Changing Epidemiology Research Articles

2466. The Evolution of Candidemia during the COVID-19 Pandemic in Connecticut

Abstract Background Candidemia is a life-threatening bloodstream infection. The changing epidemiology of candidemia during the COVID-19 pandemic has not been well described. The goal of this study is to describe trends in candidemia epidemiology throughout various phases of the COVID-19 pandemic in Connecticut. Methods Using statewide surveillance we identified all adult Connecticut residents with candidemia between January 2020 and October 2022. Cases were aggregated by four-month intervals. Three surges of COVID-19 (Initial, Delta, and Omicron variant surges) were identified based on statewide COVID-19 case numbers. Incidence rate ratios (IRR) were calculated to compare the incidence rate (IR) of candidemia during surge periods to the IR of candidemia in non-surge periods (four-month intervals before and after surges). Patient demographics and clinical characteristics were compared using chi-square analysis. Results 721 candidemia cases were included in the analysis (255 in 2020, 290 in 2021, and 176 in 2022). The IR of candidemia during the Initial surge was 1.49 times higher than the 4 months after the Initial surge (95% CI: 1.09-2.03). The IR of candidemia during the Delta surge was 1.46 times higher than the preceding 4 months (95% CI: 1.07-1.99) and 1.13 times higher than the 4 months after the Delta surge (95% CI: 0.84-1.51). The IR candidemia during the Omicron surge was 1.05 times higher than the preceding 4 months (95% CI: 0.78-1.41) but 1.56 times higher than 4 months after the surge (95% CI: 1.12-2.17). During surge periods candidemia was more frequently associated with persons of non-white race/ethnicity, hospital-onset infection, mechanical ventilation and mortality (all p < 0.05). Conclusion We identified an association between COVID-19 surges and increased rates of candidemia. Candidemia cases during surge periods occurred more frequently among non-white persons, were more likely to have hospital-onset and were more severe suggesting that COVID-19 treatments or interventions may have impacted candidemia rates. Further study is needed to understand factors that resulted in different IRs of candidemia during various phases of the COVID-19 pandemic to inform strategies to prevent candidemia during future public health crises. Disclosures All Authors: No reported disclosures

455. Changing epidemiology of SARS-CoV-2 testing, positivity rates, and variant distribution in children and adults over multiple pandemic waves in New York City

Abstract Background Children and adults have had different experiences during the COVID-19 pandemic, especially in the context of new SARS-CoV-2 variants and changing vaccine eligibility. We aimed to compare the changing epidemiology of SARS-CoV-2 testing, positivity, and variants in adults versus children over multiple pandemic waves in a multi-hospital health system in New York City. Methods We analyzed SARS-CoV-2 RT-PCR testing data from 10/1/20 to 9/11/22 from children (0-21 years) and adults ( > 21 years) and compared positivity rates during 5 pandemic waves in New York City: Wave 2 (10/1/20-6/30/21), Wave 3 (7/1/21-12/1/21), Wave 4 (12/2/21-3/5/22), Wave 5 (3/6/22-6/12/22), and Wave 6 (6/13/22-9/11/22). The first test per patient per wave was included. If a patient had a positive test, the first positive test was included. Whole genome sequencing was performed on a subset of nasopharyngeal specimens with Ct values < 33 from 12/1/20 to 5/22/22. Results From 10/1/20 to 9/11/2022, 243,457 adults and 33,298 children were tested for SARS-CoV-2 with 15095 (6.2%) adults and 1961 (5.9%) children testing positive. Distribution of cases, positivity rates, and vaccine coverage over time are presented in Figure 1. Positivity rate was higher in adults compared to children in Wave 2 (adults 6.1%, children 4.5%, p< 0.001), similar in Wave 3 (adults 2.4%, children 2.2%, p = 0.2), higher in children in Wave 4 (adults 12%, children 16%, p< 0.001) and similar in Wave 5 (3.5%, 3.8%, p = 0.6) and Wave 6 (6.8%, 7.2%, p = 0.7). In Wave 4, the high positivity rate in children was driven by younger age groups, outpatient testing, and unvaccinated children (Figures 2-4). WGS of 1996 adult and 381 pediatric SARS-CoV-2 isolates demonstrated a mix of Alpha (13%), Iota (22%), and B lineages (61%) in Wave 2, predominance of Delta (87.4%) in Wave 3, predominance of Omicron (BA.1) (81%) in Wave 4, and predominance of BA.2 (84%) in Wave 5, with no difference in distribution between adults and pediatrics over time (Figure 5).Figure 1.Distribution of SARS-CoV-2 PCR testing, positive tests, positivity rate, and vaccination rate in children and adults. Number of tested and positive cases presented as daily case counts. Positivity rates presented as 14-day rolling averages. Due to low testing numbers, rolling average of pediatric positivity rate was excluded in Waves 5 and 6. Vaccination rates indicate daily proportion of patients with 2 or more vaccines doses.Figure 2.SARS-CoV-2 positivity rates in adults and children by pandemic wave and vaccine status.Positivity rates between fully vaccinated adults and children, and not fully vaccinated adults and children compared within each wave using Pearson’s Chi-squared test. Total number tested and positive for SARS-CoV-2 indicated in table. **p<0.01, ***p<0.001.Figure 3.SARS-CoV-2 positivity rates by age group and pandemic wave.Total number tested and positive for SARS-CoV-2 indicated in table. Conclusion Despite multiple wave-specific differences, SARS-CoV-2 variant distribution did not differ between adults and children over time. Additional work is indicated to understand if the difference in positivity rates is related to differences in immune response or exposure patterns between children and adults.Figure 4.SARS-CoV-2 positivity rates in adults and children by testing site.Total number tested and positive for SARS-CoV-2 indicated in table. ED, emergency department.Figure 5.Monthly distribution of SARS-CoV-2 variants in adults and children during Waves 2, 3, 4, and 5.Proportion of each SARS-CoV-2 variant in adults (red line) and children (blue line) over time. Variants indicated by WHO classification and include following Pango lineages: Delta (B.1.617.2, AY), Omicron (BA.1, BA.2), Alpha (B.1.1.7), Iota (B.1.526), B lineages (B.1/B1.1 lineages). The distribution of each variant was compared between adults and children over time using the Kolmogorov-Smirnov test. Disclosures Melissa Cushing, MD, Cerus Corporation: Advisor/Consultant|Haemonetics: Advisor/Consultant|Octapharma: Advisor/Consultant

Trends in surgical management of spinal metastases in a Singaporean tertiary referral center: a 17-year retrospective review

IntroductionSurgical treatment is increasingly the treatment of choice in cancer patients with epidural spinal cord compression and spinal instability. There has also been an evolution in surgical treatment with the advent of minimally invasive surgical (MIS) techniques and separation surgery. This paper aims to investigate the changes in epidemiology, surgical technique, outcomes and complications in the last 17 years in a tertiary referral center in Singapore.MethodsThis is a retrospective study of 383 patients with surgically treated spinal metastases treated between January 2005 to January 2022. Patients were divided into 3 groups, patients treated between 2005 – 2010, 2011-2016, and 2017- 2021. Demographic, oncological, surgical, patient outcome and survival data were collected. Statistical analysis with univariate analysis was performed to compare the groups.ResultsThere was an increase in surgical treatment (87 vs 105 vs 191). Lung, Breast and prostate cancer were the most common tumor types respectively. There was a significant increase in MIS(p<0.001) and Separation surgery (p<0.001). There was also a significant decrease in mean blood loss (1061ml vs 664 ml vs 594ml) (p<0.001) and total transfusion (562ml vs 349ml vs 239ml) (p<0.001). Group 3 patients were more likely to have improved or normal neurology (p=<0.001) and independent ambulatory status(p=0.012). There was no significant change in overall survival.ConclusionThere has been a significant change in our surgical practice with decreased blood loss, transfusion and improved neurological and functional outcomes. Patients should be managed in a multidisciplinary manner and surgical treatment should be recommended when indicated.

Assessing the impact of chickenpox and shingles vaccination using intermittent enhanced surveillance in Queensland, Australia

IntroductionChickenpox and shingles are vaccine preventable diseases caused by varicella-zoster virus (VZV). Chickenpox is more common in children before adolescence and shingles among ≥50 years of age. With this study we aimed to determine changes in VZV epidemiology following chickenpox and shingles vaccine introduction in Queensland. MethodsThis case series study used notified cases of VZV infection in Queensland from January 2010 to December 2021. In Queensland, VZV notifications are received as mostly clinically unspecified cases from pathology laboratories. Intermittent enhanced surveillance was conducted using clinician follow up to determine chickenpox and shingles clinical presentation, and we then analysed these by age-group, time period, and within vaccine eligible cohorts. ResultsOf the 87,759 VZV notifications received, 70 % (n = 61,298) were notified as unspecified, followed by 23 % shingles (n = 19,927), and 7 % chickenpox (n = 6,534). Over the study period, the percent change in total notifications adjusted by age and sex was estimated to be an increase of 5.7 % (95 % CI 4.9–6.4) each year. The chickenpox notifications fell sharply at 18 months of age (eligible for chickenpox vaccine) with the rate being 57 % and 36 % lower among those aged 18–23 months compared to <12 and 12–17 months of age, respectively. Assuming all cases aged 60 years and older were shingles, notification rates of shingles decreased by 12–22 % among 70–79 years old (eligible for shingles vaccination) over the years 2017–2021 after vaccine introduction in 2016. ConclusionThe VZV notification rate has increased over time in Queensland. Impact of chickenpox and shingles vaccines funded under National Immunisation Program is seen with a decline in notification rates among age-specific cohorts eligible to receive the vaccines under the program. Introduction of a second childhood dose chickenpox vaccine and more effective recombinant shingles vaccine may further improve the impact of the vaccination program.

Global, regional, and national prevalence of hearing loss from 1990 to 2019: A trend and health inequality analyses based on the Global Burden of Disease Study 2019

As a severe public health issue, hearing loss has caused an increasingly disease burden, especially in the elderly population. Hearing loss may inevitably induce asymmetric hearing, which makes it difficult for elderly individuals to locate sound sources, therefore resulting in increased postural instability and falling risk. To emphasize the public health emergence of hearing loss, we investigated the temporal trend of prevalence of hearing loss over the last 30 years and further predicted its changes in the next 20 years, decomposed the trend according to demographic factors and epidemiological changes, and quantified the cross-country healthy inequalities, using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. In 2019, there were more than 140 million cases of hearing loss worldwide, a 93.89% increase from 70 million cases in 1990. The age-standardized rate (ASR) also increased with an estimated annual percentage change of 0.08% per year. Population growth and aging are the major drivers contributing to the changes, accounting for 60.83% and 35.35%. Of note, the contribution of aging varies showing a gradual increasing trend with sociodemographic index (SDI) elevating. Also notable, there were significant health inequalities across 204 countries and territories, with slope index of inequality rising over time. Projection of the global burden of hearing loss from 2020 to 2040 indicated progressive increases in both case number and ASR. These reflect the heavy disease burden of hearing loss that needed more targeted and efficient strategies in its prevention and management.

ANALYSIS OF BRAZILIAN ORAL HEALTH EPIDEMIOLOGICAL SURVEYS: A METHODOLOGICAL ANALYSIS

Introduction: Epidemiological surveys in oral health seek to assess the health situation and carry out surveillance of health actions. Objective: The objective of this study is to analyze the methodologies utilized in the National Epidemiological Surveys on Oral Health in Brazil, aiming to contribute to its improvement, considering local realities. Methods: This is a descriptive, observational study with an ecological design. The analysis is based on the notable Brazilian epidemiological surveys. Results: The development of instruments and indices guided the structuring of the analysis of community situational injuries, decentralizing the tool as a potential resource for regional diagnoses. The surveys highlighted epidemiological changes in oral health in Brazil in recent years, as well as a review of the World Health Organization's recommendations for epidemiological surveys in oral health. Conclusions: In summary, the comprehensive reflections for constructing national-level oral health diagnoses express the technical-scientific and political maturation of epidemiology and collective oral health.

The Impact of Population Aging on the Balance of Medical Insurance Fund in Vietnam

In recent years, Vietnam has made significant reforms to its health insurance system, resulting in great progress. However, changes in epidemiology and demographic shifts towards an aging population can impact the balance of the social medical insurance fund. Against this background, this paper aims to study the factors that affect the impact of population aging on the balance of the health insurance fund, by introducing seven mediating variables and subsequently analyzing the relationships between these variables to investigate the impact of population aging on the health insurance fund balance. The results indicate that population aging negatively affects the balance between revenue and expenditure of the medical insurance fund. Based on this analysis, we propose two corresponding recommendations to enhance fiscal sustainability: Enhancing healthcare resource efficiency and promoting economic development to increase income for workers.

Changes in enterovirus epidemiology after easing of lockdown measures

IntroductionPublic health measures aimed at controlling transmission of SARS-CoV-2, otherwise known as “lockdown” measures, had profound effects on circulation of non-SARS viruses, many of which decreased to very low levels. The interrupted transmission of these viruses may have lasting effects. Some of the influenza clades seem to have disappeared during this period, a phenomenon which is described as a “funnel effect”. It is currently unknown if the lockdown measures had any effect on the diversity of circulating viruses, other than influenza. Enteroviruses are especially interesting in this context, as the clinical presentation of an infection with a particular enterovirus-type may be clade-dependent. Methods and materialsEnteroviruses were detected in clinical materials using a 5′UTR-based detection PCR, and partial VP-1 sequences were obtained, using methods described before. All samples with EV detections from a large part of the Netherlands were included in the study. The samples originated from general practitioners, general hospitals, university hospitals and public health offices. ResultsFive EV-genotypes circulated in significant numbers before and after the lockdown, EV-D68, E-11, CV-A6, CV-B5 and CV-A2. All five genotypes showed decreased genetic diversity after the lockdown, and four indicate a significant number of sequences clustering together with a very high sequence homology. Moreover, children with E-11 and CV-B5 detections were significantly older after the lockdown than before. ConclusionsThe reduced enterovirus transmission in the Netherlands during the pandemic, seems to have led to a decrease in genetic diversity in the five most commonly detected enterovirus serotypes

The epidemiology of traumatic brain injuries in the fastest-paced city in China: a retrospective study.

Traumatic brain injury (TBI) seriously affects the quality of human health and the prognosis of the patient, but the epidemiological characteristics of TBI can vary among populations. Numerous changes have occurred in the epidemiological characteristics of individuals with TBI in the fast-paced city of Shenzhen, China. However, little is known about these characteristics. This study aimed to investigate the changes in TBI epidemiology, help clinicians improve medical treatment. In this retrospective cross-sectional analysis, we collected the data of 4,229 patients with TBI admitted to 20 hospitals in Shenzhen in 2017. We collected data on age, gender, cause and severity of the injury, eventual diagnosis, time from injury to admission in a neurosurgery department, and patient outcomes. Two neurosurgeons simultaneously collected the data. We compared these results with a similar study conducted in Shenzhen during the period from 1994 to 2003 to clarify and explain the changes in the epidemiological characteristics of TBI. The majority of respondents were men [2,830 (66.9%)]. The mean age was 32.5 ± 21.4 years. The youngest patient was less than 1 year old, and the oldest patient was 101 years old. A total of 3,947 (93.3%) patients had a favorable outcome, 219 (5.2%) had an unfavorable outcome, and 63 (1.5%) died. The predominant external cause was falls (1,779 [42.1%]); this was the most common cause of TBI in children and older adults. Riders of electric bicycles (423 [29.0%]) were the most vulnerable to traffic accident-related injuries. Time greater than 50 h from injury to admission to a neurosurgical department had a significant effect on prognosis (p < 0.001). The epidemiological characteristics of TBI have changed significantly over the past 20 years. Falls, rather than traffic accidents, were the most common cause of TBI. Further research is needed to devise solutions to decrease the incidence of falls and improve the outcomes of TBI.

The Influence of Time on the Epidemiology and Clinical Manifestations of Behçet's Disease in Brazil.

Modifications in the severity and clinical expression of Behçet's disease (BD) have been described in some areas that are considered endemic for the disease. This study aims to evaluate the chronological changes in epidemiology and clinical characteristics of BD patients in a referral center in Brazil, which is considered a non-endemic area for the disease. A descriptive and cross-sectional study involving BD patients divided into two groups: group 1 patients were diagnosed and followed between 1988 and 2010, and group 2 were diagnosed and followed between 2011 and 2022. No significant differences were found regarding gender and age at onset of symptoms between groups. We found a significant decrease in the frequency of bilateral ocular involvement, posterior uveitis, and retinal vasculitis. The demographic dates of this group of Brazilian BD patients remained similar over the last decade. Our study supports the notion that BD is becoming lighter in some regions. BD is a severe blinding disorder, and we found a lower frequency of ocular involvement over time. These findings may be attributed to a higher level of education of patients and a growing awareness of the disease. Newer immunomodulating and biologic agents may offer an improved prognosis in patients with BD with severe manifestations.

Degenerative or rheumatic: after all, what is the most prevalent etiology of mitral regurgitation in developing countries?

Abstract Introduction Mitral regurgitation (MR) is the most prevalent valve disease in Europe, mostly degenerative. In Brazil, on the other hand, there are few recent epidemiological data and previous studies show a higher prevalence of rheumatic disease. However, a change in the epidemiological profile of valve disease has recently been observed, largely due to the increase in life expectancy and decrease in the incidence of rheumatic fever. This study aims to evaluate patients with MR in a tertiary hospital in Brazil, emphasizing the etiological analysis. Methods Patients with moderate or severe MR on echocardiogram performed between 07/01/2018 and 06/30/2020 in a Brazilian Cardiology hospital were retrospectively evaluated, including 2,017 cases. Clinical data (age, sex, symptoms and comorbidities) were analyzed, in addition to complementary tests, such as electrocardiogram and echocardiogram. Results A total of 2,017 cases were included, of which 1,966 (97.5%) had severe MR. The mean age was 65 years and 52% were female. In this cohort, 924 patients (45.8%) had primary MR, while 1093 (54.2%) had secondary causes. Among the primary etiologies (N=1093), degenerative was the most prevalent, responding to 51.3% (n=474), followed by rheumatic disease, present in 34.5% of the patients (n=319). The other primary etiologies observed were calcific (94 patients = 4.7%), infective endocarditis (15 patients = 0.7%) and congenital (10 patients = 0.5%). In the comparative analysis between degenerative and rheumatic MR, a statistically significant difference was observed in age and gender. Patients diagnosed with rheumatic MR were younger - mean age: 58 years (standard deviation 49-68) compared to 67 years in patients with degenerative mitral disease (standard deviation 58-76 years). Most patients with rheumatic disease were female (N=255, 79.9%), with percentages almost twice as high as those observed in degenerative MR (N=192 - 40.5%). Secondary causes (N=1,093) were composed of dilated etiology in 859 patients (78.6%), ischemic (140 patients - 12.8%) and atrial functional (55 patients - 5%). Conclusion In agreement with the current epidemiological change in valvular heart disease, we could also observe an important change in the etiology of MR in Brazil, with a reduction in the burden of rheumatic disease and greater expressiveness of mitral prolapse.

Changes in clinical, demographic, and outcome patterns of children hospitalized with non-SARS-CoV-2 viral low respiratory tract infections before and during the COVID pandemic in Rome, Italy.

We performed this study aiming to evaluate changes in epidemiology, clinical presentation and outcomes of children hospitalized for viral lower respiratory tract infections (LRTI). We performed a retrospective study of children younger than 18 years of age hospitalized for LRTIs with a positive respiratory viral testing from 2018 to 2022. We compared need of pediatric intensive care unit (PICU), invasive ventilation, and other respiratory support, viral etiologies, clinical presentations, imaging, and laboratory results in the precovid (2018-2019) and covid (2020-2022) period. A total of 523 were included in the analysis. In the pandemic period, the detection of influenza was 95% less likely to occur (odds ratio [OR]: 0.05; 95% confidence interval [95% CI]: 0.02-0.12; p < .001), likewise the detection of adenovirus was 77% less likely to occur (OR: 0.23; 95% CI: 0.10-0.51; p < .001). In the pandemic period, the number of codetections increased from 15.52% in 2018 to 57.25% in 2022, resulting in a significantly increasing trend (p < .001). The odds of transfer to PICU was more than five times greater during the pandemic period (OR: 5.31; 95% CI: 1.78-15.86; p = .003). We found that the pattern of LRTI in children during COVID-19 pandemic significantly changed in terms of etiologies and increased severity.

Imported and indigenous Plasmodium Vivax and Plasmodium Falciparum malaria in the Hubei Province of China, 2005–2019

BackgroundThe Hubei Province in China reported its last indigenous malaria case in September 2012, but imported malaria cases, particularly those related to Plasmodium vivax and Plasmodium falciparum, threaten Hubei’s malaria-free status. This study investigated the epidemiological changes in P. vivax and P. falciparum malaria in this province to provide scientific evidence for preventing malaria resurgence.MethodsThe prevalence, demographic characteristics, seasonal features, and geographical distribution of malaria were assessed using surveillance data and were compared across three stages: control stage (2005–2009) and elimination stages I (2010–2014) and II (2015–2019).ResultsIn 2005–2019, 8483 malaria cases were reported, including 5599 indigenous P. vivax cases, 275 imported P. vivax cases, 866 imported P. falciparum cases, and 1743 other cases. Imported P. falciparum cases accounted for 0.07% of all cases reported in 2005, but increased to 78.81% in 2019. Most imported P. vivax and P. falciparum malaria occurred among males, aged 21–60 years, during elimination stages I and II. The number of regions affected by imported P. falciparum and P. vivax increased markedly in Hubei from the control stage to elimination stage II. Overall, 1125 imported P. vivax and P. falciparum cases were detected from 47 other nations. Eight imported cases were detected from other provinces in China. From the control stage to elimination stage II, the number of cases of malaria imported from African countries increased, and that of cases imported from Southeast Asian countries decreased.ConclusionsAlthough Hubei has achieved malaria elimination, it faces challenges in maintaining this status. Hence, imported malaria surveillance need to be strengthened to reduce the risk of malaria re-introduction.

Epidemiologic changes of infectious diseases in the post-SARS era in China, 2004–2018

ObjectivesTo outline 44 major infectious diseases in the post-SARS (severe acute respiratory syndrome) in China and describe their long-term trends and changes by age, sex, epidemic season, and province.BackgroundAfter the outbreak of severe acute respiratory syndrome (SARS) in 2003, with the change of infectious disease prevention and control system and the improvement of residents’ quality of life, the incidence and mortality of infectious diseases have undergone major changes.MethodsThe data of 44 major infectious diseases in China from 2004 to 2018 were obtained from the monthly analysis report of the China Information System for Disease Control and Prevention (CISDCP) and the Public Health Science Data Center. Joinpoint r regression models were used to examine trends in incidence and mortality for 44 major and important infectious diseases from 2004 to 2018.ResultsFrom 2004 to 2018, 20,105, 500, 772 patients (10, 306, 546, 523 males and 9, 798, 954, 249 females) were diagnosed with 44 major infectious diseases. The overall incidence of 44 infectious diseases increased significantly from 294.6 per 100,000 people in 2004 to 479.1 per 100,000 people in 2010, with 7.9% APC (95% CI 5.2% -10.7%, P < 0.001), then slowed, and then increased to 561.2 per 100,000 people in 2018, with 1.5% APC (-0.1%—3.2%, P = 0.070). The overall mortality rose significantly, from 0.49 to 1.13 per 100,000 people between 2004 and 2011, with an APC increase of 11.6% (7.7% -15.6%, P < 0.001), and then remained stable until 2018. Among these, the prevalence of vaccine-preventable diseases and gastrointestinal & enteroviral diseases remained high and increased year by year. Patients with zoonotic diseases have the greatest risk of death, while patients with sexually transmitted and blood-borne diseases have the greatest number of deaths. Incidence rates vary considerably across geographic regions. Western China has a disproportionate burden of infectious diseases compared with eastern regions.ConclusionsAfter the event of SARS in 2003, infectious disease preventing and controlling model has undergone major changes in China, and certain achievements have been made in this field. Although overall morbidity and case fatality rates are still rising, they have leveled off. In reducing the disproportionate disease burden in the western region, expanding vaccination programs, preventing further increases in rates of sexually transmitted diseases, renewing efforts for emerging and persistent infectious diseases, and addressing seasonal and unpredictable outbreaks (such as the COVID-19 pandemic), there are still remain many challenges.

No Changes in the Occurrence of Methicillin-Resistant Staphylococcus aureus (MRSA) in South-East Austria during the COVID-19 Pandemic.

Methicillin-resistant Staphylococcus aureus (MRSA) is a universal threat. Once being well established in the healthcare setting, MRSA has undergone various epidemiological changes. This includes the emergence of more aggressive community-acquired MRSA (CA-MRSA) and the occurrence of MRSA which have their origin in animal breeding, called livestock-associated MRSA (LA-MRSA). Emergence of new clones as well as changes in the occurrence of some clonal lineages also describes the fluctuating dynamic within the MRSA family. There is paucity of data describing the possible impact of the COVID-19 pandemic on the MRSA dynamics. The aim of the study was the analysis of MRSA isolates in a three-year time period, including the pre-COVID-19 years 2018 and 2019 and the first year of the pandemic 2020. The analysis includes prevalence determination, antibiotic susceptibility testing, spa typing, and detection of genes encoding the PVL toxin. The MRSA rate remained constant throughout the study period. In terms of a dynamic within the MRSA family, only a few significant changes could be observed, but all except one occurred before the start of the COVID-19 pandemic. In summary, there was no significant impact of the COVID-19 pandemic on MRSA in Austria.

Prevalence and incidence of Paget's disease of bone: Temporal trend over 20years in the province of Quebec, Canada.

Paget's disease of bone (PDB) is a focal bone disorder characterized by an increased bone remodeling and an anarchic bone structure. A decline of prevalence and incidence of PDB has been observed in some countries. No epidemiological data are available on PDB in Canada. We aimed at examining the evolution of the prevalence and incidence of PDB in Quebec (Canada) by analyzing health administrative databases. PDB case definition relied on one or more hospitalizations, or one or more physician-billing claims with a diagnosis code of PDB. To identify incident cases, a 'run-in' period of four years (1996-1999) was used to exclude prevalent cases. For each fiscal year from 2000 to 2001 to 2019-2020 (population size 2,914,480), crude age and sex-specific prevalence and incidence rates of PDB among individuals aged ≥55years were determined, and sex-specific rates were also standardized to the 2011 age structure of the Quebec population. Generalized linear regressions were used to test for linear changes in standardized prevalence and incidence rates. Over the study period, standardized prevalence of PDB has remained stable in Quebec, from 0.44% in 2000/2001 to 0.43% in 2019/2020 (mean change -0.002, p-value=0.0935). For the 2019-2020 fiscal year, 13,165 men and women had been diagnosed with PDB and prevalence of PDB increased with age. Standardized incidence of PDB has decreased over time from 0.77/1000 in 2000/2001 to 0.28/1000 in 2019-2020 (mean change -0.228/year, p-value<0.0001), the incidence decreasing from 0.82/1000 to 0.37/1000 in men and from 0.76/1000 to 0.22/1000 in women, respectively. This decrease was observed in all age categories. With the exception of a slight increase in PDB prevalence up to 0.55% in years 2005 to 2007, the prevalence of PDB has remained stable in Quebec over the past 20years, 13,160 men and women being currently diagnosed with PDB. The incidence has decreased over time. Our results support the epidemiological changes of PDB reported in other countries.

Changes in the Epidemiology of Hepatocellular Carcinoma in Carinthia, Austria, 2012-2023.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths and remains a major burden on healthcare systems worldwide. The incidence of HCC continues to rise globally, despite preventative efforts being made. This study aimed to investigate epidemiological changes observed in the etiology and survival outcomes of HCC patients at Klinikum Klagenfurt am Wörthersee between 2012 and 2023. This was a retrospective, single-center cohort study. Two time-periods (2012-2017 and 2018-2023) were created to enable comparison between the respective intervals. IBM SPSS was used to analyze statistical data. More patients were diagnosed with HCC during the second time period (n = 128, n = 148). The median age of diagnosis was 72.5 years (SD 8.6). Patients were on average 2 years younger in the second time period compared to the first (p = 0.042). Alcohol remained the leading underlying etiology of HCC and no statistically significant change was seen over time (p = 0.353). Nevertheless, a clear upward trend in the number of NASH cases was evident over time (n = 15, n = 28, respectively). Nearly half of the patient population had a normal AFP (<7 µg/L) level at the time of diagnosis (n = 116, 42.6%). The survival time for HCC patients remained similar between time periods, with a median overall survival time of 20.5 months (95% CI 16.8-24.2, p = 0.841), despite improvements in management strategies and the availability of new systemic treatments. More advanced-stage HCC cases were documented in the second period (BCLC-C, n = 23 to n = 46, p = 0.051). An increased number of HCC patients without liver cirrhosis were identified during the second time period (n = 22, n= 47, respectively, p = 0.005). NASH was the most common underlying etiology in patients without liver cirrhosis (50%) compared to alcohol use in being the primary cause in cirrhotic patients (65%, p < 0.001). HCC continues to be an important health concern in our society. The number of HCC patients without liver cirrhosis is steadily increasing, with NAFLD/NASH, due to underlying lifestyle diseases playing an important etiological role. Continued efforts should be made to prevent HCC and to screen at-risk population groups. Preventative strategies and screening techniques should be adjusted in light of the changing epidemiological landscape of HCC, where more focus will have to be placed on detecting HCC in patients without underlying cirrhosis.

Characteristics of respiratory viruses' circulation through a six-year period (2016-2022) in a pediatric population in Normandy, France, and the impact of COVID-19 pandemic.

The impact of COVID-19 on the circulation of respiratory viruses has highlighted the need for ongoing surveillance and preparedness for emerging infectious diseases. The aim of this study was to provide information on the dynamics of respiratory viruses in pediatric populations to inform public health policies and strategies for the prevention and control of respiratory infections. This study analyzed data on the detection of respiratory viruses in pediatric populations from 2016 to 2022. The weekly number of tests and positive results for respiratory viruses were collected and analyzed from the two major university hospitals, Caen and Rouen. Different assays, including multiplex panels and rapid detection kits, were used for testing. The study analyzed the epidemiological trends of respiratory viruses in a French region during the COVID-19 pandemic. The data set included 37,969 tests, with a significant increase in the number of tests in 2020-2021 and 2021-2022. The rate of positive tests fell below 50% in 2021-2022. Enteroviruses (EV)/rhinoviruses (RV) and respiratory syncytial viruses (RSV) were the most frequently identified viruses, except in 2021-2022, when Flu ranked second. The Flu epidemic appeared slightly earlier in 2021-2022 and lasted for 25 weeks, with a doubling time of 4.03. The RSV epidemic occurred earlier in 2021-2022 and had similar dynamics to pre-pandemic years. EV/RV continued to circulate throughout the lockdowns, while low numbers of other viruses were detected. Our results emphasize the importance of continuing active surveillance of respiratory virus circulation and the need for new recommendations for respiratory virus detection in pediatric patients.IMPORTANCEThe report highlights an epidemiological change in the circulation of respiratory viruses in pediatric populations due to strategies adopted against COVID-19 pandemic. COVID-19 has resulted in a significant increase in requests for multiplex respiratory research to identify the virus responsible for the symptoms. The diagnostic needs have increased, and the number of samples analyzed in 2021-2022 is equal to the samples analyzed over the four epidemic periods preceding the pandemic. The report suggests the importance of active surveillance of respiratory viruses' circulation and new recommendations for respiratory virus detection in pediatric patients.

Antimicrobial surveillance: A 20-year history of the SMART approach to addressing global antimicrobial resistance into the future

Antimicrobial resistance (AMR) is a major global public health threat, particularly affecting patients in resource-poor settings. Comprehensive surveillance programmes are essential to reducing the high mortality and morbidity associated with AMR and are integral to informing treatment decisions and guidelines, appraising the effectiveness of intervention strategies, and directing development of new antibacterial agents. Various surveillance programmes exist worldwide, including those administered by government bodies or funded by the pharmaceutical industry. One of the largest and longest running industry-sponsored AMR surveillance programme is the Study for Monitoring Antimicrobial Resistance Trends (SMART), which recently completed its 20th year. The SMART database has grown to almost 500000 isolates from over 200 sites in more than 60 countries, encompassing all major geographic regions and including many sites in low- and middle-income countries. The SMART surveillance programme has evolved in scope over time, including additional antibacterial agents, pathogens and infection sites, in line with changing epidemiology and medical need. Surveillance data from SMART and similar programmes have been used successfully to detect emerging resistance threats and AMR patterns in specific countries and regions, thus informing national and local clinical treatment guidelines. The SMART database can be accessed readily by physicians and researchers globally, which may be especially valuable to those from countries with limited healthcare resources, where surveillance and resistance data are rarely collected. Continued participation from as many sites as possible worldwide and maintenance of adequate funding are critical factors to fully realising the potential of large-scale AMR surveillance programmes into the future.

Changing Epidemiology and Outcome of Pediatric Thermal Burn Injury in South Western Nigeria.

The pediatric age group has been noted to be particularly vulnerable to burn injuries. Burn is the fifth most common cause of childhood injuries. Nigeria has a very young population with a median age of 18.1 years. Scald is the most common form of burn injuries in this age group globally; however, previous reports from our institution found flame to be the most common form of burn in pediatric age. The most recent report from 13 years ago still maintained flame as the most common cause of pediatric burn injury. This study was carried out to determine the changes in epidemiology and outcome of pediatric thermal burn injury. This was a retrospective study carried out between January 2013 and December 2022. Data were analyzed using the statistical package for social sciences software version 23. The significance was set at a P-value of .05. Two hundred and sixty-five children presented with thermal burn with a male-to-female ratio of 1.3:1. 63.4% occurred in children 0-5 years. Scald (59.6%) was the most common cause of injury. Most flame injuries in females were due to liquified petroleum gas cookstove explosion, while petrol explosion was the most common cause in males (P ≤ .001). There is a yearly increase in burn depth (P = .009). Most inhalation injuries occurred in those aged 11-16 years (P = .006). Mortality rate was 10.2%, with total body surface area burned (P ≤ .001), burn depth (P ≤ .001), and inhalation injury (P ≤ .001) associated with increasing mortality. Scald is now the most common cause of thermal burn in our institution, with a remarkable reduction in mortality rate.