The potential for measles transmission in England

<p>Abstract</p> <p>Background</p> <p>Since the schools vaccination campaign in 1994, measles has been eliminated from England. Maintaining elimination requires low susceptibility levels to keep the effective reproduction number R below 1. Since 1995, however, MMR coverage in two year old children has decreased by more than 10%.</p> <p>Methods</p> <p>Quarterly MMR coverage data for children aged two and five years resident in each district health authority in England were used to estimate susceptibility to measles by age. The effective reproduction numbers for each district and strategic health authority were calculated and possible outbreak sizes estimated.</p> <p>Results</p> <p>In 2004/05, about 1.9 million school children and 300,000 pre-school children were recorded as incompletely vaccinated against measles in England, including more than 800,000 children completely unvaccinated. Based on this, approximately 1.3 million children aged 2–17 years were susceptible to measles. In 14 of the 99 districts, the level of susceptibility is sufficiently high for R to exceed 1, indicating the potential for sustained measles transmission. Eleven of these districts are in London. Our model suggests that the potential exists for an outbreak of up to 100,000 cases. These results are sensitive to the accuracy of reported vaccination coverage data.</p> <p>Conclusion</p> <p>Our analysis identified several districts with the potential for sustaining measles transmission. Many London areas remain at high risk even allowing for considerable under-reporting of coverage. Primary care trusts should ensure that accurate systems are in place to identify unimmunised children and to offer catch-up immunisation for those not up to date for MMR.</p

Syndromic surveillance of influenza-like illness in Scotland during the influenza A H1N1v pandemic and beyond

Syndromic surveillance refers to the rapid monitoring of syndromic data to highlight and follow outbreaks of infectious diseases, increasing situational awareness. Such systems are based upon statistical models to described routinely collected health data. We describe a working exception reporting system (ERS) currently used in Scotland to monitor calls received to the NHS telephone helpline, NHS24. We demonstrate the utility of the system to describe the time series data from NHS24 both at an aggregated Scotland level and at the individual health board level for two case studies, firstly during the initial phase of the 2009 Influenza A H1N1v and secondly for the emergence of seasonal influenza in each winter season from 2006/07 and 2010/11. In particular, we focus on a localised cluster of infection in the Highland health board and the ability of the system to highlight this outbreak. Caveats of the system, including the effect of media reporting of the pandemic on the results and the associated statistical issues, will be discussed. We discuss the adaptability and timeliness of the system and how this continues to form part of a suite of surveillance used to give early warnings to public health decision makers

Guidelines for malaria prevention in travellers from the United Kingdom for 2003.

This updated guidance from the Advisory Committee on Malaria Prevention for UK Travellers provides the essential information for healthcare workers who advise travellers. The many personal, visit and location-specific factors that need to be taken into account are discussed. Tables include the available antimalarials for prophylaxis and for standby treatment, appropriate choices of regimen by region and country for malarious areas, and the adjustments needed for children and in concomitant disease. There is greater emphasis on mefloquine, doxycycline and atovaquone/proguanil as the three options for highly chloroquine-resistant falciparum malarious areas, and changes in emergency standby medication

Impact of infection control interventions on rates of Staphylococcus aureus bacteraemia in National Health Service acute hospitals, East Midlands, UK, using interrupted time-series analysis

Background: Reducing healthcare-associated infection (HCAI) is a UK national priority. Multiple national and regional interventions aimed at reduction have been implemented in National Health Service acute hospitals, but assessment of their effectiveness is methodologically challenging. Aim: To assess the effectiveness of national and regional interventions undertaken between 2004 and 2008 on rates of meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-sensitive Staphylococcus aureus (MSSA) bacteraemia within acute hospitals in the East Midlands, using interrupted time-series analysis. Methods: We used segmented regression to compare rates of MRSA and MSSA bacteraemia in the pre-intervention, implementation, and post-intervention phases for combined intervention packages in eight acute hospitals. Findings: Most of the change in MSSA and MRSA rates occurred during the implementation phase. During this phase, there were significant downward trends in MRSA rates for seven of eight acute hospital groups; in four, this was a steeper quarter-on-quarter decline compared with the pre-intervention phase, and, in one, an upward trend in the pre-intervention phase was reversed. Regarding MSSA, there was a significant positive effect in four hospital groups: one upward trend during the pre-intervention phase was reversed, two upward trends plateaued, and in one hospital group an indeterminate trend decreased significantly. However, there were significant increasing trends in quarterly MSSA rates in four hospital groups during the implementation or post-intervention periods. Conclusion The impact of interventions varied by hospital group but the overall results suggest that national and regional campaigns had a beneficial impact on MRSA and MSSA bacteraemia within the East Midlands

A review of the pesticide MCPA in the land-water environment and emerging research needs

peer-reviewedDue to its high solubility and poor adsorption to the soil matrix, the postemergence herbicide 2-methyl-4-chlorophenoxyacetic acid (MCPA) is susceptible to transport into surface and groundwater bodies, where it can result in compromised water quality and breaches of legislative standards. However, there is still poor understanding of catchment scale dynamics and transport, particularly across heterogeneous hydrogeological settings. While it is known that MCPA degrades under aerobic conditions, negligible breakdown can occur in anaerobic environments, potentially creating a legacy in saturated soils. Fast runoff pathways post application are likely transport routes, but the relative contribution from the mobilization of legacy MCPA from anaerobic zones has yet to be quantified, making the delineation of MCPA sources encountered during monitoring programs challenging. While ecotoxicological effects have been examined, little is known about the interaction of MCPA (and its degradation products) with other pesticides, with nutrients or with colloids, and how this combines with environmental conditions to contribute to multiple stressor effects. We examine the state of MCPA knowledge, using case study examples from Ireland, and consider the implications of its widespread detection in waterbodies and drinking water supplies. Research themes required to ensure the sustainable and safe use of MCPA in an evolving agricultural, social and political landscape are identified here. These include the need to identify mitigation measures and/or alternative treatments, to gain insights into the conditions governing mobilization and attenuation, to map pathways of migration and to identify direct, synergistic and antagonistic ecotoxicological effects

Arsenic Concentrations in Private Bedrock Wells in Southeastern New Hampshire

The quality of drinking water obtained from private wells in New Hampshire is not regulated; consequently, private wells are often not sampled for arsenic unless individual well owners choose to do so. To provide private well owners and Federal and State environmental and health officials with accurate information on arsenic concentrations from private wells in this region, the U.S. Geological Survey (USGS) conducted an arsenic occurrence and distribution study, in cooperation with the U.S. Environmental Protection Agency (EPA New England), New Hampshire Department of Environmental Services (NHDES), New Hampshire Estuaries Project, and with the New Hampshire Department of Health and Human Services (NHDHHS). This report describes the results of this study to determine the range of arsenic concentrations from ground water in the three counties of southeastern New Hampshire by analyzing water samples collected by a randomly selected group of well owners from this area

Biochar from Pyrolysis of Biosolids for Nutrient Adsorption and Turfgrass Cultivation

At water resource recovery facilities, nutrient removal is often required and energy recovery is an ever-increasing goal. Pyrolysis may be a sustainable process for handling wastewater biosolids because energy can be recovered in the py-gas and py-oil. Additionally, the biochar produced has value as a soil conditioner. The objective of this work was to determine if biochar could be used to adsorb ammonia from biosolids filtrate and subsequently be applied as a soil conditioner to improve grass growth. The maximum carrying capacity of base modified biochar for NH3−N was 5.3 mg/g. Biochar containing adsorbed ammonium and potassium was applied to laboratory planters simulating golf course putting greens to cultivate Kentucky bluegrass. Planters that contained nutrient-laden biochar proliferated at a statistically higher rate than planters that contained biosolids, unmodified biochar, peat, or no additive. Nutrient-laden biochar performed as well as commercial inorganic fertilizer with no statistical difference in growth rates. Biochar from digested biosolids successfully immobilized NH3−N from wastewater and served as a beneficial soil amendment. This process offers a means to recover and recycle nutrients from water resource recovery facilities