In February 2015, an outbreak of recently acquired HIV infections among people who inject drugs (PWID) was identified in Dublin, following similar outbreaks in Greece and Romania in 2011. We compared drug and risk behaviours among 15 HIV cases and 39 controls. Injecting a synthetic cathinone, snow blow, was associated with recent HIV infection (AOR: 49; p=0.003). Prevention and control efforts are underway among PWID in Dublin, but may also be needed elsewhere in Europe.
In 2011, there was a large measles outbreak in Dublin. Nationally 285 cases were notified to the end of December 2011, and 250 (88%) were located in the Dublin region. After the first case was notified in week 6, numbers gradually increased, with 25 notified in June and a peak of 53 cases in August. Following public health intervention including a measles-mumps-rubella (MMR) vaccination campaign, no cases were reported in the Dublin region in December 2011. Most cases (82%) were children aged between 6 months and 14 years, and 46 cases (18%) were under 12 months-old. This is the first outbreak in Dublin to utilise a geographic information system for plotting measles cases on a digital map in real time. This approach, in combination with the analysis of case notifications, assisted the department of public health in demonstrating the extent of the outbreak. The digital mapping documented the evolution of two distinct clusters of 87 (35%) cases. These measles cases were infected with genotype D4-Manchester recently associated with large outbreaks across Europe. The two clusters occurred in socio-economically disadvantaged areas and were attributable to inadequate measles vaccination coverage due in part to the interruption of a school-based MMR2 vaccination programme.
Recent infection testing algorithms (RITA) for HIV combine serological assays with epidemiological data to determine likely recent infections, indicators of ongoing transmission. In 2016, we integrated RITA into national HIV surveillance in Ireland to better inform HIV prevention interventions. We determined the avidity index (AI) of new HIV diagnoses and linked the results with data captured in the national infectious disease reporting system. RITA classified a diagnosis as recent based on an AI < 1.5, unless epidemiological criteria (CD4 count <200 cells/mm3; viral load <400 copies/ml; the presence of AIDS-defining illness; prior antiretroviral therapy use) indicated a potential false-recent result. Of 508 diagnoses in 2016, we linked 448 (88.1%) to an avidity test result. RITA classified 12.5% of diagnoses as recent, with the highest proportion (26.3%) amongst people who inject drugs. On multivariable logistic regression recent infection was more likely with a concurrent sexually transmitted infection (aOR 2.59; 95% CI 1.04–6.45). Data were incomplete for at least one RITA criterion in 48% of cases. The study demonstrated the feasibility of integrating RITA into routine surveillance and showed some ongoing HIV transmission. To improve the interpretation of RITA, further efforts are required to improve completeness of the required epidemiological data.
Background and aims Despite the fact that one of the peaks of Lyme disease incidence occurs in childhood, there are no population-based studies of incidence in children in Ireland, or indeed Europe. We aimed to identify the incidence and clinical presentation of serologically confirmed Lyme disease in patients aged 1-18 years in Ireland over a 5-year period. Methods A cross-sectional survey was conducted across all four laboratories in Ireland who perform in-house ELISA testing for Borrelia species (accredited to ISO 150189 standard). Between 2012-2016, all paediatric samples that were ELISA positive underwent confirmatory Western Blot testing through the Lyme Reference laboratory in the UK. For patients who were two-tier positive, an anonymous proforma was distributed by the respective Irish laboratories to their requesting clinicians to collect clinical details regarding their presentation, treatment and outcome. Results 64 patients aged 1-18 with two-tier positive Borreliaserology were identified, representing just 2% of 2914 samples tested (1.1 per 100,000 children aged 1-18 per year). Proformas were returned for 52 (87%), of whom 48 (92%) had a clinical presentation consistent with Lyme disease. The mean age at presentation was 9.5 years. 27 (51.9%) cases were reportedly contracted in Ireland, predominantly in the west, and 22 children (45.8%) recalled a tick bite. 27 (56%) children in our cohort were characterised as having Lyme Disease (LD) without focal symptoms. 19 (70%) of those had solitary erythema migrans, and 3 (11.1%) had multiple erythema migrans. 92.5% of those with LD without focal symptoms were treated with oral antibiotics. Full symptom resolution was documented in 88.8% of cases. 20 (41.6%) children were characterised as having LD with focal symptoms. 11 (22.9%) had cranial nerve palsy without associated CNS involvement, and one child (2%) had arthritis. 8 children (16.6%) had LD with central nervous system involvement. Of the 19 children with CNS or cranial nerve involvement, 7 (36.8%) had a history of erythema migrans, involving the head/neck in all cases. Full symptom resolution was documented in 95% of children with LD with focal symptoms.There were no cases of carditis. No patient had a post Lyme disease syndrome. Of the 44 children in our cohort with documented antimicrobial treatment, treatment duration was appropriate in 39 cases (88.6%). Conclusions Despite increasing public awareness, Lyme disease remains rare in Irish children. Presentation was predominantly with erythema migrans and neurological manifestations and importantly, all children for whom data were available, recovered with no long-term sequelae GP202 ABSTRACT WITHDRAWN
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