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PubMed1987

Possible windborne spread of myxomatosis to England in 1953.

An analysis of the meterological conditions showed that the first outbreaks of myxomatosis in S.E. England in 1953 could have resulted from wind carriage of insects infected with myxoma virus from northern France. South-easterly winds on the night 11-12 August would have carried the insects 120-160 km from the Départements of Nord, Pas de Calais and Somme across the English Channel to near Edenbridge, Kent. The flight would have taken 6.5-8.5 h at wind speeds of 15-22 km h-1. On the night 11-12 August, temperatures increased with height (inversion) up to 500 m; at ground level temperature was around 19 degrees C and at 500 m was 25 degrees C. Insects would have travelled up to the top of the inversion arriving on 12 August as the inversion declined. Two or possibly three generations of infection would have taken place before the disease was seen around the middle of September 1953. The most likely insect was the mosquito Anopheles atroparvus which breeds along the coastal marshes of England and northern France and which has been shown experimentally and in the field to transmit myxoma virus mechanically.

Air Movements↗
PubMed1987

The changing incidence of human hydatid disease in England and Wales.

The incidence of hospital-diagnosed human hydatid disease acquired in the UK was estimated from a survey based on Hospital Activity Analysis data for the period 1974-83. The average annual incidence in Wales was 0.4 per 100,000 population compared with 0.02 per 100,000 in England. Within Wales, Powys, and particularly Brecknock, had the highest incidence (7 per 100,000 per year). Compared with the period 1953-62, the average annual incidence for Wales fell by half (from 0.8 to 0.4 per 100,000 per year), but in Powys the incidence did not decline, and in Brecknock and Montgomery there was a marginal increase. In comparison with 1953-62, the age-specific incidence in Wales and Powys decreased in each age group with the notable exception of children less than 15 years of age. This finding emphasizes that transmission of Echinococcus granulosus to humans is still occurring at hyper-endemic levels in parts of England and Wales and that control efforts should be intensified.

Adolescent↗
PubMed1987

Paralytic poliomyelitis in England & Wales, 1970-84.

In 1962 the Public Health Laboratory Service (PHLS) became responsible for the Poliomyelitis Surveillance Scheme for England and Wales, which since 1970 has included the World Health Organisation (WHO) enquiry into Acute Persisting Spinal Paralysis. All the records have been kept, including those of patients who were later considered not to have had poliomyelitis. This paper reviews the cases between 1970-84 of patients normally resident in England and Wales, where the clinical features of the illness were considered by the clinician in charge to be those of poliomyelitis and in which either poliovirus was isolated or there was serological evidence of recent infection. Seventy cases met these criteria. Two patients died. A wild strain of poliovirus was isolated in 19 cases; a vaccine-like strain in 27; an intermediate strain in 5; and in 19 cases the strain was not known or there was no isolate. Eleven patients had a history of overseas travel; 17 had been vaccinated recently; and 12 had been in contact with a recent vaccine. In the remaining 30 cases, the source of the infection was not found. Other details, including the age distribution, vaccination history and the laboratory findings are discussed.

Adult↗
PubMed2002

The burden of Helicobacter pylori infection in England and Wales.

The prevalence of active infection with Helicobacter pylori in the general population of England and Wales was estimated using high reactivity for specific IgG in serum ELISA as a marker. A total of 10,118 anonymized residues of serum samples collected in 1986 and 1996 from persons aged 1-84 years were used. Estimated prevalence of active infection varied by region and was highest in London. Prevalence was related to decade of birth and increased from 4-3% in those born during the 1980s to 30% in those born before 1940. An estimated total of 7.5 million people living in England and Wales have an active infection and analysis by decade of birth showed no significant difference between samples collected in 1986 and 1996. These data suggest H. pylori infection is becoming less common, is acquired at an early age and is unlikely to be resolved unless suitable antimicrobial treatment is sought.

Adolescent↗
PubMed2003

Tetanus in England and Wales, 1984-2000.

A review of national tetanus surveillance in England and Wales during 1984-2000 was undertaken to evaluate the surveillance system and national vaccination policy. Hospital Episode Statistics for tetanus in England for fiscal years 1989/90-1995/6 were also examined to estimate under-reporting. A total of 175 cases of tetanus were reported, giving an annual incidence of 0.20 per million, the lowest levels ever recorded. The highest incidence was in those aged over 64 years (0.66 per million) with no significant sex difference. Twenty (11%) cases were reported in people who were eligible for routine childhood vaccination. Outdoor injuries were the commonest reported exposure risk. Tetanus case under-reporting was estimated as 54-64%. We conclude that GPs should ensure that all their patients are fully vaccinated, targeting those born before 1961. High childhood tetanus vaccination coverage remains a priority. As the disease becomes rarer, enhanced tetanus case surveillance is essential for tetanus immunization policy evaluation.

Adolescent↗
PubMed2005

Past mortality from infectious diseases and current burden of allergic diseases in England and Wales.

This study documents the changes in mortality in England and Wales over the last 100 years as a possible explanation for our increasingly allergy-prone Western society. A total of 53 million computerized recorded deaths, which occurred from 1901 to 2000 were analysed retrospectively. Childhood mortality decreased by 98%, from 40.6% of total annual deaths in 1901 to 0.9% in 2000. In 1901, 36.2% of all deaths and 51.5% of childhood deaths were from infectious diseases. By contrast in 2000, 11.6% of all deaths and only 7.4% of childhood deaths were from infectious diseases. Infectious diseases were a significant cause of childhood mortality in British cities until about 40 years ago. Several factors, including vaccination, antibiotics and improved sanitation have contributed to this trend. Survival of individuals with heightened immunity to infections may have led to natural selection of allergy-prone individuals in England and Wales. However, the relationship between changes in rates of infection and allergy is complex and not fully understood.

Adolescent↗
PubMed2005

Changes in the epidemiology of epiglottitis following introduction of Haemophilus influenzae type b (Hib) conjugate vaccines in England: a comparison of two data sources.

Paediatric cases of epiglottitis declined markedly in England following the introduction of safe effective immunization against Haemophilus influenzae type b (Hib). With the recently described resurgence in Hib infections, a corresponding rise in the number of presentations of clinical epiglottitis in children was observed, although numbers were still well below those reported prior to vaccine availability. This was seen both in microbiology reports and hospital admissions data for England. In keeping with the more diverse aetiology of epiglottitis in adults, Hib vaccination had minimal impact on hospital presentations with upper airway infections in those aged 15 years and over, which showed an overall increasing trend over 10 years. The need for a high index of suspicion to allow early diagnosis of this life-threatening clinical presentation is reinforced.

Adolescent↗
PubMed2006

Hepatitis A surveillance in England--how many cases are not reported and does it really matter?

Underreporting of hepatitis A infection in England may be high and a number of outbreaks have occurred undetected by routine surveillance. We evaluated surveillance of hepatitis A cases by employing capture-recapture analysis on data from two distinct outbreaks of hepatitis A. The overall reporting of cases of hepatitis A was 81.7% (95% CI 55.3-95) in the first outbreak in North East England and reporting through Lab Base was 65.7% (95% CI 42.8-76.4). In the second outbreak in the East Midlands the overall reporting of hepatitis A cases was 27.8% (95% CI 19-38.7) and through Lab Base 16.6% (95% CI 11.4-23.1). Underreporting of hepatitis A cases is high. Public health interventions exist to prevent and control outbreaks of hepatitis A. The lack of reliable data on incidence and prevalence hampers effective public health management of this disease.

Disease Notification↗
PubMed2006

Hepatitis C virus: laboratory surveillance in England and Wales, 1992-2004.

Between 1992 and 2004, a total of 49,819 confirmed hepatitis C infections have been reported to the Health Protection Agency (HPA) by laboratories in England and Wales; the annual number of reports increased from 241 in 1991 to 8149 in 2004. Most reports with a known risk factor were in injecting drug users (87%, 12,438/14,221), but 71% (35,598/49,819) of the total had no reported identified risk. The age-sex distribution of the latter cases was similar to that in injecting drug users. Using names to assign ethnicity, individuals with South Asian names had an older age distribution and a different risk factor profile from non-South Asians. Using published age-specific prevalence data from 1996, it was estimated that around 28,1764 cases of hepatitis C infection exist in England and Wales, and that only 17% of these cases have been reported to the HPA. Surveillance reports continue to provide important information regarding trends in hepatitis C infection in specific risk groups.

Adolescent↗
PubMed1998

Outbreaks of waterborne infectious intestinal disease in England and Wales, 1992-5.

Following the introduction of an improved surveillance system for infectious intestinal disease outbreaks in England and Wales, the Public Health Laboratory Service Communicable Disease Surveillance Centre received reports of 26 outbreaks between 1 January 1992 and 31 December 1995 in which there was evidence for waterborne transmission of infection. In these 26 outbreaks, 1756 laboratory confirmed cases were identified of whom 69 (4%) were admitted to hospital. In 19 outbreaks, illness was associated with the consumption of drinking water from public supplies (10 outbreaks) or private supplies (9 outbreaks). The largest outbreak consisted of 575 cases. In 4 of the remaining 7 outbreaks, illness was associated with exposure to swimming pool water. Cryptosporidium was identified as the probable causative organism in all 14 outbreaks associated with public water supplies and swimming pools. Campylobacter was responsible for most outbreaks associated with private water supplies. This review confirms a continuing risk of cryptosporidiosis from chlorinated water supplies in England and Wales, and reinforces governmental advice to water utilities that water treatment processes should be rigorously applied to ensure effective particle removal. High standards of surveillance are important for prompt recognition of outbreaks and institution of control measures. As microbiological evidence of water contamination may be absent or insufficient to implicate a particular water supply, a high standard of epidemiological investigation is recommended in all outbreaks of suspected waterborne disease.

Communicable Diseases↗
PubMedDate not supplied

The prevalence of occupational injuries in EMTs in New England.

OBJECTIVE: To characterize the prevalence and morbidity of injuries to emergency medical technicians EMTs) in New England [United States]. DESIGN: A survey was mailed to a 2% random sample of all registered EMTs in the six New England States. The identity of the EMTs remained anonymous, and a second mailing was used to improve return rate. The EMTs were requested to recall events that occurred during the previous six months. RESULTS: A total of 439 of the 786 (56%) surveys were returned representing 13,875 hours of duty time in the six-month period. Seventy-one percent of the EMTs were male with a mean age of 35 years. Sixty-six percent were basic-EMTs. Injury attack rates (number of injuries/100 EMTs/6 months) were: stress, 11.2; back, 10.5; extremity, 9.8; assault, 8.4; ambulance collision, 4.1; hearing loss, 2.5; and eye injury, 1.4. Twelve percent of the EMTs were injured more than once in the six-month period. The paramedics more frequently were involved in ambulance collisions, suffered from stress, and were less likely to injure their back. There were minor interstate differences. Disability due to back injury affected 2.5% of those surveyed, four EMTs lost duty time secondary to an assault, and 0.5% of the EMTs were out of work due to stress. CONCLUSIONS: This survey begins to characterize the occupational risks of EMTs. The prevalence of back injuries, assault, stress, and extremity injuries seems to be too high. Educational programs and preventive interventions should be designed to minimize back injuries, stress, and assault. There is a need for more research nationwide in order to better characterize these injuries.

Accidents, Occupational↗
PubMed2000

The law concerning the conduct of lineups in England and Wales: how well does it satisfy the recommendations of the American Psychology-Law Society?

Four rules minimize the likelihood of a false conviction resulting from the misidentification of a suspect from a lineup: (1) The person conducting the lineup should not know which member of the lineup is the suspect. (2) The eyewitness should be warned that the criminal might not be present. (3) Foils should be selected based on the eyewitness's verbal description of the criminal. (4) Confidence should be recorded at the time of identification. In this paper the relevant law relating to lineups in England and Wales is outlined and the extent to which they satisfy the four rules is reviewed. It is concluded that the way in which lineups are conducted in England and Wales would, with minor modifications, satisfy the four rules, and this demonstrates that the rules can be applied practically.

Criminal Law↗
PubMed1997

Subtypes of Campylobacter jejuni from sporadic cases of diarrhoeal disease at different locations in England are highly diverse.

Serotyping (heat stable antigens) was performed on 398 strains of Campylobacter jejuni from faeces of human enteritis cases in England. Strains isolated over 12 months at three locations were heterogeneous with 33 HS serotypes represented. HS1 and HS4 complex were the predominant types (34% of all strains). The monthly strain frequency distributions were similar at the three locations. The late spring peak appeared to be associated with a rise in miscellaneous serotypes rather than with the emergence of any characteristic predominant serotype. PFGE DNA restriction profiling provided evidence of a high degree of genomic diversity within the common HS1 and HS4 complex serotypes, irrespective of the geographical source, yet some subtypes were common to more than one location. The study showed that C. jejuni strain subtypes from human enteric infections in England were highly diverse, and that HS serotyping must be combined with a more discriminatory subtyping method such as PFGE DNA profiling to provide an accurate basis for epidemiological surveillance.

Campylobacter Infections↗
PubMed2001

Characterisation of strains of enteroaggregative Escherichia coli isolated during the infectious intestinal disease study in England.

Strains of Escherichia coli, hybridising with a DNA probe for enteroaggregative E. coli (EAggEC), were isolated from patients with infectious intestinal disease (IID) or gastro-enteritis, and healthy controls during the study of IID in England. Of 3506 cases presenting with an IID, 160 (4.6%) had faecal EAggEC as compared with 46 (1.7%) of 2772 healthy controls, 53% of EAggEC isolated from each of the 'case' and the 'control' groups adhered in a 'stacked-brick' formation. Strains from cases and controls belonged to over 39 and 14 different serogroups respectively, and approximately half of the strains isolated did not react with antisera in the current somatic antigen serotyping scheme. Forty-nine cases with EAggEC (31%) had a known history of foreign travel. Over 50% of strains isolated from cases and controls were resistant to one or more of eight antimicrobials, and antimicrobial resistance was not statistically significantly more common among cases with a known history of foreign travel (p = 0.57). These data form part of the largest investigation carried out on these organisms in the UK to date and provide the most comprehensive analysis of strains of EAggEC isolated from the general population of England.

Case-Control Studies↗
PubMed2004

A suicide prevention strategy for England.

Over the last decade an increasing number of countries have established national strategies for suicide prevention. In the autumn of 2002 the suicide prevention strategy for England was presented to the general public, introducing what could be called a second generation of national programs for suicide prevention. This strategy uses evidence-based criteria for its priorities more systematically than before. Furthermore, it has put an increased emphasis on goals being specific, preventive measures being practical, and the preventive potential being visible. Other guiding principles for this strategy are that suicide preventive measures and initiatives should be open to monitoring and evaluation, and that revisions and updates of the national strategy should be made regularly--thus constituting an evolving strategy. This paper examines the content of the new national strategy for suicide prevention in England and what new contributions to the field it may make.

England↗
PubMed2002

Survey of epidural analgesia management in general intensive care units in England.

BACKGROUND: The management of epidural analgesia is controversial. Many intensive care unit (ICU) patients may benefit from this form of analgesia but have one or more contraindications to its use. Sepsis, coagulopathy, insertion in a sedated, ventilated patient, and lack of consent are common problems in ICU patients. Little has been published to help guide practice in this area. I wished to establish the current practice of the management of epidural analgesia in general ICUs in England when relative or absolute contraindications occur, in order to determine the current standard of care for placement and use of epidural analgesia in ICU patients. METHODS: A postal questionnaire survey of the management of epidural analgesia in critically ill patients was sent to the named clinical director of all (216) general ICUs in England. RESULTS: Responses were received from 159 (75%) units: 89% of responding units use epidural analgesia but only 51(32%) have a written policy covering its use. Anesthetists or intensivists with an anesthetic background sited all epidural catheters; 68% of units would not site an epidural in a patient with positive blood cultures; but only 52% considered culture negative sepsis (systemic signs of sepsis with no organism isolated) to be a contraindication. Neither lack of consent nor the need for anticoagulation after the catheter had been sited were considered contraindications to inserting an epidural catheter by the majority of respondents. Although 71% of the units would remove an epidural catheter if a patient developed positive blood cultures after it had been sited, the majority of the ICUs did not consider culture negative sepsis and the need for anticoagulation contraindications to maintain a previously sited epidural. CONCLUSIONS: Practice varied considerably with little consensus. Although all the respondents use epidural analgesia in critically ill patients, the indications and contraindications to epidural analgesia remain controversial, and further research is required to help define the role of epidural analgesia in this high-risk group.

Analgesia, Epidural↗
PubMed2000

The efficiency of the community dental service in England: a data envelopment analysis.

OBJECTIVES: To assess the efficiency with which health authorities' Community Dental Services provide dental care in England. METHODS: A data envelopment analysis of inputs (hours worked by dental officers, therapists, hygienists and others) and outputs (screening, treatment, prevention) of the Community Dental Service (CDS) was conducted. Relative efficiency ratings of the CDS by health authority were further analysed in order to identify external factors which effect efficiency and are outside the control of the Community Dental Service. RESULTS: The relative efficiency of the CDS varies widely in England--on average the CDS is operating at 75% of efficient levels compared to best-practice services. This could not be explained by plausible factors outside the CDS's control, such as differences in deprivation and urban-rural differences between health authorities. CONCLUSIONS: These results, if validated by further studies, should be disturbing since many Community Dental Services services appear to be under-performing. However, this data-driven study could not uncover the detailed context of an individual service's performance. A useful next step would be detailed case-studies of several "star" and under-performing services to search for deeper reasons underpinning relative performance levels.

Benchmarking↗
PubMedDate not supplied

ABO genes are differentially distributed in socio-economic groups in England.

No direct evidence is available concerning what average genetic differences, if any, characterize the segments of socially stratified human populations, although theoretical considerations suggest that genetic differentiation within such populations is to be expected. We have now analysed two large samples of data from blood donors in England to test whether the distributions of the ABO and Rhesus blood group phenotypes are random with respect to socio-economic groups as determined by occupational classification. We have found that in both native and migrant sections of the populations of two widely separated regions (south-west England and part of Yorkshire) and in both sexes, the A phenotype is highly significantly more, and the O phenotype significantly less, frequent than expected in social classes I and II, while the converse is seen in social classes III-V. An individual of the A phenotype has thus about 15% greater probability than chance would dictate of being placed in classes I and II. The distribution of the Rh+ and Rh- phenotypes does not differ significantly between classes. It seems unlikely that this nonrandom distribution of the ABO phenotypes among socio-economic groups results from sampling, historical or migrational effects and we conclude that the observed association is likely to result from pleiotropic effects of the ABO alleles (or genes closely linked to them) on attributes influencing occupational type, social mobility and social class.

ABO Blood-Group System↗