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Biomedical subjects

Q Syed

Publications and source records attributed to Q Syed.

At least 19 recordsLinked to original sources
PubMed2003

Enhanced surveillance of campylobacter infection in the North West of England 1997-1999.

OBJECTIVES: To identify sources and routes of infection for sporadic cases of campylobacter infection in the North West of England. METHODS: Standard, structured questionnaires were used to gather epidemiological information from cases of campylobacter infection in the North West Region of England between 1997 and 1999. The strains of campylobacter isolated from these cases were identified and typed using serotyping and phage typing methods. Analysis of combined serotype and epidemiological data is presented. RESULTS AND CONCLUSIONS: Human campylobacter infection in the North West is seasonal and a new observation was a peak in cases in March each year. Drinking bird-pecked milk was a highly seasonal exposure that might be an indicator of environmental contamination with campylobacter. A possible environmental basis for seasonality of infection is discussed. Frequencies of risk exposures related to serotypes of cases are described and a potential association was demonstrated between Campylobacter jejuni HS6 and consumption of bird-pecked milk. Also, Campylobacter coli infections were more commonly associated with travel abroad than C. jejuni and a decreased proportion of C. jejuni HS2 and C. jejuni HS11 reported consumption of meat and unpasteurised milk (respectively). Contact with a sick animal may be a significant risk exposure in younger age groups and in those who do not consume poultry or meat. It is clear from this and other studies that the sources and vehicles of human campylobacter infection are numerous and interventions that target a single risk factor are unlikely to impact significantly on the overall burden of disease.

Adolescent↗
PubMed2003

Behind the mask. Journey through an epidemic: some observations of contrasting public health responses to SARS.

SARS has been called the first global epidemic of the 21st century and has been the cause of a massive and varied public health response in many countries of the world. This report describes observations made by two authors on a journey from Manchester in the United Kingdom to Chiang Mai in Thailand during the peak of global transmission. The public response to SARS, particularly characterised by the wearing of face masks, seemed to outstrip official guidance. Though of uncertain protective benefit, the wearing of masks may have contributed to the awareness of the collective and personal responsibility in combating infectious disease. Active and empowered involvement of the general public in implementing and cooperating with public health control measures supported by national and international authorities has clearly helped to bring SARS under control. The public health significance of such potent symbols as the face mask may be considered in strategies to tackle other emerging infections.

Awareness↗
PubMed2003

Outbreak of Legionnaires' disease on a cruise ship: lessons for international surveillance and control.

A sporadic case of Legionnaires' disease was linked to travel on a cruise ship. Investigation identified two further cases of Legionnaires' Disease and one case of non-pneumonic Legionella infection. An Incident Team confirmed the source to be the ship's water system and control measures were instituted that included pasteurisation, super chlorination and chlorine dioxide dosing. The Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC), through the European Surveillance Scheme for Travel Associated Legionnaires' Disease, identified three previous cases associated with the same ship's water system including one fatality. Lessons for the international surveillance and control of Legionnaires' disease on cruise ships are discussed.

Aged↗
PubMed2003

Secular trends in the occurrence of tuberculosis in an urban community in north west England, 1918-2001: implications for a local tuberculosis control programme.

In recent years enhanced surveillance of tuberculosis has been undertaken for England and Wales to monitor national epidemiological trends. The Chief Medical Officer's strategy for communicable diseases has identified the development of a national strategy for the control of tuberculosis as a priority. Regional and sub-regional variations in the occurrence of tuberculosis require further exploration to inform local implementation of the national strategy. Secular epidemiological trends in tuberculosis for the period 1918-2001 are described for a deprived urban area in the north west of England, and implications for local enhanced surveillance and control measures are discussed. A substantial decline in mortality and morbidity from tuberculosis is shown due to interruption of transmission following improvements to the housing stock and the introduction of chemotherapy and BCG vaccination. The proportion of incident cases of tuberculosis in non-white groups has markedly increased over the period observed. The local tuberculosis control programme now specifically targets recent non-white immigrants. Other urban areas may need to adopt similar measures to improve local control of tuberculosis.

Adolescent↗
PubMed2002

A community survey of self-reported gastroenteritis undertaken during an outbreak of cryptosporidiosis strongly associated with drinking water after much press interest.

We took the opportunity provided by a large outbreak of cryptosporidiosis in the North West of England to investigate the potential impact of recall bias on strength of association and on estimates of outbreak size. We conducted a community-based survey of 4 towns within the outbreak area and 4 control towns. A postal questionnaire was sent to 120 homes, chosen at random from the local telephone directory, in each of the 8 towns. Although not statistically significant, the prevalence of self-reported diarrhoeal disease was marginally higher in the control towns than in the outbreak towns. There was a very strong association between self-reported diarrhoea and drinking water consumption in both control and outbreak areas. The impact of recall bias in outbreak investigations is much greater than previously thought. Identification of the cause of outbreaks should not be based solely on case-control studies conducted after the press has reported the outbreak. Such evidence is likely to be unreliable and give falsely significant associations between water consumption and disease.

Bias↗
PubMed2002

An investigation into the microflora of heroin.

In 2000, an unusual increase of morbidity and mortality among illegal injecting drug users in the UK and Ireland was reported and Clostridium novyi was identified as the likely source of the serious infection, although infections due to C. botulinum and Bacillus cereus were also reported. Because heroin was a possibile source of infection, this study investigated the microflora of heroin samples seized in England during 2000 and 2002. Two methods were developed for the examination of the microflora of heroin. The first consisted of suspension of the drug in maximum recovery diluent (MRD) which was inoculated directly into Clostridium Botulinum Isolation Cooked Meat Broth (CBI). The second method rendered the heroin soluble in citric acid, concentrated particulate material (and bacterial cells) by filtration and removed heroin residues by washing with citric acid and phosphate-buffered saline before placing the filter in CBI broth. Duplicate CBI broths from both methods were incubated without heating and after heating at 60 degrees C for 30 min. Subcultures were made after incubation for 7 and 14 days on to eight different solid media. The methods were evaluated with heroin samples spiked with either C. botulinum or C. novyi spore suspensions; recovery of 10 spores in the original sample was demonstrated. Fifty-eight heroin samples were tested by citric acid solubilisation and 34 by the MRD suspension technique. Fifteen different gram-positive species of four genera were recognised. No fungi were isolated. Aerobic endospore-forming bacteria (Bacillus spp. and Paenibacillus macerans) were the predominant microflora isolated and at least one species was isolated from each sample. B. cereus was the most common species and was isolated from 95% of all samples, with B. licheniformis isolated from 40%. Between one and five samples yielded cultures of B. coagulans, B. laterosporus, B. pumilus, B. subtilis and P. macerans. Staphylococcus spp. were isolated from 23 (40%) samples; S. warneri and S. epidermidis were the most common and were cultured from 13 (22%) and 6 (10%) samples respectively. One or two samples yielded cultures of S. aureus, S. capitis and S. haemolyticus. The remainder of the flora detected comprised two samples contaminated with C. perfringens and two samples with either C. sordellii or C. tertium. Multiple bacterial species were isolated from 43 (74%) samples, a single species from the remaining 15. In 13 samples B. cereus alone was isolated, in one B. subtilis alone and in one sample B. pumilus alone. C. botulinum and C. novyi were not isolated from any of the heroin samples. Recommendations for the optimal examination of the microflora of heroin are given.

Bacillus cereus↗
PubMed2002

Surveillance of influenza in the North-West Region of England 2001-02.

A local sentinel network of general practitioners has been established in the north west of England for the surveillance of influenza. In the 2001-02 winter, consultation rates for influenza-like-illness (ILI) were low but the surveillance network was able to demonstrate sub-regional variations in the timing of peak influenza activity, and the infection of different age groups. This suggests the network can contribute to better planning to winter pressures on the North West health service.

Adolescent↗
PubMed2001

Predictors of hepatitis B and C infection in injecting drug users both in and out of drug treatment.

AIMS: To assess prevalence of, and behavioural risk factors for, hepatitis B and C in drug users both in and out of contact with drugs services. DESIGN: Cross-sectional survey of hepatitis B and C prevalence using blood samples and self-completed risk factor questionnaires. PARTICIPANTS: Three hundred and sixty injecting drug users (IDUs) in treatment for their drug use, attending syringe exchange schemes (SES), and not in contact with any services in Wirral and Manchester between 1997 and 1999, for whom test results were available for 334 (hepatitis B) and 341 (hepatitis C). FINDINGS: Hepatitis B prevalence differed between groups, from 19% of those not in contact to 41% of those presenting to request a test (p = 0.040). Prevalence of hepatitis C ranged from 48% (SES) to 62% among those presenting for a test (p = 0.233). After multivariate adjustment, hepatitis B was predicted by prison stays (p = 0.030) and injecting for longer (p = 0.003). For hepatitis C, length of injecting career (p = 0.036), having been to prison (p = 0.034), having injected more than one drug type (p < 0.001) and being female (p = 0.037) predicted infection. Overall, 38% had shared some form of injecting equipment in the previous 4 weeks. People recently starting injecting were more likely to share, and sharing was more likely to occur when injecting with only one other user rather than in larger groups. Those who had previously presented for a hepatitis C test, regardless of the result, were less likely to have recently shared injecting equipment. CONCLUSIONS: Behaviours associated with transmission of hepatitis B and C are common among IDUs. In particular, sharing of injecting equipment was more likely in small groups and in those recently beginning injecting. More broadly, chaotic drug use and time in prison were also risk factors for hepatitis infections. When assessing prevalence of hepatitis B and C, our results suggest that figures cannot be extrapolated from those in service contact to those in the wider drug-using population.

Adult↗
PubMed2001

Mercury contamination incident.

BACKGROUND: The aim of this paper is to describe an incident where elemental mercury led to widespread contamination and the exposure of 225 individuals and confirmed toxicity in 19 individuals. The paper describes the incident and difficulties found in trying to assess the risk to individuals and to identify and decontaminate the residences involved. METHODS: All individuals exposed to elemental mercury in the incident were followed up for 15 months. RESULTS: Thirty-seven individuals were found to be 'at risk' and 13 were symptomatic of mercury poisoning. Five patients required chelation therapy. The incident was closed when the risk of poisoning and re-exposure was minimized. CONCLUSION: Incident management depends on early effective communication and collaboration between all agencies involved.

Adolescent↗
PubMed2001

A case-control study of lifestyle risk factors associated with tuberculosis in Liverpool, North-West England.

The aim of this study was to identify the subtle influences of exposure and individual lifestyles on the risk of developing tuberculosis. A retrospective case-control study (with matching by sex, age, postcode and ethnicity) of all tuberculosis cases notified over a 7-yr period in Liverpool, UK, was carried out. Multiple logistic regression showed that, before diagnosis, cases were 7.4 times more likely to have had visitors from abroad; 4.0 times more likely to have been born abroad; and 3.8 times more likely to have lived with someone with tuberculosis. Subtle socioeconomic factors were also evident with cases 4.0 times less likely to have additional bathrooms. Lifestyle factors emerged with cases 2.3 times more likely to have smoked for at least 30 yrs, 3.8 times less likely to eat dairy products every week and 2.6 times less likely to have had high blood pressure. At interview, these factors were still evident, but cases, unlike controls, had reduced their smoking and alcohol consumption and were less likely to go out of the home or exercise than before their illness. Within individuals, lifestyle consequences of tuberculosis lead to a "healthier" lifestyle on the one hand (less smoking and alcohol consumption), but a reduced quality of life (social activity) on the other.

Case-Control Studies↗
PubMed2001

Community surveys of self-reported diarrhoea can dramatically overestimate the size of outbreaks of waterborne cryptosporidiosis.

This paper describes a community-based study undertaken to assess the size of a waterborne outbreak of cryptosporidiosis in the North West region of England. The outbreak was linked to a single reservoir in the English Lake District and provided drinking water to over 1.2 million people. There were some 308 laboratory confirmed cases. We conducted a community-based survey for self-reported diarrhoea in four towns within the outbreak area and four control towns. The rate of self-reported diarrhoea was higher in the control towns than in the outbreak towns. It would appear that retrospective community-based studies of diarrhoeal disease are subject to recall bias that would overestimate the incidence of illness, especially following reporting in the media. In the light of our findings, we reviewed the study undertaken during the Milwaukee outbreak that produced the estimated size of 405,000 cases. It is suggested that the estimate of the size of the Milwaukee outbreak is severely flawed, and the actual size of this outbreak was between 1% and 10% of that claimed.

Bias↗
PubMed2001

Possible undetected outbreaks of cryptosporidiosis in areas of the north west of England supplied by an unfiltered surface water source.

We report a ten-year retrospective analysis of laboratory reports of cryptosporidium infection in the North West of England. Weekly report data from six health authorities known to have been affected by outbreaks associated with a single supply were compared with data from other health authorities in the North West. Following graphical representation of report rates, it would appear that outbreaks in the six health authorities were considerably more common than the average recorded in the national outbreak surveillance system.

Animals↗
PubMed2001

Re-emerging syphilis in the UK: a behavioural analysis of infected individuals.

In-depth interviews with 27 individuals infected with syphilis in a recent UK outbreak (out of a total of 58 diagnosed between May 1999 and August 2000 in three city hospitals) were carried out to examine behaviour and attitudes. Most (23/27) participants were homosexual men, seven of whom were HIV positive. Between them, the 23 gay men had 1,494 different contacts in the twelve months prior to their awareness of having syphilis, but only 10% of these contacts could be named. While oral sex (usually unprotected) was the most prevalent behaviour (median = 30 partners per year), only 39% perceived unprotected oral sex as a syphilis risk (c.f. 70% for anal sex). Many gay men (61%) used gamma hydroxybutyrate (GHB) during sex as an aphrodisiac. This syphilis-infected subset of the population had high levels of unprotected and anonymous sex, which brings into question the usefulness of contact tracing to control syphilis outbreaks. The majority of partners were casual oral sex partners. More awareness is urgently needed around syphilis symptoms and risks, and risks of using drugs to reduce sexual inhibitions.

HIV Infections↗
PubMed2000

Post-transfusion HIV infection despite donor screening: a report of three cases.

In August 1996, a blood donation was collected which subsequently infected three patients post-transfusion with HIV 1. The donation itself was originally screened as negative for anti-HIV 1/2 using a sensitive EIA method, but subsequently was shown to contain p24 Ag and HIV RNA by an amplification technique. The proposed introduction of nucleic acid testing of all blood donations in the UK for hepatitis C, hepatitis B and HIV may further reduce the remote risk of further episodes of post-transfusion infection. The infection in the index recipient was detected on routine pre-transplant virological screening but proved difficult to confirm, at a time when she had recently received myeloablative treatment for a haematological malignancy which impaired the immune response. There is a need for continued vigilance in such patients to exclude post-transfusion infection, at a time when natural immunological responses have been impaired by their disease or treatment.

Aged↗
PubMed1999

AIDS funding. The national lottery.

The government's funding of AIDS and HIV services in England is inequitable. Spending per patient in North Thames is four times that in Manchester. Deaths from AIDS in North Thames are significantly lower than in other parts of England.

Acquired Immunodeficiency Syndrome↗