Health Protection Scotland

Biofilms represent highly structured microbial communities embedded in an extracellular matrix, exhibiting profound resilience against environmental stresses and antimicrobial interventions. While the bacterial and fungal components of biofilms are well characterized, the influence of viruses—either as active participants in biofilm formation or as modulators during coinfection—remains underexplored. This review synthesizes current evidence on viral interactions with biofilms, highlighting their roles in promoting microbial attachment, sustaining growth, enhancing virulence, and facilitating dispersal and transmission. Examples include viral modulation of host receptors to promote bacterial adherence, the impact of influenza and respiratory syncytial virus on biofilm expansion in respiratory diseases, and herpes simplex virus contributions to fungal and bacterial biofilm dynamics. Moreover, viral–biofilm interactions complicate therapeutic outcomes by enabling persistence, immune evasion, and reservoirs of infection. We also discuss emerging strategies targeting these complex interactions, including antivirals with antibiofilm activity and novel therapeutics such as antimicrobial peptides and iron chelation in cystic fibrosis. By elucidating mechanisms of viral influence on biofilms, this review underscores the importance of incorporating virological perspectives into biofilm research, with implications for both clinical management and the development of innovative treatment strategies.

Routine laboratory surveillance has identified an unprecedented and ongoing exceedance of Cryptosporidium spp. across the United Kingdom, notably driven by C. hominis transmission, since 14 August 2023. Information from 477 reported cases in England and Wales, followed up with a standardised exposure questionnaire as of 25 September 2023, identified foreign travel in 250 (54%) of 463 respondents and swimming in 234 (66%) of 353 cases. A significant, common exposure has not yet been identified in first analyses.

ABSTRACTObjectivesTo investigate rates of mpox beliefs, knowledge, and intended behaviours in the general population and in gay, bisexual or other men who have sex with men (GBMSM), and factors associated with intended behaviours. To test the impact of motivational messages (vs a factual control) on intended behaviours.DesignCross-sectional online survey including a nested randomised controlled trial.SettingData collected 5 September to 6 October 2022.ParticipantsParticipants were aged 18 years and over and lived in the UK (general population). In addition, GBMSM were male, and gay, bisexual or had sex with men. The general population sample was recruited through a market research company. GBMSM were recruited through a market research company, the dating app Grindr, and targeted adverts on Meta (Facebook and Instagram).Main outcome measuresIntention to self-isolate, seek medical help, stop all sexual contact, share details of recent sexual contacts, and accept vaccination.ResultsSocio-demographic characteristics differed by sample. There was no effect of very brief motivational messaging on behavioural intentions. Respondents from Grindr and Meta were more likely to intend to seek help immediately, completely stop sexual behaviour and be vaccinated or intend to be vaccinated, but being less likely to intend to self-isolate (ps<0.001). In the general population sample, intending to carry out protective behaviours was generally associated with being female, older, having less financial hardship, greater worry, higher perceived risk to others, and higher perceived susceptibility to and severity of mpox (ps<0.001). There were fewer associations with behaviours in the Grindr sample, possibly due to reduced power.ConclusionsGBMSM were more likely to intend to enact protective behaviours, except for self-isolation. This may reflect targeted public health efforts and engagement with this group. Associations with socio-economic factors suggests that providing financial support may encourage people to engage with protective behaviours.STRENGTHS AND LIMITATIONSAnonymous cross-sectional survey in large samples of the general population and men who are gay, bisexual, or have sex with men (recruited from a market research company, the dating app Grindr, and targeted adverts on Meta [Facebook and Instagram]).Data collection occurred over a short period (5 September to 6 October 2022) during the mpox outbreak.Responses may have been affected by social desirability or recall bias, although the anonymous nature of the survey should mitigate this somewhat.Socio-demographic characteristics differed by sample. Participants recruited from Grindr and Meta were more likely to be working, highly educated, of higher socio-economic grade, and have less financial hardship.We measured behavioural intentions. Rates of engagement with behaviours may be lower. Factors associated with intentions should still be valid.

Abstract ObjectivesTo investigate UK parents’ vaccination intention at a time when COVID-19 vaccination was available to some children.Study designData reported are from the second wave of a prospective cohort study.MethodsOnline survey of 270 UK parents (conducted 4-15 October 2021). At this time, vaccination was available to 16- and 17-year-olds and had become available to 12- to 15- year-olds two weeks prior. We asked participants whose child had not yet been vaccinated how likely they were to vaccinate their child for COVID-19. Linear regression analyses were used to investigate factors associated with intention. Parents were also asked for their main reasons behind vaccination intention. Open-ended responses were analysed using content analysis.ResultsParental vaccination intention was mixed (likely: 39.3%, 95% CI 32.8%, 45.7%; uncertain: 33.9%, 27.7%, 40.2%; unlikely: 26.8%, 20.9%, 32.6%). Intention was associated with: parental COVID-19 vaccination status; greater perceived necessity and social norms regarding COVID-19 vaccination; greater COVID-19 threat appraisal; and lower vaccine safety and novelty concerns. In those who intended to vaccinate their child, the main reasons for doing so were to protect the child and others. In those who did not intend to vaccinate their child, the main reason was safety concerns.ConclusionsParent COVID-19 vaccination and psychological factors explained a large percentage of the variance in vaccination intention for one’s child. How fluctuating infection rates, more children being vaccinated, and the UK’s reliance on vaccination as a strategy to live with COVID-19 may impact parents’ intention to vaccinate their child requires further study.

BackgroundThe COVID-19 pandemic’s impact on people with asthma is poorly understood. We hypothesised that lockdown restrictions were associated with reductions in severe asthma exacerbations requiring emergency asthma admissions and/or leading to death.MethodsUsing data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we compared weekly counts of emergency admissions and deaths due to asthma over the first 18 weeks in 2020 with the national averages over 2015–2019. We modelled the impact of instigating lockdown on these outcomes using interrupted time-series analysis. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations. We also investigated trends in asthma-related primary care prescribing and emergency department (ED) attendances in Wales.ResultsLockdown was associated with a 36% pooled reduction in emergency admissions for asthma (incidence rate ratio, IRR: 0.64, 95% CI: 0.49 to 0.83, p value 0.001) across both countries. There was no significant change in asthma deaths (pooled IRR: 0.57, 95% CI: 0.17 to 1.94, p value 0.37). ED asthma attendances in Wales declined during lockdown (IRR: 0.85, 95% CI: 0.73 to 0.99, p value 0.03). A large spike of 121% more inhaled corticosteroids and 133% more oral corticosteroid prescriptions was seen in Wales in the week before lockdown.ConclusionsNational lockdowns were associated with substantial reductions in severe asthma exacerbations leading to hospital admission across both Scotland and Wales, with no corresponding increase in asthma deaths.

ObjectivesTo describe the epidemiology, age at infection, clinical characteristics and outcome of listeria infection in young infants to inform management and empiric antibiotic choice in young infants.DesignProspective 2-year surveillance of Listeria monocytogenes infection in young infants detected through the British Paediatric Surveillance Unit ‘orange card’ system and triangulated with the public health laboratories.SettingNational population study (England, Wales, Scotland and the Ireland)PatientsAll infants under 90 days with proven or probable invasive listeriosisMain outcome measuresIncidence, mortality, age of infection, clinical characteristics and outcomeResultsDuring a 2-year period (2017–2019), 27 cases of listeriosis in infants <90 days of age were reported. The incidence of listeriosis in this study was 1.8 per 100 000 live births with 7% mortality (2/27). Nearly all cases presented within the first 24 hours of life (26/27). The majority (20/27, 74%) were born preterm and 16/24 (67%) were born to women from ethnic minority backgrounds.ConclusionsInvasive listeriosis in young infants in the UK and Ireland is rare and presents early in the neonatal period. National guidelines that recommend the use of amoxicillin as part of empiric regimes for sepsis and meningitis in infants over 1 month of age should be modified.

BACKGROUND Social media has become an established platform for individuals to discuss and debate various subjects, including vaccination. With growing conversations on the web and less than desired maternal vaccination uptake rates, these conversations could provide useful insights to inform future interventions. However, owing to the volume of web-based posts, manual annotation and analysis are difficult and time consuming. Automated processes for this type of analysis, such as natural language processing, have faced challenges in extracting complex stances such as attitudes toward vaccination from large amounts of text. OBJECTIVE The aim of this study is to build upon recent advances in transposer-based machine learning methods and test whether transformer-based machine learning could be used as a tool to assess the stance expressed in social media posts toward vaccination during pregnancy. METHODS A total of 16,604 tweets posted between November 1, 2018, and April 30, 2019, were selected using keyword searches related to maternal vaccination. After excluding irrelevant tweets, the remaining tweets were coded by 3 individual researchers into the categories &lt;i&gt;Promotional&lt;/i&gt;, &lt;i&gt;Discouraging&lt;/i&gt;, &lt;i&gt;Ambiguous&lt;/i&gt;, and &lt;i&gt;Neutral or No Stance&lt;/i&gt;. After creating a final data set of 2722 unique tweets, multiple machine learning techniques were trained on a part of this data set and then tested and compared with the human annotators. RESULTS We found the accuracy of the machine learning techniques to be 81.8% (&lt;i&gt;F&lt;/i&gt; score=0.78) compared with the agreed score among the 3 annotators. For comparison, the accuracies of the individual annotators compared with the final score were 83.3%, 77.9%, and 77.5%. CONCLUSIONS This study demonstrates that we are able to achieve close to the same accuracy in categorizing tweets using our machine learning models as could be expected from a single human coder. The potential to use this automated process, which is reliable and accurate, could free valuable time and resources for conducting this analysis, in addition to informing potentially effective and necessary interventions. CLINICALTRIAL

Abstract Background and aimsWorking from home where possible is important in reducing spread of Covid-19. In early 2021, a quarter of people in England who believed they could work entirely from home reported attending their workplace. To inform interventions to reduce this, this study examined associated factors.MethodsData from the ongoing CORSAIR survey series of nationally representative samples of people in the UK aged 16+ years in January-February 2021 were used. The study sample was 1422 respondents who reported that they could work completely from home. The outcome measure was self-reported workplace attendance at least once during the preceding week. Factors of interest were analysed in three blocks: 1) sociodemographic variables, 2) variables relating to respondents’ circumstances, and 3) psychological variables.Results26.8% (95%CI=24.5%-29.1%) of respondents reported having attended their workplace at least once in the preceding week. Sociodemographic variables and living circumstances significantly independently predicted non-essential workplace attendance: male gender (OR=1.85,95%CI=1.33-2.58), dependent children in the household (OR=1.65,95%CI=1.17-2.32), financial hardship (OR=1.14,95%CI=1.08-1.21), socio-economic grade C2DE (OR=1.74, 95%CI=1.19-2.53), working in sectors such as health or social care (OR=4.18, 95%CI=2.56-6.81), education and childcare (OR=2.45, 95%CI=1.45-4.14) and key public service (OR=3.78, 95%CI=1.83-7.81), and having been vaccinated (OR=2.08,95%CI=1.33-3.24).ConclusionsNon-essential workplace attendance in the UK in early 2021 during the Covid-19 pandemic was significantly independently associated with a range of sociodemographic variables and personal circumstances. Having been vaccinated, financial hardship, socio-economic grade C2DE, having a dependent child at home, working in certain key sectors were associated with higher likelihood of workplace attendance.