I. Giraudon - Academia.edu (original) (raw)

Papers by I. Giraudon

Research paper thumbnail of Antenatal screening and prevalence of infection: surveillance in London, 2000-2007

Eurosurveillance

In the United Kingdom (UK), it is recommended to universally offer antenatal infection screening ... more In the United Kingdom (UK), it is recommended to universally offer antenatal infection screening for human immunodeficiency virus (HIV), hepatitis B and syphilis infections, and susceptibility to rubella for the benefit of the mother and to reduce vertical transmission of infection. This paper describes the surveillance of antenatal infection including uptake of screening, and the results of testing in pregnant women in London between 2000 and 2007. Antenatal screening coordinators in liaison with midwifery heads and microbiologists at all thirty London National Health Service (NHS) Trust maternity units supplied quarterly data on the number of pregnant women booked for antenatal care, tests done, and tests results. The overall estimated uptake of screening increased since 2000 and reached 95.6% for HIV, 96.5% for syphilis, 96.2% for hepatitis B and 97% for rubella susceptibility by the second half of 2007. There is considerable variation in the performance between NHS Trusts. The o...

Research paper thumbnail of Presentations to the emergency department with non-medical use of benzodiazepines and Z-drugs: profiling and relation to sales data

European Journal of Clinical Pharmacology

Research paper thumbnail of Concurrent Use of Benzodiazepine by Heroin Users—What Are the Prevalence and the Risks Associated with This Pattern of Use?

Journal of Medical Toxicology

Research paper thumbnail of European monitoring of notifications of hepatitis C virus infection in the general population and among injecting drug users (IDUs) - the need to improve quality and comparability

Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletin, Jan 22, 2008

Research paper thumbnail of Drug use and related consequences among prison populations in European countries

ABSTRACT Key points • A history of drug use is common among European prisoners, with levels dispr... more ABSTRACT Key points • A history of drug use is common among European prisoners, with levels disproportionately high compared to the general population. • Health problems, especially communicable diseases and psychiatric co-morbidity, are especially prevalent among prisoners using drugs. • The mortality risk in the first weeks after release from prison is extremely high. • Relevant differences are reported between European countries in drug use and drug-related problems among prisoners. • In European countries, valid and comparable data on drug use and related consequences among prisoners are still scarce and harmonization work is needed.

Research paper thumbnail of Drug use and pregnancy – challenges for public health

EMCDDA and Europol Directors review new drugs entering market Monitoring new substances entering ... more EMCDDA and Europol Directors review new drugs entering market Monitoring new substances entering Europe's illicit drug market was the focus of talks on 25 March in Lisbon between the Directors of the EMCDDA and the European law enforcement agency (Europol). The two EU agencies collaborate actively in detecting and monitoring new and potentially threatening psychoactive substances entering the European market and in assessing the involvement of organised crime in their manufacture and trafficking. EMCDDA Director Wolfgang Götz and Europol Director Rob Wainwright endorsed two joint reports providing the latest update on new substances in Europe. The first of these is the 2009 EMCDDA-Europol annual report on the implementation of the 'Council Decision on the information exchange, risk assessment and control of new psychoactive substances' (see opposite). This report presents the key findings of how the mechanism was implemented in 2009, detailing the appearance of new unregulated synthetic compounds designed to circumvent controls.

Research paper thumbnail of Roundtable discussion: how lessons learned from HIV can inform the global response to viral hepatitis

BMC Infectious Diseases, 2014

Research paper thumbnail of Web-appendix S4 PRISMA Checklist 08072014

Research paper thumbnail of Hepatitis C Virus Infection Epidemiology among People Who Inject Drugs in Europe: A Systematic Review of Data for Scaling Up Treatment and Prevention

PLoS ONE, 2014

Background: People who inject drugs (PWID) are a key population affected by hepatitis C virus (HC... more Background: People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatment uptake, and burden of disease) to guide HCV treatment and prevention scale-up for PWID in the 27 countries of the European Union is systematically reviewed.

Research paper thumbnail of Factors associated with incomplete vaccination of babies at risk of perinatal hepatitis B transmission: A London study in 2006

Vaccine, 2009

We measured the hepatitis B (HB) vaccination uptake in 249 London babies born in 2004 to HBsAg po... more We measured the hepatitis B (HB) vaccination uptake in 249 London babies born in 2004 to HBsAg positive mothers. Two thirds (69%) received three vaccinations and half (49%, 95% CI 43-56) received a complete course (four doses). Complete immunization was associated with sector of delivery (p<0.001), recording of the GP details in case notes, having booked for antenatal care, having a good command of English, and receipt of written information on HB. A third of the babies (33%) had a post-vaccination test; when the mother had other children, 39% of the oldest children were vaccinated; information on partner's vaccination was available for 12%. This study highlights that appropriate counseling and information should be provided to the mothers, and the importance in London of arrangements for integrated care across acute and primary care services.

Research paper thumbnail of Audit of laboratory diagnostic methods for syphilis in England and Wales

Sexually Transmitted Infections, 2008

The number of cases of infectious syphilis is increasing rapidly across England and Wales. Concer... more The number of cases of infectious syphilis is increasing rapidly across England and Wales. Concern has been expressed about diagnostic delay and its potential impact on patient care. A standard operating procedure for the serological diagnosis of syphilis has recently been developed by the Health Protection Agency. This study aimed to audit clinical and laboratory practice in England and Wales against this standard. All microbiology departments, genitourinary medicine (GUM) clinics and antenatal clinics in England and Wales were invited to complete a web-based questionnaire. The overall response rate was 76%. Practices varied between laboratories. The proportion of microbiology departments performing enzyme immunoassay (EIA), Treponema pallidum particle agglutination assay/T pallidum haemagglutination assay, rapid plasma reagin/Venereal Disease Reference Laboratory and EIA IgM were 94%, 34%, 41% and 10%, respectively. Of these, 57% only perform a single screening assay. The turnaround time for negative results was less than 1 week for 84% of microbiology departments. For positive samples, turnaround times varied from less than 1 week to 6-8 weeks, with 19% of GUM clinics reporting turnaround times of over 3 weeks. Notably, 26% of GUM clinics and 6% of antenatal clinics reported that delays in turnaround time had adversely affected patient management in the past year. This study suggests that there is significant room to improve laboratory turnaround times for the diagnosis of syphilis in England and Wales, and such improvements would be a positive step in limiting the spread of infection and of congenital syphilis.

Research paper thumbnail of Increase in diagnosed newly acquired hepatitis C in HIV-positive men who have sex with men across London and Brighton, 2002-2006: is this an outbreak?

Sexually Transmitted Infections, 2008

Objectives: To determine the incidence of diagnosed newly acquired hepatitis C virus (HCV) in HIV... more Objectives: To determine the incidence of diagnosed newly acquired hepatitis C virus (HCV) in HIV-positive men who have sex with men (MSM) across London and Brighton in order to inform public health interventions. Methods: Cases were defined as MSM attending London and Brighton HIV/genitourinary medicine clinics from January 2002 to June 2006, with HCV PCR RNA or antibody positive, and a negative HCV test in the previous three years. The yearly number of cases and HCV screening policy in MSM were examined. A negative binomial regression model was used to estimate HCV incidence density rate ratio and 95% CI. Results: 20 out of 38 clinics provided information, covering 84% of the HIV-positive MSM workload in London and 100% in Brighton. The estimated overall incidence was 9.05 per 1000 HIV-positive MSM patientyears. It increased from 6.86 per 1000 in 2002 to 11.58 per 1000 during January-June 2006. Incidence at clinics ranged from 0 to 15.4 (median 6.52) per 1000 HIVpositive MSM patient-years. There was some evidence of difference in the incidence and trend (p = 0.02) in each clinic. The average annual rise in incidence of HCV was 20% (95% CI 4% to 39%, p = 0.001). There was little evidence of such transmission among MSM with negative or unknown HIV status. Conclusions: HCV incidence clearly increased among HIV-positive MSM in London and Brighton during January 2002 to June 2006. Prospective enhanced surveillance of HCV in MSM, including HIV status and behavioural risk factors, is recommended to help inform control measures and better determine the frequency of transmission in all MSM.

Research paper thumbnail of Assessing public health risk in the London polonium-210 incident, 2006

Public Health, 2010

, allegedly from poisoning with the radionuclide polonium-210 (210 Po). Associated circumstances ... more , allegedly from poisoning with the radionuclide polonium-210 (210 Po). Associated circumstances required an integrated response to investigate the potential risk of internal contamination for individuals exposed to contaminated environments. Study design: Descriptive study. Methods: Contaminated locations presenting a potential risk to health were identified through environmental assessment by radiation protection specialists. Individuals connected with these locations were identified and assessed for internal contamination with 210 Po. Results: In total, 1029 UK residents were identified, associated with the 11 most contaminated locations. Of these, 974 were personally interviewed and 787 were offered urine tests for 210 Po excretion. Overall, 139 individuals (18%) showed evidence of probable internal contamination with 210 Po arising from the incident, but only 53 (7%) had assessed radiation doses of 1 mSv or more. The highest assessed radiation dose was approximately 100 mSv. Conclusions: Although internal contamination with 210 Po was relatively frequent and was most extensive among individuals associated with locations judged a priori to pose the greatest risk, a high degree of assurance could be given to UK and international communities that the level of health risk from exposure to the radionuclide in this incident was low.

Research paper thumbnail of Large outbreak of salmonella phage type 1 infection with high infection rate and severe illness associated with fast food premises

Public Health, 2009

Objectives: To describe the epidemiology of an outbreak of Salmonella enteritidis phage type 1 (P... more Objectives: To describe the epidemiology of an outbreak of Salmonella enteritidis phage type 1 (PT1) infection associated with a fast food premises, and to identify the causative factors leading to an acute outbreak with high attack rate and severe illness including hospital admission. Study design: Integrated descriptive study of epidemiology, food and environmental microbiology, and professional environmental health assessment, supplemented by a case-case analytical study. Methods: Cases were identified through multiple sources and were interviewed to identify food items consumed. Descriptive epidemiology of all cases and a case-case analytical study of risk factors for severe illness were undertaken. Microbiological investigation included analysis and typing of pathogens from stools, blood and environmental surfaces. Professional environmental heath assessment of the premises was undertaken. Results: S. enteritidis PT1 was recovered from two-thirds of faecal samples. Three cases had dual infection with enterotoxin-producing Clostridium perfringens. S. enteritidis PT1 was isolated from 14 of 40 food samples examined and C. perfringens was isolated from eight food samples. Environmental health inspection of the premises revealed multiple deficiencies, including deficits in food preparation and hygiene consistent with multiple cross-contamination, and time-temperature abuse of sauces widely used across menu items. Severe cases were associated with consumption of chips and salad. Conclusions: Outbreaks from fast food premises have been infrequently described. This outbreak demonstrates the potential for fast food premises, with multiple deficiencies in food preparation and hygiene, to produce large, intense community outbreaks with high attack rates and severe illness, highly confined in space and time.

Research paper thumbnail of Epidemiology of internal contamination with polonium-210 in the London incident, 2006

Journal of Epidemiology & Community Health, 2012

More than 700 UK residents were tested for possible contamination with polonium-210 ((210)Po) fol... more More than 700 UK residents were tested for possible contamination with polonium-210 ((210)Po) following the alleged poisoning of Mr Alexander Litvinenko in London in November 2006. This paper describes the epidemiology of internal contamination with the radionuclide in this group. 11 locations in London had been identified as sufficiently environmentally contaminated with (210)Po to present a health risk to people associated with them. Public health consultant teams identified individuals at risk and offered 24-h urine testing for (210)Po excretion. Prevalence of internal contamination was estimated, and a retrospective cohort analysis was completed for each location. Overall 139 individuals (prevalence 0.19 (95% CI 0.13 to 0.27)) showed evidence of internal contamination with (210)Po, although none with uptakes likely to cause adverse health effects. Substantial prevalence was seen among specific hotel service staff, customers, staff and other users of a hotel bar, office and hospital staff, staff of one restaurant and residents of and visitors to the family home. Increased risks of contamination were seen for a hotel bar in association with occupational, behavioural and temporal factors. Occupational and guest exposure to contaminated areas of hotels were also associated with increased contamination risk. Nurses were more likely to become contaminated than other staff involved in direct patient care. Uptake of trace amounts of radionuclide in this incident was frequent. Occupational, behavioural and temporal gradients in contamination risk were mostly consistent with a priori site risk assessments. Utility of the investigation methods and findings for future accidental or deliberate environmental contamination incidents are discussed.

Research paper thumbnail of Cocaine-Related Health Emergencies in Europe: A Review of Sources of Information, Trends and Implications for Service Development

European Addiction Research, 2013

since the end of the 1990s in these countries; these increases peaked in Spain and England around... more since the end of the 1990s in these countries; these increases peaked in Spain and England around 2007/08. Conclusions: The analysis reported here suggests the need to develop more standardized approaches to monitoring drug-related emergencies. It points to the potential value of developing effective referral links between the emergency and specialized drug services working with cocaine users.

Research paper thumbnail of The European Drug Emergencies Network (Euro-DEN)

Clinical Toxicology, 2014

Research paper thumbnail of Surveillance and outbreak reports

Peer-reviewed European …, 2008

Executive Agency for Health and Consumers launched call for proposals in the field of health by E... more Executive Agency for Health and Consumers launched call for proposals in the field of health by Editorial team # Level of risk according to exposure and action and advice by category. *Contacts to be monitored for 21 days from last possible exposure to case ** Within this group, consider ribavirin prophylaxis if any extreme exposure, e.g. percutaneous injury 10.

Research paper thumbnail of Medical care costs of children born to HIV-infected mothers, in Abidjan, C??te d'Ivoire 1996???1997

AIDS, 2000

... Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidj... more ... Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan,Côte d'Ivoire: a randomized trial. Lancet 1999, 353: 781 -785. ... 9. Newell M, Dabis F, Tolley KDW, and the Ghent International Working Group on Mother-to-Child Transmission of HIV. ...

Research paper thumbnail of Reducir la mortalidad relacionada con las drogas en Europa parece una cuestión de salud pública irresoluble

Adicciones Revista De Socidrogalcohol, 2012

Drawing on an analysis of data from over 30 cohort studies, it can be estimated that between 10.0... more Drawing on an analysis of data from over 30 cohort studies, it can be estimated that between 10.000 and 20.000 opioid users die each year in Europe. Typically, annual mortality rates are between 10-20/1000, representing an excess mortality 10 to 20 times greater than expected. Most deaths occur among males in their mid-thirties. Four broad categories of cause of death can be identified: overdoses, diseases, suicide and trauma. While the long term trend in HIV related mortality among drug users is downwards, other causes of mortality have shown little sign of decreasing in recent years. Of particular concern are overdoses which account for 6300 to 8400 deaths reported annually. The fact that deaths have not decreased is surprising given the scaling up of treatment and other services. Opioid substitution treatment in particular is known to be protective and the numbers of those in substitution treatment in Europe has increased dramatically. A number of interrelated factors may help explain this intractable problem. These include: the possibility of an aging cohort becoming more vulnerable; the use of alcohol and other drugs; high levels of ill-health, risk behaviour, and co-morbidity; and social exclusion and marginalisation. Reducing overall morbidity among heroin users remains a key issue for Europe's public health services. More efforts are required to better understand and target both the direct and indirect factors associated with mortality among problem drugs users, if this major health cost associated with drug consumption is to be reduced.

Research paper thumbnail of Antenatal screening and prevalence of infection: surveillance in London, 2000-2007

Eurosurveillance

In the United Kingdom (UK), it is recommended to universally offer antenatal infection screening ... more In the United Kingdom (UK), it is recommended to universally offer antenatal infection screening for human immunodeficiency virus (HIV), hepatitis B and syphilis infections, and susceptibility to rubella for the benefit of the mother and to reduce vertical transmission of infection. This paper describes the surveillance of antenatal infection including uptake of screening, and the results of testing in pregnant women in London between 2000 and 2007. Antenatal screening coordinators in liaison with midwifery heads and microbiologists at all thirty London National Health Service (NHS) Trust maternity units supplied quarterly data on the number of pregnant women booked for antenatal care, tests done, and tests results. The overall estimated uptake of screening increased since 2000 and reached 95.6% for HIV, 96.5% for syphilis, 96.2% for hepatitis B and 97% for rubella susceptibility by the second half of 2007. There is considerable variation in the performance between NHS Trusts. The o...

Research paper thumbnail of Presentations to the emergency department with non-medical use of benzodiazepines and Z-drugs: profiling and relation to sales data

European Journal of Clinical Pharmacology

Research paper thumbnail of Concurrent Use of Benzodiazepine by Heroin Users—What Are the Prevalence and the Risks Associated with This Pattern of Use?

Journal of Medical Toxicology

Research paper thumbnail of European monitoring of notifications of hepatitis C virus infection in the general population and among injecting drug users (IDUs) - the need to improve quality and comparability

Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletin, Jan 22, 2008

Research paper thumbnail of Drug use and related consequences among prison populations in European countries

ABSTRACT Key points • A history of drug use is common among European prisoners, with levels dispr... more ABSTRACT Key points • A history of drug use is common among European prisoners, with levels disproportionately high compared to the general population. • Health problems, especially communicable diseases and psychiatric co-morbidity, are especially prevalent among prisoners using drugs. • The mortality risk in the first weeks after release from prison is extremely high. • Relevant differences are reported between European countries in drug use and drug-related problems among prisoners. • In European countries, valid and comparable data on drug use and related consequences among prisoners are still scarce and harmonization work is needed.

Research paper thumbnail of Drug use and pregnancy – challenges for public health

EMCDDA and Europol Directors review new drugs entering market Monitoring new substances entering ... more EMCDDA and Europol Directors review new drugs entering market Monitoring new substances entering Europe's illicit drug market was the focus of talks on 25 March in Lisbon between the Directors of the EMCDDA and the European law enforcement agency (Europol). The two EU agencies collaborate actively in detecting and monitoring new and potentially threatening psychoactive substances entering the European market and in assessing the involvement of organised crime in their manufacture and trafficking. EMCDDA Director Wolfgang Götz and Europol Director Rob Wainwright endorsed two joint reports providing the latest update on new substances in Europe. The first of these is the 2009 EMCDDA-Europol annual report on the implementation of the 'Council Decision on the information exchange, risk assessment and control of new psychoactive substances' (see opposite). This report presents the key findings of how the mechanism was implemented in 2009, detailing the appearance of new unregulated synthetic compounds designed to circumvent controls.

Research paper thumbnail of Roundtable discussion: how lessons learned from HIV can inform the global response to viral hepatitis

BMC Infectious Diseases, 2014

Research paper thumbnail of Web-appendix S4 PRISMA Checklist 08072014

Research paper thumbnail of Hepatitis C Virus Infection Epidemiology among People Who Inject Drugs in Europe: A Systematic Review of Data for Scaling Up Treatment and Prevention

PLoS ONE, 2014

Background: People who inject drugs (PWID) are a key population affected by hepatitis C virus (HC... more Background: People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatment uptake, and burden of disease) to guide HCV treatment and prevention scale-up for PWID in the 27 countries of the European Union is systematically reviewed.

Research paper thumbnail of Factors associated with incomplete vaccination of babies at risk of perinatal hepatitis B transmission: A London study in 2006

Vaccine, 2009

We measured the hepatitis B (HB) vaccination uptake in 249 London babies born in 2004 to HBsAg po... more We measured the hepatitis B (HB) vaccination uptake in 249 London babies born in 2004 to HBsAg positive mothers. Two thirds (69%) received three vaccinations and half (49%, 95% CI 43-56) received a complete course (four doses). Complete immunization was associated with sector of delivery (p<0.001), recording of the GP details in case notes, having booked for antenatal care, having a good command of English, and receipt of written information on HB. A third of the babies (33%) had a post-vaccination test; when the mother had other children, 39% of the oldest children were vaccinated; information on partner's vaccination was available for 12%. This study highlights that appropriate counseling and information should be provided to the mothers, and the importance in London of arrangements for integrated care across acute and primary care services.

Research paper thumbnail of Audit of laboratory diagnostic methods for syphilis in England and Wales

Sexually Transmitted Infections, 2008

The number of cases of infectious syphilis is increasing rapidly across England and Wales. Concer... more The number of cases of infectious syphilis is increasing rapidly across England and Wales. Concern has been expressed about diagnostic delay and its potential impact on patient care. A standard operating procedure for the serological diagnosis of syphilis has recently been developed by the Health Protection Agency. This study aimed to audit clinical and laboratory practice in England and Wales against this standard. All microbiology departments, genitourinary medicine (GUM) clinics and antenatal clinics in England and Wales were invited to complete a web-based questionnaire. The overall response rate was 76%. Practices varied between laboratories. The proportion of microbiology departments performing enzyme immunoassay (EIA), Treponema pallidum particle agglutination assay/T pallidum haemagglutination assay, rapid plasma reagin/Venereal Disease Reference Laboratory and EIA IgM were 94%, 34%, 41% and 10%, respectively. Of these, 57% only perform a single screening assay. The turnaround time for negative results was less than 1 week for 84% of microbiology departments. For positive samples, turnaround times varied from less than 1 week to 6-8 weeks, with 19% of GUM clinics reporting turnaround times of over 3 weeks. Notably, 26% of GUM clinics and 6% of antenatal clinics reported that delays in turnaround time had adversely affected patient management in the past year. This study suggests that there is significant room to improve laboratory turnaround times for the diagnosis of syphilis in England and Wales, and such improvements would be a positive step in limiting the spread of infection and of congenital syphilis.

Research paper thumbnail of Increase in diagnosed newly acquired hepatitis C in HIV-positive men who have sex with men across London and Brighton, 2002-2006: is this an outbreak?

Sexually Transmitted Infections, 2008

Objectives: To determine the incidence of diagnosed newly acquired hepatitis C virus (HCV) in HIV... more Objectives: To determine the incidence of diagnosed newly acquired hepatitis C virus (HCV) in HIV-positive men who have sex with men (MSM) across London and Brighton in order to inform public health interventions. Methods: Cases were defined as MSM attending London and Brighton HIV/genitourinary medicine clinics from January 2002 to June 2006, with HCV PCR RNA or antibody positive, and a negative HCV test in the previous three years. The yearly number of cases and HCV screening policy in MSM were examined. A negative binomial regression model was used to estimate HCV incidence density rate ratio and 95% CI. Results: 20 out of 38 clinics provided information, covering 84% of the HIV-positive MSM workload in London and 100% in Brighton. The estimated overall incidence was 9.05 per 1000 HIV-positive MSM patientyears. It increased from 6.86 per 1000 in 2002 to 11.58 per 1000 during January-June 2006. Incidence at clinics ranged from 0 to 15.4 (median 6.52) per 1000 HIVpositive MSM patient-years. There was some evidence of difference in the incidence and trend (p = 0.02) in each clinic. The average annual rise in incidence of HCV was 20% (95% CI 4% to 39%, p = 0.001). There was little evidence of such transmission among MSM with negative or unknown HIV status. Conclusions: HCV incidence clearly increased among HIV-positive MSM in London and Brighton during January 2002 to June 2006. Prospective enhanced surveillance of HCV in MSM, including HIV status and behavioural risk factors, is recommended to help inform control measures and better determine the frequency of transmission in all MSM.

Research paper thumbnail of Assessing public health risk in the London polonium-210 incident, 2006

Public Health, 2010

, allegedly from poisoning with the radionuclide polonium-210 (210 Po). Associated circumstances ... more , allegedly from poisoning with the radionuclide polonium-210 (210 Po). Associated circumstances required an integrated response to investigate the potential risk of internal contamination for individuals exposed to contaminated environments. Study design: Descriptive study. Methods: Contaminated locations presenting a potential risk to health were identified through environmental assessment by radiation protection specialists. Individuals connected with these locations were identified and assessed for internal contamination with 210 Po. Results: In total, 1029 UK residents were identified, associated with the 11 most contaminated locations. Of these, 974 were personally interviewed and 787 were offered urine tests for 210 Po excretion. Overall, 139 individuals (18%) showed evidence of probable internal contamination with 210 Po arising from the incident, but only 53 (7%) had assessed radiation doses of 1 mSv or more. The highest assessed radiation dose was approximately 100 mSv. Conclusions: Although internal contamination with 210 Po was relatively frequent and was most extensive among individuals associated with locations judged a priori to pose the greatest risk, a high degree of assurance could be given to UK and international communities that the level of health risk from exposure to the radionuclide in this incident was low.

Research paper thumbnail of Large outbreak of salmonella phage type 1 infection with high infection rate and severe illness associated with fast food premises

Public Health, 2009

Objectives: To describe the epidemiology of an outbreak of Salmonella enteritidis phage type 1 (P... more Objectives: To describe the epidemiology of an outbreak of Salmonella enteritidis phage type 1 (PT1) infection associated with a fast food premises, and to identify the causative factors leading to an acute outbreak with high attack rate and severe illness including hospital admission. Study design: Integrated descriptive study of epidemiology, food and environmental microbiology, and professional environmental health assessment, supplemented by a case-case analytical study. Methods: Cases were identified through multiple sources and were interviewed to identify food items consumed. Descriptive epidemiology of all cases and a case-case analytical study of risk factors for severe illness were undertaken. Microbiological investigation included analysis and typing of pathogens from stools, blood and environmental surfaces. Professional environmental heath assessment of the premises was undertaken. Results: S. enteritidis PT1 was recovered from two-thirds of faecal samples. Three cases had dual infection with enterotoxin-producing Clostridium perfringens. S. enteritidis PT1 was isolated from 14 of 40 food samples examined and C. perfringens was isolated from eight food samples. Environmental health inspection of the premises revealed multiple deficiencies, including deficits in food preparation and hygiene consistent with multiple cross-contamination, and time-temperature abuse of sauces widely used across menu items. Severe cases were associated with consumption of chips and salad. Conclusions: Outbreaks from fast food premises have been infrequently described. This outbreak demonstrates the potential for fast food premises, with multiple deficiencies in food preparation and hygiene, to produce large, intense community outbreaks with high attack rates and severe illness, highly confined in space and time.

Research paper thumbnail of Epidemiology of internal contamination with polonium-210 in the London incident, 2006

Journal of Epidemiology & Community Health, 2012

More than 700 UK residents were tested for possible contamination with polonium-210 ((210)Po) fol... more More than 700 UK residents were tested for possible contamination with polonium-210 ((210)Po) following the alleged poisoning of Mr Alexander Litvinenko in London in November 2006. This paper describes the epidemiology of internal contamination with the radionuclide in this group. 11 locations in London had been identified as sufficiently environmentally contaminated with (210)Po to present a health risk to people associated with them. Public health consultant teams identified individuals at risk and offered 24-h urine testing for (210)Po excretion. Prevalence of internal contamination was estimated, and a retrospective cohort analysis was completed for each location. Overall 139 individuals (prevalence 0.19 (95% CI 0.13 to 0.27)) showed evidence of internal contamination with (210)Po, although none with uptakes likely to cause adverse health effects. Substantial prevalence was seen among specific hotel service staff, customers, staff and other users of a hotel bar, office and hospital staff, staff of one restaurant and residents of and visitors to the family home. Increased risks of contamination were seen for a hotel bar in association with occupational, behavioural and temporal factors. Occupational and guest exposure to contaminated areas of hotels were also associated with increased contamination risk. Nurses were more likely to become contaminated than other staff involved in direct patient care. Uptake of trace amounts of radionuclide in this incident was frequent. Occupational, behavioural and temporal gradients in contamination risk were mostly consistent with a priori site risk assessments. Utility of the investigation methods and findings for future accidental or deliberate environmental contamination incidents are discussed.

Research paper thumbnail of Cocaine-Related Health Emergencies in Europe: A Review of Sources of Information, Trends and Implications for Service Development

European Addiction Research, 2013

since the end of the 1990s in these countries; these increases peaked in Spain and England around... more since the end of the 1990s in these countries; these increases peaked in Spain and England around 2007/08. Conclusions: The analysis reported here suggests the need to develop more standardized approaches to monitoring drug-related emergencies. It points to the potential value of developing effective referral links between the emergency and specialized drug services working with cocaine users.

Research paper thumbnail of The European Drug Emergencies Network (Euro-DEN)

Clinical Toxicology, 2014

Research paper thumbnail of Surveillance and outbreak reports

Peer-reviewed European …, 2008

Executive Agency for Health and Consumers launched call for proposals in the field of health by E... more Executive Agency for Health and Consumers launched call for proposals in the field of health by Editorial team # Level of risk according to exposure and action and advice by category. *Contacts to be monitored for 21 days from last possible exposure to case ** Within this group, consider ribavirin prophylaxis if any extreme exposure, e.g. percutaneous injury 10.

Research paper thumbnail of Medical care costs of children born to HIV-infected mothers, in Abidjan, C??te d'Ivoire 1996???1997

AIDS, 2000

... Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidj... more ... Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan,Côte d'Ivoire: a randomized trial. Lancet 1999, 353: 781 -785. ... 9. Newell M, Dabis F, Tolley KDW, and the Ghent International Working Group on Mother-to-Child Transmission of HIV. ...

Research paper thumbnail of Reducir la mortalidad relacionada con las drogas en Europa parece una cuestión de salud pública irresoluble

Adicciones Revista De Socidrogalcohol, 2012

Drawing on an analysis of data from over 30 cohort studies, it can be estimated that between 10.0... more Drawing on an analysis of data from over 30 cohort studies, it can be estimated that between 10.000 and 20.000 opioid users die each year in Europe. Typically, annual mortality rates are between 10-20/1000, representing an excess mortality 10 to 20 times greater than expected. Most deaths occur among males in their mid-thirties. Four broad categories of cause of death can be identified: overdoses, diseases, suicide and trauma. While the long term trend in HIV related mortality among drug users is downwards, other causes of mortality have shown little sign of decreasing in recent years. Of particular concern are overdoses which account for 6300 to 8400 deaths reported annually. The fact that deaths have not decreased is surprising given the scaling up of treatment and other services. Opioid substitution treatment in particular is known to be protective and the numbers of those in substitution treatment in Europe has increased dramatically. A number of interrelated factors may help explain this intractable problem. These include: the possibility of an aging cohort becoming more vulnerable; the use of alcohol and other drugs; high levels of ill-health, risk behaviour, and co-morbidity; and social exclusion and marginalisation. Reducing overall morbidity among heroin users remains a key issue for Europe's public health services. More efforts are required to better understand and target both the direct and indirect factors associated with mortality among problem drugs users, if this major health cost associated with drug consumption is to be reduced.