Burden Of Communicable Diseases In Europe Research Articles

Impact of twelve immunization-preventable infectious diseases on population health using disability-adjusted life years (DALYs) in Spain

BackgroundThe objective of this study is to estimate the burden of selected immunization-preventable infectious diseases in Spain using the Burden of Communicable Diseases in Europe (BCoDE) methodology, as well as focusing on the national immunization programme and potential new inclusions.MethodsThe BCoDE methodology relies on an incidence and pathogen-based approach to calculate disease burden via disability-adjusted life year (DALY) estimates. It considers short and long-term sequelae associated to an infection via outcome trees. The BCoDE toolkit was used to populate those trees with Spanish-specific incidence estimates, and de novo outcome trees were developed for four infections (herpes zoster, rotavirus, respiratory syncytial virus [RSV], and varicella) not covered by the toolkit. Age/sex specific incidences were estimated based on data from the Spanish Network of Epidemiological Surveillance; hospitalisation and mortality rates were collected from the Minimum Basic Data Set. A literature review was performed to design the de novo models and obtain the rest of the parameters. The methodology, assumptions, data inputs and results were validated by a group of experts in epidemiology and disease modelling, immunization and public health policy.ResultsThe total burden of disease amounted to 163.54 annual DALYs/100,000 population. Among the selected twelve diseases, respiratory infections represented around 90% of the total burden. Influenza exhibited the highest burden, with 110.00 DALYs/100,000 population, followed by invasive pneumococcal disease and RSV, with 25.20 and 10.57 DALYs/100,000 population, respectively. Herpes zoster, invasive meningococcal disease, invasive Haemophilus influenza infection and hepatitis B virus infection ranked lower with fewer than 10 DALYs/100,000 population each, while the rest of the infections had a limited burden (< 1 DALY/100,000 population). A higher burden of disease was observed in the elderly (≥ 60 years) and children < 5 years, with influenza being the main cause. In infants < 1 year, RSV represented the greatest burden.ConclusionsAligned with the BCoDE study, the results of this analysis show a persisting high burden of immunization-preventable respiratory infections in Spain and, for the first time, highlight a high number of DALYs due to RSV. These estimates provide a basis to guide prevention strategies and make public health decisions to prioritise interventions and allocate healthcare resources in Spain.

Burden of healthcare-associated infections in Italy: incidence, attributable mortality and disability-adjusted life years (DALYs) from a nationwide study, 2016

Healthcare-associated infections (HAIs) are an increasing public health threat. Measuring disease burden in disability-adjusted life-years (DALYs) allows the combination of morbidity and mortality into one figure, as it represents the summation of years lived with disability and years of life lost. To evaluate the incidence, attributable deaths and burden of the most significant HAIs in Italy. Prevalence data from the study sample of the 2016 national Point Prevalence Survey of HAIs in acute-care settings were used to estimate the incidence of five HAIs. The methodology from the Burden of Communicable Diseases in Europe (BCoDE)-project was employed for DALY calculations, adapting the disease models to the Italian population. We estimated a total of 641,065 (95% uncertainty interval, UI 585,543.00-699,207.90) new yearly cases of HAIs and 29,375 (95% UI 23,705.97-35,905.80) deaths in Italy in 2016. The total annual DALYs were estimated to be 424,657.45 (95% UI 346,240.35-513,357.28), corresponding to 702.53 DALYs (95% UI 575.22-844.66) per 100,000 general population. Bloodstream infections accounted for the majority of total DALYs (59%), healthcare-associated pneumonia for 29%, surgical site infections for 9%, CDI for 2% and urinary tract infections accounted for less than 1% of total DALYs. Results of this study suggest HAIs have a substantial burden in Italy. Reducing the burden of HAIs through infection prevention and control efforts is an achievable goal. This study provides data that could be used to guide policy-makers in the implementation of these measures.

Burden of Healthcare-Associated Infections in Italy: Disability-Adjusted Life Years

Abstract Background Healthcare-Associated Infections (HAIs) significantly increase adverse clinical outcomes and healthcare costs. In 2016 Italy participated in the second European Centre for Disease Prevention and Control (ECDC) Point Prevalence Survey (PPS) of HAIs and antimicrobial use in acute care hospitals. The aim of this study was to estimate the burden of the 5 most common HAIs in Italy, by evaluating incidence, attributable deaths, Years of Life Lost (YLL), Years Lived with Disability (YLD) and Disability-Adjusted Life-Years (DALYs). Methods National PPS data were used to establish sex- and age-specific incidence of Healthcare-associated Pneumonia (HAP), HA Urinary tract infections (HA UTI), HA Bloodstream Infections (HA BSI) excluding neonatal BSI, Surgical Site Infections (SSI), HA Clostridium Difficile infections (HA CDI). Patients' life expectancy was adjusted according to the severity of underlying conditions using the McCabe score. Following the methodology from the Burden of Communicable Diseases in Europe (BCoDE)-project, an adapted version of the disease models of the BCoDE toolkit was used. Results An overall yearly incidence of 643434 new cases of HAI in Italy was estimated. The aggregate burden of the 5 HAIs was 426411.98 DALYs (86731.03 YLD + 339680.96 YLL), corresponding to 702.53 DALYs per 100000 total population. HA BSI and HAP had the highest burden with respectively 253868.22? and 126038.26 DALYs. The population strata with the highest burden were the ones with McCabe Score 1 for every considered HAI. The age groups with the highest burden were 70-74 for male and 45-49 for female patients. In total, 56% of DALYs were attributable to men and 44% to women. Conclusions This nation-wide study found a significant burden of disease due to HAIs in Italy. Results of this study could be used to guide policy-makers in the implementation of measures aiming to reduce the impact of HAIs. Key messages This study estimated the burden of 5 HAIs in Italy was 426411.98 DALYs (86731.03 YLD + 339680.96 YLL according to 2016 PPS data. Considering the significant burden of HAIs found in this study, infection prevention and control measures should be a Public Health priority in Italy.

The Burden of Antimicrobial Resistant Infections in Wales: a population-level modelling analysis

Abstract Background Antimicrobial Resistance (AMR) threatens the sustainability of an effective, global public health response to infectious disease. This study uses routine surveillance data to estimate the public health burden (PHB) of AMR infections in Wales for the period 2017-19, with further stratification by Age, Sex, local Health Board (HB) area and relative deprivation, to guide public health action. Methods Welsh AMR Surveillance data, collected as part of the European AMR Surveillance Network (EARS-Net), was collated for the period 2017-19. Adapting the methodology of the European Centres for Disease Control Burden of Communicable Diseases in Europe (BCoDE), we modelled the PHB of five types of antibiotic-resistant infection (invasive and non-invasive), and 7 pathogens which associated with AMR, using the Burden of Healthcare-Acquire Infection (BHAI) R package. Postcodes were used to assign patients' resident health board, as well as their relative socio-economic deprivation, using the Welsh Index of Multiple Deprivation (WIMD). Results Preliminary results (median estimation with 95% confidence interval (CI)) were calculated for: number of infections with AMRnumber of deaths attributable to AMRnumber of DALYs attributable to AMR Estimates were stratified by age; sex; HB; relative deprivation; and pathogen and infection type. Conclusions This is the first study of its kind to study the relationship between AMR incidence and relative deprivation. It offers a clear picture of the epidemiology of AMR within Wales to support public health action. Key messages Infections from AMR bacteria represent a major PHB in Wales, and the modelling PHB of AMR by socioeconomic group and local area can inform effective public health action. The results of this study are valuable for guiding public health action to address AMR at the national and international level.

Application of a new methodology and R package reveals a high burden of healthcare-associated infections (HAI) in Germany compared to the average in the European Union/European Economic Area, 2011 to 2012.

BackgroundHealthcare-associated infections (HAIs) pose a major challenge to health systems. Burden of disease estimations in disability-adjusted life years (DALYs) are useful for comparing and ranking HAIs.AimTo estimate the number of five common HAIs, their attributable number of deaths and burden for Germany.MethodsWe developed a new method and R package that builds on the approach used by the Burden of Communicable Diseases in Europe (BCoDE) project to estimate the burden of HAIs for individual countries. We used data on healthcare-associated Clostridioides difficile infection, healthcare-associated pneumonia, healthcare-associated primary bloodstream infection, healthcare-associated urinary tract infection and surgical-site infection, which were collected during the point prevalence survey of HAIs in European acute-care hospitals between 2011 and 2012.ResultsWe estimated 478,222 (95% uncertainty interval (UI): 421,350–537,787) cases for Germany, resulting in 16,245 (95% UI: 10,863–22,756) attributable deaths and 248,920 (95% UI: 178,693–336,239) DALYs. Despite the fact that Germany has a relatively low hospital prevalence of HAIs compared with the European Union/European Economic Area (EU/EEA) average, the burden of HAIs in Germany (308.2 DALYs/100,000 population; 95% UI: 221.2–416.3) was higher than the EU/EEA average (290.0 DALYs/100,000 population; 95% UI: 214.9–376.9). Our methodology is applicable to other countries in or outside of the EU/EEA. An R package is available from https://CRAN.R-project.org/package=BHAI.ConclusionThis is the first study to estimate the burden of HAIs in DALYs for Germany. The large number of hospital beds may be a contributing factor for a relatively high burden of HAIs in Germany. Further focus on infection prevention control, paired with reduction of avoidable hospital stays, is needed to reduce the burden of HAIs in Germany.

Estimated burden of Chlamydia trachomatis female genital infection, Italy, 2009-2016

Purpose: In Italy, the nationwide burden of genital Chlamydia trachomatis (Ct) is absent because of passive voluntary reporting, its frequent asymptomaticity and consequent undiagnosed cases. Therefore, no specific health intervention has been taken so far. We aimed to estimate incidence rate (IR) and prevalence of Ct female genital infection and its nationwide burden in terms of disability-adjusted life years (DALY). Methods & Materials: We performed an ecological study on women aged 15-70 years affected by Ct genital infection registered from 2009 through 2016 in the two Italian sentinel surveillance systems (SSS) for sexually transmitted infections (STI): SSS-STIClin (composed by 12 public STI clinics, only symptomatic cases reported) and SSS-STILab (composed by 13 public microbiology laboratories, symptomatic and asymptomatic cases reported). Endo-cervical swab and/or first void urine were tested by nucleic acid amplification test (NAAT). We calculated IR by dividing the number of Ct-positive women reported in SSS-STIClin with the number of women resident in the cities where clinics are located. We calculated prevalence by dividing the number of Ct-positive women reported in SSS-STILab by the number of those tested. To estimate DALY (95% uncertainty intervals), we used data on symptomatic cases from both SSS by the Burden of Communicable Diseases in Europe (BCoDE) toolkit. Results: In the 8-year period considered, we found 981 Ct-positive women reported in SSS-STIClin (median age 25 years, interquartile range (IQR) 22-30). Mostly (70.1%), they had Italian nationality. Their number has almost tripled from 71 in 2009 to 188 in 2016. IR increased from 2.7 in 2009 to 7.1 in 2016 per 100,000 (p < 0.0001). In SSS-STILab, 2,275 Ct-positive women were reported (median age 27 years, IQR 22-34). Mostly (81.3%), they had Italian nationality. Prevalence increased from 2009 (2.4%) to 2014 (3.2%) (p < 0.05), then decreased to 2.6% in 2016. Overall, among Ct-positive women, those aged 20-24 years had the highest DALY estimation equal to 105 DALY per 100,000 stratum-specific population. Conclusion: Ct female genital infection has increased in Italy, mostly among the youngest sexually active women. Non-Italian women amounted for over one-third of cases. We recommend starting nationwide active surveillance and targeted screening programmes among women aged 20-24 years.

Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013.

Background and aimsThe Burden of Communicable Diseases in Europe (BCoDE) study aimed to calculate disability-adjusted life years (DALYs) for 31 selected diseases in the European Union (EU) and European Economic Area (EEA). Methods: DALYs were estimated using an incidence-based and pathogen-based approach. Incidence was estimated through assessment of data availability and quality, and a correction was applied for under-estimation. Calculation of DALYs was performed with the BCoDE software toolkit without applying time discounting and age-weighting. Results: We estimated that one in 14 inhabitants experienced an infectious disease episode for a total burden of 1.38 million DALYs (95% uncertainty interval (UI): 1.25–1.5) between 2009 and 2013; 76% of which was related to the acute phase of the infection and its short-term complications. Influenza had the highest burden (30% of the total burden), followed by tuberculosis, human immunodeficiency virus (HIV) infection/AIDS and invasive pneumococcal disease (IPD). Men had the highest burden measured in DALYs (60% of the total), adults 65 years of age and over had 24% and children less than 5 years of age had 11%. Age group-specific burden showed that infants (less than 1 year of age) and elderly people (80 years of age and over) experienced the highest burden. Conclusions: These results provide baseline estimates for evaluating infectious disease prevention and control strategies. The study promotes an evidence-based approach to describing population health and assessing surveillance data availability and quality, and provides information for the planning and prioritisation of limited resources in infectious disease prevention and control.

Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study.

BackgroundEstimating the burden of healthcare-associated infections (HAIs) compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. Based on the methodology of the Burden of Communicable Diseases in Europe (BCoDE) project and 2011–2012 data from the European Centre for Disease Prevention and Control (ECDC) point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals, we estimated the burden of six common HAIs.Methods and FindingsThe included HAIs were healthcare-associated pneumonia (HAP), healthcare-associated urinary tract infection (HA UTI), surgical site infection (SSI), healthcare-associated Clostridium difficile infection (HA CDI), healthcare-associated neonatal sepsis, and healthcare-associated primary bloodstream infection (HA primary BSI). The burden of these HAIs was measured in disability-adjusted life years (DALYs). Evidence relating to the disease progression pathway of each type of HAI was collected through systematic literature reviews, in order to estimate the risks attributable to HAIs. For each of the six HAIs, gender and age group prevalence from the ECDC PPS was converted into incidence rates by applying the Rhame and Sudderth formula. We adjusted for reduced life expectancy within the hospital population using three severity groups based on McCabe score data from the ECDC PPS. We estimated that 2,609,911 new cases of HAI occur every year in the European Union and European Economic Area (EU/EEA). The cumulative burden of the six HAIs was estimated at 501 DALYs per 100,000 general population each year in EU/EEA. HAP and HA primary BSI were associated with the highest burden and represented more than 60% of the total burden, with 169 and 145 DALYs per 100,000 total population, respectively. HA UTI, SSI, HA CDI, and HA primary BSI ranked as the third to sixth syndromes in terms of burden of disease. HAP and HA primary BSI were associated with the highest burden because of their high severity. The cumulative burden of the six HAIs was higher than the total burden of all other 32 communicable diseases included in the BCoDE 2009–2013 study. The main limitations of the study are the variability in the parameter estimates, in particular the disease models’ case fatalities, and the use of the Rhame and Sudderth formula for estimating incident number of cases from prevalence data.ConclusionsWe estimated the EU/EEA burden of HAIs in DALYs in 2011–2012 using a transparent and evidence-based approach that allows for combining estimates of morbidity and of mortality in order to compare with other diseases and to inform a comprehensive ranking suitable for prioritization. Our results highlight the high burden of HAIs and the need for increased efforts for their prevention and control. Furthermore, our model should allow for estimations of the potential benefit of preventive measures on the burden of HAIs in the EU/EEA.

The burden of Campylobacter-associated disease in six European countries

BackgroundFoodborne pathogens cause significant morbidity and mortality worldwide. Economic evaluations of interventions for Campylobacter are scarce. The aim of this study was to estimate the burden of disease associated with thermophilic Campylobacter spp. in Denmark, the Netherlands, Norway, Poland, Spain and the United Kingdom, to be used in an economic evaluation of interventions to reduce human campylobacteriosis. MethodsBurden of disease expressed as Disability-Adjusted-Life-Years (DALYs) was estimated using a disease model developed within the Burden of Communicable Diseases in Europe (BCoDE) project. The model links acute disease and future sequelae to the initial infection by conditional probabilities. Average numbers of country-specific symptomatic incident cases were estimated using reported cases for 2010 and adjusted for underestimation using multiplication factors (MF) based on a Swedish returning traveler study. We applied time discounting and present both discounted and undiscounted DALY estimates. ResultsOf the countries studied, the Scandinavian countries had the lowest estimated disease burden/100,000 inhabitants for Campylobacter (<10 DALY/100,000). Spain and Poland had the highest disease burden for Campylobacter (>100 DALY/100,000). Disease burden due to acute infections (i.e., gastroenteritits) accounted for <25% of the total disease burden associated with Campylobacter infections in humans. Time-discounting and assumed life-expectancy had an impact on the DALY calculations. ConclusionDifferences in reporting systems and practices necessitate country-specific MFs, with model results most sensitive to their uncertainty. Large differences in disease burden estimates were found between the six countries. Not considering sequelae strongly underestimated disease burden. The current country-specific disease burden can be used in future economic evaluation of interventions to reduce human campylobacteriosis.

Results from the 2015 Burden of Communicable Diseases in Europe (BCoDE) study

Results from the 2015 Burden of Communicable Diseases in Europe (BCoDE) study

Impact of measles national vaccination coverage on burden of measles across 29 Member States of the European Union and European Economic Area, 2006–2011

BackgroundChallenges in reaching good vaccination coverage against measles emerged in several European Union/European Economic Area Member States (EU/EEA MS) leading to progressive accumulation of susceptible individuals and outbreaks. The Burden of Communicable Diseases in Europe (BCoDE) project developed a methodology for measuring the burden of communicable diseases expressed in Disability-Adjusted Life Years (DALYs) in the EU/EEA MS. The aim of this study was to compare national vaccination coverage and burden of measles across EU/EEA MS. MethodsCountry-specific data on measles national vaccination coverage 2006–2011 from 29 EU/EEA MS (MCV1) were retrieved from Centralized Information System for Infectious Diseases (CISID). DALYs were calculated for each country separately using a disease progression model with a single input parameter (annual measles incidence, adjusted for under-estimation). A software application was used to compute estimated DALYs according to country-specific and year-specific population age-distributions (data retrieved from Eurostat). Log-linear mixed-effect regression modeling approach was used to investigate a linear relation between natural logarithm-transformed DALYs and coverage. ResultsThe reported annual vaccination coverage ranged from 72.6% to 100%. The estimated national annual burden ranged from 0 to 30.6 DALYs/100,000. Adjusting for year, there was a significant negative relationship between coverage and burden. For a given country there was a decrease in log-transformed DALYs/100,000 of 0.025 (95% confidence interval: −0.047 to −0.003) for every percentage increase in vaccination coverage. The largest effect of calendar time on estimated burden of measles was observed for the year 2011, the smallest was for the year 2007. ConclusionsThis study shows that the degree of success of national measles vaccination programs, when measured by the coverage obtained, is significantly associated with overall impact of measles across EU/EEA MS. In EU/EEA MS each percentage point increase in national vaccination coverage seems to lead to early significant reduction of overall burden of measles.

Measuring underreporting and under-ascertainment in infectious disease datasets: a comparison of methods

BackgroundEfficient and reliable surveillance and notification systems are vital for monitoring public health and disease outbreaks. However, most surveillance and notification systems are affected by a degree of underestimation (UE) and therefore uncertainty surrounds the 'true’ incidence of disease affecting morbidity and mortality rates. Surveillance systems fail to capture cases at two distinct levels of the surveillance pyramid: from the community since not all cases seek healthcare (under-ascertainment), and at the healthcare-level, representing a failure to adequately report symptomatic cases that have sought medical advice (underreporting). There are several methods to estimate the extent of under-ascertainment and underreporting.MethodsWithin the context of the ECDC-funded Burden of Communicable Diseases in Europe (BCoDE)-project, an extensive literature review was conducted to identify studies that estimate ascertainment or reporting rates for salmonellosis and campylobacteriosis in European Union Member States (MS) plus European Free Trade Area (EFTA) countries Iceland, Norway and Switzerland and four other OECD countries (USA, Canada, Australia and Japan). Multiplication factors (MFs), a measure of the magnitude of underestimation, were taken directly from the literature or derived (where the proportion of underestimated, under-ascertained, or underreported cases was known) and compared for the two pathogens.ResultsMFs varied between and within diseases and countries, representing a need to carefully select the most appropriate MFs and methods for calculating them. The most appropriate MFs are often disease-, country-, age-, and sex-specific.ConclusionsWhen routine data are used to make decisions on resource allocation or to estimate epidemiological parameters in populations, it becomes important to understand when, where and to what extent these data represent the true picture of disease, and in some instances (such as priority setting) it is necessary to adjust for underestimation. MFs can be used to adjust notification and surveillance data to provide more realistic estimates of incidence.

The disease burden of hepatitis B, influenza, measles and salmonellosis in Germany: first results of the Burden of Communicable Diseases in Europe Study

Setting priorities in the field of infectious diseases requires evidence-based and robust baseline estimates of disease burden. Therefore, the European Centre for Disease Prevention and Control initiated the Burden of Communicable Diseases in Europe (BCoDE) project. The project uses an incidence- and pathogen-based approach to measure the impact of both acute illness and sequelae of infectious diseases expressed in disability-adjusted life years (DALYs). This study presents first estimates of disease burden for four pathogens in Germany. The number of reported incident cases adjusted for underestimation served as model input. For the study period 2005-2007, the average disease burden was estimated at 33 116 DALYs/year for influenza virus, 19 115 DALYs/year for Salmonella spp., 8708 DALYs/year for hepatitis B virus and 740 DALYs/year for measles virus. This methodology highlights the importance of sequelae, particularly for hepatitis B and salmonellosis, because if omitted, the burden would have been underestimated by 98% and 56%, respectively.

The Pathogen- and Incidence-Based DALY Approach: An Appropriated Methodology for Estimating the Burden of Infectious Diseases

In 2009, the European Centre for Disease Prevention and Control initiated the ‘Burden of Communicable Diseases in Europe (BCoDE)’ project to generate evidence-based and comparable burden-of-disease estimates of infectious diseases in Europe. The burden-of-disease metric used was the Disability-Adjusted Life Year (DALY), composed of years of life lost due to premature death (YLL) and due to disability (YLD). To better represent infectious diseases, a pathogen-based approach was used linking incident cases to sequelae through outcome trees. Health outcomes were included if an evidence-based causal relationship between infection and outcome was established. Life expectancy and disability weights were taken from the Global Burden of Disease Study and alternative studies. Disease progression parameters were based on literature. Country-specific incidence was based on surveillance data corrected for underestimation. Non-typhoidal Salmonella spp. and Campylobacter spp. were used for illustration. Using the incidence- and pathogen-based DALY approach the total burden for Salmonella spp. and Campylobacter spp. was estimated at 730 DALYs and at 1,780 DALYs per year in the Netherlands (average of 2005–2007). Sequelae accounted for 56% and 82% of the total burden of Salmonella spp. and Campylobacter spp., respectively. The incidence- and pathogen-based DALY methodology allows in the case of infectious diseases a more comprehensive calculation of the disease burden as subsequent sequelae are fully taken into account. Not considering subsequent sequelae would strongly underestimate the burden of infectious diseases. Estimates can be used to support prioritisation and comparison of infectious diseases and other health conditions, both within a country and between countries.

The incidence-based and pathogen-based disability-adjusted life-years approach for measuring infectious disease burden in Europe: the Burden of Communicable Diseases in Europe (BCoDE) project

BackgroundMost estimates of disease burden due to infectious diseases focus on the impact of acute infections and do not fully capture the effects of (long-term) sequelae. To provide evidence-based and comparable estimates, the European Centre for Disease Prevention and Control (ECDC) initiated the Burden of Communicable Diseases in Europe (BCoDE) project. MethodsDisability-adjusted life-years (DALYs) were used in an incidence-based and pathogen-based approach to accommodate infectious disease characteristics. This approach involves outcome trees representing the natural history of diseases and links future sequelae to the initial infection by conditional probabilities. For calculating years of life lost (YLLs), life expectancy at birth for males and females was set to 79·9 and 82·5 years, respectively (Global Burden of Disease [GBD] 2004 study standards). For YLLs due to disability, disability weights were taken from the 2004 GBD study and from additional sets or proxies. Multiplication factors (MFs) were used to adjust for underestimation of country-specific incidences (average reported cases 2005–2007). Disease models for 32 pathogens were built in Excel, where @Risk was used to model uncertainty. No time discounting or age weighting was applied. FindingsTaking the example of hepatitis B in Germany, a loss of 7745 DALYs per year (95% CI 5527–10 256) was estimated, resulting in 9·4 DALYs per 100 000 (95% CI 6·7–12·4). 2·2% (170·4) of DALYs were due to acute infections. Chronic infections resulted in a loss of 2852 DALYs per year (95% CI 2455–3275). The disease burdens due to compensated liver cirrhosis, decompensated liver cirrhosis, and hepatocellular carcinoma were estimated at 637 DALYs per year (95% CI 478–792), 2150 DALYs per year (1294–3049), and 1790 DALYs per year (464–3376), respectively, together accounting for 59% (4577) of the overall DALYs. InterpretationThe BCoDE methodology quantifies the burden of short-term and long-term sequelae due to present infection. Quality of notification data and choice of appropriate MFs are crucial as these are the most sensitive inputs. FundingThe BCoDE consortium has been funded by the European Centre for Disease Prevention and Control (Specific agreement No. 1 to Framework Partnership Agreement GRANT/2008/003) for the conduct of burden of infectious disease studies in Europe. The funding source had no influence on writing the manuscript or on the decision to submit the abstract for publication. The corresponding author did not get any payment for writing the abstract from a pharmaceutical industry or other agency. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.