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Summary Objectives There is scant qualitative research into the experiences of tuberculosis (TB) treatment in urban risk groups with complex health and social needs in the UK. This study aimed to describe the social context of adherence to treatment in marginalized groups attending a major TB centre in London. Methods A qualitative cross-sectional study was performed using semi-structured interviews with patients receiving treatment for TB. Analytical frameworks aimed to reflect the role of broader social structures in shaping individual health actions. Results There were 17 participants; the majority were homeless and had complex medical and social needs, including drug and alcohol use or immigration problems affecting entitlement to social welfare. Participants rarely actively chose not to take their medication, but described a number of social and institutional barriers to adherence and their need for practical support. Many struggled with the physical aspects of taking medication and the side effects. Participants receiving directly observed therapy (DOT) reported both positive and negative experiences, reflecting the type of DOT provider and culture of the organization. Conclusions There is a need for integrated care across drug, alcohol, HIV, and homeless services in order to address the complex clinical co-morbidities and social needs that impact on the patient's ability to sustain a course of treatment. [ABSTRACT FROM AUTHOR]

Background: Empyema is an increasingly frequent clinical problem worldwide, and has substantial morbidity and mortality. Our objectives were to identify the clinical, surgical and microbiological features, and management outcomes, of empyema. Methods: A retrospective observational study over 12 years (1999-2010) was carried out at The Heart Hospital, London, United Kingdom. Patients with empyema were identified by screening the hospital electronic 'Clinical Data Repository'. Demographics, clinical and microbiological characteristics, underlying risk factors, peri-operative blood tests, treatment and outcomes were identified. Univariable and multivariable statistical analyses were performed. Results: Patients (n = 406) were predominantly male (74.1%); median age = 53 years (IQR = 37-69). Most empyema were community-acquired (87.4%) and right-sided (57.4%). Microbiological diagnosis was obtained in 229 (56.4%) patients, and included streptococci (16.3%), staphylococci (15.5%), Gram-negative organisms (8.9%), anaerobes (5.7%), pseudomonads (4.4%) and mycobacteria (9.1%); 8.4% were polymicrobial. Most (68%) cases were managed by open thoracotomy and decortication. Video-assisted thoracoscopic surgery (VATS) reduced hospitalisation from 10 to seven days (P = 0.0005). Allcause complication rate was 25.1%, and 28 day mortality 5.7%. Predictors of early mortality included: older age (P = 0.006), major co-morbidity (P = 0.01), malnutrition (P = 0.001), elevated red cell distribution width (RDW, P,0.001) and serum alkaline phosphatase (P = 0.004), and reduced serum albumin (P = 0.01) and haemoglobin (P = 0.04). Conclusions: Empyema remains an important cause of morbidity and hospital admissions. Microbiological diagnosis was only achieved in just over 50% of cases, and tuberculosis is a notable causative organism. Treatment of empyema with VATS may reduce duration of hospital stay. Raised RDW appears to associate with early mortality. [ABSTRACT FROM AUTHOR]

Background: As the experience of what is termed as ‘postnatal depression’ (PND) in South Asian mothers living in Great Britain has received comparatively little attention, this study used a grounded theory approach to examine their understanding of PND. Methods: Ten South Asian mothers were interviewed from within the Greater Manchester area in England. They scored above 12 on the Edinburgh Postnatal Depression Scale and were interviewed 8–12 weeks after giving birth. Data were analysed using techniques associated with constant comparison and a grounded theory approach. Results and findings: The analyses showed that their experiences of PND were extremely dynamic and complex. Three core categories were identified and termed “internalising misery”, “Others will judge me and I feel on my own” and “I talk to my health professional and they don’t understand”. Conclusions: Potential links between these categories were considered and a tentative model for PND in South Asian mothers has been proposed. Some issues were specific to the experience of PND, but this sample also experienced “cultural clashes”, somatisation, isolation, poor input from services and barriers to and from services. The methodological limitations, clinical implications and areas for further research are considered. [ABSTRACT FROM PUBLISHER]

The article discusses the increasing number of reported cases of tuberculosis in Great Britain. It examines the size of this public health problem and explores the different factors contributing to the prevalence of tuberculosis in the country including social exclusion and the use of angti-tumour necrosis factor drugs. It further describes the prevention and control strategies employed in the country, and analyzes the significant lessons that could be drawn from various tuberculosis control programmes adopted by other nations.

• Ongoing HPAI outbreaks have resulted in the culling of >4.6 M birds in the UK. • The outbreak could increase the risk of zoonotic transmission. • Increase potential for mixing of the influenza viruses of other species. • The UK faces significant disruption of chicken egg supplies in the supermarkets. • Free-range chicken eggs are becoming scarce. [ABSTRACT FROM AUTHOR]

Objectives To identify whether parliamentary scrutiny, in the form of Written Parliamentary Questions (WPQs), has any significant impact on the UK government's stated aid priorities and whether, by refining the approach that MPs with an interest in TB take to scrutinising the government on its aid priorities, more resources could be secured for TB. Methods We downloaded 19,234 Written Parliamentary Questions directed at the Department for International Development posed by Members of Parliament between June 2001 and September 2014. We categorised questions by theme, party of questioner, geographical area, date and government. We then identified questions which specifically referenced HIV, TB and Malaria, or the Global Fund to Fight Aids, TB and Malaria. Analyses were conducted on each of these categorisations to identify trends which could account for differences in government funding between the three diseases. Results A significantly greater number of questions were posed on HIV than on TB and Malaria. These questions were more likely to reference a specific geographical area, and come from a wider group of MPs. A broadly equivalent number of questions were asked on TB and Malaria although there were differences between the parties of the MPs tabling questions. We also identified a significant fall in the number of WPQs tabled from the Labour government of 2005–2010 and the Coalition Government of the present day. Conclusion High volumes of WPQs targeting specific policy areas or geographical locations can play a role in increasing political commitment within government towards a certain disease or condition, however other factors, including high-level MP champions and party policy, can play an equally significant role. Nonetheless, evidence suggests that a broad base of political support (as manifested through WPQs) is important to motivating a government response to a health issue and that the TB community should devote more effort to mobilising this wide political support. [ABSTRACT FROM AUTHOR]

Highlights • Three patients were diagnosed with monkeypox in the United Kingdom in September 2018 the index case being from Nigeria. • Nigeria is currently experiencing a large outbreak of monkeypox with a total of 116 cases as per September 2018. • The median age of the cases are 31 years. • The cases belong to an age group not immunized against smallpox. • After the eradication of smallpox and the end of the immunization program a nice for a new poxvirus may have been created. Abstract The identification of monkeypox in 3 separate patients in the United Kingdom in September raised media and political attention on an emerging public health threat. Nigeria, whose last confirmed case of monkeypox was in 1978, is currently experiencing an unusually large and outbreak of human monkeypox cases, a 'One Human-Environmental-Animal Health' approach is being effectively used to define and tackle the outbreak. As of 13th October 2018, there have been one hundred and sixteen confirmed cases the majority of whom are under 40 years. Over the past 20 years ten Central and West African countries have reported monkeypox cases which have risen exponentially. We review the history and evolution of monkeypox outbreaks in Africa and USA, the changing clinical presentations, and discuss possible factors underlying the increasing numbers being detected including the cessation of smallpox vaccination programs. Major knowledge gaps remain on the epidemiology, host reservoir, and emergence, transmission, pathogenesis and prevention of monkeypoz. [ABSTRACT FROM AUTHOR]

Summary Background Over 25 000 pilgrims from the UK visit Saudi Arabia every year for the Umrah and Hajj pilgrimages. The recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea and the continuing reports of MERS-CoV cases from Saudi Arabia highlight the need for active surveillance for MERS-CoV in returning pilgrims or travellers from the Middle East. Public Health England Birmingham Laboratory (PHEBL) is one of a few selected UK public health laboratories responsible for MERS-CoV screening in travellers returning to the UK from the Middle East who present to hospital with severe respiratory symptoms. The results of the PHEBL MERS-CoV screening and surveillance over the past 3 years is presented. Methods UK travellers/pilgrims who returned from the Middle East and presented to a hospital with respiratory symptoms were studied over the period February 1, 2013 to December 31, 2015. Patients with respiratory symptoms, who satisfied the Public Health England MERS-CoV case algorithm, were tested for MERS-CoV and other respiratory tract viruses on admission to hospital. Results Two hundred and two patients suspected of having MERS-CoV were tested. None of them had a laboratory-confirmed MERS-CoV infection. A viral aetiology was detected in half (50.3%) of the cases, with rhinoviruses, influenza A (H1N1 and H3N2), and influenza B being most frequent. Peak testing occurred following the annual Hajj season and in other periods of raised national awareness. Conclusions Respiratory tract infections in travellers/pilgrims returning to the UK from the Middle East are mainly due to rhinoviruses, influenza A, and influenza B. Whilst MERS-CoV was not detected in the 202 patients studied, heightened awareness of the possibility of MERS-CoV and continuous proactive surveillance are essential to rapidly identify cases of MERS-CoV and other seasonal respiratory tract viruses such as avian influenza, in patients presenting to hospital. Early identification and isolation may prevent outbreaks in nosocomial settings. [ABSTRACT FROM AUTHOR]

The article presents a study that assessed a tuberculosis screening program in Hackney, London, Great Britain, set up in response to the reemergence of tuberculosis in developed countries. The screening took place in general practice offices in Hackney and involved a interview and a tuberculin skin test if warranted. The screening program increased awareness of tuberculosis in primary care, identified untreated cases, and increased vaccination coverage in the area. The article recommends that developed countries consider adding tuberculosis screening programs to their primary health care services.

Competing Interests: We declare no conflicts of interest. All authors have an academic interest in infectious diseases with pandemic potential and globalisation of infections from mass gathering events. AZ acknowledges support from the Pan-African Network for Rapid Response, Research and Preparedness for Emerging and Re-Emerging Infections (PANDORA-ID-NET), funded by the EU-EDCTP2 - EU Horizon 2020 Framework Program. AZ is also in receipt of a UK NIHR Senior Investigator Award.