A common framework for using and reporting consumer purchase data (CPD) in foodborne outbreak investigations in Europe

Publisher Copyright: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.Consumer purchase data (CPD) can be a powerful tool in the investigation of foodborne outbreaks through analyses of electronic records of food that individuals buy. The objective of this study was to develop a common framework for use of CPD in foodborne outbreak investigations using the expertise of European public health professionals from 11 European countries. We also aimed to describe barriers and limitations preventing CPD utilization. CPD are mainly gathered from supermarket loyalty programmes, smaller consortia, and independent supermarkets. Privacy legislation governing CPD was perceived as the most crucial barrier for CPD usage, but still resolvable. The main practical challenges were obtaining consumer consent for CPD usage, the associated workload, data access, format, and analysis. Harmonising methods and reporting across countries, standardised consent forms and electronic consent methods were identified as solutions. This guideline was developed to support outbreak investigators in overcoming barriers in using CPD, thereby increasing public health professionals’ application and value of this powerful investigation tool. In addition, we hope this framework will lead to more public health institutions, in collaboration with food safety authorities, making use of CPD in outbreak investigations in the future.Peer reviewe

Forgotten but not gone : yersinia infections in England, 1975 to 2020

Background Yersiniosis is one of the most common food-borne zoonoses in Europe, but there are large variations in the reported incidence between different countries. Aim We aimed to describe the trends and epidemiology of laboratory-confirmed Yersinia infections in England and estimate the average annual number of undiagnosed Yersinia enterocolitica cases, accounting for under-ascertainment. Methods We analysed national surveillance data on Yersinia cases reported by laboratories in England between 1975 and 2020 and enhanced surveillance questionnaires from patients diagnosed in a laboratory that has implemented routine Yersinia testing of diarrhoeic samples since 2016. Results The highest incidence of Yersinia infections in England (1.4 cases per 100,000 population) was recorded in 1988 and 1989, with Y. enterocolitica being the predominant species. The reported incidence of Yersinia infections declined during the 1990s and remained low until 2016. Following introduction of commercial PCR at a single laboratory in the South East, the annual incidence increased markedly (13.6 cases per 100,000 population in the catchment area between 2017 and 2020). There were notable changes in age and seasonal distribution of cases over time. The majority of infections were not linked to foreign travel and one in five patients was admitted to hospital. We estimate that around 7,500 Y. enterocolitica infections may be undiagnosed in England annually. Conclusions Findings suggest a considerable number of undiagnosed yersiniosis cases in England, with possibly important changes in the epidemiology. The apparently low incidence of yersiniosis in England is probably due to limited laboratory testing

Novel methods for estimating the instantaneous and overall COVID-19 case fatality risk among care home residents in England

The COVID-19 pandemic has had high mortality rates in the elderly and frail worldwide, particularly in care homes. This is driven by the difficulty of isolating care homes from the wider community, the large population sizes within care facilities (relative to typical households), and the age/frailty of the residents. To quantify the mortality risk posed by disease, the case fatality risk (CFR) is an important tool. This quantifies the proportion of cases that result in death. Throughout the pandemic, CFR amongst care home residents in England has been monitored closely. To estimate CFR, we apply both novel and existing methods to data on deaths in care homes, collected by Public Health England and the Care Quality Commission. We compare these different methods, evaluating their relative strengths and weaknesses. Using these methods, we estimate temporal trends in the instantaneous CFR (at both daily and weekly resolutions) and the overall CFR across the whole of England, and dis-aggregated at regional level. We also investigate how the CFR varies based on age and on the type of care required, dis-aggregating by whether care homes include nursing staff and by age of residents. This work has contributed to the summary of measures used for monitoring the UK epidemic

Novel methods for estimating the instantaneous and overall COVID-19 case fatality risk among care home residents in England.

The COVID-19 pandemic has had high mortality rates in the elderly and frail worldwide, particularly in care homes. This is driven by the difficulty of isolating care homes from the wider community, the large population sizes within care facilities (relative to typical households), and the age/frailty of the residents. To quantify the mortality risk posed by disease, the case fatality risk (CFR) is an important tool. This quantifies the proportion of cases that result in death. Throughout the pandemic, CFR amongst care home residents in England has been monitored closely. To estimate CFR, we apply both novel and existing methods to data on deaths in care homes, collected by Public Health England and the Care Quality Commission. We compare these different methods, evaluating their relative strengths and weaknesses. Using these methods, we estimate temporal trends in the instantaneous CFR (at both daily and weekly resolutions) and the overall CFR across the whole of England, and dis-aggregated at regional level. We also investigate how the CFR varies based on age and on the type of care required, dis-aggregating by whether care homes include nursing staff and by age of residents. This work has contributed to the summary of measures used for monitoring the UK epidemic

Transmission dynamics of COVID-19 in household and community settings in the United Kingdom

AbstractBackgroundHouseholds appear to be the highest risk setting for transmission of COVID-19. Large household transmission studies were reported in the early stages of the pandemic in Asia with secondary attack rates ranging from 5–30% but few large scale household transmission studies have been conducted outside of Asia.MethodsA prospective case ascertained study design based on the World Health Organization FFX protocol was undertaken in the UK following the detection of the first case in late January 2020. Household contacts of cases were followed using enhanced surveillance forms to establish whether they developed symptoms of COVID-19, became confirmed cases and their outcomes. Household secondary attack rates and serial intervals were estimated. Individual and household basic reproduction numbers were also estimated. The incubation period was estimated using known point source exposures that resulted in secondary cases.ResultsA total of 233 households with two or more people were included with a total of 472 contacts. The overall household SAR was 37% (95% CI 31–43%) with a mean serial interval of 4.67 days, an R0 of 1.85 and a household reproduction number of 2.33. We find lower secondary attack rates in larger households. SARs were highest when the primary case was a child. We estimate a mean incubation period of around 4.5 days.ConclusionsHigh rates of household transmission of COVID-19 were found in the UK emphasising the need for preventative measures in this setting. Careful monitoring of schools reopening is needed to monitor transmission from children.</jats:sec

HCV testing in NSP (needle and syringe provision) community pharmacies pilot (phase 2). Report and findings.

Hepatitis C (HCV) is a blood borne virus that affects the liver and is predominately transmitted by contact with infected blood. In the UK, those at highest risk of contracting HCV are people who inject drugs (PWID), with national data demonstrating PWID account for over 90% of all HCV infections. Since 2014, direct-acting, all oral antiviral treatments have revolutionized the treatment of HCV as well as mitigating complications such as liver failure, liver cancer and the need for liver transplantation. Direct-acting antivirals (DAAs) are effective in curing the infection in more than 90% of those infected with HCV of all genotypes, thus making the HCV elimination targets of the World Health Organisation (WHO) by 2030 and NHS England by 2025 achievable. Despite this, diagnosis and treatment rates in HCV positive people who are actively injecting remain low. This vulnerable group faces many barriers to access existing services and need more accessible testing and treatment pathways given their high risks of HCV transmission and acquisition. The LJWG’s phase 1 pharmacy pilot offered HCV antibody testing to PWIDs accessing needle and syringe programmes (NSPs) at specific community pharmacies and provided pathways to secondary care for treatment. The LJWG’s pharmacy testing pilot, phase 2, builds on learning from phase 1 in order to increase testing and treatment for those most at risk of HCV acquisition and transmission. Phase 2 provides point of care capillary blood testing for HCV RNA to PWIDs accessing NSPs from community pharmacies in London, whereas phase 1 tests provided on-the-spot HCV antibody testing. This change enables those with chronic HCV infection to be identified directly in the pharmacies. Both pilots aimed to ensure transition to treatment with pathways from NSP community pharmacies to tertiary treatment centres. Six pharmacies providing NSPs across London took part in the phase 2 pilot between April 2018 and March 2019. Key findings were: • Of the 308 patients offered HCV testing across all sites, 57% accepted (n=176). • 38% (n = 66) tested positive for HCV, of whom 21% completed treatment (n=14). • 29% (n=51) of those tested did not know that interferon-free treatment was available. • 78% (n=137) of those tested would prefer to receive HCV treatment in their community pharmacy, followed by 9% (n=16) reporting they would prefer to receive treatment from a GP practice. • Over three-quarters (78%) of people reported having previously been tested for HCV, and 41% said they had been tested within the last year. • 75% (n=132) of service users said they would recommend the pharmacy testing service to a friend. Following on from the success of the phase 1 pilot conducted in 2017-18, this report confirms the feasibility and value of offering point of care HCV diagnosis to PWIDs attending community pharmacies for needle exchange services. This report provides valuable insights for future HCV testing programmes in pharmacies and recommends a broader roll-out

Effectiveness of BNT162b2 and ChAdOx-1 vaccines in residents of long-term care facilities in England using a time-varying proportional hazards model

INTRODUCTION: residents of long-term care facilities (LTCFs) are at high risk of adverse outcomes from SARS-CoV-2. We aimed to estimate the vaccine effectiveness (VE) of one and two doses of BNT162b2 and ChAdOx-1 against SARS CoV-2 infection and COVID-19-related death in residents of LTCFs. METHODS: this observational study used testing, vaccination and mortality data for LTCF residents aged ≥ 65 years who were regularly tested regardless of symptoms from 8 December 2020 to 30 September 2021 in England. Adjusted VE, calculated as one minus adjusted hazard ratio, was estimated using time-varying Cox proportional hazards models for infection and death within 28 days of positive test result. Vaccine status was defined by receipt of one or two doses of vaccine and assessed over a range of intervals. RESULTS: of 197,885 LTCF residents, 47,087 (23.8%) had a positive test and 11,329 (5.8%) died within 28 days of a positive test during the study period. Relative to unvaccinated individuals, VE for infection was highest for ChAdOx-1 at 61% (40-74%) at 1-4 weeks and for BNT162b2 at 69% (52-80%) at 11-15 weeks following the second dose. Against death, VE was highest for ChAdOx-1 at 83% (58-94%) at 1-4 weeks and for BNT162b2 at 91% (75-97%) at 11-15 weeks following second dose. CONCLUSIONS: compared with unvaccinated residents, vaccination with one dose of BNT162b2 or ChAdOx-1 provided moderate protection against infection and death in residents of LTCFs. Protection against death improved after two doses. However, some waning of protection over time was noted