Publications by authors named "Emma Aarons"

28 Publications

  • Page 1 of 1

Seoul Virus Associated with Pet Rats, Scotland, UK, 2019.

Emerg Infect Dis 2021 ;27(10):2677-2680

We describe a case of hemorrhagic fever with renal syndrome caused by Seoul virus in a woman in Scotland, UK. Whole-genome sequencing showed the virus belonged to a lineage characterized by recent international expansion, probably driven by trade in pet rats.
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http://dx.doi.org/10.3201/eid2710.211298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462346PMC
October 2021

Exportation of Monkeypox virus from the African continent.

J Infect Dis 2020 Sep 3. Epub 2020 Sep 3.

Department of Biochemistry and Molecular Biology, Israel Institute for Biological Research, Israel.

Background: The largest West African monkeypox outbreak began September 2017, in Nigeria. Four individuals traveling from Nigeria to the UK (2), Israel, and Singapore became the first human monkeypox cases exported from Africa, and a related nosocomial transmission event in the UK became the first confirmed human-to-human monkeypox transmission event outside of Africa.

Methods: Epidemiological and molecular data for exported and Nigerian cases were analyzed jointly to better understand the exportations in the temporal and geographic context of the outbreak.

Results: Isolates from all travelers and a Bayelsa case shared a most recent common ancestor and traveled to Bayelsa, Delta, or Rivers states. Genetic variation for this cluster was lower than would be expected from a random sampling of genomes from this outbreak, but data did not support direct links between travelers.

Conclusions: Monophyly of exportation cases and the Bayelsa sample, along with the intermediate levels of genetic variation suggest a small pool of related isolates is the likely source for the exported infections. This may be the result of the level of genetic variation present in monkeypox isolates circulating within the contiguous region of Bayelsa, Delta, and Rivers states, or another more restricted, yet unidentified source pool.
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http://dx.doi.org/10.1093/infdis/jiaa559DOI Listing
September 2020

Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018.

Emerg Infect Dis 2020 04 17;26(4):782-785. Epub 2020 Apr 17.

In September 2018, monkeypox virus was transmitted from a patient to a healthcare worker in the United Kingdom. Transmission was probably through contact with contaminated bedding. Infection control precautions for contacts (vaccination, daily monitoring, staying home from work) were implemented. Of 134 potential contacts, 4 became ill; all patients survived.
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http://dx.doi.org/10.3201/eid2604.191164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101111PMC
April 2020

Rhombencephalitis and Myeloradiculitis Caused by a European Subtype of Tick-Borne Encephalitis Virus.

Emerg Infect Dis 2019 12;25(12):2317-2319

We report a case of a previously healthy man returning to the United Kingdom from Lithuania who developed rhombencephalitis and myeloradiculitis due to tick-borne encephalitis. These findings add to sparse data on tick-borne encephalitis virus phylogeny and associated neurologic syndromes and underscore the importance of vaccinating people traveling to endemic regions.
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http://dx.doi.org/10.3201/eid2512.191017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874248PMC
December 2019

Prolonged Zika Virus RNA Detection in Semen of Immunosuppressed Patient.

Emerg Infect Dis 2019 08;25(8):1598-1600

Zika virus RNA has been detected in semen samples collected <370 days after symptom onset. We report unusual persistence of Zika virus RNA in semen, confirmed by sequencing at 515 days after symptom onset and detectable for >900 days, in a patient with immunosuppression.
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http://dx.doi.org/10.3201/eid2508.181543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6649331PMC
August 2019

Zika virus infection in travellers returning to the United Kingdom during the period of the outbreak in the Americas (2016-17): A retrospective analysis.

Travel Med Infect Dis 2019 May - Jun;29:21-27. Epub 2019 Mar 7.

Rare and Imported Pathogens Laboratory, Public Health England, Porton, Salisbury, UK. Electronic address:

Background: In 2016, Zika virus (ZIKV) spread rapidly throughout the Americas and Caribbean in an explosive outbreak. In the UK, testing for ZIKV infection is performed at Public Health England's Rare and Imported Pathogens Laboratory. Here we present the UK's experience of imported ZIKV during the epidemic.

Method: A retrospective review was performed on the laboratory computer system searching by orders for ZIKV PCR and/or ELISA serology tests between 1st January 2016 and 31st December 2017. Each individual request form and result was reviewed.

Results: Of 6333 symptomatic patients tested for ZIKV, 374 (6%) had molecular or serological evidence consistent with recent infection; most of these had travelled to the Caribbean in 2016. On follow-up of PCR-confirmed cases, ZIKV IgM disappeared within 6 weeks and often didn't appear in patients with previous dengue infection. Rash was the commonest symptom in PCR-confirmed infection (93%). There were only single cases of presumed sexual transmission and of in-utero transmission.

Conclusions: The rise and fall in numbers of imported ZIKV cases largely reflected the temporal course of the outbreak in the Caribbean. ZIKV serology is difficult to interpret but the absence of antibodies to ZIKV 14 days after symptom onset makes infection very unlikely.
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http://dx.doi.org/10.1016/j.tmaid.2019.03.001DOI Listing
July 2019

West Nile Virus Infection in Travelers Returning to United Kingdom from South Africa.

Emerg Infect Dis 2019 02;25(2):367-369

West Nile virus (WNV) is an arthropod-transmitted flavivirus that causes West Nile fever and may infrequently cause neuroinvasive disease in humans. We present 2 cases of confirmed WNV infection, 1 of severe encephalitis and 1 of mild febrile illness, in a couple returning to the United Kingdom from South Africa.
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http://dx.doi.org/10.3201/eid2502.172101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346434PMC
February 2019

Assessment of metagenomic Nanopore and Illumina sequencing for recovering whole genome sequences of chikungunya and dengue viruses directly from clinical samples.

Euro Surveill 2018 Dec;23(50)

NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom.

BackgroundThe recent global emergence and re-emergence of arboviruses has caused significant human disease. Common vectors, symptoms and geographical distribution make differential diagnosis both important and challenging. AimTo investigate the feasibility of metagenomic sequencing for recovering whole genome sequences of chikungunya and dengue viruses from clinical samples.MethodsWe performed metagenomic sequencing using both the Illumina MiSeq and the portable Oxford Nanopore MinION on clinical samples which were real-time reverse transcription-PCR (qRT-PCR) positive for chikungunya (CHIKV) or dengue virus (DENV), two of the most important arboviruses. A total of 26 samples with a range of representative clinical Ct values were included in the study.ResultsDirect metagenomic sequencing of nucleic acid extracts from serum or plasma without viral enrichment allowed for virus identification, subtype determination and elucidated complete or near-complete genomes adequate for phylogenetic analysis. One PCR-positive CHIKV sample was also found to be coinfected with DENV. ConclusionsThis work demonstrates that metagenomic whole genome sequencing is feasible for the majority of CHIKV and DENV PCR-positive patient serum or plasma samples. Additionally, it explores the use of Nanopore metagenomic sequencing for DENV and CHIKV, which can likely be applied to other RNA viruses, highlighting the applicability of this approach to front-line public health and potential portable applications using the MinION.
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http://dx.doi.org/10.2807/1560-7917.ES.2018.23.50.1800228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299504PMC
December 2018

Two cases of monkeypox imported to the United Kingdom, September 2018.

Euro Surveill 2018 09;23(38)

Emerging Infections and Zoonoses Section, National Infection Service, Public Health England, Colindale, London, United Kingdom.

In early September 2018, two cases of monkeypox were reported in the United Kingdom (UK), diagnosed on 7 September in Cornwall (South West England) and 11 September in Blackpool (North West England). The cases were epidemiologically unconnected and had recently travelled to the UK from Nigeria, where monkeypox is currently circulating. We describe the epidemiology and the public health response for the first diagnosed cases outside the African continent since 2003.
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http://dx.doi.org/10.2807/1560-7917.ES.2018.23.38.1800509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157091PMC
September 2018

Lack of Zika virus antibody response in confirmed patients in non-endemic countries.

J Clin Virol 2018 Feb - Mar;99-100:31-34. Epub 2017 Dec 21.

Erasmus MC, Department of Viroscience, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, Rotterdam, The Netherlands.

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http://dx.doi.org/10.1016/j.jcv.2017.12.007DOI Listing
July 2019

Management of Zika virus in pregnancy: a review.

Br Med Bull 2017 Dec;124(1):157-169

Institute for Women's Health, University College London Hospital, 74 Huntley Street, London, WC1E 6AU UK.

Introduction/background: Since 2015, an epidemic of Zika virus spread across the Americas. This coincided with an increased incidence of microcephaly reported at birth in Brazil, with subsequent evidence of a causal association.

Sources Of Data: Systemic reviews, observational studies, public health organizations.

Areas Of Agreement: Zika virus causes microcephaly and brain abnormalities in infants born to mothers infected during or shortly before pregnancy. Zika virus is a trigger for Guillain Barre Syndrome. Whilst mosquito bite is the main route of transmission, sexual transmission is another confirmed route.

Areas Of Controversy: Uncertainty remains regarding the proportion of Zika-infected pregnancies that will give rise to a significantly affected infant.

Growing Points: The development of a vaccine remains a priority whilst public health efforts continue to educate at risk populations on reducing transmission.

Areas Timely For Developing Research: Follow-up studies of affected infants are vital to inform on prognosis and guide screening programmes of the future.
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http://dx.doi.org/10.1093/bmb/ldx038v1DOI Listing
December 2017

A series of Zika virus cases imported into the UK 2016: Comparative epidemiological and clinical features.

J Infect 2017 06 23;74(6):616-618. Epub 2017 Mar 23.

Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK. Electronic address:

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http://dx.doi.org/10.1016/j.jinf.2017.03.004DOI Listing
June 2017

Presence and Persistence of Zika Virus RNA in Semen, United Kingdom, 2016.

Emerg Infect Dis 2017 04 15;23(4):611-615. Epub 2017 Apr 15.

Zika virus RNA has been detected in semen collected several months after onset of symptoms of infection. Given the potential for sexual transmission of Zika virus and for serious fetal abnormalities resulting from infection during pregnancy, information regarding the persistence of Zika virus in semen is critical for advancing our understanding of potential risks. We tested serial semen samples from symptomatic male patients in the United Kingdom who had a diagnosis of imported Zika virus infection. Among the initial semen samples from 23 patients, Zika virus RNA was detected at high levels in 13 (56.5%) and was not detected in 9 (39.1%); detection was indeterminate in 1 sample (4.4%). After symptomatic infection, a substantial proportion of men have detectable Zika virus RNA at high copy numbers in semen during early convalescence, suggesting high risk for sexual transmission. Viral RNA clearance times are not consistent and can be prolonged.
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http://dx.doi.org/10.3201/eid2304.161692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367426PMC
April 2017

Zika virus.

BMJ 2016 Feb 26;352:i1049. Epub 2016 Feb 26.

Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London NW3 2QG, UK

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http://dx.doi.org/10.1136/bmj.i1049DOI Listing
February 2016

Evaluation of the Biofire FilmArray BioThreat-E Test (v2.5) for Rapid Identification of Ebola Virus Disease in Heat-Treated Blood Samples Obtained in Sierra Leone and the United Kingdom.

J Clin Microbiol 2016 Jan 4;54(1):114-9. Epub 2015 Nov 4.

Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, Salisbury, United Kingdom.

Rapid Ebola virus (EBOV) detection is crucial for appropriate patient management and care. The performance of the FilmArray BioThreat-E test (v2.5) using whole-blood samples was evaluated in Sierra Leone and the United Kingdom and was compared with results generated by a real-time Ebola Zaire PCR reference method. Samples were tested in diagnostic laboratories upon availability, included successive samples from individual patients, and were heat treated to facilitate EBOV inactivation prior to PCR. The BioThreat-E test had a sensitivity of 84% (confidence interval [CI], 64% to 95%) and a specificity of 89% (CI, 73% to 97%) in Sierra Leone (n = 60; 44 patients) and a sensitivity of 75% (CI, 19% to 99%) and a specificity of 100% (CI, 97% to 100%) in the United Kingdom (n = 108; 70 patients) compared to the reference real-time PCR. Statistical analysis (Fisher's exact test) indicated there was no significant difference between the methods at the 99% confidence level in either country. In 9 discrepant results (5 real-time PCR positives and BioThreat-E test negatives and 4 real-time PCR negatives and BioThreat-E test positives), the majority (n = 8) were obtained from samples with an observed or probable low viral load. The FilmArray BioThreat-E test (v2.5) therefore provides an attractive option for laboratories (either in austere field settings or in countries with an advanced technological infrastructure) which do not routinely offer an EBOV diagnostic capability.
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http://dx.doi.org/10.1128/JCM.02287-15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702715PMC
January 2016

Post-exposure prophylaxis against Ebola virus disease with experimental antiviral agents: a case-series of health-care workers.

Lancet Infect Dis 2015 Nov 25;15(11):1300-4. Epub 2015 Aug 25.

Department of Infection, Royal Free London NHS Foundation Trust, London, UK; Research Department of Infection and Population Health, University College London, London, UK.

Background: Although a few international health-care workers who have assisted in the current Ebola outbreak in west Africa have been medically evacuated for treatment of Ebola virus disease, more commonly they were evacuated after potential accidental exposure to Ebola virus. An urgent need exists for a consensus about the risk assessment of Ebola virus transmission after accidental exposure, and to investigate the use of post-exposure prophylaxis (PEP). Experimental vaccines have occasionally been used for Ebola PEP, but newly developed experimental antiviral agents have potential advantages. Here, we describe a new method for risk assessment and management of health-care workers potentially exposed to Ebola virus and report the use of experimental antiviral therapies for Ebola PEP in people.

Methods: We devised a risk assessment and management algorithm for health-care workers potentially exposed to Ebola virus and applied this to eight consecutive individuals who were medically evacuated to the UK from west Africa between January, and March, 2015. PEP with antiviral agents was given to health-care workers assessed to have had substantial risk exposures to Ebola virus. Participants were followed up for 42 days after potential exposure.

Findings: Four of eight health-care workers were classified as having had low risk exposures and managed by watchful waiting in the community. None of these health-care workers developed Ebola virus disease. The other four health-care workers had intermediate or maximum risk exposures and were given PEP with antiviral agents. PEP was well tolerated with no serious adverse effects. None of these four health-care workers, including two with maximum risk exposures from penetrating injuries with freshly used hollow-bore needles, developed Ebola virus disease.

Interpretation: Standardised risk assessment should be adopted and consensus guidelines developed to systematically study the efficacy and safety of PEP with experimental agents. New experimental antiviral treatments are a viable option for PEP against Ebola.

Funding: Royal Free London NHS Foundation Trust.
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http://dx.doi.org/10.1016/S1473-3099(15)00228-5DOI Listing
November 2015

A non-fatal case of hantavirus cardiopulmonary syndrome imported into the UK (ex Panama), July 2014.

J Clin Virol 2015 Jun 8;67:52-5. Epub 2015 Apr 8.

Research Department, Microbiology Services Division, Public Health England, Porton Down, Salisbury, United Kingdom; National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom.

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http://dx.doi.org/10.1016/j.jcv.2015.04.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451477PMC
June 2015

Viral haemorrhagic fever.

Clin Med (Lond) 2015 Feb;15(1):61-6

Rare and Imported Pathogens Laboratory, PHE Porton, Salisbury, UK

Viral haemorrhagic fevers (VHF) are a range of viral infections with potential to cause life-threatening illness in humans. Apart from Crimean-Congo haemorrhagic fever (CCHF), they are largely confined to Africa, distribution being dependent on the ecology of reservoir hosts. At present, the largest ever epidemic of Ebola virus disease (EVD or Ebola) is occurring in West Africa, raising the possibility that cases could be imported into non-endemic countries. Diagnosis and management is challenging due to the non-specificity of early symptoms, limited laboratory facilities in endemic areas, severity of disease, lack of effective therapy, strict infection control requirements and propensity to cause epidemics with secondary cases in healthcare workers.
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http://dx.doi.org/10.7861/clinmedicine.15-1-61DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954527PMC
February 2015

Patient characteristics and severity of human rhinovirus infections in children.

J Clin Virol 2013 Sep 22;58(1):216-20. Epub 2013 Jul 22.

Department of Infectious Diseases, King's College London School of Medicine, London, UK.

Background: It is increasingly recognized that human rhinoviruses (HRV) can be associated with severe infections. However, conflicting results have been reported on the relative prevalence and severity of the three HRV species.

Objectives: The relative prevalence and clinical characteristics of HRV-A, B and C, in children attending a South London teaching hospital were investigated retrospectively.

Study Design: Children aged<16 years with episodes of respiratory tract infections and detectable entero/rhinovirus RNA in respiratory samples between November 2009 and December 2010 were investigated. Retrospective case review was performed and patients' characteristics recorded.

Results: Entero/rhinoviruses were the commonest viral pathogens (498/2316; 21.5%). Amongst 204 infection episodes associated with entero/rhinovirus, 167 were typed HRV, HRV-C was the most prevalent (99/167, 59.3%) followed by HRV-A (60/167; 35.9%) and HRV-B (8/167, 4.8%). The severity spectrum of HRV-A and HRV-C infections were similar and affected all parts of the respiratory tract. Co-pathogens were observed in 54 (26.5%) episodes. Severity was increased in patients with non-viral co-pathogens and those with an underlying respiratory condition. Univariate and multiple regression analyses of potential prognostic variables including age, co-pathogens and underlying respiratory illnesses showed that mono-infection with HRV-C, as compared with other HRV species, was associated with more severe disease in young children<3 years.

Conclusions: HRV-C was the most prevalent species and on its own was associated with severe disease in children<3 years. The association between infection with HRV species and clinical presentation is complex and affected by many confounding factors.
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http://dx.doi.org/10.1016/j.jcv.2013.06.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108361PMC
September 2013

Lineages, sub-lineages and variants of enterovirus 68 in recent outbreaks.

PLoS One 2012 20;7(4):e36005. Epub 2012 Apr 20.

Department of Infectious Diseases, School of Medicine, King's College London, London, United Kingdom.

Enterovirus 68 (EV68) was first isolated in 1962. Very few cases of EV68 infection were described over the ensuing 40 years. However, in the past few years, an increase in severe respiratory tract infections associated with EV68 has been reported. We identified two clusters of EV68 infection in South London, UK, one each in the autumn/winters of 2009 and 2010. Sequence comparison showed significant homology of the UK strains with those from other countries including the Netherlands, Japan and the Philippines, which reported EV68 outbreaks between 2008 and 2010. Phylogenetic analysis of all available VP1 sequences indicated the presence of two modern EV68 lineages. The 2010 UK strains belonged to lineage 2. Lineage 1 could be further divided into two sub-lineages: some Japanese and Dutch strains collected between 2004 and 2010 form a distinct sub-lineages (sub-lineage 1.1), whereas other strains from the UK, Japan, Netherlands and Philippines collected between 2008 and 2010 represent sub-lineage 1.2. The UK 2009 strains together with several Dutch and Japanese strains from 2009/2010 represents one variant (1.2.1), whereas those from the Philippines a second variant (1.2.2). Based on specific deletions and substitutions, we suggest rules for the assignment of lineages and sub-lineages. Molecular epidemiological analysis indicates rapid recent evolution of EV68 and this may explain the recent findings of a global resurgence of EV68. Continuous global monitoring of the clinical and molecular epidemiology of EV68 is recommended.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0036005PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335014PMC
August 2012

Bio-electrospraying whole human blood: analysing cellular viability at a molecular level.

J Tissue Eng Regen Med 2009 Oct;3(7):562-6

BioPhysics Group, Department of Mechanical Engineering, University College London, UK.

Bio-electrosprays, pioneered in 2005, have undergone several developmental studies which have seen this technique evolve as a novel direct in vivo tissue engineering and regenerative medicinal strategy. Those studies have been a hallmark for electrosprays; however, in this communication we report our on-going developmental investigations for exploring bio-electrosprays as a potential medical device and diagnostic protocol. The studies reported here demonstrate the ability to directly jet whole human blood without affecting the genetic make-up, which has been interrogated by way of reverse transcription-polymerase chain reaction (RT-PCR) in comparison to controls (p = 0.7337). These studies demonstrate bio-electrosprays as a possible diagnostic protocol.
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http://dx.doi.org/10.1002/term.185DOI Listing
October 2009

Genetic, genomic and physiological state studies on single-needle bio-electrosprayed human cells.

Analyst 2008 Oct 2;133(10):1347-51. Epub 2008 Jul 2.

Cytogenetics Department, Guy's Hospital, 5th Floor Tower Wing, Great Maze Pond, London, UKSE1 9RT.

Bio-electrospraying, a non-contact jet-based direct cell engineering approach, was recently pioneered and demonstrated for handling a wide range of primary living cells. In those studies, post-treated cells were biologically assessed in comparison to several controls by way of flow cytometry. Although flow cytometry accurately assesses those viable populations of cells, subtle effects at a sub-cellular level could have been missed. Therefore, in the present study we demonstrate metaphase chromosome breakage studies carried out on single-needle bio-electrosprayed human T-lymphocytes, which are compared with several controls. The results indicate that post-treated T-lymphocytes do not demonstrate any increase in chromosome damage in comparison to control cells. These studies further validate bio-electrospraying as a technique with potential for clinical utility.
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http://dx.doi.org/10.1039/b806901hDOI Listing
October 2008

Management of Suspected Avian (H5N1) Influenza in a Non-pandemic Setting.

Acute Med 2007 ;6(1):9-13

Dept of Microbiology John Radcliffe Hospital Headley Way Headington Oxford OX3 9DU.

Avian (H5N1) influenza has been responsible for millions of wild bird and poultry deaths throughout the world. Sporadic human cases with a high mortality have occurred, almost exclusively in association with very close contact with sick, dying or dead birds. Appropriate management of suspected cases requires their prompt recognition via attention to travel and bird-exposure history. The early isolation, diagnosis and treatment of suspected cases as well as prompt involvement of the health protection unit should enable patients to be optimally managed with minimum risk to health care staff.
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October 2012

Failure to diagnose recent hepatitis C virus infections in London injecting drug users.

J Med Virol 2004 Aug;73(4):548-53

Centre of Virology, University College London, London, United Kingdom.

Hepatitis C virus (HCV) infection results in chronic liver disease in a substantial proportion of those infected. Most new cases of HCV infection in the UK are associated with intravenous drug use. It is important to identify these infections because of the implications for the future health of the individuals concerned and for the control of further spread of infection. However, as hepatitis C infection is characterised by a relatively long asymptomatic period of seronegative viraemia, a laboratory diagnostic protocol that does not test HCV seronegative samples for the presence of HCV RNA may wrongly designate HCV viraemic seronegative individuals as uninfected. Amongst 424 injecting drug users whose serum was sent to our diagnostic laboratory for "HCV screening" over a 14-month period, the prevalence of HCV seropositivity was 48.4%. We retrospectively identified seven individuals for whom there was evidence of recent acquisition of HCV infection. Three of these infections were identified using our routine diagnostic protocol: testing for the presence of HCV-specific antibody and performing HCV RNA testing only on seropositive and seroindeterminate specimens. However, four cases were only identified by HCV RNA testing of HCV seronegative serum. On the basis of these observations, we estimate the incidence of HCV infection amongst London injecting drug users as being 14.3 per 100 person-years. We advocate that all HCV seronegative blood samples obtained from injecting drug users should be tested for the presence of HCV RNA, and suggest that this could be done efficiently by nucleic acid testing the specimens in small pools. .
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http://dx.doi.org/10.1002/jmv.20124DOI Listing
August 2004

Prenatal diagnosis of congenital rubella infection in the second trimester of pregnancy.

Prenat Diagn 2003 Jun;23(6):509-12

Department of Virology, Royal Free and University College Medical School, London, UK.

Objectives: This case report describes the clinical presentation, diagnosis and management of a case of acute rubella infection in the second trimester. The complex issues of prenatal diagnosis of a congenital rubella infection are discussed.

Methods: A 30-year-old woman presented with a fine macular rash at 15 weeks' gestation. Laboratory testing included maternal rubella-specific IgG and IgM detection (booking blood and acute-phase sample) together with measurement of IgG avidity. Prenatal diagnosis at 19 weeks (amniocentesis) and 23 weeks (amniocentesis and fetal blood) was done using a reverse-transcriptase polymerase chain reaction to detect rubella-specific RNA. The fetal blood sample was also tested for rubella-specific IgM.

Results: Maternal serological results confirmed an acute rubella infection at 15 weeks' gestation. Rubella-specific RNA and IgM were detected in the fetal blood taken at 23 weeks' gestation. However, no rubella RNA was detected in either of the amniotic fluid samples collected at 19 and 23 weeks.

Conclusion: In second-trimester rubella where risk of fetal damage is low, prenatal diagnosis can identify the rubella-infected fetus, allowing the parents to make a more informed decision about their options. The optimal sample for prenatal diagnosis is fetal blood as no rubella-specific RNA was detected in the amniotic fluid.
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http://dx.doi.org/10.1002/pd.631DOI Listing
June 2003
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