Early #impact of the #coronavirus disease (#COVID19) pandemic and physical #distancing #measures on routine #childhood #vaccinations in #England, January to April 2020 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Early impact of the coronavirus disease (COVID-19) pandemic and physical distancing measures on routine childhood vaccinations in England, January to April 2020

Helen I McDonald1,2, Elise Tessier3, Joanne M White3, Matthew Woodruff4, Charlotte Knowles4, Chris Bates4, John Parry4, Jemma L Walker1,2,5, J Anthony Scott1,2, Liam Smeeth1,2, Joanne Yarwood1,3, Mary Ramsay1,3, Michael Edelstein1,2,3

Affiliations: 1 NIHR Health Protection Research Unit (HPRU) in Immunisation, London, United Kingdom; 2 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; 3 Immunisation and Countermeasures Division, Public Health England, Colindale, United Kingdom; 4 The Phoenix Partnership (TPP) (Leeds) Ltd, Leeds, United Kingdom; 5 Statistics, Modelling and Economics Department, Public Health England, Colindale, United Kingdom

Correspondence:  Helen I McDonald

Citation style for this article: McDonald Helen I, Tessier Elise, White Joanne M, Woodruff Matthew, Knowles Charlotte, Bates Chris, Parry John, Walker Jemma L, Scott J Anthony, Smeeth Liam, Yarwood Joanne, Ramsay Mary, Edelstein Michael. Early impact of the coronavirus disease (COVID-19) pandemic and physical distancing measures on routine childhood vaccinations in England, January to April 2020. Euro Surveill. 2020;25(19):pii=2000848. https://doi.org/10.2807/1560-7917.ES.2020.25.19.2000848

Received: 06 May 2020;   Accepted: 14 May 2020



Using electronic health records, we assessed the early impact of coronavirus disease (COVID-19) on routine childhood vaccination in England by 26 April 2020. Measles-mumps-rubella vaccination counts fell from February 2020, and in the 3 weeks after introduction of physical distancing measures were 19.8% lower (95% confidence interval: −20.7 to −18.9) than the same period in 2019, before improving in mid-April. A gradual decline in hexavalent vaccination counts throughout 2020 was not accentuated by physical distancing.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: SARS-CoV-2; COVID-19; England; Vaccines; Pediatrics.


#Emergence of a Novel #Coronavirus (#COVID-19): #Protocol for Extending #Surveillance Used by the #RCGP RSC and Public Health #England (JMIR Public Health Surveill., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

JMIR Public Health Surveill, 6 (2), e18606 2020 Apr 2

Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance Centre and Public Health England

Simon de Lusignan # 1, Jamie Lopez Bernal # 2, Maria Zambon # 2, Oluwafunmi Akinyemi # 1, Gayatri Amirthalingam # 2, Nick Andrews # 2, Ray Borrow # 3, Rachel Byford # 1, André Charlett # 2, Gavin Dabrera # 2, Joanna Ellis # 2, Alex J Elliot # 4, Michael Feher # 1, Filipa Ferreira # 1, Else Krajenbrink # 5, Jonathan Leach # 5, Ezra Linley # 3, Harshana Liyanage # 1, Cecilia Okusi # 1, Mary Ramsay # 2, Gillian Smith # 4, Julian Sherlock # 1, Nicholas Thomas # 5, Manasa Tripathy # 1, John Williams # 1, Gary Howsam # 5, Mark Joy # 1, Richard Hobbs # 1

Affiliations: 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom. 2 Public Health England, London, United Kingdom. 3 Vaccine Evaluation Unit, Public Health England, Manchester, United Kingdom. 4 Real-time Syndromic Surveillance Team, Public Health England, Birmingham, United Kingdom. 5 Royal College of General Practitioners, London, United Kingdom.

#Contributed equally.

PMID: 32240095 DOI: 10.2196/18606




The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC’s surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy.


The aims of this study are to surveil COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections, ascertain both the rate and pattern of COVID-19 spread, and assess the effectiveness of the containment policy.


The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)-with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories.


General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling.


We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning.

International registered report identifier (irrid): DERR1-10.2196/18606.
Keywords: COVID-19; SARS-CoV-2; computerized; coronavirus; general practice; infections; medical record systems; pandemic; records as topic; sentinel surveillance; serology; surveillance.

©Simon de Lusignan, Jamie Lopez Bernal, Maria Zambon, Oluwafunmi Akinyemi, Gayatri Amirthalingam, Nick Andrews, Ray Borrow, Rachel Byford, André Charlett, Gavin Dabrera, Joanna Ellis, Alex J Elliot, Michael Feher, Filipa Ferreira, Else Krajenbrink, Jonathan Leach, Ezra Linley, Harshana Liyanage, Cecilia Okusi, Mary Ramsay, Gillian Smith, Julian Sherlock, Nicholas Thomas, Manasa Tripathy, John Williams, Gary Howsam, Mark Joy, Richard Hobbs. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 02.04.2020.

Keywords: SARS-CoV-2; COVID-19; England.


Public #Activities Preceding the Onset of Acute #Respiratory #Infection Syndromes in Adults in #England – Implications for the Use of #SocialDistancing to Control #Pandemic Respiratory Infections (SSRN, abstract)

[Source: SSRN, full page: (LINK). Abstract, edited.]

Public Activities Preceding the Onset of Acute Respiratory Infection Syndromes in Adults in England – Implications for the Use of Social Distancing to Control Pandemic Respiratory Infections

17 Pages Posted: 19 Mar 2020

Andrew C. Hayward, University College London – Research Department of Epidemiology & Public Health; Sarah Beale, University College London – Research Department of Epidemiology & Public Health; Anne M Johnson, University College London – Institute for Global Health; Ellen B Fragaszy, University College London – Department of Infectious Disease Informatics; Flu Watch Group




Social distancing measures may reduce the spread of emerging respiratory infections however, there is little empirical data on how exposure to crowded places affects risk of acute respiratory infection.


We used a case-crossover design nested in a community cohort to compare self-reported measures of activities during the week before infection onset and baseline periods. The design eliminates the effect of non-time-varying confounders. Time-varying confounders were addressed by exclusion of illnesses around the Christmas period and seasonal adjustment.


626 participants had paired data from the week before 1005 illnesses and the week before baseline. Each additional day of undertaking the following activities in the prior week was associated with illness onset: Spending more than five minutes in a room with someone (other than a household member) who has a cold (Seasonally adjusted OR 1·15, p=0·003); use of underground trains (1·31, p=0·036); use of supermarkets (1·32, p<0·001); attending a theatre, cinema or concert (1·26, p=0·032); eating out at a café, restaurant or canteen (1·25, p=0·003); and attending parties (1·47, p<0·001). Undertaking the following activities at least once in the previous week was associated with illness onset: using a bus, (aOR 1.48, p=0.049), shopping at small shops (1.9, p<0.002) attending a place of worship (1.81, p=0.005).


Exposure to potentially crowded places, public transport and to individuals with a cold increases risk of acquiring circulating acute respiratory infections. This suggests social distancing measures can have an important impact on slowing transmission of emerging respiratory infections.


Funding Statement: The Flu Watch study received funding from the Medical Research Council (MRC) and the Wellcome Trust (MR/K006584/1). S.B. is supported by an MRC doctoral studentship (MR/N013867/1).

Declaration of Interests: AH serves on UK New and Emerging Respiratory Virus Threats Advisory Group. AMJ was a Governor of Wellcome Trust from 2011-18 and is Chair of the Committee For Strategic Coordination for Health of the Public Research. The other authors declare no competing interests.

Ethics Approval Statement: The protocol was approved by the Oxford Multi-Centre Research Ethics Committee (06/Q1604/103).

Keywords: Respiratory Infection; Pandemic; Social distancing; transmission; case crossover; cohort

Suggested Citation: Hayward, Andrew C. and Beale, Sarah and Johnson, Anne M and Fragaszy, Ellen B and Group, Flu Watch, Public Activities Preceding the Onset of Acute Respiratory Infection Syndromes in Adults in England – Implications for the Use of Social Distancing to Control Pandemic Respiratory Infections (3/8/2020). Available at SSRN: https://ssrn.com/abstract=3551361

Keywords: COVID-19; SARS-CoV; England; Quarantine.


Srinivasa #Ramanujan: in #celebration of the #centenary of his election as #FRS (Phil Transact Roy Soc., summary)

[Source: Philosophical Transaction of the Royal Society, full page: (LINK). Summary, edited.]

Srinivasa Ramanujan: in celebration of the centenary of his election as FRS

Ken Ono

Published: 09 December 2019 / DOI: https://doi.org/10.1098/rsta.2019.0386

Citation: Ono Ken, Srinivasa Ramanujan: in celebration of the centenary of his election as FRS378Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Scienceshttp://doi.org/10.1098/rsta.2019.0386


Srinivasa Ramanujan, the so-called Man Who Knew Infinity, was one of the most influential, as well as most enigmatic, mathematicians in the recent history of mathematics. With a letter written to G. H. Hardy in 1913, the impoverished Hindu college dropout, self-taught in mathematics, reaching for worlds beyond the shores of India, introduced himself to the history of science.


Keywords: Mathematics.


#Assessment of #Effectiveness of Seasonal #Influenza #Vaccination During #Pregnancy in Preventing Influenza Infection in #Infants in #England, 2013–2014 and 2014–2015 (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Assessment of Effectiveness of Seasonal Influenza Vaccination During Pregnancy in Preventing Influenza Infection in Infants in England, 2013–2014 and 2014–2015

Jemma L Walker, Hongxin Zhao, Gavin Dabrera, Nick Andrews, Sarah L Thomas, Camille Tsang, Joanna Ellis, Matthew Donati, Richard G Pebody

The Journal of Infectious Diseases, jiz310, https://doi.org/10.1093/infdis/jiz310

Published: 09 November 2019



Maternal influenza vaccination is increasingly recognized to protect infants from influenza infection in their first 6 months. We used the screening method to estimate vaccine effectiveness (VE) against laboratory-confirmed influenza in infants in England, using newly available uptake data from the Clinical Practice Research Datalink pregnancy register, matched on week of birth and region and adjusted for ethnicity. We found VE of 66% (95% confidence interval [CI], 18%–84%) in the 2013–2014 season and 50% (95% CI, 11%–72%) in 2014–2015, with similar VE against influenza-related hospitalization. VE against the dominant circulating influenza strain was higher, at 78% (95% CI, 16%–94%) against H1N1 in 2013–2014, and 60% (95% CI, 16%–81%) against H3N2 in 2014–2015.

influenza, vaccine effectiveness, pregnancy, infants, electronic health records

Issue Section: Brief Report

Keywords: Seasonal Influenza; Pregnancy; Vaccines; Pediatrics; England.


#Congenital viral #infections in #England over five decades: a population-based observational study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Congenital viral infections in England over five decades: a population-based observational study

Seilesh Kadambari, PhD, Prof Andrew J Pollard, FMedSci, Prof Michael J Goldacre, FFPH, Raphael Goldacre, MSc

Published: November 07, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30416-5




Congenital viral infections cause substantial long-term morbidity but population-based data about diagnosis rates are scarce. The aim of this study was to assess the long-term trends in congenital viral infections in England and to report on how the rates of these infections might have changed with improved methods for detection, the introduction of the two-dose measles–mumps–rubella (MMR) vaccine in 1996, and the implementation of the Newborn Hearing Screening Programme (NHSP) in 2006.


For this population-based, observational cohort study, we used national and regional hospitalisation data from 1968 to 2016 in England (Hospital In-Patient Enquiry, Hospital Episode Statistics, and Oxford Record Linkage Study) to calculate annual rates of hospital discharges coded with—and individuals aged younger than 1 month diagnosed with—congenital cytomegalovirus, herpes simplex virus (HSV), varicella zoster virus (VZV), and rubella. We investigated associations of congenital cytomegalovirus, HSV, and VZV with perinatal and maternal factors (sex, mother’s ethnicity, mode of delivery, gestational age, birthweight, mother’s age, mother’s index of multiple deprivation, and number of previous pregnancies).


In 2016, discharge rates per 100 000 infant population were 22·3 (95% CI 18·8–26·1) for congenital cytomegalovirus, 17·6 (14·6–21·1) for HSV, 32·6 (28·4–37·2) for VZV, and 0·15 (0·0–0·8) for rubella. Compared with earlier years of the study, the discharge rate in 2016 was higher for congenital cytomegalovirus, HSV, and VZV, whereas it was lower for rubella. For congenital cytomegalovirus, there was a significant step-increase between 2006 and 2007 following implementation of the NHSP (rate ratio comparing the trend line post-NHSP with that pre-NHSP 1·55 [95% CI 1·12–2·14], p=0·0072). Congenital cytomegalovirus infection was associated with birthweight less than 1 kg, maternal age younger than 25 years, socioeconomically deprived households, casearean section, and mothers of black ethnicity. Congenital HSV infection was associated with maternal age younger than 20 years, gestational age less than 32 weeks, and vaginal and emergency caesarean section deliveries, while VZV infection was associated with increased parity and black and south Asian ethnicities.


The increase in hospital discharges coded with congenital cytomegalovirus is most likely due to the introduction of sensitive diagnostic techniques and retrospective diagnoses made in infants after implementation of the NHSP. Public health strategies to improve prevention and treatment of congenital viral infections are urgently warranted. The decrease in discharges for rubella is most likely due to the MMR vaccine.



Keywords: Pediatrics; England; Cytomegalovirus.


#Influenza-associated #mortality in #hospital care: a retrospective cohort study of #risk #factors and impact of #oseltamivir in an #English teaching hospital, 2016 to 2017 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Influenza-associated mortality in hospital care: a retrospective cohort study of risk factors and impact of oseltamivir in an English teaching hospital, 2016 to 2017

Mark Reacher1,2, Ben Warne3, Lucy Reeve1, Neville Q. Verlander4, Nicholas K. Jones3, Kyriaki Ranellou3,5, Silvana Christou3, Callum Wright3, Saher Choudhry3, Maria Zambon6, Clare Sander3, Hongyi Zhang2, Hamid Jalal2

Affiliations: 1 Public Health England Field Service, Cambridge Institute of Public Health, Cambridge, United Kingdom; 2 Public Health England and Cambridge Universities Hospitals NHS Foundation Trust Cambridge, Cambridge, United Kingdom; 3 Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; 4 Statistics Unit, Statistics, Modelling and Economics Department, National Infection Service – Data and Analytical Sciences, Public Health England, London, United Kingdom; 5 Division of Virology, Department of Pathology, University of Cambridge, United Kingdom; 6 National Infection Service, Public Health England, London, United Kingdom

Correspondence:  Mark Reacher

Citation style for this article: Reacher Mark, Warne Ben, Reeve Lucy, Verlander Neville Q., Jones Nicholas K., Ranellou Kyriaki, Christou Silvana, Wright Callum, Choudhry Saher, Zambon Maria, Sander Clare, Zhang Hongyi, Jalal Hamid. Influenza-associated mortality in hospital care: a retrospective cohort study of risk factors and impact of oseltamivir in an English teaching hospital, 2016 to 2017. Euro Surveill. 2019;24(44):pii=1900087. https://doi.org/10.2807/1560-7917.ES.2019.24.44.1900087

Received: 26 Jan 2019;   Accepted: 04 Sep 2019




Evidence of an oseltamivir treatment effect on influenza A(H3N2) virus infections in hospitalised patients is incomplete.


This cohort study aimed to evaluate risk factors for death among PCR-confirmed hospitalised cases of seasonal influenza A(H3N2) of all ages and the impact of oseltamivir.


Participants included all 332 PCR-confirmed influenza A(H3N2) cases diagnosed between 30 August 2016 and 17 March 2017 in an English university teaching Hospital. Oseltamivir treatment effect on odds of inpatient death was assessed by backward stepwise multivariable logistic regression analysis.


The odds of death were reduced by two thirds (odds ratio (OR): 0.32; 95% confidence interval (CI): 0.11–0.93), in inpatients treated with a standard course of oseltamivir 75 mg two times daily for 5 days – compared with those untreated with oseltamivir, after adjustment for age, sex, current excess alcohol intake, receipt of 2016/17 seasonal influenza vaccine, serum haemoglobin and hospital vs community attribution of acquisition of influenza.


Oseltamivir treatment given according to National Institutes of Clinical Excellence (NICE); United States Centres for Disease Control and Prevention (CDC); Infectious Diseases Society of America (IDSA) and World Health Organization (WHO) guidelines was shown to be effective in reducing the odds of mortality in inpatients with PCR-confirmed seasonal influenza A(H3N2) after adjustment in a busy routine English hospital setting. Our results highlight the importance of hospitals complying with relevant guidelines for prompt seasonal influenza PCR testing and ensuring standard oseltamivir treatment to all PCR-confirmed cases of seasonal influenza.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Seasonal Influenza; Antivirals; Oseltamivir; England.