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R C Slack

Publications and source records attributed to R C Slack.

At least 19 recordsLinked to original sources
PubMed2000

Changing carriage rate of Neisseria meningitidis among university students during the first week of term: cross sectional study.

OBJECTIVE: To determine the rates of, and risk factors for, meningococcal carriage and acquisition among university students. DESIGN: Repeated cross sectional study. PARTICIPANTS: 2,507 students in their first year at university. MAIN OUTCOME MEASURES: Prevalence of carriage of meningococci and risk factors for carriage and acquisition of meningococci. RESULTS: Carriage rates for meningoccoci increased rapidly in the first week of term from 6.9% on day 1, to 11.2% on day 2, to 19.0% on day 3, and to 23.1% on day 4. The average carriage rate during the first week of term in October among students living in catered halls was 13.9%. By November this had risen to 31.0% and in December it had reached 34. 2%. Independent associations for acquisition of meningococci in the autumn term were frequency of visits to a hall bar (5-7 visits: odds ratio 2.7, 95% confidence interval 1.5 to 4.8), active smoking (1.6, 1.0 to 2.6), being male (1.6, 1.2 to 2.2), visits to night clubs (1. 3, 1.0 to 1.6), and intimate kissing (1.4, 1.0 to 1.8). Lower rates of acquisition were found in female only halls (0.5, 0.3 to 0.9). The most commonly acquired meningococcal strain was C2a P1.5 (P1.2), which has been implicated in clusters of invasive meningococcal disease at other UK universities. CONCLUSIONS: Carriage rates of meningococci among university students increase rapidly in the first week of term, with further increases during the term. The rapid rate of acquisition may explain the increased risk of invasive meningococcal disease and the timing of cases and outbreaks in university students.

Activities of Daily Living↗
PubMed2000

Dynamics of meningococcal long-term carriage among university students and their implications for mass vaccination.

In the 1997-98 academic year, we conducted a longitudinal study of meningococcal carriage and acquisition among first-year students at Nottingham University, Nottingham, United Kingdom. We examined the dynamics of long-term meningococcal carriage with detailed characterization of the isolates. Pharyngeal swabs were obtained from 2,453 first-year students at the start of the academic year (October), later on during the autumn term, and again in March. Swabs were immediately cultured on selective media, and meningococci were identified and serologically characterized. Nongroupable strains were genetically grouped using a PCR-based assay. Pulsed-field gel electrophoresis was used to determine the link between sequential isolates. Of the carriers initially identified in October, 44.1% (98 of 222) were still positive later on in the autumn (November or December); 57.1% of these remained persistent carriers at 6 months. Of the index carriers who lost carriage during the autumn, 16% were recolonized at 6 months. Of 344 index noncarriers followed up, 22.1% acquired carriage during the autumn term and another 13.7% acquired carriage by March. Overall, 43.9% (397 of 904) of the isolates were noncapsulated (serologically nongroupable); by PCR-based genogrouping, a quarter of these belonged to the capsular groups B and C. The ratio of capsulated to noncapsulated forms for group B and C strains was 2.9 and 0.95, respectively. Sequential isolates of persistent carriers revealed that individuals may carry the same or entirely different organisms at different times. We identified three strains that clearly switched their capsular expression on and off at different times in vivo. One student developed invasive meningococcal disease after carrying the same organism for over 7 weeks. The study revealed a high rate of turnover of meningococcal carriage among students. Noncapsulated organisms are capable of switching their capsular expression on and off (both ways) in the nasopharynx, and group C strains are more likely to be noncapsulated than group B strains. Carriage of a particular meningococcal strain does not necessarily protect against colonization or invasion by a homologous or heterologous strain.

Carrier State↗
PubMed1999

Seven-week interval between acquisition of a meningococcus and the onset of invasive disease. A case report.

Invasive meningococcal disease (IMD) is thought to occur within a few days of pharyngeal acquisition of Neisseria meningitidis. During a longitudinal study of carriage and acquisition among 2453 first-year undergraduates we identified a male student from whom N. lactamica was isolated in October 1997 followed by N. meningitidis in December 1997. In mid-January 1998 this student suffered a mild episode of IMD (meningitis) during which N. meningitidis was isolated from his CSF. The meningococcus carried in December 1997 was phenotypically and genotypically indistinguishable from the invading organism, suggesting the possibility that the organism may have been carried for 7 weeks prior to the onset of invasive disease. Further studies are needed to assess more accurately the range of asymptomatic carriage prior to disease onset.

Adult↗
PubMed1999

A collaborative approach to management of chlamydial infection among teenagers seeking contraceptive care in a community setting.

OBJECTIVES: To develop and assess a coordinated model of care for effective management of genital chlamydial infection in young women, identified through a selective screening programme in a community based teenage health clinic. METHODS: Selective screening for genital Chlamydia trachomatis was undertaken among young women aged 13-19 years who were having a routine cervical smear test, being referred for termination of pregnancy, or who reported behavioural risk factors, for, and/or symptoms of, genital infection. Collaboration among family planning, genitourinary medicine (GUM), and public health staff was used to enhance management of infected individuals, with particular focus on partner notification. RESULTS: 94 young women had confirmed genital chlamydial infection, representing 11% of those tested. All index patients received appropriate antibiotic therapy and follow up; 93 (99%) of these were counselled by a health adviser, of whom 62 (66%) were able to provide sufficient details for partner notification, resulting in treatment of male partners associated with 51 (82%) of these young women. Younger age (< or = 16 years) was significantly associated with delay in attending for treatment. CONCLUSIONS: Effective management of genital chlamydial infection is achievable in settings outside GUM clinics using a collaborative approach which incorporates cross referencing between community based services and GUM clinics.

Adolescent↗
PubMed1998

Training issues.

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Accreditation↗
PubMed1998

What is a community?

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Communicable Disease Control↗
PubMed1997

Diabetes mellitus, anti-secretory drugs and other risk factors for campylobacter gastro-enteritis in adults: a case-control study.

The epidemiology of notified cases of campylobacter gastroenteritis in adults in Nottingham Health District was investigated using a case-control study with a postal questionnaire to ascertain data on risk factors. Over a 14-month period 531 cases (a 73% response rate of all laboratory confirmed cases) and 512 controls replied. Conditional logistic regression analysis was used to determine independent associations with infection. These included foreign travel (odds ratio (OR) 3.4; 95% confidence intervals (CI) 2.0-5.7), diabetes mellitus (OR 4.1, CI 1.1-17), medication with omeprazole (OR 3.5, CI 1.1-12) and H2 and H2 antagonists (OR 3.7, CI 1.3-15), contact with puppies (OR 11.3, CI 1.2-105), eating chicken (OR 1.4, CI 1.1-1.8) and drinking milk from bottles with tops damaged by a bird (OR 3.3, CI 1.0-11). Preparing main meals (OR 0.9, CI 0.8-1.0) and drinking delivered milk (OR 0.6, CI 0.4-0.9) were associated with a reduced risk of campylobacter infection. Foreign travel was reported in 25% of cases and another 15% had significant associations with other risk factors. The majority of cases, 60%, remained unexplained, indicating the need for further evolution of sporadic cases.

Adolescent↗
PubMed1997

Health at work.

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Attitude of Health Personnel↗
PubMed1995

The autumn peak in campylobacter gastro-enteritis. Are the risk factors the same for travel- and UK-acquired campylobacter infections?

BACKGROUND: In the autumn of 1992 there was an excess of campylobacter cases in Nottingham compared with the national average. No relative increase was seen for salmonella infections. METHODS: A case-control study with a postal questionnaire was carried out to determine exposure to possible risk factors. The patients were 282 laboratory confirmed cases of campylobacter and 318 culture negative controls who had submitted a faeces specimen. All patients were aged 18 or older. The main outcome measures were relative risks for campylobacter infection compared with controls with a negative faeces culture. RESULTS: Twenty-five per cent of cases were associated with foreign travel. Eating chicken and handling raw poultry were the main risk factors for UK-acquired infections. The number of cases with a history of contact with puppies or drinking milk that was either unpasteurized or from bottles with bird-damaged tops was small. CONCLUSION: Eating chicken and handling raw poultry are the main risk factors for campylobacter infections. Contact with puppies or drinking potentially infected milk can explain only a small percentage of campylobacter infections. Risk factors for infection acquired abroad follow a different pattern compared with UK-acquired cases.

Adult↗