Publications by authors named "Alison Smith-Palmer"

IntroductionFood-borne disease outbreak investigations use epidemiological, microbiological and food chain evidence to identify the implicated food and inform risk management actions.AimsWe used Shiga toxin-producing (STEC) as a model pathogen to investigate the success of outbreak strain isolation from food or environmental samples during outbreak investigations, and examined the factors influencing the chance of isolation.MethodsWe searched for reports of food-borne STEC outbreak investigations worldwide in peer-reviewed and grey literature in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

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Objectives: We aimed to assess the effects of risk-based travel restrictions on (1) international travel frequency, (2) SARS-CoV-2 case importation risk, (3) national SARS-CoV-2 incidence and (4) importation of SARS-CoV-2 variants into Scotland.

Design: Population-based surveillance study.

Setting: The study utilises SARS-CoV-2 community testing from February 2021 to May 2022 in Scotland, UK and spans the introduction of the UK's 'traffic light system' policy in May 2021.

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  • Over the past 20 years, the frequency of human infections caused by the E. coli strain O157 has been 2.5 times higher in Scotland compared to England and Wales.
  • A study combining cattle survey data and human clinical cases from 2014-2015 found that certain strains of O157 are more prevalent in Scottish cattle and humans, particularly the Stx2a+ strain PT21/28.
  • Whole genome sequencing revealed that most O157 diversity in human cases stemmed from cattle, with significant strain differences indicating localized transmission within Scotland.
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  • The flagellated pathogen causing giardiasis is a major cause of gastrointestinal illness globally, often under-reported in higher income countries due to the misconception that it is mainly travel-related.
  • A review of literature found that contaminated water and contact with young children were the main transmission pathways, while food handlers were involved in most food-related outbreaks.
  • This study highlights existing knowledge gaps, particularly concerning zoonotic transmission and the need for advanced molecular typing techniques to enhance understanding of the pathogen's epidemiology.
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Whole genome sequencing of SARS-CoV-2 has occurred at an unprecedented scale, and can be exploited for characterising outbreak risks at the fine-scale needed to inform control strategies. One setting at continued risk of COVID-19 outbreaks are higher education institutions, associated with student movements at the start of term, close living conditions within residential halls, and high social contact rates. Here we analysed SARS-CoV-2 whole genome sequences in combination with epidemiological data to investigate a large cluster of student cases associated with University of Glasgow accommodation in autumn 2020, Scotland.

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  • Shiga toxin-producing E. coli (STEC) is a dangerous foodborne pathogen that can lead to severe conditions like haemolytic uraemic syndrome (HUS), especially in children.
  • The study focused on a newly emerged STEC clonal complex, CC165, in the UK, to analyze its virulence factors and antibiotic resistance using genetic sequencing techniques.
  • Out of 48 isolates, most were multidrug-resistant, with a significant presence of virulence genes, indicating the potential for severe health risks and the ability to spread beyond the gut.
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  • * A significant association was found between these infections and the consumption of pre-packed sandwiches from a national food chain, particularly those containing a mixed salad of specific lettuce types.
  • * Although food testing did not find STEC O26:H11, related strains were detected, highlighting the difficulty of identifying pathogens in short-shelf-life products and suggesting a need for better supply chain investigation rather than just microbiological testing.
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Background: Coronavirus disease 2019 (COVID-19) can lead to significant respiratory failure with between 14% and 18% of hospitalised patients requiring critical care admission. This study describes the impact of socioeconomic deprivation on 30-day survival following critical care admission for COVID-19, and the impact of the COVID-19 pandemic on critical care capacity in Scotland.

Methods: This cohort study used linked national hospital records including ICU, virology testing and national death records to identify and describe patients with COVID-19 admitted to critical care units in Scotland.

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In August 2019, public health surveillance systems in Scotland and England identified seven, geographically dispersed cases infected with the same strain (defined as isolates that fell within the same five single nucleotide polymorphism single linage cluster) of Shiga toxin-producing Escherichia coli O157:H7. Epidemiological analysis of enhanced surveillance questionnaire data identified handling raw beef and shopping from the same national retailer (retailer A) as the common exposure. Concurrently, a microbiological survey of minced beef at retail identified the same strain in a sample of minced beef sold by retailer A, providing microbiological evidence of the link.

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Objectives: To describe the epidemiology, age at infection, clinical characteristics and outcome of listeria infection in young infants to inform management and empiric antibiotic choice in young infants.

Design: Prospective 2-year surveillance of infection in young infants detected through the British Paediatric Surveillance Unit 'orange card' system and triangulated with the public health laboratories.

Setting: National population study (England, Wales, Scotland and the Ireland) PATIENTS: All infants under 90 days with proven or probable invasive listeriosis MAIN OUTCOME MEASURES: Incidence, mortality, age of infection, clinical characteristics and outcome RESULTS: During a 2-year period (2017-2019), 27 cases of listeriosis in infants <90 days of age were reported.

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Background: The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing.

Methods: Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register.

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Background: We aimed to ascertain the cumulative risk of fatal or critical care unit-treated COVID-19 in people with diabetes and compare it with that of people without diabetes, and to investigate risk factors for and build a cross-validated predictive model of fatal or critical care unit-treated COVID-19 among people with diabetes.

Methods: In this cohort study, we captured the data encompassing the first wave of the pandemic in Scotland, from March 1, 2020, when the first case was identified, to July 31, 2020, when infection rates had dropped sufficiently that shielding measures were officially terminated. The participants were the total population of Scotland, including all people with diabetes who were alive 3 weeks before the start of the pandemic in Scotland (estimated Feb 7, 2020).

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Objective: To assess the risk of hospital admission for coronavirus disease 2019 (covid-19) among patient facing and non-patient facing healthcare workers and their household members.

Design: Nationwide linkage cohort study.

Setting: Scotland, UK, 1 March to 6 June 2020.

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Background: The objectives of this study were to identify risk factors for severe coronavirus disease 2019 (COVID-19) and to lay the basis for risk stratification based on demographic data and health records.

Methods And Findings: The design was a matched case-control study. Severe COVID-19 was defined as either a positive nucleic acid test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the national database followed by entry to a critical care unit or death within 28 days or a death certificate with COVID-19 as underlying cause.

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Article Synopsis
  • Giardia duodenalis is a prevalent parasite in the UK, primarily causing diarrheal illnesses, with many local cases likely going unreported due to reliance on travel history for testing.
  • Data from reported cases in Scotland between 2011-2018 revealed a total of 1,631 confirmed giardiasis cases, with increased detection linked to improved testing methods, especially after antigen testing was introduced in one NHS lab.
  • The study found higher incidence rates in certain regions and age groups, particularly among males aged 20-49, emphasizing the importance of awareness and better diagnostic practices for giardiasis.
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Background: Salmonella outbreaks in childcare facilities are relatively rare, most often occurring secondary to contaminated food products or poor infection control practices. We report an outbreak of Salmonella Saintpaul at a pre-school facility in Ayrshire, Scotland with atypical clinical and epidemiological features.

Methods: Following notification of the initial two cases, the multi-disciplinary Incident Management Team initiated enhanced active case finding and two environmental inspections of the site, including food preparation areas.

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  • There was a notable increase in acute hepatitis A cases in Scotland in early 2017, particularly among men who have sex with men (MSM), coinciding with ongoing outbreaks in Europe.
  • The study aimed to uncover the reasons for this rise by analyzing 42 hepatitis A patient samples collected throughout 2017, focusing on their genetic typing to identify connections.
  • Results revealed that most samples belonged to genotypes 1A and 1B, with some strains linked to European outbreaks, allowing public health officials to identify clusters and compare local strains with others globally.
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Between 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16-25801 and RIVM-HAV16-090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions.

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BackgroundPrevious studies showed low levels of circulating hepatitis E virus (HEV) in Scotland. We aimed to reassess current Scottish HEV epidemiology. Blood donor samples from five Scottish blood centres, the minipools for routine HEV screening and liver transplant recipients were tested for HEV antibodies and RNA to determine seroprevalence and viraemia.

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In December 2014, Ebola virus disease (EVD) was diagnosed in a healthcare worker in the United Kingdom after the worker returned from an Ebola treatment center in Sierra Leone. The worker flew on 2 flights during the early stages of disease. Follow-up of 238 contacts showed no evidence of secondary transmission of Ebola virus.

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  • - The study analyzed tuberculosis (TB) infection rates among healthcare workers in the UK from 2000 to 2015, finding an overall mean incidence of 15.4 cases per 100,000 healthcare workers.
  • - There was a significant disparity in TB infection rates, with non-UK-born healthcare workers experiencing a much higher incidence at 164.8 per 100,000 compared to 5.0 per 100,000 for UK-born workers.
  • - A notable 57% of non-UK-born healthcare workers were diagnosed with TB within five years of arriving in the UK, suggesting that an effective health screening for latent TB infection could help prevent active cases among new entrants to the National Health Service. *
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During the summers of 2015 and 2016, the United Kingdom experienced large outbreaks of cyclosporiasis in travellers returning from Mexico. As the source of the outbreaks was not identified, there is the potential for a similar outbreak to occur in 2017; indeed 78 cases had already been reported as at 27 July 2017. Early communication and international collaboration is essential to provide a better understanding of the source and extent of this recurring situation.

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  • - Six cases of invasive meningococcal disease were reported among participants from Scotland and Sweden at the World Scout Jamboree in Japan, with all cases linked to the same rare strain.
  • - Health authorities in Scotland and Sweden took emergency actions including vaccinations and chemoprophylaxis for attendees, while Japan's Ministry of Health urged participants to seek medical help if symptoms appeared.
  • - No further cases were identified post-Jamboree, emphasizing the need for improved risk assessment, education, and communication among countries to prevent the spread of infections at large events.
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Background: An urgent UK investigation was launched to assess risk of invasive Mycobacterium chimaera infection in cardiothoracic surgery and a possible association with cardiopulmonary bypass heater-cooler units following alerts in Switzerland and The Netherlands.

Methods: Parallel investigations were pursued: (1) identification of cardiopulmonary bypass-associated M. chimaera infection through national laboratory and hospital admissions data linkage; (2) cohort study to assess patient risk; (3) microbiological and aerobiological investigations of heater-coolers in situ and under controlled laboratory conditions; and (4) whole-genome sequencing of clinical and environmental isolates.

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The 23rd World Scout Jamboree was held in Japan from 28 July to 8 August 2015 and was attended by over 33,000 scouts from 162 countries. An outbreak of invasive meningococcal disease capsular group W was investigated among participants, with four confirmed cases identified in Scotland, who were all associated with one particular scout unit, and two confirmed cases in Sweden; molecular testing showed the same strain to be responsible for illness in both countries. The report describes the public health action taken to prevent further cases and the different decisions reached with respect to how wide to extend the offer of chemoprophylaxis in the two countries; in Scotland, chemoprophylaxis was offered to the unit of 40 participants to which the four cases belonged and to other close contacts of cases, while in Sweden chemoprophylaxis was offered to all those returning from the Jamboree.

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