BackgroundAround 67 million pets are owned by households in the United Kingdom, and an increasing number of these are exotic animals. Approximately a third of pets are purchased through retail outlets or direct from breeders. A wide range of infections can be associated with companion animals.ObjectivesThis study uses a systematic literature review to describe the transmission of zoonotic disease in humans associated with a pet shop or other location selling pets (incidents of rabies tracebacks and zoonoses from pet food were excluded).Data sourcesPubMed and EMBASE.ResultsFifty seven separate case reports or incidents were described in the 82 papers that were identified by the systematic review. Summary information on each incident is included in this manuscript. The infections include bacterial, viral and fungal diseases and range in severity from mild to life threatening. Infections associated with birds and rodents were the most commonly reported. Over half of the reports describe incidents in the Americas, and three of these were outbreaks involving more than 50 cases. Many of the incidents identified relate to infections in pet shop employees.LimitationsThis review may have been subject to publication bias, where unusual and unexpected zoonotic infections may be over-represented in peer-reviewed publications. It was also restricted to English-language articles so that pathogens that are more common in non-Western countries, or in more exotic animals not common in Europe and the Americas, may have been under-represented.Conclusions/implicationsA wide spectrum of zoonotic infections are acquired from pet shops. Salmonellosis and psittacosis were the most commonly documented diseases, however more unusual infections such as tularemia also appeared in the review. Given their potential to spread zoonotic infection, it is important that pet shops act to minimise the risk as far as possible.

ObjectiveLyme disease is a tick-borne disease of increasing incidence and public concern across the Northern Hemisphere. However, the socio-demographics and geographic distribution of the population affected in England and Wales are poorly understood. Therefore, the proposed study was designed to describe the demographics and distribution of laboratory-confirmed cases of Lyme disease from a national testing laboratory.DesignAn ecological study of routinely collected laboratory surveillance data.SettingPublic Health England’s national Lyme disease testing laboratory.Participants3986 laboratory-confirmed cases of Lyme disease between 2013 and 2016.ResultsIn England and Wales, the incidence of laboratory-confirmed Lyme disease rose significantly over the study period from 1.62 cases per 100 000 in 2013 to 1.95 cases per 100 000 in 2016. There was a bimodal age distribution (with peaks at 6–10 and 61–65 years age bands) with a predominance of male patients. A significant clustering of areas with high Lyme disease incidence was located in southern England. An association was found between disease incidence and socioeconomic status, based on the patient’s resident postcode, with more cases found in less deprived areas. Cases were disproportionately found in rural areas compared with the national population distribution.ConclusionsThese results suggest that Lyme disease patients originate from areas with higher socioeconomic status and disproportionately in rural areas. Identification of the Lyme disease hotspots in southern England, alongside the socio-demographics described, will enable a targeted approach to public health interventions and messages.

We studied the timing of occurrence of 1676 sporadic, community-acquired cases of Legionnaires' disease in England and Wales between 1993 and 2008, in relation to temperature, relative humidity, rainfall, windspeed and ultraviolet light using a fixed-stratum case-crossover approach. The analysis was conducted using conditional logistic regression, with consideration of appropriate lag periods. There was evidence of an association between the risk of Legionnaires' disease and temperature with an apparently long time lag of 1-9 weeks [odds of disease at 95th vs. 75th centiles: 3·91, 95% confidence interval (CI) 2·06-7·40], and with rainfall at short time lags (of 2-10 days) (odds of disease at 75th vs. 50th centiles: 1·78, 95% CI 1·50-2·13). There was some evidence that the risk of disease in relation to high temperatures was greater at high relative humidities. A higher risk of Legionnaires' disease may be indicated by preceding periods of warmer wetter weather.

General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Summary (150-200 words)The number of South American camelids (SAC) in England and Wales is increasing and with this comes a risk of new and emerging infections. Although classified as livestock, these animals are also treated as pets and may be in regular contact with humans. This paper reviews zoonotic diseases that have been identified in SAC in England and Wales, and which pose a potential risk to human health. We also highlight the importance of surveillance continuing to capture information on infections in SAC for the protection of both public and animal health.2

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Background and objectivesGlucocorticoids are used to manage adrenal insufficiency (AI). We describe treatments used in the United Kingdom and real-world clinical outcomes for each treatment.MethodsWe used 2010–2016 primary care data from The Health Improvement Network (THIN). Descriptive analyses were conducted, and differences in variables between patients prescribed immediate-release hydrocortisone (IR HC), prednisolone or modified-release hydrocortisone (MR HC) were assessed using Fisher’s exact test.ResultsOverall, 2648 patients were included: 1912 on IR HC (72%), 691 on prednisolone (26%) and 45 (2%) on MR HC. A total of 1174 (44.3%) had primary and 1150 (43.4%) had secondary AI. Patients on prednisolone were older (P < 0.001) and had a greater history of smoking (292/691, P < 0.001) and CVD (275/691, P < 0.001). Patients on MR HC had more PCOS (3/45, P = 0.001) and diabetes (27/45, P = 0.004). The number of GP visits/patient/year was 6.50 in IR HC, 9.54 in prednisolone and 9.11 in MR HC cohorts. The mean number of A&E visits and inpatient and outpatient hospital admissions ranged from 0.42 to 0.93 visits/patient/year. The mean number of adrenal crises/patient/year was between 0.02 and 0.03 for all cohorts.ConclusionIR HC is most commonly used for the management of AI in the United Kingdom, followed by prednisolone. Few patients receive MR HC. The prednisolone and MR HC cohorts displayed a greater prevalence of vascular risk factors compared with IR HC. The occurrence of AC and primary and secondary resource use were similar between treatment cohorts, and they indicate significant resource utilisation. Improved treatment and management of patients with AI is needed.

Toxocara infection occurs through ingestion of parasite eggs excreted by dogs and cats, and can cause severe morbidity. The burden of disease in England and Wales is not well described, and the impact of public health campaigns conducted in the mid-1990s is uncertain. This paper uses data from two extensive databases to explore the trends in this disease in England and Wales from the 1970s to 2009.

SUMMARYOver 300 cases of acute toxoplasmosis are confirmed by reference testing in England and Wales annually. We conducted a case-control study to identify risk factors for Toxoplasma gondii infection to inform prevention strategies. Twenty-eight cases and 27 seronegative controls participated. We compared their food history and environmental exposures using logistic regression to calculate odds ratios (OR) and 95% confidence intervals in a model controlling for age and sex. Univariable analysis showed that the odds of eating beef (OR 10·7, P < 0·001), poultry (OR 6·4, P = 0·01) or lamb/mutton (OR 4·9, P = 0·01) was higher for cases than controls. After adjustment for potential confounders a strong association between beef and infection remained (OR 5·6, P = 0·01). The small sample size was a significant limitation and larger studies are needed to fully investigate potential risk factors. The study findings emphasize the need to ensure food is thoroughly cooked and handled hygienically, especially for those in vulnerable groups.