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Polymerase chain reaction (PCR) detection has become the gold standard for diagnosis and typing of enterovirus (EV) and human parechovirus (HPeV) infections. Its effectiveness depends critically on using the appropriate sample types and high assay sensitivity as viral loads in cerebrospinal fluid samples from meningitis and sepsis clinical presentation can be extremely low. This study evaluated the sensitivity and specificity of currently used commercial and in‐house diagnostic and typing assays. Accurately quantified RNA transcript controls were distributed to 27 diagnostic and 12 reference laboratories in 17 European countries for blinded testing. Transcripts represented the four human EV species (EV‐A71, echovirus 30, coxsackie A virus 21, and EV‐D68), HPeV3, and specificity controls. Reported results from 48 in‐house and 15 commercial assays showed 98% detection frequencies of high copy (1000 RNA copies/5 µL) transcripts. In‐house assays showed significantly greater detection frequencies of the low copy (10 copies/5 µL) EV and HPeV transcripts (81% and 86%, respectively) compared with commercial assays (56%, 50%; P = 7 × 10−5). EV‐specific PCRs showed low cross‐reactivity with human rhinovirus C (3 of 42 tests) and infrequent positivity in the negative control (2 of 63 tests). Most or all high copy EV and HPeV controls were successfully typed (88%, 100%) by reference laboratories, but showed reduced effectiveness for low copy controls (41%, 67%). Stabilized RNA transcripts provide an effective, logistically simple and inexpensive reagent for evaluation of diagnostic assay performance. The study provides reassurance of the performance of the many in‐house assay formats used across Europe. However, it identified often substantially reduced sensitivities of commercial assays often used as point‐of‐care tests. [ABSTRACT FROM AUTHOR]

Chronic infection with the hepatitis B virus ( HBV) is a frequent cause of cirrhosis and liver cancer. Targeted HBV screening is recommended by the Centre for Disease Control (CDC) and Prevention for subjects born in countries with >2% HBV prevalence. However, there are no UK guidelines. Here, we applied the ( CDC) recommendations to the British-Chinese and British-South Asian community of North-East (NE) England. British-Chinese and South Asian subjects were invited to attend for HBV education and screening sessions held in community centres. Hepatitis B surface antigen ( HBsAg) and hepatitis B core total antibody ( HBcAb) were tested with dry blood spot tests. South Asians were also tested for hepatitis C antibody ( HCVAb). A total of 1126 subjects (606 Chinese and 520 South Asian) were screened. Sixty-two (5.5%) were HBsAg positive. Ten of these reported a previous diagnosis of HBV. The prevalence of HBsAg positivity was 4.6% when previously diagnosed individuals were excluded. The HBsAg prevalence was significantly higher in the Chinese subjects compared with South Asians (8.7% VS. 1.7% P < 0.001). In Chinese subjects, HBsAg positivity was highest in subjects born in Vietnam (17.4%), followed by China (11%), Hong Kong (7.8%) and the UK (6.7%). Subjects from Pakistan had the highest HBsAg and HCV Ab prevalence in the South Asians (3.1% and 1.8%, respectively). Ten percentage of HBsAg positive patients who had follow-up assessment had active disease requiring antiviral treatment. Undiagnosed HBV infection was above the 2% threshold for screening suggested by the CDC in the British-Chinese and Pakistani community of NE England, which provides evidence for a UK HBV-targeted screening programme. [ABSTRACT FROM AUTHOR]

Background: The incidence of empyema in children in the UK is increasing. The reason for this is unclear. A prospective study was undertaken to investigate the clinical features, aetiology, and outcome of cases of empyema and parapneumonic effusion presenting to a tertiary paediatric respiratory centre between February 1997 and August 2001.Method: Routine bacterial culture of blood and pleural fluid was performed for 47 cases. Forty three pleural fluid specimens, culture negative for pneumococcus, were analysed for pneumococccal DNA by real time polymerase chain reaction (PCR). Penicillin susceptibility was determined for DNA positive specimens using complementary PCR assay. Capsular serotype specific antigen detection was by enzyme immunoassay (EIA) using monoclonal antibodies to serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F. Clinical data were obtained from patient notes, supplemented by a postal questionnaire.Results: The median (range) age of the patients was 5.6 (0.6-16.9) years and 70% were male. The median (range) duration of illness before referral to hospital was 5 (0-25) days. Forty five (96%) had received antibiotics before referral; 32 (68%) required decortication and eight (21%) thoracocentesis. Median postoperative stay was 4 days (2-8). Thirty two (75%) pneumococcal culture negative specimens were pneumococcal DNA positive; 17 (53%) of these were serotype 1. All were penicillin sensitive.Conclusions: Pneumococcus is the major pathogen in childhood empyema and serotype 1 is the prevalent serotype. This has implications for vaccine development and immunisation strategy as the current 7-valent pneumococcal conjugate vaccine does not protect against serotype 1. [ABSTRACT FROM AUTHOR]

Introduction Chronic hepatitis B (HBV) is highly prevalent in China and the Far East (>8% seroprevalence). AASLD guidelines recommend HBV screening and vaccination in subjects born in high (>8%) or intermediate (2–7%) endemic areas. However, there are no current UK guidelines. The study aim was to apply AASLD recommendations locally to the community with the highest endemicity – British Chinese (estimated population 430 000). Methods Members of the NE Chinese community were invited to attend screening sessions at the Newcastle Chinese Healthy Living Centre. Dry blood spots were obtained by finger prick and tested for HBsAg and HBcAb (Abbott ARCHITECT). HBsAg positive individuals were advised to undergo confirmatory testing and be referred for specialist assessment. Results 315 subjects were screened (mean age 52±18 years, 63% female). 31 (10%) were HBsAg positive (48% female) indicating chronic HBV. Of these, 7 reported being previously diagnosed with HBV, but were not under follow-up. When previously diagnosed individuals were excluded the prevalence of HBsAg positivity was 8%. 50 (16%) subjects were HBsAg negative and HBcAb positive indicating past HBV infection. HBsAg positive individuals were significantly younger than HBcAb and negative subjects (44±12 vs 59±15 vs 52±19 years, p<0.001). HBsAg individuals were most commonly born in China (52%), followed by Hong Kong (19%), Vietnam (13%), UK (10%), Macau (3%) and Malaysia (3%). The prevalence of HBsAg positivity for subjects born in China was 12% (16/129), Hong Kong 5% (6/126), Vietnam 18% (4/22) and UK 18% (3/17). Only 8% of subjects in the study reported previous vaccination against HBV. Conclusion (1) Undiagnosed chronic Hepatitis B is highly prevalent in British-Chinese in NE England, including subjects born in the UK. (2) The frequency of previous HBV vaccination was low in this high risk group. (3) These results provide evidence for a UK HBV screening and vaccination program for the British Chinese community, which is the largest in Europe and is the fastest growing non-European ethnic group in the UK. [ABSTRACT FROM PUBLISHER]