Gastroenteritis In England Research Articles

Genomic approaches used to investigate an atypical outbreak of Salmonella Adjame

In 2017, an outbreak of gastroenteritis in England attributed to Salmonella Adjame was detected and investigated. With the introduction of whole genome sequencing (WGS) for microbial typing, methods for comparing international outbreak data require evaluation. A case was defined as a person resident in England with a clinical sample from 1 June 2017 to 27 July 2017 from whom S. Adjame was isolated. Cases were interviewed and exposures analysed. Backward tracing of food provenance was undertaken. WGS was performed on isolates from cases and historical isolates and compared using Public Health England’s SnapperDB high-quality SNP pipeline and Enterobase’s Salmonella core genome multi-locus sequence typing (cgMLST) scheme. In total, 14 cases were identified. The majority were vegetarian, probably of South Asian descent, with a median age of 66.5 years with no recent international travel reported. Cases consumed a range of fresh food products including herbs and spices bought from South Asian grocers. Backward tracing did not identify a common source. WGS typing showed sub-clustering and considerable genetic variation across human samples. cgMLST allele-based analysis was comparable to SNP-derived phylogenetic analysis and clusters were defined using each method. Imported herbs or spices were suspected vehicles. The cases were linked in time and place but WGS showed marked heterogeneity, atypical of a point source Salmonella outbreak. The application of incorporating SNP or allelic differences into the case definition may not always be appropriate. With further validation, cgMLST could be used for international outbreak alerts when WGS analysis is being undertaken to facilitate comparison.

Estimating the Hospital Burden of Norovirus-Associated Gastroenteritis in England and Its Opportunity Costs for Nonadmitted Patients.

Norovirus places a substantial burden on healthcare systems, arising from infected patients, disease outbreaks, beds kept unoccupied for infection control, and staff absences due to infection. In settings with high rates of bed occupancy, opportunity costs arise from patients who cannot be admitted due to beds being unavailable. With several treatments and vaccines against norovirus in development, quantifying the expected economic burden is timely. The number of inpatients with norovirus-associated gastroenteritis in England was modeled using infectious and noninfectious gastrointestinal Hospital Episode Statistics codes and laboratory reports of gastrointestinal pathogens collected at Public Health England. The excess length of stay from norovirus was estimated with a multistate model and local outbreak data. Unoccupied bed-days and staff absences were estimated from national outbreak surveillance. The burden was valued conventionally using accounting expenditures and wages, which we contrasted to the opportunity costs from forgone patients using a novel methodology. Between July 2013 and June 2016, 17.7% (95% confidence interval [CI], 15.6%‒21.6%) of primary and 23.8% (95% CI, 20.6%‒29.9%) of secondary gastrointestinal diagnoses were norovirus attributable. Annually, the estimated median 290000 (interquartile range, 282000‒297000) occupied and unoccupied bed-days used for norovirus displaced 57800 patients. Conventional costs for the National Health Service reached £107.6 million; the economic burden approximated to £297.7 million and a loss of 6300 quality-adjusted life-years annually. In England, norovirus is now the second-largest contributor of the gastrointestinal hospital burden. With the projected impact being greater than previously estimated, improved capture of relevant opportunity costs seems imperative for diseases such as norovirus.

Burden, duration and costs of hospital bed closures due to acute gastroenteritis in England per winter, 2010/11–2015/16

SummaryBackgroundBed closures due to acute gastroenteritis put hospitals under pressure each winter. In England, the National Health Service (NHS) has monitored the winter situation for all acute trusts since 2010/11.AimTo estimate the burden, duration and costs of hospital bed closures due to acute gastroenteritis in winter.MethodsA retrospective analysis of routinely collected time-series data of bed closures due to diarrhoea and vomiting was conducted for the winters 2010/11 to 2015/16. Two key issues were addressed by imputing non-randomly missing values at provider level, and filtering observations to a range of dates recorded in all six winters. The lowest and highest values imputed were taken to represent the best- and worst-case scenarios. Bed-days were costed using NHS reference costs, and potential staff absence costs were based on previous studies.FindingsIn the best-to-worst case, a median of 88,000–113,000 beds were closed due to gastroenteritis each winter. Of these, 19.6–20.4% were unoccupied. On average, 80% of providers were affected, and had closed beds for a median of 15–21 days each winter. Hospital costs of closed beds were £5.7–£7.5 million, which increased to £6.9–£10.0 million when including staff absence costs due to illness.ConclusionsThe median number of hospital beds closed due to acute gastroenteritis per winter was equivalent to all general and acute hospital beds in England being unavailable for a median of 0.88–1.12 days. Costs for hospitals are high but vary with closures each winter.

Impact of the national rotavirus vaccination programme on acute gastroenteritis in England and associated costs averted

BackgroundIntroduction of infant oral rotavirus vaccination in the UK in July 2013 has resulted in decreased hospitalisations and Emergency Department (ED) visits for acute gastroenteritis (AGE), for both adults and children. We investigated reductions in AGE incidence seen in primary care in the two years after vaccine introduction, and estimated the healthcare costs averted across healthcare settings in the first year of the vaccination programme. MethodsWe used primary care data from the Clinical Practice Research Datalink and age-stratified time-series analyses to derive adjusted incidence rate ratios (IRRa) for AGE in the first two years of the post-vaccination era (July 2013-April 2015) compared to the pre-vaccination era (July 2008-June 2013). We estimated cases averted among children aged <5years in the first year of the vaccination programme by comparing observed numbers of AGE cases in 2013–2014 to numbers predicted from the time-series models. We then estimated the healthcare costs averted for general practice consultations, ED visits and hospitalisations. ResultsIn general practice, AGE rates in infants (the target group for vaccination) decreased by 15% overall after vaccine introduction (IRRa=0.85; 95%CI=0.76–0.95), and by 41% in the months of historically high rotavirus circulation (IRRa=0.59; 95%CI=0.53–0.66). Rates also decreased in other young children and to a lesser degree in older individuals, indicating herd immunity. Across all three settings (general practice, EDs, and hospitalisations) an estimated 87,376 (95% prediction interval: 62,588–113,561) AGE visits by children aged <5years were averted in 2013–14, associated with an estimated £12.5million (9,209–16,198) reduction in healthcare costs. ConclusionsThe marked decreases in the general practice AGE burden after rotavirus vaccine introduction mirror decreases seen in other UK healthcare settings. Overall, these decreases are associated with substantial averted healthcare costs.

Winter burden of hospital bed closures due to acute gastroenteritis in England, 2010–11 to 2015–16: a population-based observational study

BackgroundWinter pressure on hospital beds is a recurring public health concern. We aimed to estimate and compare the extent of hospital bed closures due to gastroenteritis during the past six winters in England. MethodsWe obtained all available daily records of occupied and unoccupied hospital beds closed because of diarrhoea and vomiting for all acute Trusts in England for 2010–11 to 2015–16 from National Health Service (NHS) England's winter situation reports. Because recording lengths differed in all six winters, we focused on an overlapping range of dates (Nov 30 to Feb 20—ie, 83 days or 11·9 weeks). About one-third of values were missing non-randomly (ie, all weekends and bank holidays), for which we imputed numbers at provider-level through last-observation carried forward and next-observation carried backward. We considered the lowest and highest value imputed as best and worst case estimates. We report numbers of all general and acute beds available in England and of all beds closed; the total number of beds closed per winter and the proportion unoccupied; and Pearson's correlation coefficient for occupied and unoccupied beds closed. FindingsTotal hospital capacity was a median 8·30 million beds (IQR 8·28–8·35 million) to 8·36 million beds (8·35–8·39 million) with the lowest and highest value imputed, respectively, corresponding to 100 000 (99 500–101 000) and 101 000 (99 900–102 000) beds per day. The median number of beds closed because of diarrhoea and vomiting was 88 300 (70 900–123 000) to 113 000 (88 300–151 000) with the lowest and highest value imputed, with totals for each of the six winters of 98 500 to 123 000 (2010–11), 135 000 to 168 000 (2011–12), 131 000 to 161 000 (2012–13), 68 600 to 83 800 (2013–14), 78 100 to 102 000 (2014–15), and 37 800 to 50 100 (2015–16). Respective proportions of beds closed unoccupied were 0·21 and 0·22, 0·19 and 0·20, 0·18 and 0·20, 0·19 and 0·21, 0·18 and 0·18, and 0·19 and 0·19. The number of occupied and unoccupied beds closed per day was strongly positively correlated (r=0·91 and r=0·89). InterpretationBed closures were equivalent to all general and acute NHS beds in England being unavailable for a median of 0·88 to 1·12 days with the lowest and highest value imputed. 20% were lost when unoccupied. The peak bed closures in 2011–12 coincided with a novel norovirus strain and the decline after 2012–13 with rotavirus vaccine introduction in July, 2013. FundingThis study originates from FGS's doctoral research that is jointly supported by a PhD studentship from the London School of Hygiene & Tropical Medicine and Public Health England.

PIN14 - Burden of Medically Attended Acute Gastroenteritis in England: A Cohort Study in CPRD

PIN14 - Burden of Medically Attended Acute Gastroenteritis in England: A Cohort Study in CPRD

Risk of Salmonella infection with exposure to reptiles in England, 2004-2007

Non-typhoidal Salmonella infections are a common cause of gastroenteritis in England. Non-Enteritidis, non-Typhimurium Salmonella serotypes have gained in relative importance in recent years, but their modes of transmission are poorly understood. In a large case-case study in England between 2004 and 2007, the association between exposure to reptiles and Salmonella illness was investigated using multivariable logistic regression. Recent reptile exposure was associated with Salmonella illness with an odds ratio of 2.46 (95% confidence interval: 1.57-3.85, p<0.001), with much stronger effects among children under five years of age. The exposure was rare, and a population attributable fraction was estimated as 0.9%. Among the Salmonella serotypes found in people exposed to reptiles, several non-Enteritidis, non-Typhimurium serotypes were strongly associated with exposure. Reptile exposure is a rare but significant risk factor for Salmonella illness in England, with much higher risk in children.

Clinical laboratory practices for the detection of rotavirus in England and Wales: can surveillance based on routine laboratory testing data be used to evaluate the impact of vaccination?

Two rotavirus vaccines have recently been licensed in Europe. Rotavirus surveillance data in many European countries are based on reports of laboratory-confirmed rotavirus infections. If surveillance data based on routine laboratory testing data are to be used to evaluate the impact of vaccination programmes, it is important to determine how the data are influenced by differences in testing practices, and how these practices are likely to affect the ability of the surveillance data to represent trends in rotavirus disease in the community. We conducted a survey of laboratory testing policies for rotavirus gastroenteritis in England and Wales in 2008. 60% (94/156) of laboratories responded to the survey. 91% of reporting laboratories offered routine testing for rotavirus all year round and 89% of laboratories offered routine rotavirus testing of all stool specimens from children under the age of five years. In 96% of laboratories, rotavirus detection was presently done either by rapid immunochromatographic tests or by enzyme-linked immunosorbent assay. Currently, rotavirus testing policies among laboratories in England and Wales are relatively homogenous. Therefore, surveillance based on laboratory testing data is likely to be representative of rotavirus disease trends in the community in the most frequently affected age groups (children under the age of five years) and could be used to help determine the impact of a rotavirus vaccine.

Temperature dependence of reportedCampylobacterinfection in England, 1989–1999

Campylobacter is the most common bacterial cause of gastroenteritis in England and Wales, with 45000 cases reported annually. Campylobacter incidence is highly seasonal; the consistent peak in late spring suggests a role for meteorological factors in the epidemiology of this organism. We investigated the relationship between ambient temperature and Campylobacter enteritis using time-series analysis to study short-term associations between temperature and number of Campylobacter reports adjusted for longer-term trend and seasonal patterns. We found a linear relationship between mean weekly temperature and reported Campylobacter enteritis, with a 1 degrees C rise corresponding to a 5% increase in the number of reports up to a threshold of 14 degrees C. There was no relationship outside this temperature range. Our findings provide evidence that ambient temperature influences Campylobacter incidence, and suggest that its effect is likely to be indirect, acting through other intermediate pathways.

Regular Review: Dietary management of gastroenteritis in Britain

Gastroenteritis is becoming less of a problem in Britain, but still 4*6 of every 1000 children under 5 were admitted to hospital for gastroenteritis in 1983,l a rate only slightly lower than the 5*8 admitted in 1978.2 Mortality has fallen sub? stantially. In 1978 142 infants and 22 toddlers (1-4 year olds) died from gastroenteritis in England and Wales,3 while in 1983 deaths numbered 38 and 10 respectively.4 In the 1970s the mortality from gastroenteritis in Britain was higher than that in many other countries in Europe.5 The infant mortality from gastroenteritis in Britain (6 for every 100 000 in 1983) is now much lower than that in some countries?for example, Greece (18) and Portugal (113); on a par with that in countries such as Belgium (5) and France (6); but still above that seen in West Germany (3) and the Netherlands (Nil).6

Brief Note. Campylobacter Jejuni gastroenteritis in Brisbane

Campylobacter has been shown to be a common cause of gastroenteritis in England (Skirrow, 1977), Africa (De Mol & Bosmans, 1978) and Belgium (Lauwers et al., 1978). Cumpylobacter,jejuni has now been isolated from faeces of patients with gastroenteritis in Brisbane. The primary isolation medium was composed of chocolited blood agar containing 10 pg/ml vancomycin, 40 pg/ml colistin methanesulphonate, 25 pg/ml trimethoprim and 1% isovitalex (Baltimore Biological Laboratory) with a moist surface to produce the characteristic, thin, swarming growth of Campylobacter. Incubation was at 43’C in a microaerophilic atmosphere of 5% oxygen and 79/, carbon-dioxide in hydrogen. The isolates were oxidase and catalase positive, Gram-negative, curved rods with darting motility that did not grow aerobically. They were identified by inhibition of growth on blood agar containing& brilliant green or 40 pg/ml nalidixic acid, and by production of H,S from 0.02% cysteine and inhibition by 3.5% NaCl in semi-solid medium (Smibert, 1965). Solid and liquid media were incubated microaerophilically; semi-solid media (cysteine and NaCI) were incubated aerobically, as microaerophilic conditions exist a few mm below the surface. In a 7 wk survey, during autumn, of 69 in-patients with gastroenteritis, Campylobacter was isolated as commonly as the other recognized faecal pathogens. C. jejuni was isolated from 6 patients, Salmonella from 8, Shigella from 3 and specific, pathogenic serotypes of Escherichia coli from 5. Five patients were aged from 1 mth to 8 yr and one was 21 yr old. Signs and symptoms were diarrhoea (4 patients) or loose, soft stools (2), blood in faeces (l), colicky abdominal pain (2), headache (l), pyrexia (3), vomiting (1) and dehydration (1). Four patients recovered within 3 to 8 d and one within 16 d, all without antibiotic therapy. One patient, whose symptoms lasted for 5 d, was treated with co-trimoxazole for a chest infection. Campylobacter should be considered as a possible cause of gastroenteritis in Australia. Isolation and identification of this organism requires appropriate microaerophilic culture techniques and differential media.

A review of transmissible gastro-enteritis in England and a study of outbreaks in 1970-71.

A review of transmissible gastro-enteritis in England and a study of outbreaks in 1970-71.