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In September 2018, monkeypox virus was transmitted from a patient to a healthcare worker in the United Kingdom. Transmission was probably through contact with contaminated bedding. Infection control precautions for contacts (vaccination, daily monitoring, staying home from work) were implemented. Of 134 potential contacts, 4 became ill; all patients survived.

Indigenous, foodborne transmission of hepatitis E virus genotype 3 (HEV G3) has become recognized as an emerging problem in industrialized countries. Although mostly asymptomatic, HEV G3 infection has a range of outcomes, including mild illness, severe acute hepatitis, and, of particular concern, chronic progressive hepatitis in immunocompromised patients. Public Health England has monitored cases of acute HEV infection in England and Wales since 2003. Between 2010 and 2017, enhanced surveillance using 2 linked laboratory databases and questionnaires on clinical features and risk factors was conducted. There was a year-on-year increase in the number of infections from 2008 (183) through 2016 (1243). Then, in 2017, the number of infections declined (to 912). As reported previously, HEV G3 group 2 (also known as “G3 abcdhij”) is the predominant cause of acute infections, and older men are most at risk. Consumption of pork and pork products was significantly higher among patients than in the general population, but other previously reported associations, such as consumption of shellfish, were not observed. Ongoing surveillance is required to monitor future trends and changes in the epidemiology of the virus. The changing methods of animal husbandry and processing and distribution of animal products needs to be further investigated.

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in England. Substantial yearly increases of autochthonous infections were observed during 2003-2016 and again during 2017-2019. Previous studies associated acute HEV cases with consumption of processed pork products, we investigated risk factors for autochthonous HEV infections in the blood donor population in England. Study participants were 117 HEV RNA-positive blood donors and 564 HEV RNA-negative blood donors. No persons with positive results were vegetarian; 97.4% of persons with positive results reported eating pork products. Consuming bacon (OR 3.0, 95% CI 1.7-5.5; p<0.0001), cured pork meats (OR 3.5, 95% CI 2.2-5.4; p<0.0001), and pigs' liver (OR 2.9, 95% CI 1.0-8.3; p = 0.04) were significantly associated with HEV infection. Our findings confirm previous links to pork products and suggest that appropriate animal husbandry is essential to reduce the risk for HEV infection.

Background. Enhanced surveillance and molecular characterisation studies of hepatitis E virus (HEV) in England and Wales have been undertaken since 2003. The dynamics of hepatitis E have changed recently with an increase in the number of indigenous cases and an observed viral shift. Methods. HEV antibody and RNA data were analysed to ascertain the annual number of acute infections, the HEV genotype disposition and viral phylogeny. These data were investigated in the context of collected travel history and demographic data. Results. In total, 2713 acute hepatitis E cases were diagnosed, of which 1376 were indigenous infections. Travel associated cases remained steady and mainly associated with Genotype 1 infections. In contrast, major fluctuations were noted in indigenously-acquired cases with a dramatic year on year increase during 2010-2012. Molecular characterisation demonstrated indigenous infections to cluster into two distinct phylogenetic groups with the emergence of a novel group of Genotype 3 viruses coinciding with the recent increase in cases. Conclusions. HEV infection rates are dynamic in England and Wales, influenced by changing trends in indigenously-acquired cases. The recent increase in indigenous cases and the emergence of indigenous viruses not commonly circulating prior to 2010 suggest that the risk of acquiring HEV has changed.

Vibrio cholerae non-01 and V. mimicus, isolated from clinical and environmental sources, were examined for factors related to virulence. The aim was to identify factors which would distinguish pathogenic from non-pathogenic strains and to establish a correlation, if any, with serogroup. The lipopolysaccharide (LPS) of epidemic V. cholerae belonging to serogroups 01 and 0139 are regarded as'virulence factors. In this study certain other serogroups, such as 02,05 and 09 were associated with diarrhoeal disease. LPS of these organisms may have a role in adhesion. Although 90% of V. cholerae non-01 and V. mimicus colonised tissue culture cells, neither smooth LPS, the presence of flagella nor the possession of the toxin coregulated pilus gene (tcpA) were essential for adhesion. Cholera toxin (CT) is the factor responsible for the dramatic symptoms of epidemic cholera and is produced by V. cholerae serogroups 01 and 0139. However, less than 1% of V. cholerae non-01, non-0139 and V. mimicus possessed the gene for CT. Southern blot analysis of the CT genes revealed that most strains carried one CT gene except for serogroups 023 and 0139 which had two hybridising fragments. The variations in fragment size within the 0139 serogroup suggested that this serogroup was not strictly clonal. In addition to CT both V. cholerae non-01 and V. mimicus expressed several other toxins, often concurrently, which made detection of specific toxins difficult. Over 80% of strains produced haemolysin(s) and cytotoxin(s). The cytotoxic effects on tissue culture cells masked cytotonic effects, such as that caused by CT. V. cholerae and V. mimicus did not produce verocytotoxin (VT) and did not possess the genes for VT. The heat-stable enterotoxin (NAG-ST) gene was found in 3% of V. cholerae non-01 and 12% of V. mimicus strains. All V. cholerae strains belonging to serogroup 014, were NAG-ST positive and Southern blot analysis of the NAG-ST genes suggested that this serogroup represented a single clone. In addition to the established toxins two novel factors, which may contribute to the virulence of V. cholerae non-01 and V. mimicus, were found. A novel cytotoxin, produced by 16% of strains, was expressed on Vero cells causing vacuolation of cell cytoplasm. Another putative \"toxin\" found in 19% of strains was demonstrated in a GMI-ELISA. This \"toxin\" had the ability to bind ganglioside GMI and shared antibody binding sites with CT. V. cholerae non-01 and V. mimicus also expressed species specific high affinity iron chelating molecules; 74% of V. cholerae non-01 produced enterochelin, whereas 90% of V. mimicus produced aerobactin. Aerobactin production is usually associated with invasive organisms and is unusual among Vibrio spp. None of the virulence factors, except CT, was more prevalent in clinical than in environmental strains. This is perhaps not surprising as vibrio-associated disease is often linked with exposure to the aquatic environment or consumption of seafood. Within V. cholerae the 01 and 0139 serogroups were linked with CT and 014 with NAG-ST, in future, other serogroup - virulence factor associations may be found. For V. mimicus the main virulence factors expressed were aerobactin and NAG-ST. Therefore the pathogenicity of V. cholerae and V. mimicus appears to be multifactorial and it is likely that, as with diarrhoeagenic, E. coli, a heterogeneous pattern of virulence will be found.

Objective: Excessive screen exposure that negatively affects a person's life is called problematic media use. Problematic media uses in healthy children is associated with a sedentary lifestyle and negative health outcomes. Problematic media use and its negative effects on attention are a subject of debate. Methods: We screened children between the ages of 5 and 6 who visited the pediatric department. One hundred and eighty-six children were included in the study. Demographic data were collected from the patients and their families. Additionally, daily screen exposure times were evaluated. The long form of the Problematic Media Use Scale (screen addiction scale), which is valid for ages 4-11, and the Frankfurter Concentration Test for 5-6 Year Old Children (FTF-K) were applied to all participants. Results: Children using multiple screens had significantly higher problematic media use scores and screen time compared to those using only television (p=0.003, p=0.017). No statistically significant relationship was found between children's age, screen addiction scale scores, screen exposure duration, and final FTF-K test scores (p>0.05). A significant positive correlation was found between the number of siblings and screen addiction scale scores, and screen exposure duration; (r=0.19, p=0.010), (r=0.20, p=0.007). Conclusion: Problematic media use and exposure duration in preschool children were not found to have a direct relationship with attention. Keywords: Screen exposure, attention development, FTF-K test, screen addiction, children, problematic media use