Characterization of #cefotaxime #resistant #urinary #Escherichia coli from primary care in South-West #England 2017–18 (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Characterization of cefotaxime-resistant urinary Escherichia coli from primary care in South-West England 2017–18

Jacqueline Findlay, Virginia C Gould, Paul North, Karen E Bowker, Martin O Williams, Alasdair P MacGowan, Matthew B Avison

Journal of Antimicrobial Chemotherapy, dkz397,

Published: 20 September 2019




Third-generation cephalosporin-resistant Escherichia coli from community-acquired urinary tract infections are increasingly reported worldwide. We sought to determine and characterize the mechanisms of cefotaxime resistance employed by urinary E. coli obtained from primary care, over 12 months, in Bristol and surrounding counties in South-West England.


Cefalexin-resistant E. coli isolates were identified from GP-referred urine samples using disc susceptibility testing. Cefotaxime resistance was determined by subsequent plating onto MIC breakpoint plates. β-Lactamase genes were detected by PCR. WGS was performed on 225 isolates and analyses were performed using the Center for Genomic Epidemiology platform. Patient information provided by the referring general practices was reviewed.


Cefalexin-resistant E. coli (n = 900) isolates were obtained from urines from 146 general practices. Following deduplication by patient approximately 69% (576/836) of isolates were cefotaxime resistant. WGS of 225 isolates identified that the most common cefotaxime-resistance mechanism was blaCTX-M carriage (185/225), followed by plasmid-mediated AmpCs (pAmpCs) (17/225), AmpC hyperproduction (13/225), ESBL blaSHV variants (6/225) or a combination of both blaCTX-M and pAmpC (4/225). Forty-four STs were identified, with ST131 representing 101/225 isolates, within which clade C2 was dominant (54/101). Ciprofloxacin resistance was observed in 128/225 (56.9%) of sequenced isolates, predominantly associated with fluoroquinolone-resistant clones ST131 and ST1193.


Most cefalexin-resistant E. coli isolates were cefotaxime resistant, predominantly caused by blaCTX-M carriage. The correlation between cefotaxime resistance and ciprofloxacin resistance was largely attributable to the high-risk pandemic clones ST131 and ST1193. Localized epidemiological data provide greater resolution than regional data and can be valuable for informing treatment choices in the primary care setting.


© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email:

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (

Keywords: Antibiotics; Drugs Resistance; Cephalosporins; Fluoroquinolones; E. Coli; UTI; Cefalexin; Cefotaxime; UK; England.



Emergence of dominant #toxigenic M1T1 #Streptococcus pyogenes clone during increased #scarletfever activity in #England: a population-based molecular epidemiological study (Lancet Infect Dis., abstract)

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

Emergence of dominant toxigenic M1T1 Streptococcus pyogenes clone during increased scarlet fever activity in England: a population-based molecular epidemiological study

Nicola N Lynskey, PhD †, Elita Jauneikaite, PhD †, Ho Kwong Li, MBBS, Xiangyun Zhi, PhD, Claire E Turner, PhD, Mia Mosavie, MSc, Max Pearson, MSc, Masanori Asai, MSc, Ludmila Lobkowicz, MSc, J Yimmy Chow, MBBS, Prof Julian Parkhill, PhD, Theresa Lamagni, PhD, Victoria J Chalker, PhD, Prof Shiranee Sriskandan, FRCP

Open Access / Published: September 10, 2019 / DOI:




Since 2014, England has seen increased scarlet fever activity unprecedented in modern times. In 2016, England’s scarlet fever seasonal rise coincided with an unexpected elevation in invasive Streptococcus pyogenes infections. We describe the molecular epidemiological investigation of these events.


We analysed changes in S pyogenes emm genotypes, and notifications of scarlet fever and invasive disease in 2014–16 using regional (northwest London) and national (England and Wales) data. Genomes of 135 non-invasive and 552 invasive emm1 isolates from 2009–16 were analysed and compared with 2800 global emm1 sequences. Transcript and protein expression of streptococcal pyrogenic exotoxin A (SpeA; also known as scarlet fever or erythrogenic toxin A) in sequenced, non-invasive emm1 isolates was quantified by real-time PCR and western blot analyses.


Coincident with national increases in scarlet fever and invasive disease notifications, emm1 S pyogenes upper respiratory tract isolates increased significantly in northwest London in the March to May period, from five (5%) of 96 isolates in 2014, to 28 (19%) of 147 isolates in 2015 (p=0·0021 vs 2014 values), to 47 (33%) of 144 in 2016 (p=0·0080 vs 2015 values). Similarly, invasive emm1 isolates collected nationally in the same period increased from 183 (31%) of 587 in 2015 to 267 (42%) of 637 in 2016 (p<0·0001). Sequences of emm1 isolates from 2009–16 showed emergence of a new emm1 lineage (designated M1UK)—with overlap of pharyngitis, scarlet fever, and invasive M1UK strains—which could be genotypically distinguished from pandemic emm1 isolates (M1global) by 27 single-nucleotide polymorphisms. Median SpeA protein concentration in supernatant was nine-times higher among M1UK isolates (190·2 ng/mL [IQR 168·9–200·4]; n=10) than M1global isolates (20·9 ng/mL [0·0–27·3]; n=10; p<0·0001). M1UK expanded nationally to represent 252 (84%) of all 299 emm1 genomes in 2016. Phylogenetic analysis of published datasets identified single M1UK isolates in Denmark and the USA.


A dominant new emm1 S pyogenes lineage characterised by increased SpeA production has emerged during increased S pyogenes activity in England. The expanded reservoir of M1UK and recognised invasive potential of emm1 S pyogenes provide plausible explanation for the increased incidence of invasive disease, and rationale for global surveillance.


UK Medical Research Council, UK National Institute for Health Research, Wellcome Trust, Rosetrees Trust, Stoneygate Trust.

Keywords: Streptococcus pyogenes; Scarlet Fever; England.


#Human exposures to #H5N6 #Avian #influenza, #England, 2018 (J Infect Dis., abstract)

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

J Infect Dis. 2019 Feb 21. pii: jiz080. doi: 10.1093/infdis/jiz080. [Epub ahead of print]

Human exposures to H5N6 Avian influenza, England, 2018.

Thornton AC1, Parry-Ford F2, Tessier E2, Oppilamany N3, Zhao H2, Dunning J4, Pebody R1, Dabrera G1.

Author information: 1 National Infection Service, Public Health England, London, UK. 2 Immunisations and Countermeasures Division, National Infection Service, Public Health England, London, UK. 3 Respiratory Diseases Department, National Infection Service, Public Health England, London, UK. 4 Virus Reference Department, National Infection Service, Public Health England, London, UK.



The human risk following exposure to the European reassortant avian influenza A (H5N6) is unknown. We used routine data collected as part of public health follow-up to assess outcomes of individuals exposed to H5N6 infected wild birds in England. There were 19 separate incidents of confirmed H5N6 among wild birds in the first quarter of 2018 in England and 69 individuals exposed to infected birds during these incidents. Five exposed individuals developed respiratory symptoms. However, no H5N6 infection was detected among those individuals with respiratory symptoms who underwent diagnostic testing, indicating that the human risk from this strain remains low.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail:

KEYWORDS: Avian influenza; follow-up; prophylaxis; public health

PMID: 30788504 DOI: 10.1093/infdis/jiz080

Keywords: Avian Influenza; H5N6; Human; England.


Increased #Risk for #IGAS Disease for #Household Contacts of #ScarletFever Cases, #England, 2011–2016 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 3—March 2019 / Research

Increased Risk for Invasive Group A Streptococcus Disease for Household Contacts of Scarlet Fever Cases, England, 2011–2016

Vicky Watts  , Sooria Balasegaram, Colin S. Brown, Suzanna Mathew, Rachel Mearkle, Derren Ready, Vanessa Saliba, and Theresa Lamagni

Author affiliations: Public Health England, Liverpool, UK (V. Watts); Public Health England, London, UK (S. Balasegaram, C.S. Brown, D. Reddy, V. Saliba, T. Lamagni); Public Health England, Leeds, UK (S. Mathew); Public Health England, Chilton, UK (R. Mearkle)



The incidence of scarlet fever in England and Wales is at its highest in 50 years. We estimated secondary household risk for invasive group A Streptococcus (iGAS) disease within 60 days after onset of scarlet fever. Reports of scarlet fever in England during 2011–2016 were matched by residential address to persons with laboratory-confirmed iGAS infections. We identified 11 iGAS cases in ≈189,684 household contacts and a 60-day incidence rate of 35.3 cases/100,000 person-years, which was 12.2-fold higher than the background rate (2.89). Infants and contacts >75 years of age were at highest risk. Three cases were fatal; sepsis and cellulitis were the most common manifestations. Typing for 6 iGAS cases identified emm 1.0 (n = 4), emm 4.0 (n = 1), and emm 12.0 (n = 1). Although absolute risk in household contacts was low, clinicians assessing household contacts should be aware of the risk to expedite diagnosis and initiate life-saving treatment.

Keywords: Scarlet Fever; UK; England; IGAS; Sepsis.


A large, #refractory #nosocomial #outbreak of #KPC-producing #Ecoli demonstrates carbapenemase gene #outbreaks involving #sink sites require novel approaches to infection control (AAC, abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Summary, edited.]

A large, refractory nosocomial outbreak of Klebsiella pneumoniaecarbapenemase (KPC)-producing Escherichia coli demonstrates carbapenemase gene outbreaks involving sink sites require novel approaches to infection control

V Decraene, H. T. T. Phan, R George, D. H. Wyllie, O Akinremi, Z Aiken, P Cleary, A Dodgson, L Pankhurst, D. W. Crook, C Lenney, A. S. Walker, N Woodford, R Sebra, F Fath-Ordoubadi,A. J. Mathers, A. C. Seale, M Guiver, A McEwan, V Watts, W Welfare, N Stoesser, J Cawthorne, the TRACE Investigators’ Group

DOI: 10.1128/AAC.01689-18



Carbapenem-resistant Enterobacteriaceae (CRE) are a health threat, but effective control interventions remain unclear. Hospital wastewater sites are increasingly highlighted as important potential reservoirs. We investigated a large Klebsiella pneumoniae carbapenemase (KPC)-producing E. coli (KPC-EC) outbreak and wider CRE incidence trends over eight years in the Central Manchester Foundation NHS Trust (CMFT), UK, to determine the impact of Infection Prevention and Control measures.

Bacteriology and patient administration data (2009 to 2017) were linked; a subset of CMFT/regional KPC-EC isolates (n=268) was sequenced. Control interventions followed international guidelines and included cohorting, rectal screening (n=184,539 screens), environmental sampling, enhanced cleaning, and ward closure/plumbing replacement. Segmented regression of time trends of CRE detections was used to evaluate the impact of interventions on CRE incidence.

Genomic analysis (n=268 isolates) identified spread of a KPC-EC outbreak clone (ST216, strain-A; n=125) amongst patients and the environment, particularly on two cardiac wards (W3/W4), despite control measures. ST216 strain-A had caused an antecedent outbreak, and shared its KPC plasmids with other E. coli lineages and Enterobacteriaceae. CRE acquisition incidence declined after W3/W4 closure and plumbing replacement, suggesting an environmental contribution. However, W3/W4 wastewater sites were rapidly re-colonised with CRE and patient CRE acquisitions recurred, albeit at lower rates.

Patient relocation and plumbing replacement were associated with control of a clonal KPC-EC outbreak; however, environmental contamination with CRE and patient CRE acquisitions recurred rapidly following this intervention. The large numbers of cases and persistence of blaKPC in E. coli, including pathogenic lineages, is a concern.


Copyright © 2018 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; UK; England; E. Coli; Carbapenem; Nosocomial Outbreaks.


Two cases of #monkeypox imported to the #UK, September 2018 (Euro Surveill., abstract)

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

Two cases of monkeypox imported to the United Kingdom, September 2018

Aisling Vaughan1,15, Emma Aarons2, John Astbury3, Sooria Balasegaram3, Mike Beadsworth4,5, Charles R Beck3,14, Meera Chand6,7,8, Catherine O’Connor1, Jake Dunning6,9, Sam Ghebrehewet3, Nick Harper10, Ruth Howlett-Shipley11, Chikwe Ihekweazu12,Michael Jacobs9, Lukeki Kaindama13, Parisha Katwa13, Saye Khoo4,5, Lucy Lamb9,11, Sharon Mawdsley10, Dilys Morgan1, Ruth Palmer10,Nick Phin6, Katherine Russell1, Bengü Said1, Andrew Simpson2, Roberto Vivancos3,15,16, Michael Wade3, Amanda Walsh1, Jennifer Wilburn1

Affiliations: 1 Emerging Infections and Zoonoses Section, National Infection Service, Public Health England, Colindale, London, United Kingdom; 2 Rare and Imported Pathogens Laboratory, Public Health England, Porton, Salisbury, United Kingdom; 3 Field Service, National Infection Service, Public Health England, United Kingdom; 4 Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; 5 University of Liverpool, Liverpool, United Kingdom, Liverpool, United Kingdom; 6 National Infection Service, Public Health England, Colindale, London, United Kingdom; 7 Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom; 8 NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, United Kingdom; 9 Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom; 10 Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom; 11 Defence Medical Services, Ministry of Defence (MOD), United Kingdom; 12 Nigeria Centre for Disease Control (NCDC), Abuja, Nigeria; 13 Travel and Migrant Health Section, National Infection Service, Public Health England, Colindale, London, United Kingdom; 14 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; 15 NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom; 16 NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom

Correspondence:  Aisling Vaughan

Citation style for this article: Vaughan Aisling, Aarons Emma, Astbury John, Balasegaram Sooria, Beadsworth Mike, Beck Charles R, Chand Meera, O’Connor Catherine,Dunning Jake, Ghebrehewet Sam, Harper Nick, Howlett-Shipley Ruth, Ihekweazu Chikwe, Jacobs Michael, Kaindama Lukeki, Katwa Parisha, Khoo Saye, Lamb Lucy,Mawdsley Sharon, Morgan Dilys, Palmer Ruth, Phin Nick, Russell Katherine, Said Bengü, Simpson Andrew, Vivancos Roberto, Wade Michael, Walsh Amanda,Wilburn Jennifer. Two cases of monkeypox imported to the United Kingdom, September 2018. Euro Surveill. 2018;23(38):pii=1800509.

Received: 17 Sep 2018;   Accepted: 20 Sep 2018



In early September 2018, two cases of monkeypox were reported in the United Kingdom (UK), diagnosed on 7 September in Cornwall (South West England) and 11 September in Blackpool (North West England). The cases were epidemiologically unconnected and had recently travelled to the UK from Nigeria, where monkeypox is currently circulating. We describe the epidemiology and the public health response for the first diagnosed cases outside the African continent since 2003.

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

Keywords: Monkeypox; England; UK.


An #Evaluation of #Global #Hazard #Communication with #Ethical Considerations (PLoS Curr., abstract)

[Source: PLoS Currents Disasters, full page: (LINK). Abstract, edited.]

An Evaluation of Global Hazard Communication with Ethical Considerations


AUTHORS: Thomas Richardson, Gemma Hayward, Mr. Kevin Blanchard, Professor Virginia Murray




Despite the large number of hazards occurring every year, it is often only the most catastrophic and rapidly occurring hazards that are covered in detail by major news outlets. This can result in an under-reporting of smaller or slowly evolving hazards such as drought. Furthermore, the type or country in which the hazard occurs may have a bearing on whether it receives media coverage. The Public Health England (PHE) global weekly hazards bulletin is designed to inform subscribers of hazards occurring in the world in a given week regardless of location or type of natural hazard. This paper will aim to examine whether the bulletin is reporting these events in a way that matches a number of international disaster databases.  It will also seek to answer if biases within media outlets reporting of an event is impacting on the types of hazards and events being covered.  Through the analysis of data collected, it is hoped to be able to consider the ethical implications of such a bulletin service and provide recommendations on how the service might be improved in the future.


The study used a year’s worth of global hazards bulletins sent by Public Health England.  These bulletins aim to communicate hazards in the form of compiled articles from news outlets around the world. Data from these bulletins was collected and analysed by hazard type and the country in which hazards occurred.  It was then compared to recognised hazard databases to assess similarities and differences in the hazards being reported via media or through dedicated hazard databases. The recognised hazard databases were those run by the Emergency Events Database (EM-DAT), European Civil Protection and Humanitarian Aid Operations (ECHO) and National Aeronautics and Space Administration (NASA) respectively.


The PHE bulletin overall was found to be comparable to other global hazard or disaster databases in terms of hazards included by both country and type of hazard. The PHE bulletin covered a greater number of unique hazard events than the other databases and also covered more types of hazard. It also gave more frequent coverage to the United Kingdom and Canada than the other databases, with other countries appearing less frequently. More generally, the PHE bulletin and the databases it was compared to appear to focus more on hazards either occurring in developed countries or fast-onset ones such as landslides or floods. On the other hand, slow-onset hazards such as drought or those occurring in developing countries appear to be under-reported and are given less importance in both the bulletin and databases.

Discussion and recommendations

” We recommend that the resources compared review their inclusion criteria and assess whether the discrepancies in hazard type and country can be ratified through changes in how hazards are assessed for inclusion. More research should be undertaken to assess whether similar findings arise when comparing databases in other areas within the remit of public health.


The authors received no specific funding for this work.

Keywords: Disaster Preparedness; UK.