Background. Administration of convalescent plasma, serum, or hyperimmune immunoglobulin may be of clinical benefit for treatment of severe acute respiratory infections (SARIs) of viral etiology. We conducted a systematic review and exploratory meta-analysis to assess the overall evidence.Methods. Healthcare databases and sources of grey literature were searched in July 2013. All records were screened against the protocol eligibility criteria, using a 3-stage process. Data extraction and risk of bias assessments were undertaken.Results. We identified 32 studies of SARS coronavirus infection and severe influenza. Narrative analyses revealed consistent evidence for a reduction in mortality, especially when convalescent plasma is administered early after symptom onset. Exploratory post hoc meta-analysis showed a statistically significant reduction in the pooled odds of mortality following treatment, compared with placebo or no therapy (odds ratio, 0.25; 95% confidence interval, .14–.45; I2 = 0%). Studies were commonly of low or very low quality, lacked control groups, and at moderate or high risk of bias. Sources of clinical and methodological heterogeneity were identified.Conclusions. Convalescent plasma may reduce mortality and appears safe. This therapy should be studied within the context of a well-designed clinical trial or other formal evaluation, including for treatment of Middle East respiratory syndrome coronavirus CoV infection.

BACKGROUND AND OBJECTIVES: Despite numerous studies reporting an elevated risk of infant mortality among women who are obese, the magnitude of the association is unclear. A systematic review and metaanalysis was undertaken to assess the association between maternal overweight or obesity and infant mortality.METHODS: Four health care databases and gray literature sources were searched and screened against the protocol eligibility criteria. Observational studies reporting on the relationship between maternal overweight and obesity and infant mortality were included. Data extraction and risk of bias assessments were performed.RESULTS: Twenty-four records were included from 783 screened. Obese mothers (BMI $30) had greater odds of having an infant death (odds ratio 1.42; 95% confidence interval, 1.24-1.63; P , .001; 11 studies); these odds were greatest for the most obese (BMI .35) (odds ratio 2.03; 95% confidence interval, 1.61-2.56; P , .001; 3 studies). CONCLUSIONS:Our results suggest that the odds of having an infant death are greater for obese mothers and that this risk may increase with greater maternal BMI or weight; however, residual confounding may explain these findings. Given the rising prevalence of maternal obesity, additional high-quality epidemiologic studies to elucidate the actual influence of elevated maternal mass or weight on infant mortality are needed. If a causal link is determined and the biological basis explained, public health strategies to address the issue of maternal obesity will be needed. Mr Meehan developed the protocol, executed the search strategy, screened all records, assessed risk of bias, extracted data, carried out the data analysis, interpreted results, and prepared the manuscript draft; Dr Beck advised on study methods and analysis, extracted data, assessed methodological quality, and reviewed and revised the manuscript; Mr Mair-Jenkins extracted data, assessed methodological quality, and reviewed and revised the manuscript; Dr Leonardi-Bee advised on study methods and analysis, provided arbitration, critically appraised the analysis, and reviewed and revised the manuscript; Dr Puleston supervised the study, screened all records for eligibility, extracted data and prepared, and reviewed and revised the manuscript; and all authors approved the manuscript for submission.The protocol is registered at the National Institute for Health Research international prospective register of systematic reviews (identifier CRD42012002171). Overweight and obesity are increasing in women of childbearing age and during pregnancy. 2 The prevalence of maternal obesity ranges from 1.8% to 25.3% across different countries. 3 A recent study from the United States showed an increase in the prevalence of obesity during pregnancy from 13.0% in 1993 to 22.0% in 2003. 4 Obese pregnant women are likely to be older, have higher parity, and live in areas of higher deprivation than nonobese women. 3 Although global infant mortality rates have declined from 61 to 40 deaths per 1000 live births betw...

Following notification of a Salmonella enterica serovar Typhimurium gastroenteritis outbreak, we identified 82 cases linked to a restaurant with symptom onset from 12 February 2015 to 8 March 2016. Seventy-two cases had an isolate matching the nationally unique whole genome sequencing profile (single nucleotide polymorphism (SNP) address: 1.1.1.124.395.395). Interviews established exposure to the restaurant and subsequent case–control analysis identified an association with eating carvery buffet food (adjusted odds ratios (AOR): 20.9; 95% confidence interval (CI): 2.2 – ∞). Environmental inspections, food/water testing, and a food trace-back investigation were inconclusive. Repeated cycles of cleaning were undertaken, including hydrogen peroxide fogging, however, transmission continued. After 7 months of investigation, environmental swabbing identified 106 isolates from kitchen surfaces and restaurant drains matching the outbreak profile. We found structural faults with the drainage system and hypothesised that a reservoir of bacteria in drain biofilm and underfloor flooded areas may have sustained this outbreak. Ineffective drain water-traps (U-bends) may have also contributed by allowing transmission of contaminated aerosols into the kitchen environment. These findings suggest that routine swabbing of sink drain points and inspection of drainage systems should be considered in future outbreak scenarios.

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In 2017 Public Health England were asked to assist with investigating why 1-year cancer survival rates appeared lower than expected in a local area. We identified 50 premature deaths that surveillance data suggested we would not expect. These deaths highlighted a gap in recognising and responding to this kind of systematic non communicable disease (NCD) outcome variation. We hypothesise that the lack of a universally agreed systematic response to variations is not only counter-intuitive, but wholly unacceptable where non-communicable diseases (NCDs) rather than infectious diseases have become the leading causes of illness and death worldwide. In the United Kingdom (UK) alone over 89% of mortality in 2014 was attributable to NCDs. We argue that a new approach is urgently needed to turn the curve on NCD outcome variation to protect and improve the public’s health. We set out a definition of an NCD “incident” and propose a phased approach that could be used to respond to local variation in NCD outcomes. Establishing parity of response for local variations in NCD outcomes and CD control is critically important. Although evidence shows that prevention and early intervention will make the biggest difference to NCD incidence, collective local whole health economy response, exploiting the wealth of surveillance data in real time, needs to be at the heart of responding to variations in NCD outcomes at a population level. We argue that local and national public health agencies should mandate a standardised ‘incident’ response to significant changes in outcomes from NCD to mitigate and reduce the loss of quality life.

Introduction:On 14th August 2015 an office manager informed Public Health England of five employees known to have been diagnosed with pneumonia over the previous three weeks. We investigated to establish whether an outbreak occurred and to identify and control the source of infection.Methods:We undertook case finding for self-reported pneumonia cases at local businesses (July-August 2015). Clinical samples from a hospitalised case were tested for common respiratory pathogens, but returned negative results. Further testing confirmed Chlamydia psittaci infection in this case (serology and PCR).  We subsequently undertook C. psittaci testing for all cases, redefining them as confirmed (C. psittaci PCR or high antibody titre via serology) or probable (inconclusive C. psittaci serology). Twenty-eight day exposure histories informed descriptive epidemiological analysis. We conducted an environmental investigation at the office to identify potential sources of exposure.Results:We identified six office workers with pneumonia; four met case definitions (three confirmed, one probable) with symptom onset between 29th July and 4th August 2015. Workplace was the only epidemiological link and only one case reported limited, indirect bird contact. Environmental investigations identified pigeons roosting near the office which were being fed by workers (none cases).Discussion:This was a probable outbreak of psittacosis with no direct bird-to-human contact reported. Cases recovered after receiving appropriate antibiotics. Feeding of pigeons was stopped. A deep clean of office ventilation systems was conducted and workers were advised to avoid bird contact.  We hypothesised that indirect environmental exposure to infected pigeons was to the source of this outbreak. This work provides evidence that health professionals should consider psittacosis in the differential diagnosis of cases of severe or atypical respiratory illness even without overt bird contact.

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