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

Andrew Riordan, Saul N Faust and Elizabeth Whittaker
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DOI: https://doi.org/10.7861/clinmed.Let.23.2.2
Clin Med March 2023
Andrew Riordan
Alder Hey Children's NHS Foundation Trust, Liverpool, UK; paediatric lead, NHS England High Consequence Infectious Diseases (Airborne) Network
Roles: Consultant in paediatric infectious diseases and immunology
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Saul N Faust
University of Southampton, Southampton, UK; consultant in paediatric immunology and infectious diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK
Roles: Professor in paediatric immunology and infectious diseases
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Elizabeth Whittaker
Imperial College, London, UK; convenor, British Paediatric Allergy, Immunity and Infection Group
Roles: Senior clinical lecturer and consultant in paediatric infectious diseases and immunology
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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.

  • © Royal College of Physicians 2023. All rights reserved.

References

  1. ↵
    1. Llewelyn MJ
    , Price N, Ratnaraja N, et al. Where now for infection services in the NHS? How lessons from the pandemic should drive long-overdue integration of microbiology and infectious diseases. Clin Med 2022;22:586–9.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. NHS England
    . 2013/14 NHS standard contract for paediatric medicine: immunology and infectious diseases - service specifications. www.england.nhs.uk/wp-content/uploads/2013/06/e03-paedi-medi-immun-infec-disease.pdf [Accessed 3 Jan 2023].
  3. ↵
    1. Ratnaraja NVDV
    , Davies AP, Atkins BL, et al. Best practice standards for the delivery of NHS infection services in the United Kingdom. Clin Infect Pract 2021;12:100095.
    OpenUrl
  4. ↵
    1. Joint Royal College of Physicians Training Board
    . Rough guide to infection specialties curricula. JRCPTB, 2021. Available from www.jrcptb.org.uk/documents/rough-guide-infection-specialties-2021-curricula-0 [Accessed 29 Dec 2022].
  5. ↵
    1. Adler H
    , Gould S, Hine P, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis 2022;22:1153–62.
    OpenUrlPubMed
  6. ↵
    1. Ramnarayan P
    , Mitting R, Whittaker E, et al. Neonatal monkeypox virus infection. N Engl J Med 2022;387:1618–20.
    OpenUrl
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Where now for infection services in the NHS? What about children?
Andrew Riordan, Saul N Faust, Elizabeth Whittaker
Clinical Medicine Mar 2023, 23 (2) 190-191; DOI: 10.7861/clinmed.Let.23.2.2

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Where now for infection services in the NHS? What about children?
Andrew Riordan, Saul N Faust, Elizabeth Whittaker
Clinical Medicine Mar 2023, 23 (2) 190-191; DOI: 10.7861/clinmed.Let.23.2.2
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