Comprehensive Surveillance System Research Articles

P-180. Enhancing Mortality Surveillance: Insights from Excess Deaths Analysis during the COVID-19 Pandemic

Abstract Background The global repercussions of the COVID-19 pandemic extend beyond reported fatalities, imprinting a lasting effect on global health. The COVID-19 pandemic has presented substantial issues, encompassing not only direct infections but also excess mortality. The death rates in the Federation of Bosnia and Herzegovina (FB&H) have been significantly affected by the pandemic, leading to a need for a thorough analysis of the elements that contribute to this phenomenon. Mortality in Federation of Bosnia and Herzegovina age 15 - 44 Methods The objective of this study was to quantitatively assess the rise in overall excess mortality rates in the FB&H region for the years 2020, 2021, and 2022. We employed data from the FB&H mortality record, along with population statistics and official COVID-19 death counts, to emphasize the often underestimated number of deaths. Our objective was to offer a thorough comprehension of the actual scale of the pandemic. Mortality in Federation of Bosnia and Herzegovina age above 65 Results During the initial three years of the pandemic, FB&H encountered three separate instances of heightened mortality from any cause, accounting for 18 % of the overall excess mortality during the period of 2020–2022. The biggest burden was recorded among adults aged 45–74, with 22.4% falling within the 45–64 age group, 22.1% within the 65–74 age group, and 19.4% within the 75–84 age group. Children under 15 years old did not exhibit any excess mortality. Conclusion COVID-19-related mortality in FB&H are significantly underreported, especially among younger persons. This statement highlights the pressing necessity to enhance civil registration and vital statistics, while pushing for the implementation of comprehensive surveillance systems for all causes of mortality. These measures are of utmost importance in improving the surveillance of forthcoming pandemics and effectively addressing other significant public health occurrences. Disclosures Sinisa Skocibusic, Medicopharmacia: Travel grant to ECCMIDs

The current state of data to estimate prevalence and severity of food allergies in the United States

Currently, in the United States, there is no comprehensive surveillance system to collect data on food allergies; however, prevalence and severity data are critical to quantify the burden of food allergies, develop evidence-based control measures, detect emerging issues, and monitor trends. To address this gap, we conducted a literature search, and expert interviews to identify surveillance systems and datasets that could be used to estimate the prevalence and severity of food allergies in the United States overall and for specific foods. Inclusion and exclusion criteria were developed and used to screen each data source. Selected articles were evaluated according to quality parameters to identify the most appropriate studies. Most studies estimated the prevalence of food allergies in children, investigated multiple foods, and used surveys to collect self-reported data. Despite the high quality, robust study designs, and comprehensive survey instruments that currently exist, the studies identified do not provide sufficiently recent data to estimate the current burden of food allergies in the country. Studies lack consistencies across the years making the analysis of trends over time a challenge. National surveys conducted by Northwestern University in 2009/2010 and 2015/2016 represented the best available data; however, these data are likely outdated and are limited in assessing temporal food allergy trends. Data to accurately estimate the current prevalence and severity of food allergies and related trends are lacking. U.S. public health agencies should explore the development of a comprehensive surveillance program to address this gap and help inform evidence-based policies in food allergy management and prevention.

Bolstering the HIV Surveillance System Through Innovative Methods, Technologic Advances, and Community-Driven Solutions to Inform Intervention Efforts and End the Epidemic.

An accurate and comprehensive HIV surveillance system is critical to understanding the burden of HIV infection. Reliable estimates into the surveillance system serve as the cornerstone for HIV prevention and treatment programs. PURPOSE OF REVIEW: In this article, we review the current structure and function of the HIV surveillance system in the US, identify gaps in reporting, and propose multiple potential interventions to augment the HIV surveillance system. RECENT FINDINGS: Recent literature demonstrate that substantial gaps in reporting to health departments from clinical providers exist. These gaps include stigma, knowledge of HIV reporting requirements, inaccurate direct testing estimates, reporting errors, and lack of community engagement. All of these gaps place a substantial burden on health departments, hinder responses, and effect funding. Leveraging community partnerships, technologic advances, and emerging methodologies may fill some of these gaps. Advancements in HIV self-testing, broad community HIV testing, indirect statistical methods, and machine learning bolstered by broad community engagement and oversight could modernize the HIV surveillance system to achieve the Ending the HIV Epidemic goals.

Connectivity in VTS area via social network analysis: focused on South Korea case

Abstract Vessel traffic services (VTS) is a marine information exchange system vital for the safety and efficiency of ship traffic within designated regions. The harmonisation, integration and exchange of marine information have emerged as significant components in promoting maritime safety, in line with the concept of e-navigation. This study aimed to analyse the flow of information between VTS areas employing social network analysis to ensure seamless marine information exchange across VTS areas. Information flow was analysed based on data obtained from ships navigating through coastal waters and ports in Korea, revealing that the sea area near Busan New Port exhibited the highest concentration of information flow, while the Tongyoung Coast VTS area represented a critical link in the flow of information. Given its history of marine accidents, the current Masan (Opko) VTS region emerged as a susceptible area. The study provides valuable foundational data for a comprehensive coastal surveillance system.

Epidemiological analysis of event-based surveillance data of Crimean-Congo Hemorrhagic Fever (CCHF) outbreaks across Balochistan Province, Pakistan, from 2000 to August 2021

Background Crimean-Congo hemorrhagic fever (CCHF) is endemic in Balochistan, caused by the Bunyaviridae family’s tick-borne virus (Nairovirus). The CCHF virus leads to severe viral hemorrhagic fever outbreaks with a fatality rate of 10–40%. This study aims to describe the epidemiological trend of CCHF in Balochistan and provide recommendations for controlling current and future outbreaks. Methods A descriptive approach was adopted for data analysis, utilizing the standard case definition of the Vector-Borne Diseases (VBD) program. “Any person of any age and gender residing in Balochistan from 2000 until August 10, 2021, presenting with the acute onset of illness, featuring a high-grade fever (38.5°C) persisting for more than 3 days but less than 10 days. Individuals should also exhibit any two of the following symptoms: hemorrhagic or purpuric rash, nosebleed, blood in vomit/sputum/stool, or other hemorrhagic symptoms. Moreover, there should be no known predisposing factors for hemorrhagic manifestations, and individuals must have had contact with a confirmed patient or engaged in handling animals and raw animal products.” The study covered cases identified from 2000 to August 10, 2021, and the descriptive study was conducted at the Provincial Disease Surveillance and Response Unit (PDSRU) in Quetta. Frequencies were calculated, and Excel 2016 was used to generate tables and graphs. Results Based on the case definition, 1418 laboratory-confirmed cases of CCHF were identified out of 2542 reported cases from 2000 to August 10, 2021. Most cases (89%, n = 1262) were found to be males. The case fatality rate increased from 5% to 13% over the last decade. The highest number of CCHF cases occurred in 2017 (n = 172), followed by 2005 (n = 108) and 2004 (n = 107). Direct animal contact was reported in 61% of cases, with 22% being butchers and farmers each. CCHF poses a significant public health issue in Balochistan. Conclusion This study provides a detailed overview of CCHF in Balochistan over the last 21 years, recommending the declaration of CCHF as a public health emergency. Establishing a comprehensive tick surveillance system, ecological studies, and health education sessions in collaboration with the livestock department is crucial to prevent future outbreaks.

Family doctors play a crucial role in a comprehensive healthcare surveillance system.

Family doctors play a crucial role in a comprehensive healthcare surveillance system.

Antibiotic resistance and virulence characteristics of Vibrio vulnificus isolated from Ningbo, China.

Vibrio vulnificus (V. vulnificus) is a deadly opportunistic human pathogen with high mortality worldwide. Notably, climate warming is likely to expand its geographical range and increase the infection risk for individuals in coastal regions. However, due to the absence of comprehensive surveillance systems, the emergence and characteristics of clinical V. vulnificus isolates remain poorly understood in China. In this study, we investigate antibiotic resistance, virulence including serum resistance, and hemolytic ability, as well as molecular characteristics of 21 V. vulnificus isolates collected from patients in Ningbo, China. The results indicate that all isolates have been identified as potential virulent vcg C type, with the majority (16 of 21) classified as 16S rRNA B type. Furthermore, these isolates exhibit a high level of antibiotic resistance, with 66.7% resistance to more than three antibiotics and 61.9% possessing a multiple antibiotic resistance (MAR) index exceeding 0.2. In terms of virulence, most isolates were categorized as grade 1 in serum resistance, with one strain, S12, demonstrating intermediate sensitivity in serum resistance, belonging to grade 3. Whole genome analysis disclosed the profiles of antibiotic resistance genes (ARGs) and virulence factors (VFs) in these strains. The strains share substantial VF genes associated with adherence, iron uptake, antiphagocytosis, toxin, and motility. In particular, key VFs such as capsule (CPS), lipopolysaccharide (LPS), and multifunctional autoprocessing repeats-in-toxin (MARTX) are prevalent in all isolates. Specifically, S12 possesses a notably high number of VF genes (672), which potentially explains its higher virulence. Additionally, these strains shared six ARGs, namely, PBP3, adeF, varG, parE, and CRP, which likely determine their antibiotic resistance phenotype. Overall, our study provides valuable baseline information for clinical tracking, prevention, control, and treatment of V. vulnificus infections.

Epidemiology of Enterovirus Genotypes in Association with Human Diseases.

Enteroviruses (EVs) are well-known causes of a wide range of infectious diseases in infants and young children, ranging from mild illnesses to severe conditions, depending on the virus genotypes and the host's immunity. Recent advances in molecular surveillance and genotyping tools have identified over 116 different human EV genotypes from various types of clinical samples. However, the current knowledge about most of these genotypes, except for those of well-known genotypes like EV-A71 and EV-D68, is still limited due to a lack of comprehensive EV surveillance systems. This limited information makes it difficult to understand the true burden of EV-related diseases globally. Furthermore, the specific EV genotype associated with diseases varies according to country, population group, and study period. The same genotype can exhibit different epidemiological features in different areas. By integrating the data from established EV surveillance systems in the USA, Europe, Japan, and China, in combination with other EV infection studies, we can elaborate a better understanding of the distribution of prevalent EV genotypes and the diseases associated with EV. This review analyzed the data from various EV surveillance databases and explored the EV seroprevalence and the association of specific EV genotypes with human diseases.

Epidemiological characteristics and drug resistance of diarrheagenic Escherichia coli infection in diarrhea patients in Shanghai, 2016-2022

Objective: To understand the infection status, epidemiological characteristics and drug resistance of Diarrheagenic Escherichia coli (DEC) in Shanghai and provide evidence for the disease surveillance. Methods: The epidemiological data of diarrhea cases in Shanghai from 2016 to 2022 were collected from Shanghai Diarrhea Comprehensive Surveillance System, and stool samples were collected from the cases for DEC detection. The drug resistance data was obtained from Chinese Pathogen Identification Network. Statistical analysis was conducted by using χ2 and fisher test. Results: In 24 883 diarrhea cases detected during 2016-2022, the DEC positive rate was 9.13% (2 271/24 883), the single DEC positive rate was 8.83% (2 197/24 883) and the mixed DEC positive rate was 0.30% (74/24 883). The main type of DEC was Enterotoxigenic Escherichia coli (ETEC) [4.33% (1 077/24 883)]. The DEC positive rate was highest in people aged ≤5 years 18.48% (22/119). The annual peak of DEC positive rate was observed during July - September [5.91% (1 470/24 883)]. The DEC positive rate were 9.47% (554/5 847) and 9.02% (1 717/19 036) in urban area and in suburbs, respectively, Enteroaggregative Escherichia coli (EAEC) [3.98% (233/5 847)] and ETEC [4.56% (868/19 036)] were mainly detected. From 2016 to 2019, the DEC positive rate was 9.42% (1 821/19 330), while it was 8.10% (450/5 553) from 2020 to 2022, the main DEC types were ETEC (4.87%, 941/19 330) and EAEC (4.70%, 261/5 553). The multi-drug resistance rate was 40.21% (618/1 537). The top three antibiotics with high drug resistance rates were ampicillin [64.74% (995/1 537)], nalidixic acid [58.49% (899/1 537)] and tetracycline [45.09% (693/1 537)]. Conclusions: Compared with 2016- 2019, a decrease in DEC detection rate was observed during 2020-2022, and the main type of DEC detected shifted from ETEC to EAEC. The prevalence of multi-drug resistance was severe. Therefore, it is necessary to further strengthen the surveillance for DEC drug resistance and standardize the use of clinical antibiotics.

Aeromonas hydrophila Septicaemia in a 6-Month-Old Infant: A Case Report

Background: Aeromonas hydrophila, a Gram-negative, motile, facultative anaerobe, is emerging as a serious pathogen. It is found in water, soil, and food, causing various infections, from mild diarrhoea to life-threatening sepsis. Young children, older people, and immunocompromised people are most susceptible. While treatable with antibiotics, A. hydrophila’s growing resistance to penicillin and other commonly available antibiotics complicates treatment. This case report highlights a rare instance of A. hydrophila sepsis in a young child in rural Gambia. Case summary: A 6-month-old African female child with high fever, cough, fast breathing, and vomiting was diagnosed with septicemia caused by Aeromonas hydrophila, a waterborne bacteria. The infant likely contracted the infection from contaminated fish or water. We started the child on the initial first-line empirical antibiotics but later switched to ceftriaxone due to antibiotic resistance, and the child recovered fully. This case highlights the importance of appropriate diagnosis, antibiotic susceptibility and surveillance of emerging antibiotic-resistant pathogens in young children. Conclusion: This report describes the infection of emerging antibiotic-resistant A. hydrophila sepsis in an African female child. A. hydrophila is an emerging pathogen causing opportunistic infections in both immunocompetent and immunocompromised patients. This study suggests that prompt identification of bacterial pathogens, coupled with targeted antimicrobial therapy guided by local antibiogram data and blood culture for antibiotic susceptibility, is likely a crucial factor for optimal patient outcomes. Furthermore, we advocate for more comprehensive surveillance systems to effectively track and monitor these emerging antibiotic-resistant pathogens.

Common Seasonal Pathogens and Epidemiology of Henoch-Schönlein Purpura Among Children

Henoch-Schönlein purpura (HSP) is the most common type of vasculitis in children. The factors that trigger the disease are poorly understood. Although several viruses and seasonal bacterial infections have been associated with HSP, differentiating the specific associations of these pathogens with the onset of HSP remains a challenge due to their overlapping seasonal patterns. To analyze the role of seasonal pathogens in the epidemiology of HSP. This cohort study comprised an interrupted time-series analysis of patient records from a comprehensive national hospital-based surveillance system. Children younger than 18 years hospitalized for HSP in France between January 1, 2015, and March 31, 2023, were included. Implementation and relaxation of nonpharmaceutical interventions (NPIs) for the COVID-19 pandemic, such as social distancing and mask wearing. The main outcomes were the monthly incidence of HSP per 100 000 children, analyzed via a quasi-Poisson regression model, and the estimated percentage of HSP incidence potentially associated with 14 selected common seasonal pathogens over the same period. The study included 9790 children with HSP (median age, 5 years [IQR, 4-8 years]; 5538 boys [56.4%]) and 757 110 children with the infectious diseases included in the study (median age, 0.7 years [IQR, 0.2-2 years]; 393 697 boys [52.0%]). The incidence of HSP decreased significantly after implementation of NPIs in March 2020 (-53.6%; 95% CI, -66.6% to -40.6%; P < .001) and increased significantly after the relaxation of NPIs in April 2021 (37.2%; 95% CI, 28.0%-46.3%; P < .001). The percentage of HSP incidence potentially associated with Streptococcus pneumoniae was 37.3% (95% CI, 22.3%-52.3%; P < .001), the percentage of cases associated with Streptococcus pyogenes was 25.6% (95% CI, 16.7%-34.4%; P < .001), and the percentage of cases associated with human rhino enterovirus was 17.1% (95% CI, 3.8%-30.4%; P = .01). Three sensitivity analyses found similar results. This study found that significant changes in the incidence of HSP simultaneously with major shifts in circulating pathogens after NPIs for the COVID-19 pandemic indicated that approximately 60% of HSP incidence was potentially associated with pneumococcus and group A streptococcus. This finding suggests that preventive measures against these pathogens could reduce the incidence of pediatric HSP.

Profile and Geospatial Analysis of Dog Bite Cases Attending the Antirabies Vaccine Outpatient Department at the Tertiary Level Hospital of Mumbai.

Dog bites pose a significant public health concern in India, necessitating an understanding of their epidemiological profile and spatial distribution. Adopting the One Health approach, which considers the interconnection of human, animal, and environmental health, is vital for developing effective interventions. The study aimed to assess the epidemiological profile and geospatial trends of dog bite cases in an urban area, focusing on the age and gender distribution of victims, severity of bites, and spatial distribution of cases to inform prevention strategies. A retrospective secondary data analysis was conducted on dog bite cases reported in 2022 at a tertiary care hospital in Mumbai. The epidemiological profile, including age, gender, and severity of bites, was examined. Quantum Geographic Information System (QGIS) was utilized for spatial distribution analysis, identifying hotspots within the urban area. Of the 3350 cases, 70.7% were below 40 years old, 81.6% were male, and 78.18% had Category III bites indicating severe injuries. Most cases (74%) were caused by stray dogs. QGIS analysis revealed five hotspots within the urban area. The study highlights the predominance of dog bites among younger males and the severity of injuries. Spatial analysis identified specific hotspots, underscoring the need for targeted interventions. Implementing a comprehensive surveillance system incorporating GIS technology and adopting a One Health approach can enhance the control and prevention of dog bite cases and reduce the risk of rabies outbreaks.

Factors Associated with Influenza-like Illness among Inmates in an All-male Prison, Songkhla Province, Thailand, 2023

On 9 Feb 2023, the Office of Disease Prevention and Control Region 12Songkhlawas informed of an influenza-like illness (ILI) cluster in an all-male prison in Songkhla Province. We investigated to identify the causative agent, possible sources and risk factors, and provide control measures. We conducted an active case finding by interviewing inmates and officers. Prison facilities and hygiene behaviors of inmates and officers were inspected. A retrospective cohort study was performed. Basic and effective reproductive numbers were estimated. The overall attack rate was 12.6% (474/3,648). Most cases were inmates from Wing C (80.4%). There were no severe cases or deaths. Of ten specimens tested, all were positive for influenza B/Victoria lineage, V1a.3a.2. Fifty-four percent of inmates had received influenza vaccine within the last 12 months. A mismatch between the viral strain in the vaccine and the one causing this outbreak likely contributed to the outbreak as the vaccine provided to the inmates was manufactured during the previous year's influenza season. Vaccine effectiveness was 36.2% against ILI. Having high-risk conditions (adjusted odds ratios (AOR) 2.83, 95% confidence interval (CI) 1.27–6.32) and sharing drinking glasses (AOR 2.02, 95% CI 1.21–3.36) were significant risk factors. The basic reproductive number for ILI in this outbreak was 1.36. The effective reproductive number ranged from 0.18–3.69. For effective management of ILI outbreaks in prisons, a continuous program of influenza vaccination following updated World Health Organization recommendations and a comprehensive surveillance system with rigorous respiratory illness management practices are suggested.

How much should we sequence? An analysis of the Swiss SARS-CoV-2 surveillance effort.

During the SARS-CoV-2 pandemic, many countries directed substantial resources toward genomic surveillance to detect and track viral variants. There is a debate over how much sequencing effort is necessary in national surveillance programs for SARS-CoV-2 and future pandemic threats. We aimed to investigate the effect of reduced sequencing on surveillance outcomes in a large genomic data set from Switzerland, comprising more than 143k sequences. We employed a uniform downsampling strategy using 100 iterations each to investigate the effects of fewer available sequences on the surveillance outcomes: (i) first detection of variants of concern (VOCs), (ii) speed of introduction of VOCs, (iii) diversity of lineages, (iv) first cluster detection of VOCs, (v) density of active clusters, and (vi) geographic spread of clusters. The impact of downsampling on VOC detection is disparate for the three VOC lineages, but many outcomes including introduction and cluster detection could be recapitulated even with only 35% of the original sequencing effort. The effect on the observed speed of introduction and first detection of clusters was more sensitive to reduced sequencing effort for some VOCs, in particular Omicron and Delta, respectively. A genomic surveillance program needs a balance between societal benefits and costs. While the overall national dynamics of the pandemic could be recapitulated by a reduced sequencing effort, the effect is strongly lineage-dependent-something that is unknown at the time of sequencing-and comes at the cost of accuracy, in particular for tracking the emergence of potential VOCs.IMPORTANCESwitzerland had one of the most comprehensive genomic surveillance systems during the COVID-19 pandemic. Such programs need to strike a balance between societal benefits and program costs. Our study aims to answer the question: How would surveillance outcomes have changed had we sequenced less? We find that some outcomes but also certain viral lineages are more affected than others by sequencing less. However, sequencing to around a third of the original effort still captured many important outcomes for the variants of concern such as their first detection but affected more strongly other measures like the detection of first transmission clusters for some lineages. Our work highlights the importance of setting predefined targets for a national genomic surveillance program based on which sequencing effort should be determined. Additionally, the use of a centralized surveillance platform facilitates aggregating data on a national level for rapid public health responses as well as post-analyses.

Evaluation of a surveillance system for Clostridioides difficile infections for Swiss hospitals.

This study evaluated an approach to establishing a comprehensive nationwide surveillance system forClostridioides difficileinfection in Switzerland. We report the results of patient-related surveillance and calculate the incidence rate ofC. difficileinfection in Switzerland in 2022. Initiated in 2017 by the National Centre for Infection Prevention (Swissnoso), in collaboration with the Swiss Centre for Antibiotic Resistance (ANRESIS), laboratory surveillance enables the automatic import ofC. difficileinfection laboratory data and is fully operational. However, the very limited number of participating laboratories impedes the generation of representative results. To address this gap, Swissnoso introduced patient-related surveillance, with a questionnaire-based survey used across Swiss acute care hospitals. This survey revealed an incidence of 3.8 (Poisson 95% CI: 3.2-4.5)C. difficileinfection episodes per 10,000 patient-days, just above the mean rate reported by the European Centre for Disease Prevention and Control (ECDC). Additionally, we report substantial heterogeneity in laboratory tests, diagnostic criteria and infection control practices among Swiss hospitals. This study underscores the importance of a joint effort towards standardized surveillance practices in providing comprehensive insights intoC. difficileinfection epidemiology and effective prevention strategies in Swiss healthcare settings. The patient-related approach remains the gold standard forC. difficileinfection surveillance, although it demands substantial resources and provides results only annually. The proposed implementation of nationwide automated laboratory-based surveillance would be pragmatic and efficient, empowering authorities and hospitals to detect outbreaks promptly and to correlate infection rates with antibiotic consumption.

Antibiograms, multidrug resistance, and milk-related parameters of bacteria isolated from milk of dairy cattle in Phatthalung, Thailand.

Milk, a nutritious food, is widely consumed in human diets; however, contamination by micro-organisms can negatively impact its quality and consumer health. Contamination by micro-organisms affects the quality of milk, which can affect the quality of the milk production chain. This study aimed to determine the changes in milk composition and antibiotic susceptibility related to bacteria isolated from dairy cow milk. Raw milk samples were collected from 72 dairy cows. All milk samples were subjected to the California Mastitis Test (CMT) for CMT score determination. We also investigated milk composition, bacterial culture (BC), and antibiotic susceptibility. About 47.22% and 30.56% of dairy cattle were positive for CMT + BC and automatic somatic cell count (ASCC) + BC, respectively. Fecal appearance and animal age were found to be risk factors for ASCC + BC positivity in dairy cattle. Bacteria were found in approximately 76% of milk samples, with the most common isolated species being α-hemolytic Streptococcus spp., coagulase-negative Staphylococcus spp., and Escherichia coli. Of these, 70% are resistant to at least one antibiotic. Variation in the multidrug resistance pattern was high in Klebsiella spp. Fecal appearance and animal age are risk factors for ASCC + BC positivity in dairy cattle. This study identified antibiotic and multidrug resistance patterns, which require comprehensive studies and effective surveillance systems. Remarkably, the use of antibiotic therapy in dairy cattle should be monitored.

National safety monitoring of vaccines from the Canadian Adverse Events Following Immunization Surveillance System (CAEFISS), 2018-2019.

The Canadian Adverse Events Following Immunization Surveillance System (CAEFISS) is a comprehensive vaccine safety surveillance system that includes both passive and active surveillance of vaccines administered in Canada. This work presents a summary of adverse events following immunization (AEFI) nationally for 2018 and 2019. Data extracted from CAEFISS included all AEFI reports received by the Public Health Agency of Canada by April 30, 2022, for vaccines marketed in Canada and administered between January 1, 2018, and December 31, 2019. Descriptive statistics were conducted on AEFI reports by type of surveillance program (i.e., active vs. passive), AEFIs, demographics, healthcare utilization, outcome, seriousness of adverse events and type of vaccine. Between 2018 and 2019, 5,875 AEFI reports were received from across Canada. The average annual AEFI reporting rate was 10.9/100,000 doses distributed in Canada for vaccines administered during 2018-2019 and was found to be inversely proportional to age. The majority of reports (91%) were non-serious events, involving vaccination site reactions, rash and allergic events. Overall, there were 511 serious adverse event reports during 2018-2019. Of the serious adverse event reports, the most common primary AEFIs were anaphylaxis followed by seizure. There were no unexpected vaccine safety issues identified or increases in frequency or severity of adverse events. Canada's continuous monitoring of the safety of marketed vaccines during 2018-2019 did not identify any increase in the frequency or severity of AEFIs, previously unknown AEFIs, or areas that required further investigation or research.

Anthrax outbreak: exploring its biological agents and public health implications

The (re)emergence of several infectious zoonoses underlines the need for the re-evaluation of the transmission patterns and key players responsible for effective inter-species transfer of diseases. Anthrax is caused by Bacillus anthracis, a zoonotic rod-shaped, Gram-positive, spore-forming bacterium that is highly fatal to both human and animal populations. B. anthracis is widespread across several regions of the world, including Africa, Asia, southern Europe, North and South America, and Australia, and it has a remarkably high attendant impact on the sustainability and profitability of livestock. The current trend in the global distribution of anthrax necessitates an urgent contextual understanding of the key drivers of the spread of B. anthracis in different parts of the world toward the end goal of an anthrax-free world. The understanding of the drivers is integral for the development of control and preventive measures, and also the development of agents such as therapeutics and vaccines against B. anthracis. This review presents a holistic description of the transmission pattern and epidemiology of B. anthracis, and updates on the diagnostic techniques and approaches available for the detection of B. anthracis. In addition, this review highlights plausible prevention and control strategies for the bacterium. This review further underscores the need for participatory epidemiology, hygiene, and safety protocols, the establishment of comprehensive surveillance systems, and global collaborative efforts toward vaccine development as critical steps in controlling anthrax.

Enhanced automated detection of outbreaks of a rare antimicrobial-resistant bacterial species.

Surveillance of antimicrobial resistance (AMR) is a crucial strategy to combat AMR. Using routine surveillance data, we could detect and control hospital outbreaks of AMR bacteria as early as possible. Previously, we developed a framework for automatic detection of clusters of AMR bacteria using SaTScan, a free cluster detection tool integrated into WHONET. WHONET is a free software used globally for microbiological surveillance data management. We applied this framework to data from the Japan Nosocomial Infections Surveillance (JANIS), one of the world's most comprehensive and largest national AMR surveillance systems. Although WHONET-SaTScan has several cluster detection algorithms, no published studies have compared how different algorithms can produce varying results in cluster detection. Here, we conducted a comparison to detect clusters of vancomycin-resistant enterococci (VRE), which has been rare in Japan, by analyzing combinations of resistance to several key antimicrobials ("resistance profiles") using the comprehensive national routine AMR surveillance data of JANIS and validated the detection capabilities of each algorithm using publicly available reports of VRE clusters. All publicly reported VRE hospital outbreaks were detected as statistical clusters using the space-time uniform algorithm implemented in WHONET-SaTScan. In contrast, only 18.8% of the publicly reported outbreaks were detected using another algorithm (space-time permutation). The space-time uniform algorithm was also effective in identifying hospital wards affected by outbreaks attributed to specific resistance profiles. Although half of the publicly reported outbreaks were attributed to VRE resistant to five particular antimicrobials, four other resistance profiles also contributed to the outbreaks, highlighting the diversity of AMR bacteria within these occurrences. Our comparison revealed a clear advantage in using an algorithm (space-time uniform) for detecting VRE clusters in WHONET-SaTScan based on national surveillance data and further demonstrated the capability to distinguish detected clusters based on resistance profiles.

Conception on Public Health Surveillance System Based on Big Data in Health and Medical Care

In recent years, public health events in varying degrees have occurred in different parts of China, these public health emergencies are characterized by volatility and complexity. To effectively respond to major challenges, we must establish a comprehensive public health surveillance system capable of efficiently collecting, analyzing, and processing data, while providing effective and timely information support. This paper focuses on how big data technologies can be used to achieve this goal. The theoretical basis is first introduced, including the definition, characteristics and application methods of big data; then the existing public health surveillance system is analyzed and summarized, its shortcomings are pointed out; finally, a design scheme for a public health monitoring system based on health care big data is proposed, detailing the design ideas, functional modules and database structure of the scheme. The scheme can help the authorities to monitor and manage information in real time so as to provide the basis for scientific-decision making. Through testing and verification, the scheme is found to have good performance and can meet the needs of large-scale public health surveillance. The findings of this project hold significant relevance in advancing the development of the public health surveillance system in China.