Aims: To identify changes in the presenting number and species of imported malaria in children in southwest London. Methods: A prospective single observer study over 25 years of all cases of paediatric malaria seen at St George's Hospital. Results: A confirmed diagnosis was made in 249 children (56% boys; 44% girls; median age 8.0 years). Of these, 53% were UK residents and 44% were children travelling to the UK. A significant increase was noted in the number of cases over the 25 years (1975-79: mean 4.8 cases/year; 1990-99: mean 13.7 cases/year). Over the 25 years Plasmodium falciparum was seen in 77%, P vivax in 14%, P ovale in 6%, and P malariae in 3% of cases. P falciparum had increased in frequency (1975-79: P falciparum 50%, P vivax 50%; 1990-99: P falciparum 82%, P vivax 6%), associated with an increase in the proportion of children acquiring their infection in sub-Saharan Africa. Median time between arrival in the UK to the onset of fever was: P falciparum, 5 days; P ovale, 25 days; P malariae, 37 days; and P vivax, 62 days. Median time interval between the onset of fever to commencement of treatment was 4 days. This had not improved over the 25 year period. Only 41% of UK resident children presenting to hospital had taken prophylaxis and the overall number of symptomatic children taking no prophylaxis was increasing. Conclusion: Imported childhood P falciparum malaria is increasing in southwest London associated with increasing travel from sub-Saharan Africa. Over the 25 year period there has been no improvement in chemoprophylaxis rates or time to diagnosis. M alaria is widely prevalent throughout the tropics and subtropics. Annually it affects 300-500 million people, with 1.5-2.7 million deaths estimated each year.1 An increasing number of families in the UK are travelling to tropical destinations every year, both as tourists and returning to visit families resident abroad. A recent study suggests that the proportion of travellers not taking adequate prophylaxis is rising.2 There is already evidence of an increasing incidence of imported malaria in the UK in adults.3 More children are travelling to malarial areas each year, leading to an increasing number of cases of imported paediatric malaria in the UK. 4 In the London Borough of Wandsworth, nearly a quarter of the population are from an ethnic minority background. At St George's Hospital we had noted that families returning to their country of origin often assumed that their children born in the UK would be immune to malaria, and did not require prophylaxis. We therefore studied the changing pattern of the incidence and species of imported malaria in children over the past 25 years in Wandsworth, and the uptake of prophylaxis. We were also interested to determine whether there had been any improvement in the time to the diagnosis of imported malaria. SUBJECTS AND METHODSProspective data collection was performed over a 25 year period from 1975 to end 1999. All children from birth to 16 years presenting to St George's Hospital, with a confirmed diag...

In the absence of formal guidelines, IGRA-based screening for LTBI was infrequently performed. Our data suggests that screening and treatment of renal transplant recipients born in high incidence countries is an important preventive measure.

IntroductionIn 2014, over 500 workers in a local factory were screened for TB. 3 cases of active pulmonary TB were identified and seen in the next weekly TB Clinic. 128 workers were identified for further assessment by the local TB Service, of whom 100 were found to be IGRA-reactive. This was declared a major incident and a TB Action Group was set up to facilitate additional out-of-hours TB clinics.MethodsThe local CCG commissioned the additional TB clinics at standard respiratory out-patient tariff: approximately 35 workers were to be assessed by 5 TB clinicians in 2 weekly sessions (18:00–21:00 – 20 min slots) for the first 2 weeks, so that by week 3, all workers would be assessed. As in the weekly TB Clinic, the TB Pharmacy Team would be present to dispense TB medication with drug information leaflets and contact details. Chemoprophylaxis for LTBI was offered to all workers with reactive IGRA and no evidence of active TB independent of their age despite NICE guidance.ResultsOf the 100 workers with reactive IGRA: 18 did not attend; 82 were offered chemoprophylaxis of whom 15 declined treatment; 67 started chemoprophylaxis of whom only 33 completed 3 months treatment with rifampicin and isoniazid. The rate of completion of chemoprophylaxis in the eligible group was 9/35 (25.7%) compared to 24/47 (51.1%) in the over 35 year olds. There was a transient rise in liver enzymes in 1 worker aged over 35 but otherwise there were no other significant side-effects.DiscussionIt is difficult to deny chemoprophylaxis for LTBI infection on the basis of age in a large screening event such as this when the average age is 40 (range 17–63) and the oldest member of the cohort tolerated chemoprophylaxis without significant side-effects. The reasons for reluctance to continue chemoprophylaxis in this cohort are poorly understood although lifestyle issues such as reducing alcohol consumption were perceived to be barriers to successful completion of treatment.ConclusionChemoprophylaxis for LTBI in this cohort was not tolerated in the eligible population. When undertaking mass screening, it is important to ensure that non-standard treatment is funded, if this is to be offered. Treatment of the over 35s significantly increased the workload and cost of this cohort, although uptake of chemoprophylaxis and successful completion was twice that of the workers aged 35 or less.

Introduction and aimsAlthough two thirds of smokers wish to quit, referral, uptake and engagement with smoking cessation (SC) services are frequently poor. In Leicester, uptake of smoking cessation referred from secondary care is approximately 20% with successful quit rate at four weeks of 10%. Provision of immediate support through smoking cessation specialist advice provided at the point of clinical assessment in outpatients might enhance referral uptake and quit rates. We assessed the value of this “in-clinic” approach in specialist respiratory outpatient clinics in two secondary care centres.MethodsProvision of immediate smoking cessation advice was implemented in two outpatient clinic services providing specialist care for patients with complex, chronic obstructive pulmonary disease (COPD); an Acute General Hospital (Peterborough City Hospital, PCH) and a Tertiary Care Hospital (Glenfield Hospital, GH). All current smokers were referred to an on-site smoking cessation specialist advisor by the physician, or clinic nurse, as part of their outpatient review on the same day of their clinic visit.In the Glenfield service SC was provided by a smoking cessation specialist, using a harm reduction approach with a guided patient-led tailored programme and the possibility of direct supply treatment at the initial assessment.In the PCH service, SC using psychosocial and/or pharmacological therapy was undertaken by a dedicated smoking cessation officerFollow-up visits and telephone calls were arranged separately by the smoking service and data including demographics, treatment uptake and quit rates after 4 weeks were analysed.ResultsA population of 122 smokers with a diagnosis of COPD were assessed for in-clinic SC over a period of twelve months in both centres.Demographic details of both cohorts, outcomes of both SC strategies including treatment uptake and quit rates are disclosed in Table 1.ConclusionsProviding “in-clinic”, expert smoking cessation advice results in favourable referral uptake and four week quit rates when compared with locally available data from paper based referral routes. Reinforcing physician delivered smoking cessation advice through immediate provision of proactive cessation support may be an effective means to enhance quit rates in secondary care.Abstract S124 Table 1Smoking cessation outcomesIn-Clinic SC Approach at Peterborough HospitalIn-Clinic SC Approach at Glenfield HospitalN patients referred6557Age (years) (mean, [SD])61.3 [9]61.1 [9]Gender53% Male53% MaleApproach to SCConventionalHarm ReductionTreatment Uptake (% of N)32 (49%)29 (50%)SC managed after 4 weeks (% of N)29 (44%)16 (28%)