End of season #influenza #vaccine #effectiveness in #adults and #children in the #UK in 2017/18 (Euro Surveill., abstract)

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

End of season influenza vaccine effectiveness in adults and children in the United Kingdom in 2017/18

Richard Pebody 1, Abdelmajid Djennad 1, Joanna Ellis 1, Nick Andrews 1, Diogo F P Marques 2, Simon Cottrell 3,Arlene J Reynolds 2, Rory Gunson 4, Monica Galiano 1, Katja Hoschler 1, Angie Lackenby 1, Chris Robertson 5, Mark O’Doherty 6,Mary Sinnathamby 1, Nikolaos Panagiotopoulos 1, Ivelina Yonova 7,8, Rebecca Webb 7, Catherine Moore 3, Matthew Donati 1, Muhammad Sartaj 6,Samantha J Shepherd 4, Jim McMenamin 2, Simon de Lusignan 7,8, Maria Zambon 1

Affiliations: 1 Public Health England, United Kingdom; 2 Health Protection Scotland, Glasgow, United Kingdom; 3 Public Health Wales, Cardiff, United Kingdom; 4 West of Scotland Specialist Virology Centre, Glasgow, United Kingdom; 5 University of Strathclyde, Glasgow, United Kingdom; 6 Public Health Agency Northern Ireland, Belfast, United Kingdom; 7 University of Surrey, Guildford, United Kingdom; 8 Royal College of General Practitioners, London, United Kingdom

Correspondence:  Richard Pebody

Citation style for this article: Pebody Richard, Djennad Abdelmajid, Ellis Joanna, Andrews Nick, Marques Diogo F P, Cottrell Simon, Reynolds Arlene J, Gunson Rory,Galiano Monica, Hoschler Katja, Lackenby Angie, Robertson Chris, O’Doherty Mark, Sinnathamby Mary, Panagiotopoulos Nikolaos, Yonova Ivelina, Webb Rebecca,Moore Catherine, Donati Matthew, Sartaj Muhammad, Shepherd Samantha J, McMenamin Jim, de Lusignan Simon, Zambon Maria. End of season influenza vaccine effectiveness in adults and children in the United Kingdom in 2017/18. Euro Surveill. 2019;24(31):pii=1800488. https://doi.org/10.2807/1560-7917.ES.2019.24.31.1800488

Received: 31 Aug 2018;   Accepted: 11 Jun 2019




In the United Kingdom (UK), in recent influenza seasons, children are offered a quadrivalent live attenuated influenza vaccine (LAIV4), and eligible adults mainly trivalent inactivated vaccine (TIV).


To estimate the UK end-of-season 2017/18 adjusted vaccine effectiveness (aVE) and the seroprevalence in England of antibodies against influenza viruses cultured in eggs or tissue.


This observational study employed the test-negative case–control approach to estimate aVE in primary care. The population-based seroprevalence survey used residual age-stratified samples.


Influenza viruses A(H3N2) (particularly subgroup 3C.2a2) and B (mainly B/Yamagata/16/88-lineage, similar to the quadrivalent vaccine B-virus component but mismatched to TIV) dominated. All-age aVE was 15% (95% confidence interval (CI): −6.3 to 32) against all influenza; −16.4% (95% CI: −59.3 to 14.9) against A(H3N2); 24.7% (95% CI: 1.1 to 42.7) against B and 66.3% (95% CI: 33.4 to 82.9) against A(H1N1)pdm09. For 2–17 year olds, LAIV4 aVE was 26.9% (95% CI: −32.6 to 59.7) against all influenza; −75.5% (95% CI: −289.6 to 21) against A(H3N2); 60.8% (95% CI: 8.2 to 83.3) against B and 90.3% (95% CI: 16.4 to 98.9) against A(H1N1)pdm09. For ≥ 18 year olds, TIV aVE against influenza B was 1.9% (95% CI: −63.6 to 41.2). The 2017 seroprevalence of antibody recognising tissue-grown A(H3N2) virus was significantly lower than that recognising egg-grown virus in all groups except 15–24 year olds.


Overall aVE was low driven by no effectiveness against A(H3N2) possibly related to vaccine virus egg-adaption and a new A(H3N2) subgroup emergence. The TIV was not effective against influenza B. LAIV4 against influenza B and A(H1N1)pdm09 was effective.

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

Keywords: Seasonal Influenza; H1N1pdm09; H3N2; Influenza B; Vaccines, UK.



Direct #evidence of #H7N7 #avian #influenza virus #mutation from low to high virulence on a single #poultry premises during an #outbreak in free range chickens in the #UK, 2008 (Infect Genet Evol., abstract)

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

Infect Genet Evol. 2018 Oct;64:13-31. doi: 10.1016/j.meegid.2018.06.005. Epub 2018 Jun 5.

Direct evidence of H7N7 avian influenza virus mutation from low to high virulence on a single poultry premises during an outbreak in free range chickens in the UK, 2008.

Seekings AH1, Slomka MJ2, Russell C2, Howard WA2, Choudhury B2, Nuñéz A3, Löndt BZ2, Cox W2, Ceeraz V2, Thorén P4, Irvine RM2, Manvell RJ2, Banks J2, Brown IH2.

Author information: 1 Virology Department, Animal and Plant Health Agency (APHA-Weybridge), Addlestone, Surrey KT15 3NB, United Kingdom. Electronic address: amanda.seekings@apha.gsi.gov.uk. 2 Virology Department, Animal and Plant Health Agency (APHA-Weybridge), Addlestone, Surrey KT15 3NB, United Kingdom. 3 Pathology Department, Animal and Plant Health Agency (APHA-Weybridge), Addlestone, Surrey KT15 3NB, United Kingdom. 4 Swedish Agricultural University (SLU), Uppsala, Sweden.



H5 and H7 subtypes of low pathogenicity avian influenza viruses (LPAIVs) have the potential to evolve into highly pathogenic avian influenza viruses (HPAIVs), causing high mortality in galliforme poultry with substantial economic losses for the poultry industry. This study provides direct evidence of H7N7 LPAIV mutation to HPAIV on a single poultry premises during an outbreak that occurred in June 2008 in free range laying hens in Oxfordshire, UK. We report the first detection of a rare di-basic cleavage site (CS) motif (PEIPKKRGLF), unique to galliformes, that has previously been associated with a LPAIV phenotype. Three distinct HPAIV CS sequences (PEIPKRKKRGLF, PEIPKKKKRGLF and PEIPKKKKKKRGLF) were identified in the infected sheds suggesting molecular evolution at the outbreak premises. Further evidence for H7N7 LPAIV preceding mutation to HPAIV was derived by examining clinical signs, epidemiological descriptions and analysing laboratory results on the timing and proportions of seroconversion and virus shedding at each infected shed on the premises. In addition to describing how the outbreak was diagnosed and managed via statutory laboratory testing, phylogenetic analysis revealed reassortant events during 2006-2008 that suggested likely incursion of a wild bird origin LPAIV precursor to the H7N7 HPAIV outbreak. Identifying a precursor LPAIV is important for understanding the molecular changes and mechanisms involved in the emergence of HPAIV. This information can lead to understanding how and why only some H7 LPAIVs appear to readily mutate to HPAIV.

Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

KEYWORDS: Avian influenza; H7N7; HPAIV; Pathogenicity

PMID: 29883773 DOI: 10.1016/j.meegid.2018.06.005 [Indexed for MEDLINE]

Keywords: Avian Influenza; H7N7; Poultry; UK.


Elevated #prevalence of #azole #resistant #Aspergillus fumigatus in #urban versus #rural environments in the #UK (Antimicrob Agents Chemother., abstract)

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

Elevated prevalence of azole resistant Aspergillus fumigatus in urban versus rural environments in the United Kingdom

Thomas R Sewell, Yuyi Zhang, Amelie P Brackin, Jennifer M. G. Shelton, Johanna Rhodes, Matthew C Fisher

DOI: 10.1128/AAC.00548-19



Azole resistance in the opportunistic pathogen Aspergillus fumigatus is increasing, dominated primarily by two environmentally-associated resistance alleles: TR34/L98H and TR46/Y121F/T289A. By sampling soils across the South of England we assess the prevalence of azole resistant A. fumigatus (ARAf) in samples collected in both urban and rural locations. We characterise the susceptibility profiles of the resistant isolates to three medical azoles, identify the underlying genetic basis of resistance and investigate their genetic relationships. ARAf was detected in 6.7% of the soil samples, with a higher prevalence in urban (13.8%) compared to rural (1.1%) locations. Twenty isolates were confirmed to exhibit clinical breakpoints for resistance to at least one of three medical azoles, with 18 isolates exhibiting resistance to itraconazole, six to voriconazole and two showing elevated minimum inhibitory concentration to posaconazole. Thirteen of the resistant isolates harboured the TR34/L98H resistance allele and six isolates carried the TR46/Y121F/T289A allele. The 20 azole-resistant isolates were spread across five csp1 genetic subtypes, t01, t02, t04B, t09 and t18 with t02 the predominant subtype. Our study demonstrates that ARAf can be easily isolated in the South of England, especially in urban city centres, which appear to play an important role in the epidemiology of environmentally-linked drug resistant A. fumigatus.

Copyright © 2019 Sewell et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

Keywords: Antibiotics; Drugs Resistance; Triazoles; Voriconazole; Aspergillus fumigatus; UK.


#Fluconazole #resistance in isolates of uncommon pathogenic #yeast species from the #UK (Antimicrob Agents Chemother., abstract)

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

Fluconazole resistance in isolates of uncommon pathogenic yeast species from the UK

Andrew M. Borman, Julian Muller, Jo Walsh-Quantick, Adrien Szekely, Zoe Patterson, Michael D. Palmer, Mark Fraser, Elizabeth M. Johnson

DOI: 10.1128/AAC.00211-19



The triazole drug fluconazole remains one of the most commonly prescribed antifungal drugs, both for prophylaxis in high risk patients and also as a second line treatment option for invasive Candida infections. Established susceptibility profiles, and clinical interpretive breakpoints are available for fluconazole with Candida albicans, C.glabrata, C.tropicalis and C.parapsilosis, which account for the majority of infections due to pathogenic yeast species. However, less common species for which only limited susceptibility data are available are increasingly reported in high risk patients and from breakthrough infections. The UK National Mycology Reference Laboratory performs routine antifungal susceptibility testing of clinical isolates of pathogenic yeast submitted from across the UK. Between 2002-2016, ∼32 000 isolates were referred, encompassing 94 different yeast species. Here we present fluconazole antifungal susceptibility data generated by CLSI methodology over this 15 year period for 82 species (2004 isolates) of less common yeast and yeast-like fungi, and amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole and anidulafungin with members of the Nakaseomyces clade (C.glabrata, C.nivariensis and C.bracarensis). At least 22 different teleomorph genera, comprising 45 species, exhibited high minimum inhibitory concentrations (MICs) when tested with fluconazole (>20% of isolates with MICs higher than the clinical breakpoint [≥8mg/L] proposed for C. albicans). Since several of these species have been reported anecdotally from breakthrough infections and therapeutic failures in patients receiving fluconazole, the current study underscores the importance of rapid and accurate yeast identification, and also may aid clinicians dealing with infections with rarer yeasts to decide whether fluconazole would be appropriate.

© Crown copyright 2019. The government of Australia, Canada, or the UK (“the Crown”) owns the copyright interests of authors who are government employees. The Crown Copyright is not transferable.

Keywords: Antibiotics; Drugs Resistance; Candida spp.; UK; Fluconazole.


#Social #norm #feedback reduces primary care #antibiotic #prescribing in a regression discontinuity study (J Antimicrob Chemother., abstract)

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

Social norm feedback reduces primary care antibiotic prescribing in a regression discontinuity study

Declan T Bradley, Sarah E Allen, Helen Quinn, Brenda Bradley, Matthew Dolan

Journal of Antimicrobial Chemotherapy, dkz222, https://doi.org/10.1093/jac/dkz222

Published: 20 May 2019




Reducing antibiotic prescribing is a priority for health authorities responsible for preventing antimicrobial resistance. Northern Ireland has high rates of antimicrobial use. We implemented a social norm feedback intervention and evaluated its impact.


To estimate the size and duration of the effect of a social norm feedback letter to GPs who worked in the 20% of practices with the highest antimicrobial prescribing.


The letter was sent in October 2017 to 221 GPs in 67 practices. To assess the effect of the intervention, we used a sharp non-parametric regression discontinuity (RD) design, with prescribing rates in the four calendar quarters following the intervention as the outcome variables.


In the quarter following the intervention (October to December 2017) there was a change of −25.7 (95% CI = −42.5 to −8.8, P = 0.0028) antibiotic items per 1000 Specific Therapeutic group Age-sex Related Prescribing Units (STAR-PU). At 1 year, the coefficient was −58.7 (95% CI = −116.7 to −0.7, P = 0.047) antibiotic items per 1000 STAR-PU. The greatest change occurred soon after the intervention. Approximately 18 900 fewer antibiotic items were prescribed than if the intervention had not been made (1% of Northern Ireland’s annual primary care antibiotic prescribing).


A social norm feedback intervention reduced antibiotic prescribing in the intervention practices. The diminishing effect over time suggests the need for more frequent feedback. The RD method allowed measurement of the effectiveness of an intervention that was delivered as part of normal business, without a randomized trial.

Topic:  antibiotics – feedback – northern ireland – primary health care – prescribing behavior – social norms


© 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: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; UK.


#Extension of the known #distribution of a novel clade C #betacoronavirus in a #wildlife host (Epidemiol Infect., abstract)

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

Epidemiol Infect. 2019 Jan;147:e169. doi: 10.1017/S0950268819000207.

Extension of the known distribution of a novel clade C betacoronavirus in a wildlife host.

Saldanha IF1, Lawson B2, Goharriz H3, Rodriguez-Ramos Fernandez J4, John SK2, Fooks AR3, Cunningham AA2, Johnson N3, Horton DL1.

Author information: 1 School of Veterinary Medicine, University of Surrey, Guildford,UK. 2 Institute of Zoology, Zoological Society of London,London,UK. 3 Wildlife Zoonoses & Vector-Borne Diseases Research Group, Animal and Plant Health Agency, New Haw, Addlestone,Surrey, KT15 3NB,UK. 4 IDEXX Laboratories Ltd.,Wetherby, West Yorkshire,UK.



Disease surveillance in wildlife populations presents a logistical challenge, yet is critical in gaining a deeper understanding of the presence and impact of wildlife pathogens. Erinaceus coronavirus (EriCoV), a clade C Betacoronavirus, was first described in Western European hedgehogs (Erinaceus europaeus) in Germany. Here, our objective was to determine whether EriCoV is present, and if it is associated with disease, in Great Britain (GB). An EriCoV-specific BRYT-Green® real-time reverse transcription PCR assay was used to test 351 samples of faeces or distal large intestinal tract contents collected from casualty or dead hedgehogs from a wide area across GB. Viral RNA was detected in 10.8% (38) samples; however, the virus was not detected in any of the 61 samples tested from Scotland. The full genome sequence of the British EriCoV strain was determined using next generation sequencing; it shared 94% identity with a German EriCoV sequence. Multivariate statistical models using hedgehog case history data, faecal specimen descriptions and post-mortem examination findings found no significant associations indicative of disease associated with EriCoV in hedgehogs. These findings indicate that the Western European hedgehog is a reservoir host of EriCoV in the absence of apparent disease.

KEYWORDS: Coronavirus; geographical information systems; virology; wildlife; zoonoses

PMID: 31063092 DOI: 10.1017/S0950268819000207

Keywords: Betacoronavirus; Erinaceus coronavirus; Wildlife; UK.


Are we prepared for the next #influenza #pandemic? #Lessons from modelling different #preparedness policies against four pandemic #scenarios (J Theor Biol., abstract)

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

J Theor Biol. 2019 May 3. pii: S0022-5193(19)30187-0. doi: 10.1016/j.jtbi.2019.05.003. [Epub ahead of print]

Are we prepared for the next influenza pandemic? Lessons from modelling different preparedness policies against four pandemic scenarios.

Panovska-Griffiths J1, Grieco L2, van Leeuwen E3, Baguelin M4, Pebody R5, Utley M6.

Author information: 1 Clinical Operational Research Unit, University College London, London, United Kingdom; Department of Applied Health Research, University College London, London, United Kingdom; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom. Electronic address: j.panovska-griffiths@ucl.ac.uk. 2 Clinical Operational Research Unit, University College London, London, United Kingdom. Electronic address: l.grieco@ucl.ac.uk. 3 Vaccines and Countermeasures Service, Public Health England, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom. Electronic address: Edwin.VanLeeuwen@phe.gov.uk.4 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; Vaccines and Countermeasures Service, Public Health England, London, United Kingdom. Electronic address: marc.baguelin@phe.gov.uk. 5 Vaccines and Countermeasures Service, Public Health England, London, United Kingdom. Electronic address: richard.pebody@phe.gov.uk. 6 Clinical Operational Research Unit, University College London, London, United Kingdom. Electronic address: m.utley@ucl.ac.uk.



In the event of a novel influenza strain that is markedly different to the current strains circulating in humans, the population have little/no immunity and infection spreads quickly causing a global pandemic. Over the past century, there have been four major influenza pandemics: the 1918 pandemic (“Spanish Flu”), the 1957-58 pandemic (the “Asian Flu”), the 1967-68 pandemic (the “Hong Kong Flu”) and the 2009 pandemic (the “Swine flu”). To inform planning against future pandemics, this paper investigates how different is the net-present value of employing pre-purchase and responsive- purchased vaccine programmes in presence and absence of anti-viral drugs to scenarios that resemble these historic influenza pandemics. Using the existing literature and in discussions with policy decision makers in the UK, we first characterised the four past influenza pandemics by their transmissibility and infection-severity. For these combinations of parameters, we then projected the net-present value of employing pre-purchase vaccine (PPV) and responsive-purchase vaccine (RPV) programmes in presence and absence of anti-viral drugs. To differentiate between PPV and RPV policies, we changed the vaccine effectiveness value and the time to when the vaccine is first available. Our results are “heat-map” graphs displaying the benefits of different strategies in pandemic scenarios that resemble historic influenza pandemics. Our results suggest that immunisation with either PPV or RPV in presence of a stockpile of effective antiviral drugs, does not have positive net-present value for all of the pandemic scenarios considered. In contrast, in the absence of effective antivirals, both PPV and RPV policies have positive net-present value across all the pandemic scenarios. Moreover, in all considered circumstances, vaccination was most beneficial if started sufficiently early and covered sufficiently large number of people. When comparing the two vaccine programmes, the RPV policy allowed a longer timeframe and lower coverage to attain the same benefit as the PPV policy. Our findings suggest that responsive-purchase vaccination policy has a bigger window of positive net-present value when employed against each of the historic influenza pandemic strains but needs to be rapidly available to maximise benefit. This is important for future planning as it suggests that future preparedness policies may wish to consider utilising timely (i.e. responsive-purchased) vaccines against emerging influenza pandemics.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Epidemiological modelling; Net-present value of pandemic immunisation; Pandemic influenza; Pre-purchase pandemic vaccine; Responsive-purchase pandemic vaccine

PMID: 31059716 DOI: 10.1016/j.jtbi.2019.05.003

Keywords: Pandemic Influenza; Pandemic Preparedness; Vaccines; Antivirals; UK.