Search

An audit was undertaken in a number of NHS trusts to establish the prevalence of pressure ulcers among hospital patients over a three-year period. The audit also recorded patient profiles and the provision of preventative pressure area care. The findings were analysed to compare pressure ulcer prevalence with implementation of NICE guidelines on managing pressure ulcers. The audit uncovered areas where care appears to fall below expected standards, which may partly explain continuing high prevalence rates.

Repeated measures data for rotavirus infection in children within 14 day care centres (DCCs) in the Oxfordshire area, UK, are used to explore aspects of rotavirus transmission and immunity. A biologically realistic model for the transmission of infection is presented as a set of probability models suitable for application to the data. Two transition events are modelled separately: incidence and recovery. The complexity of the underlying mechanistic model is reflected in the choice of the fixed variables in the probability models. Parameter estimation was carried out using a Bayesian Markov chain Monte Carlo method. We use the parameter estimates obtained to build a profile of the natural history of rotavirus reinfection in an individual child. We infer that rotavirus transmission in children in DCCs is dependent on the DCC prevalence, with symptomatic infection of longer duration, but no more infectious per day of infectious period, than asymptomatic infection. There was evidence that a recent previous infection reduces the risk of disease and, to a lesser extent, reinfection, but not duration of infection. The results provide evidence that partial immunity to rotavirus infection develops over several time scales.

Conjugate polysaccharide vaccines are a recent intervention to combat the relative inability of young children to mount an effective immune response against encapsulated bacteria, especially Haemophilus influenzae (Hib), Neisseria meningitidis (Nm) and Streptococcus pneumoniae (Sp). These organisms cause the majority of community acquired septicaemia and meningitis in UK children. Their capsular polysaccharides, important virulence factors in evading phagocytosis, are poorly immunogenic in young children compared to adults. Conjugation, by covalent linking, of the polysaccharide to an immunogenic protein, has been demonstrated for each of these organisms to produce good antibody response to the polysaccharide. Conjugate Hib vaccines have proven effective in reducing Hib meningitis and invasive disease in the countries that have introduced them. Pneumococcal conjugate vaccines have proven effective in preventing invasive disease caused by serotypes contained in the vaccines. Efficacy studies are awaited for meningococcal conjugate vaccines.