Where now for infection services in the NHS? What about children?

Editor – We agree with Llewelyn et al that a fundamental review of NHS infection service provision is required.¹ However, we would suggest that this review should also include children's infection linked with the adult services they describe.

Llewelyn et al advocate ‘removing barriers to training and service delivery’ and ‘training encompassing all aspects of infection service provision’. We would support these suggestions but feel they should be expanded to included paediatric infection.

Children's infection services have repeatedly been left out of recent attempts to improve infection services in the UK, despite a formal NHS England specialist service specification.² The best practice standards for the delivery of NHS infection services specifically excludes paediatric infection services, as these were felt to be ‘outwith the scope of this document’.³ Training in microbiology is not accessible for those with paediatric experience, only those who have undertaken training in adult internal medicine.⁴ The majority of infection diagnostic laboratories will process samples for a paediatric population, but experience in Paediatric infection for those running these laboratories is becoming increasingly limited.

Children can be more affected by certain infections than adults (eg scarlet fever, respiratory syncytial virus), but may be the source of these infection to vulnerable adults. Conversely children can be affected by chronic infections in adult family members such as TB, HIV and hepatitis B and C. Managing all family members with the infection in a joined-up way is thus required.

An example of integrating adult and paediatric infection services is the NHS England High Consequence Infectious Diseases (Airborne) Network. This network specifically commissioned to jointly manage adults and children has proved invaluable as the UK has recently seen its first cases of paediatric high consequence infectious diseases, all of whom had parents affected with the same illness and needing care from both adult and paediatric infection specialists.^5,6

We would suggest that any fundamental review of NHS infection services should include paediatric infectious diseases as well as adult infectious diseases, microbiology and virology. If a national network of specialised infectious diseases units is developed, then linked paediatric infection units need to be specifically aligned.