared with the actual events preceding illness by conditional logistic regression analysis. There was good agreement between the risks identified by using our new method and the risks elicited in the original outbreak case-control studies. This was also the case in analysis of 2 further historical outbreaks. These initial findings suggest that the technique, which we have called the "case-chaos" technique, appeared to be useful in this setting. Analysis of simulated data supports this view. Circumventing the need for traditional control data has the potential to reduce outbreak investigation lead times, leading to earlier interventions and reduced morbidity and mortality. However, further validation is necessary, coupled with an awareness of limitations of the method.

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