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Recent cases of acute kidney injury due to Seoul hantavirus infection from exposure to wild or pet fancy rats suggest this infection is increasing in prevalence in the UK. We conducted a seroprevalence study in England to estimate cumulative exposure in at-risk groups with contact with domesticated and wild rats to assess risk and inform public health advice. From October 2013 to June 2014, 844 individual blood samples were collected. Hantavirus seroprevalence amongst the pet fancy rat owner group was 34.1% (95% CI 23·9-45·7%) compared with 3·3% (95% CI 1·6-6·0) in a baseline control group, 2·4% in those with occupational exposure to pet fancy rats (95% CI 0·6-5·9) and 1·7% with occupational exposure to wild rats (95% CI 0·2-5·9). Variation in seroprevalence across groups with different exposure suggests that occupational exposure to pet and wild rats carries a very low risk, if any. However incidence of hantavirus infection among pet fancy rat owners/breeders, whether asymptomatic, undiagnosed mild viral illness or more severe disease may be very common and public health advice needs to be targeted to this at-risk group. [ABSTRACT FROM AUTHOR]

Background: Studies in Asia, Europe, and the Americas have provided evidence that ambient air pollution may have an adverse effect on birth weight, although results are not consistent. Methods: Average exposure during pregnancy to five common air pollutants was estimated for births in metropolitan Sydney between 1998 and 2000. The effects of pollutant exposure in the first, second, and third trimesters of pregnancy on risk of "small for gestational age" (SGA), and of pollutant exposure during pregnancy on birth weight were examined. Results: There were 138 056 singleton births in Sydney between 1998 and 2000; 9.7% of babies (13 402) were classified as SGA. Air pollution levels in Sydney were found to be quite low. In linear regression models carbon monoxide and nitrogen dioxide concentrations in the second and third trimesters had a statistically significant adverse effect on birth weight. For a 1 part per million increase in mean carbon monoxide levels a reduction of 7 (95% CI -5 to 19) to 29 (95% CI 7 to 51) grams in birth weight was estimated. For a 1 part per billion increase in mean nitrogen dioxide levels a reduction of 1 (95% CI 0 to 2) to 34 (95% CI 24 to 43) grams in birth weight was estimated. Particulate matter (diameter less than ten microns) in the second trimester had a small statistically significant adverse effect on birth weight. For a 1 microgram per cubic metre increase in mean particulate matter levels a reduction of 4 grams (95% CI 3 to 6) in birth weight was estimated. Conclusion: These findings of an association between carbon monoxide, nitrogen dioxide, and particulate matter, and reduction in birth weight should be corroborated by further study. [ABSTRACT FROM AUTHOR]

Introduction: The Department of Health in New South Wales, Australia, expanded public health surveillance for the 2003 Rugby World Cup and for its ongoing counterterrorism response. Cup games were played in and around the Sydney region. Objectives: This study explains the development of an automated, near real-time, syndromic surveillance system in which data are used that are already being collected in emergency department (ED) databases for routine patient administration. Methods: Demographic, triage, physician-assigned provisional diagnosis, and disposition information from 12 of 49 public hospital EDs in the greater Sydney metropolitan area was frequently and automatically transmitted, analyzed, and reported in daily statistical summaries on Intranet websites beginning October 10, 2003. Diagnoses were categorized by syndrome, disease, and injury. Presenting problem and nursing-assessment free text routinely entered by nurses during patient triage were automatically classified into >30 syndrome categories by using automated preprocessing techniques and naïve Bayesian automatic text classification methods. The diagnosis-based categories were used to train the automatic classifier to associate words in the free text with syndrome categories. An adjusted cumulative sum (CUSUM) accumulating day-of-week differences in daily counts was used to assess the statistical significance of disease and injury trends. Public health personnel monitored the reports daily and notified the Rugby World Cup Public Health Committee of unusual trends. Results: During the tournament, October 10-November 22, health trends identified by the system were not sufficient to cause concern among public health personnel but did provide reassurance that the health of the population was not adversely affected. Data collection did not add to the work load of clinical staff in EDs, and surveillance downtime was negligible. Since the games, this now ongoing surveillance system has rapidly identified a community-based epidemic of gastrointestinal illness, an increase in recreational drug misuse, the annual influenza epidemic, and an increase in episodes of acute asthma. Variation by syndrome occurred in the degree of correlation between daily visit counts from automatically classified nurse text and the equivalent diagnosis groups used to train the classifier. Conclusion: During the Rugby World Cup, the surveillance system complemented traditional public health surveillance to provide a comprehensive assessment of health trends in the population. A substantial advantage of the system has been its ongoing sustainability. Physician-assigned diagnoses are more specific than free text for some syndrome and diagnostic categories. However, diagnoses are not available for analysis until at least the end of a patient's ED visit, and they are sometimes incomplete. Free text from patient triage is available for analysis early in an ED visit, and depending on the scope of the text description, multiple text-based syndromes can be automatically assigned to a visit. [ABSTRACT FROM AUTHOR]