RESUMEN
BACKGROUND: A cluster of seven cases of skin and wound infections caused by a multiply resistant meticillin-resistant Staphylococcus aureus (MRSA) were detected in a small-town community in South Yorkshire. Initial microbiological investigations showed that all isolates belonged to a spa type observed rarely in England (t1476). AIM: To describe the epidemiology of t1476 MRSA in South Yorkshire. METHODS: Retrospective and prospective case ascertainment was promoted through communication with local microbiology laboratories. Public health investigation included a detailed review of clinical notes for a subset of nine cases. Genomic and phylogenetic analysis was undertaken on t1476 MRSA. FINDINGS: Thirty-two cases of t1476 MRSA infection or colonization were identified between December 2014 and February 2018. Cases were older adults (aged 50-98 years). Healthcare exposures for a subset of nine cases indicated frequent contact with a team of district nurses, with all but one case receiving treatment on the same day as another case prior to their own diagnosis. No cases were admitted to hospital at the time of specimen collection. Despite detailed investigations, no carriers were detected among district nursing staff. A long-term carrier/super-shedder was not found. Phylogenetic analysis indicated that t1476 MRSA cases from South Yorkshire were monophyletic and distant from both MRSA of the same lineage from elsewhere in the UK (N = 15) and from publicly available sequences from Tanzania. CONCLUSION: Genomic and epidemiological analyses indicate community-based transmission of a multiply resistant MRSA clone within South Yorkshire introduced around 2012-2013, prior to the detection of a spatial-temporal cluster associated with a distinct risk group. Surveillance data indicate continued circulation.
Asunto(s)
Infección Hospitalaria/epidemiología , Farmacorresistencia Bacteriana Múltiple , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Tipificación Molecular , Infecciones Cutáneas Estafilocócicas/epidemiología , Secuenciación Completa del Genoma , Infección de Heridas/epidemiología , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Servicios de Salud Comunitaria , Infección Hospitalaria/microbiología , Infección Hospitalaria/transmisión , Transmisión de Enfermedad Infecciosa , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/genética , Persona de Mediana Edad , Epidemiología Molecular , Filogenia , Estudios Prospectivos , Estudios Retrospectivos , Infecciones Cutáneas Estafilocócicas/microbiología , Infecciones Cutáneas Estafilocócicas/transmisión , Infección de Heridas/microbiología , Infección de Heridas/transmisiónRESUMEN
Background: This study aims to estimate pertussis vaccine uptake in pregnant women in England, describe timing of vaccine delivery and examine variations in uptake. Methods: Cross-sectional survey of vaccine uptake in women delivering in maternity units in England. Variation in uptake described according to geography, maternal age, ethnicity and parity as reported by the midwife completing the survey. Results: A total of 1325 surveys were returned, 85% of which (1128) contained information about vaccination. Vaccine uptake was 61.8% (95% CI: 56.8-66.5) and was higher in the White British ethnic group than any other (67.7%, 95% CI: 63.5 to 71.5). Uptake was higher outside London (65.3%, 95% CI: 61.1-69.3) than within London (31.0%, 95% CI: 24.9-38.0). Reported uptake was lower in areas of high deprivation, and in women of higher parity, observations that were not statistically significant in the multivariable model. Overall, 74% of women were vaccinated between 28 and 32 weeks. Conclusions: Pertussis vaccine uptake in pregnant women varies significantly across the country and is affected by ethnicity, deprivation and parity. Variations should be addressed through service delivery models designed to reduce potential inequalities in infant protection.
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Aceptación de la Atención de Salud/estadística & datos numéricos , Vacuna contra la Tos Ferina , Vacunación/estadística & datos numéricos , Adulto , Estudios Transversales , Inglaterra , Femenino , Encuestas de Atención de la Salud , Humanos , Aceptación de la Atención de Salud/etnología , Embarazo , Adulto JovenRESUMEN
We investigated the epidemiology and characterization of isolates of Staphylococcus aureus within the Yorkshire and Humber (YH) region in the UK. In July 2015, each laboratory within YH (n = 14) was assigned two consecutive days during which all clinical isolates of S. aureus were collected. Isolates were tested for antibiotic susceptibilities and the presence of genes encoding methicillin resistance (mecA and mecC), Panton-Valentine leukocidin (PVL) (lukS-PV), and efflux-mediated chlorhexidine resistance (qacA); isolates were also characterized by spa-types. Minimum inhibitory concentrations (MICs) to chlorhexidine were determined by the broth dilution method. Of 520 isolates collected, 6·2% were methicillin-resistant S. aureus (MRSA, all mecA-positive) and mupirocin resistance was low [0·8%, 95% confidence interval (CI) 0·3-2·0] and only found in MRSA. Carriage of the qacA gene was identified in 1·7% (95% CI 0·8-3·3) of isolates and 3·5% (95% CI 2·2-5·4) had a chlorhexidine MIC of 4 mg/l. The PVL gene was infrequent (3·7%, 95% CI 2·4-5·6). Genotyping identified 234 spa-types that mapped to 22 clonal complexes. Comparison of these current data with previous work suggest that the widespread use of staphylococcal decolonization regimens over the past decade or more has not had an adverse impact on resistance rates, PVL carriage or the prevalence of specific S. aureus lineages.
Asunto(s)
Variación Genética , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/clasificación , Staphylococcus aureus/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Niño , Preescolar , Farmacorresistencia Bacteriana , Femenino , Genes Bacterianos , Genotipo , Humanos , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Tipificación Molecular , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/genética , Reino Unido/epidemiología , Adulto JovenRESUMEN
A case-control study was conducted to investigate an outbreak of 46 cases of cryptosporidiosis in visitors to a petting farm in England. Details of exposures on the farm were collected for 38 cases and 39 controls, recruited through snowball sampling. Multivariable logistic regression identified that cases were 5·5 times more likely than controls to have eaten without washing their hands [95% confidence interval (CI) 1·51-19·9, P = 0·01] and 10 times less likely to report being informed of risk of infection on arrival (odds ratio 0·10, 95% CI 0·01-0·71, P = 0·02). An uncommon Cryptosporidium parvum gp60 subtype (IIaA19G1R1) was identified in a lamb faecal sample and all subtyped cases (n = 22). We conclude that lack of verbal advice and non-compliance with hand washing are significantly associated with a risk of cryptosporidiosis on open farms. These findings highlight the public health importance of effectively communicating risk to petting farm visitors in order to prevent future outbreaks of zoonotic infections.