Laboratory-based surveillance of Campylobacter and Salmonella infection and the importance of denominator data

Laboratory data are the cornerstone in surveillance of infectious disease. We investigated whether changes in reported incidence of Campylobacter and Salmonella infection might be explained by changes in stool sampling rates. Data were extracted from a national database on 585 843 patient stool samples tested by microbiology laboratories in Wales between 1998 and 2008. Salmonella incidence fell from 43 to 19 episodes/100 000 population but Campylobacter incidence after declining from 111/100 000 in 1998 to 84/100 000 in 2003 rose to 119/100 000 in 2008. The proportion of the population sampled rose from 2·0% in 1998 to 2·8% in 2008, mostly due to increases in samples from hospital patients and older adults. The proportion of positive samples declined for both Salmonella and Campylobacter from 3·1% to 1·1% and from 8·9% to 7·5%, respectively. The decline in Salmonella incidence is so substantial that it is not masked even by increased stool sampling, but the recent rise in Campylobacter incidence may be a surveillance artefact largely due to the increase in stool sampling in older people

Carers' perspectives on the presentation of community-acquired pneumonia and empyema in children: a case series

Objective To describe carers’ perceptions of the development and presentation of community-acquired pneumonia or empyema in their children. Design Case series. Setting Seven hospitals with paediatric inpatient units in South Wales, UK. Participants Carers of 79 children aged 6 months to 16 years assessed in hospital between October 2008 and September 2009 with radiographic, community-acquired pneumonia or empyema. Methods Carers were recruited in hospital and participated in a structured face-to-face or telephone interview about the history and presenting features of their children's illnesses. Responses to open questions were initially coded very finely and then grouped into common themes. Cases were classified into two age groups: 3 or more years and under 3 years. Results The reported median duration of illness from onset until the index hospital presentation was 4 days (IQR 2–9 days). Pain in the torso was reported in 84% of cases aged 3 or more years and was the most common cause for carer concern in this age group. According to carer accounts, clinicians sometimes misjudged the origin of this pain. Almost all carers reported something unusual about the index illness that had particularly concerned them—mostly non-specific physical symptoms and behavioural changes. Conclusions Pain in the torso and carer concerns about unusual symptoms in their child may provide valuable additional information in a clinician's assessment of the risk of pneumonia in primary care. Further research is needed to confirm the diagnostic value of these features

Salmonella Enteritidis PT6: Another egg-associated Salmonellosis?

Salmonella Enteritidis phage type 6 (PT6) increased dramatically in the United Kingdom during 1997. The sharp rise suggests that PT6 contamination has spread rapidly throughout a basic food commodity; however, the source and food vehicle remain unknown. We present evidence from three outbreaks suggesting a possible link between PT6 and eggs. Poor documentation of the egg supply network continues to pose problems for public health investigators. Thorough investigation of all future PT6 outbreaks and case-control studies of sporadic infections are needed to confirm the etiology of PT6 infection

Cryptosporidiosis outbreak associated with an educational farm holiday

In April 1995 an outbreak of cryptosporidiosis occurred among 43 schoolchildren and four staff after a week's holiday at a rural farm. A retrospective cohort study found illness to be 3.8 times more likely in those who handled calves and 1.5 times more likely in those who habitually bit their nails or sucked their thumbs. Cryptosporidium oocysts were detected in faecal specimens from six of the 29 pupils and one of the four staff who were ill. Infection occurred in children despite supervised handwashing. The infection hazards of farm visits need more publicity, and further study on the risks of cryptosporidiosis transmission in the farm environment is required to guide preventive measures

Cryptosporidiosis outbreak associated with an educational farm holiday

In April 1995 an outbreak of cryptosporidiosis occurred among 43 schoolchildren and four staff after a week's holiday at a rural farm. A retrospective cohort study found illness to be 3.8 times more likely in those who handled calves and 1.5 times more likely in those who habitually bit their nails or sucked their thumbs. Cryptosporidium oocysts were detected in faecal specimens from six of the 29 pupils and one of the four staff who were ill. Infection occurred in children despite supervised handwashing. The infection hazards of farm visits need more publicity, and further study on the risks of cryptosporidiosis transmission in the farm environment is required to guide preventive measures

Completeness of infectious disease notification in the United Kingdom: a systematic review

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

How complete is influenza immunization coverage? a study in 75 nursing and residential homes for elderly people

Elderly people in residential accommodation are particularly susceptible to outbreaks of influenza. Up to 70% of residents can become ill and many will develop complications or die. Immunization can prevent such outbreaks and is cost-effective