Redefining the population at risk of listeriosis in England and Wales

Listeriosis is a rare but severe food‐borne disease caused by the opportunistic, bacterial pathogen Listeria monocytogenes. The elderly, those who are immunocompromised and pregnant women and their unborn or newborn infants are disproportionately affected. Listeriosis has a high case fatality ratio (up to 44%) and is the commonest cause of death ascribed to a food‐borne pathogen in the United Kingdom (UK). The number of cases of listeriosis in England and Wales reported to the Health Protection Agency (HPA) ‐ the arms length governmental body mandated with protecting the health of the population ‐ increased from an average of 110 cases per year between 1990 and 2000 to an average of 192 cases per year between 2001 and 2009. The epidemiology of listeriosis appeared to change with the observed increase almost exclusively among non‐pregnancy related cases, aged ≥60 years presenting with bacteraemia in the absence of central nervous system infection (CNS). Given the potential severity of listeriosis and that, as a predominantly foodborne disease, these infections are largely avoidable, there was a public health imperative to investigate the observed increase. Disease presentation, concurrent conditions, medications, deprivation, diet and mortality risk factors amongst non‐pregnancy related listeriosis cases and ethnicity amongst pregnancy related cases were investigated using national surveillance data. The increased incidence of bacteraemic cases occurred in those with cancer, particularly digestive organ malignancies (Odds ratio (OR) [95% confidence interval (CI)]: 16.7 [3.8 – 73]) and, to a lesser degree, those with conditions that necessitate treatment with stomach acid inhibiting medication (3.2 [1.5 – 6.6]). Ethnicity and/or deprivation were found to be important drivers for infection. Compared to the most affluent areas, disease incidence was 38% (95% CI: 16 to 65) higher in the most deprived areas of the country. Cases were more likely than the general population to purchase foods from convenience stores (OR [95% CI]: 5.37\ud [3.53 – 8.17]) or from local services ‐ bakers (3.40 [2.39 – 4.86]), butchers (1.62 [1.11 – 2.34]), fishmongers (5.05 [3.19 – 7.99]) and greengrocers (1.92 [1.32 – 2.78]) ‐ and their risk profile changed with increasing deprivation. The proportion of pregnancy related cases classed as ethnic increased significantly from 2001 to 2008 (chi‐square test for trend; p=0.002). The increase in the proportion of pregnancy related cases that were ethnic was most marked in 2006, 2007 and 2008, when the incidence was higher than expected given the underlying population (Relative risk (RR) [95% CI]: 2.38 [1.07 – 5.29], 3.82 [1.82 – 8.03] and 4.33 [1.74 – 10.77], respectively). A wide range of underlying conditions appeared to increase the risk of infection, most notably diseases of the liver (RR [95% CI]: 22.4 [17.7 – 28.4]), systemic connective tissue disorders (18.3 [12.6 – 26.6]), neoplasms of the lymphoid, hematopioetic, and related tissues (17.6 [15.1 – 20.6]), psychoactive substance (alcohol related in 96% of reports; 12.3 [9.4 – 16.1]) and renal failure (12.2 [9.8 – 15.1]). Associated medications, including cytotoxic drugs (RR [95% CI]: 320.9 [228.5 – 450.7]), drugs affecting the immune response (18.5 [11.6 – 29.5]) and corticosteroids (11.1 [8.5 – 14.6]), and food groups, most notably smoked salmon (OR [95% CI]: 4.82 [2.99 – 7.76]), other cold cooked fish (22.32 [15.85 – 31.44]), camembert (4.80 [2.32 – 9.90]), hard cheese other than cheddar (2.37 [1.69 – 3.30]), blue cheese (2.24 [1.47 – 3.43]), also appeared to be associated with increased risk of infection. Underlying conditions, particularly malignancies of the breast (OR [95% CI]: 3.2 [1.7 – 6.2]) and respiratory and intrathoracic organs (3.9 [2.2 – 7.1]), alcoholism (2.7 [1.6 – 4.3]), cardiovascular diseases (1.4 [1.01 – 1.9]), treatment to reduce stomach acid secretion (1.6 [1.1 – 2.3])and increasing age (cases ≥80 years versus less than 60 years; 3.1 [2.3 – 4.2]) increased the risk of death amongst cases. This cohesive body of work redefines the population at risk of listeriosis and indicates that there is added value in actively targeting appropriate food safety advice at a range of vulnerable groups other than pregnant women, to whom information has previously been routinely and preferentially disseminated

Are food exposures obtained through commercial market panels representative of the general population? Implications for outbreak investigations

Current methods of control recruitment for case-control studies can be slow (a particular issue for outbreak investigations), resource-intensive and subject to a range of biases. Commercial market panels are a potential source of rapidly recruited controls. Our study evaluated food exposure data from these panel controls, compared with an established reference dataset. Market panel data were collected from two companies using retrospective internet-based surveys; these were compared with reference data from the National Diet and Nutrition Survey (NDNS). We used logistic regression to calculate adjusted odds ratios to compare exposure to each of the 71 food items between the market panel and NDNS participants. We compared 2103 panel controls with 2696 reference participants. Adjusted for socio-demographic factors, exposure to 90% of foods was statistically different between both panels and the reference data. However, these differences were likely to be of limited practical importance for 89% of Panel A foods and 79% of Panel B foods. Market panel food exposures were comparable with reference data for common food exposures but more likely to be different for uncommon exposures. This approach should be considered for outbreak investigation, in conjunction with other considerations such as population at risk, timeliness of response and study resources

Concurrent Conditions and Human Listeriosis, England, 1999–2009

The epidemiology of listeriosis in England and Wales changed during 2001–2008; more patients >60 years of age had bacteremia than in previous years. To investigate these changes, we calculated risk for listeriosis by concurrent condition for non–pregnancy-associated listeriosis cases reported to the national surveillance system in England during 1999–2009. Conditions occurring with L. monocytogenes infection were coded according to the International Classification of Diseases, 10th Revision, and compared with appropriate hospital episode statistics inpatient denominator data to calculate incidence rates/million consultations. Malignancies (especially of the blood), kidney disease, liver disease, diabetes, alcoholism, and age >60 years were associated with an increased risk for listeriosis. Physicians should consider a diagnosis of listeriosis when treating patients who have concurrent conditions. Providing cancer patients, who accounted for one third of cases, with food safety information might help limit additional cases

Very little influenza in the WHO European Region during the 2020/21 season, weeks 40 2020 to 8 2021

Between weeks 40 2020 and 8 2021, the World Health Organization European Region experienced a 99.8% reduction in sentinel influenza virus positive detections (33/25,606 tested; 0.1%) relative to an average of 14,966/39,407 (38.0%; p < 0.001) over the same time in the previous six seasons. COVID-19 pandemic public health and physical distancing measures may have extinguished the 2020/21 European seasonal influenza epidemic with just a few sporadic detections of all viral subtypes. This might possibly continue during the remainder of the influenza season.ECDC and WHO internal fundsS

Spotlight influenza: Laboratory-confirmed seasonal influenza in people with acute respiratory illness: a literature review and meta-analysis, WHO European Region, 2004 to 2017

Background: Across the WHO European Region, there are few estimates of the proportion of people seeking medical care for influenza-like illness or acute respiratory infections and who have confirmed seasonal influenza infection when tested for respiratory viruses.Methods: We conducted meta-analyses of data extracted from a) literature review of studies published between 2004 and 2017; b) sentinel data from the European surveillance system (TESSy), pooling within-season estimates by influenza type/subtype, setting (outpatient/inpatient) and age-group, to estimate the proportion of people tested who have laboratory-confirmed medically-attended seasonal influenza in Europe.Results: In the literature review, the pooled proportion for all influenza was 33% (95% CI, 30%-36%), and higher among outpatients (36% [33-40%]) than inpatients (24% [20-29%]). Pooled estimates for all influenza by age group were: 0-17 years, 26% (22-31); 18-64 years, 41% (32-50); ≥65 years, 33% (27-40%). From TESSY data, 33% (31-24%) of outpatients and 24% (21-27%) of inpatients were positive. The highest proportion of influenza A overall was in people aged 18-64 years (22% [16-29%]). By subtype, influenza A(H1N1)pdm09 was highest in 18-64 year-olds (16% [11-21%]) whereas influenza A(H3N2) was highest in those ≥65 years (10% [2-22%]). For influenza B, the highest proportion of infections was those aged 18-64 years (15% [9-24%]). Estimated proportions of confirmed influenza varied across seasons and across countries. Conclusions: Both the literature review and TESSy analyses showed a higher proportion of laboratory-confirmed influenza in non-hospitalised patients, with further variation by influenza type, age-group, country and season

Alternating patterns of seasonal influenza activity in the WHO European Region following the 2009 pandemic, 2010-2018

Background: Influenza virus infections are common and lead to substantial morbidity and mortality worldwide. We characterized the first eight influenza epidemics since the 2009 influenza pandemic by describing the distribution of viruses and epidemics temporally and geographically across the WHO European Region. Methods: We retrospectively analyzed laboratory-confirmed influenza detections in ambulatory patients from sentinel sites. Data were aggregated by reporting entity and season (weeks 40-20) for 2010-2011 to 2017-2018. We explored geographical spread using correlation coefficients. Results: There was variation in the regional influenza epidemics during the study period. Influenza A virus subtypes alternated in dominance, except for 2013-2014 during which both cocirculated, and only one season (2017-2018) was B virus dominant. The median start week for epidemics in the Region was week 50, the time to the peak ranged between four and 13 weeks, and the duration of the epidemic ranged between 19 and 25 weeks. There was evidence of a west-to-east spread across the Region during epidemics in 2010-2011 (r = .365; P = .019), 2012-2013 (r = .484; P = .001), 2014-2015 (r = .423; P = .006), and 2017-2018 (r = .566; P < .001) seasons. Variation in virus distribution and timing existed within reporting entities across seasons and across reporting entities for a given season. Conclusions: Aggregated influenza detection data from sentinel surveillance sites by season between 2010 and 2018 have been presented for the European Region for the first time. Substantial diversity exists between influenza epidemics. These data can inform prevention and control efforts at national, sub-national, and international levels. Aggregated, regional surveillance data from early affected reporting entities may provide an early warning function and be helpful for early season forecasting efforts.WHO Regional Office for Europe was supported for work on influenza by a cooperative agreement from the United States Centers for Disease Control and Prevention (NU511P000876); the funder had no role in the analysis or interpretation of the data.S

Whole-genome sequencing revealed concurrent outbreaks of shigellosis in the English Orthodox Jewish Community caused by multiple importations of Shigella sonnei from Israel.

In December 2013, Public Health England (PHE) observed an increase in the number of cases of Shigella sonnei linked to the Orthodox Jewish Community (OJC). Ultimately, 52 cases of S. sonnei phage type (PT) P and PT7 were notified between November 2013 and July 2014. Whole-genome sequencing (WGS) was performed on a HiSeq 2500 platform (Illumina) on isolates of S. sonnei submitted to PHE during the investigation. Quality trimmed sequence reads were mapped to a reference genome using BWA-MEM, and single-nucleotide polymorphisms (SNPs) were identified using GATK2. Analysis of the core genome SNP positions (>90 % consensus, minimum depth 10×, MQ≥30) revealed that isolates linked to the outbreak could be categorized as members of distinct monophyletic clusters (MPCs) representing concurrent regional outbreaks occurring in the OJCs across the United Kingdom. A dated phylogeny predicted the date of the most recent common ancestor of the MPCs to be approximately 3.1 years previously [95 % highest posterior density (HPD), 2.4-3.4]. Isolates of S. sonnei from cases from the OJCs in Israel included in the phylogeny, branched from nodes basal to the UK OJC outbreak clusters, indicating they were ancestral to the UK OJC isolates, and that the UK isolates represented multiple importations of S. sonnei into the UK population from Israel. The level of discrimination exhibited by WGS facilitated the identification of clusters of isolates within the closely related bacterial populations circulating in the OJC that may be linked to a unique point sources or transmission routes, thus enabling a more appropriate public health response and targeted interventions

Eliashberg-type equations for correlated superconductors

The derivation of the Eliashberg -- type equations for a superconductor with strong correlations and electron--phonon interaction has been presented. The proper account of short range Coulomb interactions results in a strongly anisotropic equations. Possible symmetries of the order parameter include s, p and d wave. We found the carrier concentration dependence of the coupling constants corresponding to these symmetries. At low hole doping the d-wave component is the largest one.Comment: RevTeX, 18 pages, 5 ps figures added at the end of source file, to be published in Phys.Rev. B, contact: [email protected]

Estimated number of deaths directly averted in people 60 years and older as a result of COVID-19 vaccination in the WHO European Region, December 2020 to November 2021

Since December 2019, over 1.5 million SARS-CoV-2-related fatalities have been recorded in the World Health Organization European Region - 90.2% in people ≥ 60 years. We calculated lives saved in this age group by COVID-19 vaccination in 33 countries from December 2020 to November 2021, using weekly reported deaths and vaccination coverage. We estimated that vaccination averted 469,186 deaths (51% of 911,302 expected deaths; sensitivity range: 129,851-733,744; 23-62%). Impact by country ranged 6-93%, largest when implementation was early.S