SUMMARYRespiratory syncytial virus (RSV) infection produces more severe disease and increased hospitalization rates in high-risk babies. The monoclonal antibody palivizumab offers protection against complications, and the first of five monthly doses should be administered before the onset of community RSV activity. However, the required real-time prediction of this onset is problematic. We attempted to identify seasonal RSV patterns by retrospectively examining 10 years of laboratory reports for RSV and clinical episode reports for certain respiratory presentations in both primary and secondary care. Analysis of hospital laboratory reports, incidence of acute bronchitis in primary care, and hospital admissions for acute bronchitis and bronchiolitis in young children revealed a consistent increase in RSV activity during week 43 each year. Promptly commencing prophylaxis during the second week of each October (week 42) would precede the onset of the RSV season in the United Kingdom, and provide coverage until its decline in mid-March.Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection in young children ; its manifestations include bronchiolitis in infants/young children, and acute bronchitis in older children [1,2]. Approximately 80 % of children are infected by 2 years of age, but re-infection can occur throughout life. RSV infection is the commonest cause of hospitalization in children aged <1 year [3], and it causes more severe disease in high-risk infants. Early data suggest a possible association between RSV infection in children with chronic lung disease who were born prematurely, and chronic respiratory morbidity [4]. The UK Joint Committee on Vaccination and Immunisation advises that the RSV-monoclonal antibody, palivizumab, should be offered prophylactically to babies under 2 years of age with severe chronic lung disease, who are on home oxygen during the RSV season and on a case-bycase basis for babies with rare conditions such as multiple congenital abnormalities or severe immunodeficiency [5].Thresholds for community influenza activity are used to trigger the use of neuraminidase inhibitors in high-risk patients [6,7], although the intervention of choice in these patients remains prevention through vaccination. In contrast, RSV activity cannot be employed in the same way to trigger the use of palivizumab. Laboratory data are subject to reporting delays, and therefore cannot be used for real-time decision making. In addition, the first dose of palivizumab should be given prior to the onset of RSV activity and there are limited data to support its use beyond five doses at monthly intervals. Thus, waiting until laboratory data indicate that RSV is circulating risks starting therapy too late ; conversely, starting therapy too far in advance of RSV activity risks giving This retrospective study aimed to identify patterns in seasonal RSV activity by examining 10 years of laboratory data on RSV isolations, the incidence of acute bronchitis in primary care, and hospi...

A mixed infection of a single tick or host by Lyme disease spirochetes is common and a unique challenge for the diagnosis, treatment, and surveillance of Lyme disease. Here, we describe a novel protocol for differentiating Lyme strains on the basis of deep sequencing of the hypervariable outer surface protein C locus (). Improving upon the traditional DNA-DNA hybridization method, the next-generation sequencing-based protocol is high throughput, quantitative, and able to detect new pathogen strains. We applied the method to more than one hundred infected ticks collected from New York State, USA, in 2015 and 2016. An analysis of strain distributions within individual ticks suggests an overabundance of multiple infections by five or more strains, inhibitory interactions among coinfecting strains, and the presence of a new strain closely related to A supporting bioinformatics pipeline has been developed. The newly designed pair of universal primers target intergenic sequences conserved among all known Lyme pathogens. The protocol could be used for culture-free identification and quantification of Lyme pathogens in wildlife and potentially in clinical specimens.