Listeriosis is a rare but severe foodborne disease with low morbidity and high case-fatality rates. Pregnant women, unborn and newborn babies are among the high-risk groups for listeriosis. We examined listeriosis cases reported to the enhanced surveillance system in England and Wales from 1990 to 2010 to identify risk factors influencing outcome. Cases were defined as pregnancy-associated if Listeria monocytogenes was isolated from a pregnant woman or newborn infants aged <28 days. Of the 3088 cases reported, pregnancy-associated listeriosis accounted for 462 (15%) cases and 315 cases resulted in a live birth. Several factors were identified as affecting the severity and outcome of listeriosis in pregnancy in both mother and child including: presence or absence of maternal symptoms, gestational age at onset of symptoms, and clinical presentation in the infant (meningitis or septicaemia). Deprivation, ethnicity and molecular serotype had no effect on outcome.
The West Midlands was the first English region to report sustained community transmission during the 'containment' phase of the influenza A(H1N1)pdm09 pandemic in England. To describe the epidemiological experience in the region, West Midlands and national datasets containing laboratory-confirmed A(H1N1)pdm09 virus cases in the region during the 'containment' phase were analysed. The region accounts for about 10·5% of England's population, but reported about 42% of all laboratory-confirmed cases. Altogether 3063 cases were reported, with an incidence rate of 56/100 000 population. School-associated cases accounted for 25% of cases. Those aged <20 years, South Asian ethnic groups, and residents of urban and socioeconomically deprived areas were disproportionately affected. Imported cases accounted for 1% of known exposures. Regional R 0 central estimates between 1·41 and 1·43 were obtained. The West Midlands experience suggests that interpretation of transmission rates may be affected by complex interactions within and between sub-populations in the region.
Listeria monocytogenes is a Gram-positive bacterium which can cause invasive infection in the immunocompromised, pregnant women and young infants. Listeria are not susceptible to the third generation cephalosporins (such as cefotaxime or ceftriaxone) usually given as empirical antibiotic treatment to unwell children. Amoxicillin or ampicillin is thus added for infants less than 3 months of age with suspected serious bacterial infection. However empirical antibiotic cover for L. monocytogenes infection beyond the neonatal period may not be needed.
CURRENT RECOMMENDATIONThe National Institute of Health and Care Excellence (NICE) clinical guidelines on 'Feverish illness in children' (2007) 1 and 'Bacterial meningitis and meningococcal septicaemia' (2010) 2 recommend that the empirical antibiotic cover for infants 0-3 months of age admitted from home with suspected serious bacterial infection should be amoxicillin and cefotaxime. 1 2 This recommendation reflects the range of bacterial pathogens that cause these serious infections in the first 3 months of life. The inclusion of amoxicillin specifically acknowledges the importance of L. monocytogenes and highlights its non-susceptibility to thirdgeneration cephalosporins.
CURRENT EPIDEMIOLOGYPopulation-based surveillance undertaken in England and Wales in the 1980s and 1990s showed that the aetiology and incidence of neonatal bacterial meningitis changed very little over this period with Group B streptococci and Escherichia coli being the leading causative organisms, followed by L. monocytogenes. 3 4 A more recent population-based surveillance study of bacterial meningitis in infants aged <90 days in the UK and Ireland undertaken between July 2010 and July 2011 showed that these three causative bacteria remained dominant, and that their frequency varied significantly by month of life. In the first 30 days of life, L. monocytogenes was the third most common bacteria, responsible for 6% of cases (compared with 7% and 5% (for the first 28 days) in the previous national studies). The median age of meningitis due to L. monocytogenes was 13 days (IQR 3-18 days) with the oldest infant being 29 days; Listeria meningitis was therefore not seen beyond the 1st month of life. 5 Of the 11 cases of Listeria meningitis, 7 (64%) were female, 2/9 (22%) were born preterm (<37 weeks gestation) and 6/9 (67%) first became unwell when at home. Outcome was known in nine cases and all survived although two cases (22%) had a serious complication at discharge (one baby had hydrocephalus while the second baby had focal neurological signs).A summary of all cases of L. monocytogenes infection (sepsis and meningitis inclusive) in infants <1 year of age reported to Public Health England over the 24 years period between 1990 and 2013 is shown in tables 1 and 2. This data expands on previously published surveillance. 6 Ninety-seven per cent of all cases (351/362), and 99% of all cases occurring in the first 90 days of life (351/356), presented in the first 30 days of life. Clinical presentation was kn...
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