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The UK was one of few European countries to document a substantial wave of pandemic (H1N1) 2009 influenza in summer 2009. The First Few Hundred (FF100) project ran from April-June 2009 gathering information on early laboratory-confirmed cases across the UK. In total, 392 confirmed cases were followed up. Children were predominantly affected (median age 15 years, IQR 10-27). Symptoms were mild and similar to seasonal influenza, with the exception of diarrhoea, which was reported by 27%. Eleven per cent of all cases had an underlying medical condition, similar to the general population. The majority (92%) were treated with antiviral drugs with 12% reporting adverse effects, mainly nausea and other gastrointestinal complaints. Duration of illness was significantly shorter when antivirals were given within 48 h of onset (median 5 vs. 9 days, P=0.01). No patients died, although 14 were hospitalized, of whom three required mechanical ventilation. The FF100 identified key clinical and epidemiological characteristics of infection with this novel virus in near real-time.

BackgroundThe majority of influenza transmission occurs in homes, schools and workplaces, where many frequently touched communal items are situated. However the importance of transmission via fomites is unclear since few data exist on the survival of virus on commonly touched surfaces. We therefore measured the viability over time of two H1N1 influenza strains applied to a variety of materials commonly found in households and workplaces.Methodology and Principal FindingsInfluenza A/PuertoRico/8/34 (PR8) or A/Cambridge/AHO4/2009 (pandemic H1N1) viruses were inoculated onto a wide range of surfaces used in home and work environments, then sampled at set times following incubation at stabilised temperature and humidity. Virus genome was measured by RT-PCR; plaque assay (for PR8) or fluorescent focus formation (for pandemic H1N1) was used to assess the survival of viable virus.Conclusions/SignificanceThe genome of either virus could be detected on most surfaces 24 h after application with relatively little drop in copy number, with the exception of unsealed wood surfaces. In contrast, virus viability dropped much more rapidly. Live virus was recovered from most surfaces tested four hours after application and from some non-porous materials after nine hours, but had fallen below the level of detection from all surfaces at 24 h. We conclude that influenza A transmission via fomites is possible but unlikely to occur for long periods after surface contamination (unless re-inoculation occurs). In situations involving a high probability of influenza transmission, our data suggest a hierarchy of priorities for surface decontamination in the multi-surface environments of home and hospitals.

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SUMMARY Of the first 250 heart and 35 heart and lung transplant recipients at Papworth Hospital, Cambridge, who survived for more than one month after transplantation, 217 heart and 33 heart and lung patients were investigated serologically for evidence of Toxoplasma gondii infection. Six patients acquired primary Tgondii infection, most probably from the donor organ. Five patients experienced Tgondii recrudescence, two of whom had recovered from primary infection a few years earlier. Two patients died from primary Tgondii infection and the severity of symptoms in the other patients with primary infection was related to the amount of immunosuppressive treatment. Prophylaxis with pyrimethamine (25 mg a day for six weeks) was introduced for Tgondii antibody negative transplant recipients who received a heart from a T gondii antibody positive donor after the first four cases of primary toxoplasmosis. Ofthe seven patients not given pyrimethamine, four (57%) acquired primary Tgondii infection. This compared with two of the 14 patients (14%) given prophylaxis.

Objective To evaluate ascertainment of the onset of community transmission of influenza A/H1N1 2009 (swine flu) in England during the earliest phase of the epidemic through comparing data from two surveillance systems.Design Cross sectional opportunistic survey.Study samples Results from self samples by consenting patients who had called the NHS Direct telephone health line with cold or flu symptoms, or both, and results from Health Protection Agency (HPA) regional microbiology laboratories on patients tested according to the clinical algorithm for the management of suspected cases of swine flu.Setting Six regions of England between 24 May and 30 June 2009. Main outcome measure Proportion of specimens with laboratory evidence of influenza A/H1N1 2009.Results Influenza A/H1N1 2009 infections were detected in 91 (7%) of the 1385 self sampled specimens tested. In addition, eight instances of influenza A/H3 infection and two cases of influenza B infection were detected. The weekly rate of change in the proportions of infected individuals according to self obtained samples closely matched the rate of increase in the proportions of infected people reported by HPA regional laboratories. Comparing the data from both systems showed that local community transmission was occurring in London and the West Midlands once HPA regional laboratories began detecting 100 or more influenza A/H1N1 2009 infections, or a proportion positive of over 20% of those tested, each week.Conclusions Trends in the proportion of patients with influenza A/H1N1 2009 across regions detected through clinical management were mirrored by the proportion of NHS Direct callers with laboratory confirmed infection. The initial concern that information from HPA regional laboratory reports would be too limited because it was based on testing patients with either travel associated risk or who were contacts of other influenza cases was unfounded. Reports from HPA regional laboratories could be used to recognise the extent to which local community transmission was occurring.

The Serodia Myco II particle agglutination test, which the manufacturers claim exclusively detects IgM antibody, was compared with two IgM-specific tests, a p-capture ELISA, and indirect immunofluorescence for their ability to detect recent Mycoplasma pneumoniae infection. In general there was good agreement among the three tests, all three having similar sensitivity. One hundred and nine (78%) of serum samples gave concordant results in all three assays. Several sera gave positive particle agglutination titres, however, while being negative by the two other assays, and the Serodia Myco The p-capture ELISA was performed as previously described.5 Negative and positive control sera were selected as previously described' and allocated 0 arbitrary units and 100 u, respectively. The positive control serum was diluted in negative control serum to give dilutions containing 33, 10, 3 3, 1, 0-33 and 0-1 u. Sera with > 0 33 u of M pneumoniae-specific IgM were regarded as positive.The indirect immunofluorescence antibody (IFAT) test was performed as previously described.4 IgM, IgA, and IgG were detected by means of anti-human Ig fluorescein isothiocyanate (FITC) conjugate (IgM and IgG, Wellcome Diagnostics, IgA, Miles). Sera with titres of > 4 (IgM), > 16 (IgA), or >64 (IgG) were regarded as indicating recent M pneumoniae infection.The Serodia Myco II gelatin particle agglutination test (Fujirebio, Japan) is marketed in the United Kingdom by Mast Diagnostics, Bootle, and was performed according to the manufacturer's instructions. It is based on the principle that gelatin particles sensitised with M pneumoniae cell membrane components are agglutinated in the presence of M pneumoniae antibody. Serum samples were inactivated at 56°C for 30 minutes. Rigid U-well microtitre plates (supplied with the kits) were soaked in detergent solution overnight and then rinsed thoroughly under running tap water. They were then washed with distilled water and dried. Using the serum diluent supplied, 25 p1 serum samples were double diluted to give dilutions of 1 in 10 to 1 in 10240. Sensitised and unsensitised lyophilised gelatin particles were suspended in diluent. Twenty five microlitre drops of the unsensitised particle suspension were added to the 1 in 10 serum dilutions to give a final dilution of 1 in 20, and 25 p1 drops of the sensitised particle suspension were added to the remaining wells giving final dilutions of 1 in 40 to 1 in 20480. The plates were shaken for 30 seconds and then covered and left undisturbed on a level surface at room temperature for three hours (or overnight).The test was initially calibrated using the control sera dilution series.

Aims: To determine the causes of morbilliform rash and fever in a population with high vaccination coverage for measles and rubella. Methods: Comprehensive laboratory investigation additional to routine oral fluid testing of children presenting to primary care physicians in East Anglia, England. Results: Laboratory confirmation of infection was obtained in 93 (48%) of 195 children: parvovirus B19 in 34 (17%); group A streptococcus in 30 (15%); human herpesvirus type 6 in 11 (6%); enterovirus in nine (5%); adenovirus in seven (4%); and group C streptococcus in six (3%) (four individuals tested positive for two agents). None had measles or rubella. Conclusions: Oral fluid testing to cover infections additional to measles and rubella aids clinical management and is likely to maintain uptake of testing, which is essential for measles and rubella surveillance in highly immunised low incidence populations.T he infectious causes of morbilliform rash and fever in childhood are varied and include measles virus, rubella virus, group A streptococci (GAS)-the cause of scarlet fever, parvovirus B19, non-polio enteroviruses, adenoviruses, and human herpesvirus type 6 (HHV6).1 Laboratory investigation is therefore necessary for accurate diagnosis. In populations with high levels of immunisation against measles and rubella, other causes of rash-fever illness predominate, but knowledge of the epidemiology and natural history of these infections is generally limited. Oral fluid (saliva) testing for measles and rubella antibody was introduced in England and Wales following the 1994 vaccination campaign. [4][5][6] The test is non-invasive and reliable and has proved popular with doctors investigating morbilliform rash-fever illness. The vast majority of suspected measles and rubella cases which are tested are not confirmed. It is therefore desirable to extend oral fluid testing to the other common causes of rash-fever illness so that positive diagnostic information can be provided in a higher proportion of cases. This would probably make oral fluid testing more attractive to physicians and carers and ensure continued high levels of laboratory surveillance for measles and rubella, which is crucial for their control and elimination, especially when the incidence of both diseases is low. In order to investigate the current causes of morbilliform rash and fever in a highly vaccinated population of English children, and to inform development of extended oral fluid testing, children presenting to general practitioners with morbilliform rash and fever underwent comprehensive laboratory investigation at the same time as routine oral fluid testing for measles and rubella. SUBJECTS AND METHODSSubjects were children under 16 years of age presenting with a morbilliform rash and fever to participating general practitioners (primary care physicians) in the East Anglian region of England between 1996 and 1998, and whose parent or guardian gave informed consent to participation. Ethical approvalEthical approval was obtained from health authority l...