European Union's Seventh Framework programme.

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Urinary fluoride was evaluated as an exposure index for a prospective study of asthma in an aluminum smelter. Two studies were conducted to evaluate the relationship between airborne exposure and urinary excretion over a workweek, and to describe exposures among jobs and over time. Thirty-two subjects were evaluated on Days 1 and 3 of a 3-day workweek. On each day, spot urine samples were collected prior to the start of work and again at the end of the shift. Samples were analyzed for fluoride and expressed as milligrams fluoride per gram of creatinine. Airborne exposures to total particulate, fluoride particulate, and hydrogen fluoride (HF; using a 37-mm filter cassette containing a filter and treated back-up pad) were also evaluated on each subject. In the second study, postshift urine samples were collected from asthma study volunteers in three surveys extending over 1.5 years and analyzed for fluoride. Average airborne exposures were 15.7, 4.1, and 0.7 mg/m3 for particulates, particulate fluorides and HF, respectively, and were substantially higher among carbon setters than other workers. However, average urine fluorides among the same workers were reasonably low, 1.3 and 3.0 mg/g creatinine in pre- and postshift urine samples, respectively. Carbon setters, who routinely wore respiratory protection during high exposure periods, had urinary fluoride levels similar to those of other potroom personnel. A significant variation in dose, as expressed by postshift urinary fluoride levels, was observed between potroom and nonpotroom jobs and over three survey periods. These results suggest that postshift urinary fluorides provide a reasonable exposure index for surveillance of exposure levels for an epidemiologic study, and that a substantial variation of exposure occurs between jobs and over time. Although urinary fluorides may be used for exposure surveillance, additional details on individual exposure agents and patterns of exposure over time are required for complete assessment.

Group A streptococcal (GAS) disease shows increasing incidence worldwide. We characterised children admitted with GAS infection to European hospitals and studied risk factors for severity and disability. This is a prospective, multicentre, cohort study (embedded in EUCLIDS and the Swiss Pediatric Sepsis Study) including 320 children, aged 1 month to 18 years, admitted with GAS infection to 41 hospitals in 6 European countries from 2012 to 2016. Demographic, clinical, microbiological and outcome data were collected. A total of 195 (61%) patients had sepsis. Two hundred thirty-six (74%) patients had GAS detected from a normally sterile site. The most common infection sites were the lower respiratory tract (LRTI) (22%), skin and soft tissue (SSTI) (23%) and bone and joint (19%). Compared to patients not admitted to PICU, patients admitted to PICU more commonly had LRTI (39 vs 8%), infection without a focus (22 vs 8%) and intracranial infection (9 vs 3%); less commonly had SSTI and bone and joint infections ( p < 0.001); and were younger (median 40 (IQR 21–83) vs 56 (IQR 36–85) months, p = 0.01). Six PICU patients (2%) died. Sequelae at discharge from hospital were largely limited to patients admitted to PICU (29 vs 3%, p < 0.001; 12% overall) and included neurodisability, amputation, skin grafts, hearing loss and need for surgery. More patients were recruited in winter and spring ( p < 0.001). Conclusion : In an era of observed marked reduction in vaccine-preventable infections, GAS infection requiring hospital admission is still associated with significant severe disease in younger children, and short- and long-term morbidity. Further advances are required in the prevention and early recognition of GAS disease. What is Known: • Despite temporal and geographical variability, there is an increase of incidence of infection with group A streptococci. However, data on the epidemiology of group A streptococcal infections in European children is limited. What is New: • In a large, prospective cohort of children with community-acquired bacterial infection requiring hospitalisation in Europe, GAS was the most frequent pathogen, with 12% disability at discharge, and 2% mortality in patients with GAS infection. • In children with GAS sepsis, IVIG was used in only 4.6% of patients and clindamycin in 29% of patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00431-022-04718-y.

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