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This study investigates the background to low uptake of nasal influenza vaccination in Polish pupils in Edinburgh, Scotland. In autumn 2018, one week after their child's nasal flu vaccination sessions, 365 Polish parents were sent a questionnaire exploring influences on their vaccination choices. The questionnaire included a series of 10 vaccine hesitancy questions recommended by the WHO SAGE Working Group on Vaccine Hesitancy. 128 questionnaires were returned representing 43.4% of vaccinated, 41.9% of refusing and 23.8% of non-consent form returning parents. Responses highlighted concerns about side effects, new vaccines and the accuracy of professional advice and information sources. There was complacency expressed about vaccination against diseases that are not common any more. Vaccine refusers were consistently more negative about all aspects vaccination and more likely to answer 'don't know'. Almost half of refusers were uncertain about the quality of health information offered to them. Polish migrants in Scotland come with their beliefs about vaccination and modify these as they acculturate to the UK system. They also continue to be influenced by developments and opinions, norms and values from their home country, as well as diaspora media. We have highlighted issues of concern among Polish migrants as a group and gained additional insights by comparing responses of parents who have refused or accepted vaccination. These insights can inform and target messages and strategies to build confidence and encourage immunisation, which should lead to improved vaccine uptake among ethnic population groups., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Vaccine hesitancy is increasing and failure to vaccinate is well-recognised in Europe as a contributing factor to outbreaks of infectious diseases. In Lothian and Scotland, low vaccine uptake has been seen in migrants - notably in the Polish group who have arrived since 2004. The recent Vaccine Confidence in European Union report highlights a concerning recent decline in vaccine confidence in Poland. We held three focus groups containing 13 Polish women about the childhood vaccination programme in Lothian, with specific focus on influenza and Human Papillomavirus vaccinations. Key emergent themes were: trust in the national vaccination policy, trust in the vaccination providers (health professionals), trust in the individual vaccines, balancing the risk of disease, and language and communication. Polish norms, beliefs and behaviours shape how Polish migrants navigate the UK health system and its vaccination programme. While not confident in the Scottish primary care model and its generalist practitioners, the participants liked the ethos of informed consent in Scotland and compared this favourably with the compulsory vaccination policy in Poland. There was a belief that vaccines in Scotland were of higher quality than Poland and with fewer adverse effects. Respondents reported returning to Poland for specialist clinical appointments and diagnostic testing. They regularly access Polish clinical expertise and their opinions about health are influenced by Polish friends and family. They say they have difficulty finding official UK Government and health authority vaccination material and often access Polish media, online resources and information. They are familiar with anti-vaccination activities in Poland. Consequently, there are important unmet information needs for this group of parents who may not be making truly informed choices about vaccination. This requires further investigation especially as migration continues and declining immunisation uptake is reported in many countries across Europe., (Copyright © 2019. Published by Elsevier Ltd.)

Failure to vaccinate is well-recognised in Europe as a contributing factor to outbreaks of infectious diseases. Low immunisation rates are often associated with religious, social and ethnic minorities, including refugees or migrant groups. Polish people form Scotland's newest and largest migrant group. They have moved to Scotland since 2004, joining established ethnic minorities from China, the Indian subcontinent and Africa. Scotland has had a seasonal influenza nasal vaccination programme for all primary school children since 2013. We investigated three primary schools in Edinburgh, which had reported low influenza vaccination uptake rates in 2016 and 2017 and found that these schools contained many pupils from ethnic minorities, the majority of whom were Polish. Pupils were categorized as one of three ethnic groupings: White British, Polish and Other Identified Ethnic Minority (OIEM). We ascertained ethnicity using NHS and Education Department information sources and name recognition. We examined vaccine acceptance, declination and non-return of consent forms. In 2017, nasal influenza vaccine uptake was 70.7% (65.2-75.6%, p < 0.001) in White British, 60.9% (53.9-67.6%%, p < 0.001) in other identified ethnic minorities and 25.0% (20.9-29.6%, p > 0.001) in Polish children. White British children were more likely to return completed forms (78.9%) than other groups (OIEM 68.2% and Polish 61.8%). 36.8% of Polish families completed a consent form declining vaccination compared to 6.2% of White British families. These findings demonstrate that significant differences exist in nasal influenza vaccination uptake rates, which have important implications for the trans-national study of vaccine hesitancy. Further qualitative work and an investigation of uptake rates of other childhood immunisations in Polish and other migrant groups is required to assess differences in uptake and behaviours., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Transmission of hepatitis C virus (HCV) in the healthcare setting is rare. Routine infection prevention and control measures mean that this should be a preventable 'never event'., Aim: To investigate the diagnosis of acute healthcare-associated HCV infection., Methods: Epidemiological and molecular investigation of a case of acute HCV infection associated with nosocomial exposure., Findings: Detailed investigation of the treatment history of a patient with acute HCV infection identified transmission from a co-attending patient in an emergency department as the likely source; this possibility was confirmed by virus sequence analysis. The precise route of transmission was not identified, though both patient and source had minimally invasive healthcare interventions. Review of infection, prevention and control identified potentially contributory factors in the causal pathway including hand hygiene, inappropriate use of personal protective equipment, and blood contamination of the surface of the departmental blood gas analyser., Conclusion: We provide molecular and epidemiological evidence of HCV transmission between patients in an emergency department that was made possible by environmental contamination. Patients with HCV infection are higher users of emergency care than the general population and a significant proportion of those affected remain unknown and/or infectious. Equipment, departmental design, staff behaviour, and patient risk require regular review to minimize the risk of nosocomial HCV transmission., (Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: Healthcare-associated infections (HCAIs) endanger safety by increasing morbidity, mortality, and hospital stay. Studies identifying risk factors for HCAI rarely address the wider determinants of health. However, a well-characterized association exists between increasing social deprivation and poor health outcomes. Therefore it is important to determine whether HCAIs are associated with social deprivation., Aim: To determine the association between social deprivation and the prevalence of HCAI, in all inpatients in an acute hospital in Scotland on a single day across September and October 2011., Methods: This study linked Scottish data from the 2011 European Point Prevalence Survey of HCAI and Antimicrobial Prescribing to the Scottish Morbidity Record 01, a national dataset with Scottish Index of Multiple Deprivation (SIMD) included. Multivariate logistic regression was used to model HCAI prevalence against SIMD quintile., Findings: No overall association was found between SIMD quintile and prevalence of HCAI in all inpatients. A significant difference was found between HCAI prevalence across SIMD quintile in patients undergoing surgical procedures, with higher prevalence observed with increasing deprivation (P = 0.0071). Variables associated with HCAI prevalence were: intensive care specialty, psychiatric and medical specialties, minimum invasive surgery, and all categories of length of stay., Conclusion: This study found a significant difference in HCAI prevalence across SIMD quintile in patients undergoing surgery. To our knowledge this was the first study to examine the overall association between HCAI and SIMD. The findings highlight the broad and comprehensive nature of social deprivation in determining health outcomes., (Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms but rarely cause infections. Clinical, microbiological and epidemiological investigations and subsequent management of a cluster of NTM bacteraemia on a haemato-oncology unit are reported. From October 2007 to July 2008, five patients being managed for haematological malignancies developed pyrexia and general malaise. Mycobacterium mucogenicum (four patients) and Mycobacterium neoaurum (one patient) were identified from their blood cultures. The environment, in particular the water system, was investigated to identify the source of the infection and multiple water samples were cultured according to established criteria. NTM were also isolated from the hospital water system. Central venous catheters (CVCs) were removed and the patients were successfully treated with antibiotics. Environmental measures and changes in CVC care were introduced to prevent further episodes of NTM bacteraemia in these patients. Despite these measures, NTM continued to be present in the water system, but new clinical cases were not identified. NTM are common environmental organisms and are recognized as being difficult to remove from water systems. CVCs were presumed to be the portal of entry in this cluster of NTM bacteraemia, and the implementation of changes to CVC care protocols was successful in preventing further infections in this immunocompromised patient group., (Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

The effect of different laboratory testing policies on the surveillance of rotavirus was assessed in eight laboratories between 1995 and 1998. In 1995, five laboratories tested all faecal specimens from children aged 5 years and under all year, two tested all specimens from children aged 4 years and under all year, and one tested all specimens from children aged 3 years and under between November and May only. Five laboratories changed their testing policy between 1995 and 1998. By 1998, three tested all specimens from children aged 5 years and under all year and two from the same age group during the 'season' only. Three laboratories had unique policies: one tested all specimens from children aged 2 years and under between January and June, one tested all specimens from children aged 4 years and under all year, and one tested specimens only on clinical request. The onset date of the rotavirus infection 'season' as determined by retrospective scrutiny of reported cases varied by up to 15 weeks between laboratories, starting as early as week 45 (November) and as late as week 13 (March). Laboratories with more restrictive testing policies yielded fewer reports of rotavirus and changes in policy within a particular laboratory affected the number of reports. Temporal and geographic trends were visible, even within the relatively small area covered by this study, and showed how laboratory testing policies affect surveillance data.

All 2000 employees of a hospital in an area of the North Thames region where 300,000 households were advised to boil tap water before consumption during a large outbreak of cryptosporidiosis were surveyed about compliance with and adverse events linked to the boil water notice. Eighty-five per cent (408/479) of respondents who lived in the boil water area said that they used boiled water while the notice was in place, 72% (347) used bottled water, and 12% (59) did not continue to boil water for the whole 16 days. Although 88% believed that they were following the advice, 20% washed food that would be eaten raw in unboiled tap water and 57% used it to clean their teeth. If a boil water notice is applied for more than a few days it may be helpful to issue a detailed follow up letter.