Disease In Europe Research Articles

Family Pediatrician and Public Health collaboration, an alliance to increase vaccination coverage: an experience with MenB vaccination in Italy.

Invasive Meningococcal Disease is a severe disease mainly affecting infants and young children. Most infections are caused by serogroups A, B, C, W, X, and Y. In the last 10 years, serogroup B has been the main cause of Invasive Meningococcal Disease in Europe. Recent data resulting from an observational study conducted in Italy show a significant reduction in the number of Invasive Meningococcal Disease cases due to Neisseria meningitidis B after the introduction of vaccine 4CMenB. Thus, the Naples Team of Federation of Italian Primary Care Pediatricians and the Public Health Department started an active collaboration focused on vaccination process management (named "Progetto Via") with the aim of increasing Meningococcal B vaccination coverage. Source of data is the regional platform "GE.VA.". Every Primary care Pediatrician uses daily to record vaccination activity. This platform is integrated with data entered by operators of the District/Vaccination Center. Time: January 2019 - December 2019. The Federation of Italian Primary Care Pediatricians/Naples organized a meeting to identify six coordinators. The pediatricians could choose to counsel in their own offices and send children to the vaccination center or to counsel and vaccinate directly in their own clinics. A total of 78 pediatricians took part in the project: 46 did only counseling and 32 did both counseling and vaccination in their medical clinic. Data obtained show an overall average vaccination coverage growth of about 13% in the first 4 months of the survey, and a further growth of about 11% in the following seven months, with a total growth in the entire period of 24%. The pediatricians' counseling is essential to recover non-compliant subjects, considering both the relationship of trust with the families and the visits already scheduled as an ideal moment for vaccinations' status check. The project highlights how an effective collaboration between family pediatricians and the Local Health Authority becomes valuable in getting closer to reach the Ministerial goal of 95%. Vaccination coverage increased significantly when family pediatricians supported the activity of vaccine centers in distress in many regional situations. The trust relationship, the hourly availability and the capillary network of family pediatricians' clinics were key elements for the success of this project and were also recognized by parents.

Harmonizing development, approval and access of drugs for rare diseases in Europe.

In the past few decades, the regulatory system has changed its approach to speed up the assessment and approval of drugs for the treatment of serious and orphan diseases. However, too early assessments may fail to provide solid evidence to define the therapeutic value of drugs and their fair price. As for rare diseases, patients' expectations amplify such criticalities due to the lack of therapeutic alternatives. The revision of the EU regulation on orphan medicinal products represents an opportunity to promote greater integration between the development and approval of drugs with their subsequent access. For this reason, we propose: 1) establishing a process for evaluating the comparative efficacy and quantification of the therapeutic benefit of a drug at a European level, while addressing incentives towards rarer diseases to support their development and marketing; 2) downsizing the impact of orphan drugs on general sustainability, considering that incentives supporting their development and marketing cannot transform them into new 'blockbusters'. In this perspective, a European procurement - initially intended for drugs for ultra-rare diseases - could improve access by all EU countries through simplifying the burdensome procedures for the pharmaceutical industry; 3) enhancing the contribution of post-authorization research from a public-private partnership perspective to steer the development of drugs already approved towards rarer pathologies or mutations of little commercial interest.

Register-based information on thyroid diseases in Europe: lessons and results from the EUthyroid collaboration.

ObjectiveRegisters of diagnoses and treatments exist in different forms in the European countries and are potential sources to answer important research questions. Prevalence and incidence of thyroid diseases are highly dependent on iodine intake and, thus, iodine deficiency disease prevention programs. We aimed to collect European register data on thyroid outcomes to compare the rates between countries/regions with different iodine status and prevention programs.DesignRegister-based cross-sectional study.MethodsNational register data on thyroid diagnoses and treatments were requested from 23 European countries/regions. The provided data were critically assessed for suitability for comparison between countries/regions. Sex- and age-standardized rates were calculated.ResultsRegister data on ≥1 thyroid diagnoses or treatments were available from 22 countries/regions. After critical assessment, data on medication, surgery, and cancer were found suitable for comparison between 9, 10, and 13 countries/regions, respectively. Higher rates of antithyroid medication and thyroid surgery for benign disease and lower rates of thyroid hormone therapy were found for countries with iodine insufficiency before approx. 2001, and no relationship was observed with recent iodine intake or prevention programs.ConclusionsThe collation of register data on thyroid outcomes from European countries is impeded by a high degree of heterogeneity in the availability and quality of data between countries. Nevertheless, a relationship between historic iodine intake and rates of treatments for hyper- and hypothyroid disorders is indicated. This study illustrates both the challenges and the potential for the application of register data of thyroid outcomes across Europe.

Monitoring and Evaluation of Patient Engagement in Health Product Research and Development: Co-Creating a Framework for Community Advisory Boards.

While patient engagement is becoming more customary in developing health products, its monitoring and evaluation to understand processes and enhance impact are challenging. This article describes a patient engagement monitoring and evaluation (PEME) framework, co-created and tailored to the context of community advisory boards (CABs) for rare diseases in Europe. It can be used to stimulate learning and evaluate impacts of engagement activities. A participatory approach was used in which data collection and analysis were iterative. The process was based on the principles of interactive learning and action and guided by the PEME framework. Data were collected via document analysis, reflection sessions, a questionnaire, and a workshop. The tailored framework consists of a theory of change model with metrics explaining how CABs can reach their objectives. Of 61 identified metrics, 17 metrics for monitoring the patient engagement process and short-term outcomes were selected, and a "menu" for evaluating long-term impacts was created. Example metrics include "Industry representatives' understanding of patients' unmet needs;" "Feeling of trust between stakeholders;" and "Feeling of preparedness." "Alignment of research programs with patients' needs" was the highest-ranked metric for long-term impact. Findings suggest that process and short-term outcome metrics could be standardized across CABs, whereas long-term impact metrics may need to be tailored to the collaboration from a proposed menu. Accordingly, we recommend that others adapt and refine the PEME framework as appropriate. The next steps include implementing and testing the evaluation framework to stimulate learning and share impacts.

The Cost of Von Willebrand Disease in Europe: The CVESS Study.

BackgroundVon Willebrand disease (VWD) is one of the most common inherited bleeding disorders, imposing a substantial health impact and financial burden. The Cost of von Willebrand disease in Europe: A Socioeconomic Study (CVESS) characterises the socio-economic cost of VWD across Germany, Spain, Italy, France, and the UK.MethodsA retrospective, cross-sectional design captured 12 months of patient disease management, collected from August-December 2018, for 974 patients. This enabled estimation of direct medical, direct non-medical and indirect costs, utilising prevalence estimates to extrapolate to population level.ResultsTotal annual direct medical cost (including/excluding von Willebrand factor [VWF]) across all countries was the highest cost (€2 845 510 345/€444 446 023), followed by indirect costs (€367 330 271) and direct non-medical costs (€60 223 234). Differences were seen between countries: the UK had the highest direct medical costs excluding VWF (€159 791 064), Italy the highest direct-non medical (€26 564 496), and Germany the highest indirect cost burden (€197 036 052). Total direct medical costs per adult patient increased across VWD types with Type 1 having the lowest cost (€23 287) and Type 3 having the highest cost (€133 518).ConclusionA substantial financial burden arises from the prevalence of VWD for the European healthcare systems considered.

The "Nastas'in Pestilence": the Great Plague of 1417-1425 in Rus

The plague pandemic ("The Black Death") that struck Eurasia in the middle of XIV century, "settled" this lethal disease in Europe for a long time. The new outbreaks of this disease, with breaks of several years, occurred in single cities, regions and states, covering sometimes entire continent over the next centuries. However, impression that "The Black Death" made upon minds of European scribes, staggering European society by its inevitability, for a long time determined particular angle of view under which it is accepted to consider the history of plague in Europe in the epoch of Middle Ages and early New Age. The image of The Great Plague of XIV century overshadowed all subsequent outbreaks of this lethal disease, so its subsequent occurrences are traditionally given less attention. The article, being based on on analysis of numerous chronicle evidences, for the first time in Russian historiography analyzes the history of plague in Rus during first decades of XV century and restores chronology of its occurrence and development and determines areas affected by the plague in the first place, estimating caused damage.

Pulmonary tularemia : a diagnosis not to be missed

Tularemia (caused by the facultative intracellular Gram-negative bacillus Francisella tularensis) is an endemic zoonotic disease in Europe, which exhibits different clinical patterns. Following the glandular form, pneumonia is the second most frequent manifestation in Switzerland. Pulmonary tularemia often has a subacute course and fails to respond to beta-lactam antibiotics. It can also mimic tuberculosis, because of the presence of systemic symptoms, such as fever, sweats and weight loss. History of animal exposure is not always reported. Clinicians should be aware of pulmonary tularemia. They should be able to diagnose it with appropriate tools (PCR, serology) and initiate appropriate therapy (fluoroquinolones, tetracyclines or aminoglycosides).

POSA363 Lasting Impacts of the COVID-19 Pandemic on Patients Affected By Chronic Diseases in Europe

Patients with Chronic Medical Conditions (CMC) require regular access to healthcare professionals and are often under long-term treatments. Even though the direct effects of the COVID-19 pandemic are diminishing, they may still affect CMC patients’ clinical outcomes. The present study aims to assess these lasting impacts.

Quantitative Methods for the Prioritization of Foods Implicated in the Transmission of Hepatititis E to Humans in Italy.

Hepatitis E is considered an emerging foodborne disease in Europe. Several types of foods are implicated in the transmission of the hepatitis E virus (HEV) to humans, in particular, pork and wild boar products. We developed a parametric stochastic model to estimate the risk of foodborne exposure to HEV in the Italian population and to rank the relevance of pork products with and without liver (PL and PNL, respectively), leafy vegetables, shellfish and raw milk in HEV transmission. Original data on HEV prevalence in different foods were obtained from a recent sampling study conducted in Italy at the retail level. Other data were obtained by publicly available sources and published literature. The model output indicated that the consumption of PNL was associated with the highest number of HEV infections in the population. However, the sensitivity analysis showed that slight variations in the consumption of PL led to an increase in the number of HEV infections much higher than PNL, suggesting that PL at an individual level are the top risky food. Uncertainty analysis underlined that further characterization of the pork products preparation and better assessment of consumption data at a regional level is critical information for fine-tuning the most risky implicated food items in Italy.

Tree mortality caused by Diplodia shoot blight on Pinus sylvestris and other mediterranean pines

Diplodia shoot blight is an emergent forest disease in Europe caused by Diplodia sapinea. The short-term impacts of the pathogen on tree physiology are well known, but its capacity to cause mortality has been poorly documented.We compared the survival of four pine species affected by Diplodia shoot blight following a hailstorm: Pinus sylvestris, P. nigra, P. pinea and P. halepensis. In the case of P. sylvestris, survival in the hail-affected sites was compared with survival in other sites affected by Diplodia shoot blight with no hailstorm records. Mortality and crown condition were recorded over two years. Dendrochronological analyses were conducted to assess growth responses to drought and to test the influence of radial growth before the outbreak of Diplodia shoot blight on survival. The endophytic community, as well as the abundance of D. sapinea, was quantified by metabarcoding and qPCR respectively, and were correlated with crown damage.Crown damage was the best predictor of mortality across species. Pinus sylvestris experienced a much higher rate of mortality than P. nigra, P. pinea and P. halepensis. Two years after the outbreak, P. halepensis was the only species that could recover crown condition. Mortality was found to be unrelated to radial growth prior the outbreak. Drought responses did not correlate with mortality differences across pine species or sites. In the case of P. sylvestris, mortality was initially higher amongst diseased trees in areas affected by hailstorms than in sites not affected by hailstorms, however it tended to equalise after two years. Amongst P. sylvestris trees, crown damage correlated with a higher abundance of the pathogen. Signs of competition amongst endophytes were observed between non-defoliated and defoliated Scots pine trees following hailstorms.Our study shows that D. sapinea can cause a significant mortality to P. sylvestris. The legacy effects of crown damage can last for at least two years after an outbreak. During this time, crown damage is a good predictor of survival, and can help managers decide which trees remove after an outbreak.

Imaging in Transcatheter Mitral Valve Replacement: State-of-Art Review.

Mitral regurgitation is the second-most frequent valvular heart disease in Europe and it is associated with high morbidity and mortality. Recognition of MR should encourage the assessment of its etiology, severity, and mechanism in order to determine the best therapeutic approach. Mitral valve surgery constitutes the first-line therapy; however, transcatheter procedures have emerged as an alternative option to treat inoperable and high-risk surgical patients. In patients with suitable anatomy, the transcatheter edge-to-edge mitral leaflet repair is the most frequently applied procedure. In non-reparable patients, transcatheter mitral valve replacement (TMVR) has appeared as a promising intervention. Thus, currently TMVR represents a new treatment option for inoperable or high-risk patients with degenerated or failed bioprosthetic valves (valve-in-valve); failed repairs, (valve-in-ring); inoperable or high-risk patients with native mitral valve anatomy, or those with severe annular calcifications, or valve-in-mitral annular calcification. The patient selection requires multimodality imaging pre-procedural planning to select the best approach and device, study the anatomical landing zone and assess the risk of left ventricular outflow tract obstruction. In the present review, we aimed to highlight the main considerations for TMVR planning from an imaging perspective; before, during, and after TMVR.

733 Evaluation of pulmonary pressures in patients underwent to MitraClip

Abstract Mitral regurgitation (MR) is the second most frequent valve heart disease in Europe and its underlying mechanism primary-organic (due to disease of the mitral leaflets), or secondary-functional (where valve leaflets and chordae are structurally normal and MR results from alterations in left ventricle and left atrium geometry), determines the therapeutic approach. Transcatheter Edge-to-Edge Repair (TEER) with MitraClip implantation is a minimal-invasive treatment that according to 2021 ESC Guidelines should be considered (class indication IIa) in selected symptomatic patients with severe MR despite optimal medical therapy, not eligible for surgery and fulfilling COAPT trial inclusion criteria, suggesting an increased chance of responding to treatment. Optimal valve morphology features for TEER are central pathology (second scallop), no leaflet calcifications, mitral valve area >4 cm2, mobile length of posterior leaftel >10 mm, coaptation depth <11mm, normal leaflet strength and mobility, flail width <15 mm, flail gap <10 mm. TEER may be considered (class IIb) only in selected cases when the COAPT criteria are not fulfilled with the aim of improving symptoms and quality of life. MR occurs during systole, that at normal heart rates represents 30–50% of the cardiac cycle. As such, marked left atrial (LA) pressure elevation is present only transiently, representing less of a drive to development of secondary pulmonary hypertension compared to chronic LA pressure elevation seen in severe mitral stenosis. Anyway, in patients with severe MR echocardiography often reveals elevated systolic pulmonary artery pressure (PAPs) and MitraClip implantation usually is associated with a slight increase of the trans-mitral gradient with possible repercussions on pulmonary pressures. To better describe the effect of MitraClip implantation on pulmonary pressures and clinical outcomes we did a retrospective study enrolling in the period 2012–2021 25 patients with severe mitral regurgitation treated with TEER. We aimed to evaluate the clinical outcomes (symptoms, signs of heart failure, NYHA functional class) and the pulmonary pressures assessed by an echocardiographic examination before and after the intervention. At 6-month follow-up all patients with repaired mitral regurgitation showed an improvement in the NYHA class (from IV to II) and no need for re-hospitalization. We observed a trend in the reduction of the mean sistolic pulmonary arterial pressure of 2.68 mmHg ± 15 mmHg (P 0.39, 95% C.I. −9.03 to 3.67) with an unchanged left ventricle ejection fraction. Moreover, the echocardiographic exam showed a normalization of the S and D waves pattern in the pulmonary veins at the PW Doppler evaluation. We can assume that the clinical improvement and the reduction of dyspnoea in these patients underwent TEER is related to a reduction of pressures in the pulmonary circulation regardless of the ejection fraction. This finding could be used as a tool that the cardiologist has to evaluate in the echocardiography lab to reveal a new mitral valve disfunction. Considering the small sample, a greater number of patients will be enrolled to highlight the statistical significance.

Tick Borne Encephalitis

Tick-borne encephalitis (TBE) is the medically most common tick-borne viral disease in Europe and Asia. The TBE virus (TBEV) is a member of the family Flaviviridae. Transmission mainly to humans occurs by ticks of the Family Ixodidae, mainly the castor bean tick (Ixodes ricinus) in Europe and the taiga tick (Ixodes persulcatus) in Asia. Rarely TBEV is also transmitted by contaminated milk of infected ungulates (goat, sheep, cow). The clinical course of TBE is variable and may range from subclinical to fatal encephalomyelitis. Probably host and viral factors are involved in the pathogenesis of disease. So far, no specific treatment of the disease is available. The only effective prevention of TBE is vaccination. A number of different vaccines are available worldwide. In Europe two vaccines are licensed which contain inactivated European subtype TBEV. Probably the European vaccines protect also against infections with other subtypes of TBEV.

Healthcare practices and interventions in Europe towards families of older patients with cardiovascular disease: A scoping review.

In Europe, cardiovascular disease is one of the predominant causes of mortality and morbidity among older people over 65years. The occurrence of cardiovascular disease can have a negative impact on the quality of life of older patients and their families and family health overall. Assuming that illness is a family affair shaped by culture and health care systems, we explored European health care practices and interventions toward families of older patients with cardiovascular disease and heart failure. This paper aimed to determine the extent, range, and variety of practices and interventions in Europe directed to families of older patients and to identify knowledge gaps. A scoping review was conducted including studies published in Medline, CINHAL, or Cochrane library between 2009 and mid-2020. A total of 22 articles from 17 studies were included, showing diverse practices and interventions. The interventions targeted the family as a unit (six studies), dyads (five studies), patients alone, but assessed family members' reactions (five studies) or the family member primarily, but assessed the reaction of the patient (one study). Target outcomes were family caregiver burden; health-related QoL; and perceived control in patients; and family functioning and changes in health behavior or knowledge in both, family members and patients. Most studies did not include an integral view of the family as the unit of care but rather had a disease-centered approach. This scoping review provides insight into a variety of healthcare practices towards families of older patients with cardiovascular disease in Europe. Clarifying underlying assumptions to involve families is needed. More studies with family-focused approaches as integral models could lead to practices that improve families' well-being. Exploring integral models for their acceptance in health care and family systems appears pertinent to develop European policy to support and add to family health.

Limited Access to Transcranial Doppler Screening and Stroke Prevention for Children with Sickle Cell Disease in Europe: Results of a Multinational Eurobloodnet Survey

Background:Children with sickle cell disease (SCD) are at increased risk of cerebrovascular events such as stroke, silent infarcts and neurocognitive impairment. The role of Transcranial Doppler ultrasound scanning (TCD) to identify sickle cell anemia (SCA) children at high risk of stroke is well established. Adam et al in 1998 recommended those with abnormal cerebrovascular flow velocities are offered prophylactic blood transfusion therapy to prevent stroke between ages 2 to 16 years. Therefore, TCD screening for stroke prevention in now is a mandatory in all guidelines for the management of children with SCA. However, there is still no uniform implementation of the program globally and in European countries (Rees 2016). Moreover, the information available on the quality of the TCD screening is limited to educational experiences in a few countries (Inusa 2019) but to evaluation of stroke prevention programs has been performed in Europe.As more disease modifying therapies become available for children with SCD, it is mandatory to know TCD availability, screening practices, and real-world data on stroke prevention in Europe.EuroBloodNet is the European Reference Network (ERN) on rare Hematological Disorders, one of the 24 ERN established by the European Union to improve care of patients with rare disorders in Europe. EuroBloodNet's main goal is to improve the healthcare and overall quality of life of patients with a Rare Hematological Disease by: 1) Improving equal access to highly specialized healthcare delivery through a multidisciplinary patient centered approach; 2) Enhancing the best practices in prevention, diagnosis and safe clinical care across Europe based on promotion of evidence based guidelines.We wanted to assess the state of the art of TCD screening and stroke prevention programs in European Expert Centers.Methods: An online survey was developed by SCD experts in 5 European countries and sent to all Representatives of the Health Care Providers (HCP) and the Red Cell Disorder representatives in each HCP within the EuroBloodNet network, as well as to National Representatives of Scientific Societies within European Countries. Items in the survey are listed in Table 1.Results81 hematologists or pediatricians from 77 centers in 16 European countries responded to the survey (14/16 in Western Europe); 39/77 (51%) were EuroBloodNet Expert centers, 14/77 (18%) were under evaluation as being recognized; 67/77 specified their expertise: 24% were pediatric, 3% adult, 58% both; 12 centers had >200 patients in the age range 1-16 years.36% Physicians reported not having a dedicated TCD/TCDi service for children with SCD so exams had to be performed by cardiologists (10%), general radiologists (28%), TCD is not performed (31%), or patients have to be sent in another center (31%). 74% reported requesting annual TCD for their patients, but to the question “What percentage of your patients receives annual TCD” only 28% confirmed that all their patients managed to actually receive annual TCD, due to lack of trained staff (43%), lack of TCD instruments (11%), refusal of patients due to logistical difficulties (22%) (i.e TCD in another city), lack of funds for dedicated staff or equipment (11%), or other reasons.Only 74% of hematologists were aware of the protocol in use at their center by the staff performing TCD; the STOP criteria were applied by 64% of the physicians, mainly due non evaluation of the Internal Carotid Artery. The extracranial part of the carotid artery was evaluated only in 30% of the respondents.In case of abnormal/conditional TCD results, the approach varies and is not uniform across centers.ConclusionsOur data show that less than 30% of children with SCD followed in European Centers receive annual TCD according to recognized guidelines. This first multinational European survey allowed the identification of issues related to the lack of access to TCD, lack of trained staff, lack of adequate protocols for implementation of TCD and treatment afterwards, which will need to be addressed through dedicated actions. [Display omitted] DisclosuresCasale: Novartis Farma SpA: Honoraria, Membership on an entity's Board of Directors or advisory committees. Mañú Pereira: Novartis: Research Funding; Agios Pharmaceuticals: Research Funding. de Montalembert: Vertex: Membership on an entity's Board of Directors or advisory committees; BlueBirdBio: Membership on an entity's Board of Directors or advisory committees; Addmedica: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Colombatti: Global Blood Therapeutics: Research Funding; Addmedica: Consultancy; Forma Therapeutics: Consultancy; Novartis: Consultancy; NovoNordisk: Consultancy; BlueBirdBio: Consultancy; Global Blood Therapeutics: Consultancy; BlueBirdBio: Research Funding.

Dietary factors and non-communicable disease risk in Europe: evidence for European nutritional guidelines?

Abstract Findings from large global studies support the hypothesis that Europe is suffering from a double burden of malnutrition, affecting food security, undernutrition and nutrition deficiencies on one side, and overnutrition and higher risk of obesity and chronic diseases on the other. Data from the NCD Risk Factor Collaboration (NCD-RisC) and the Global Burden of Disease (GBD) Study as well as meta-review from the scientific literature provides insight on the burden of nutritional risk factors on non-communicable diseases in Europe. Over the last 40 years, obesity prevalence has increased threefold in several European countries, reaching over 50% of individuals having weight problems. However, obesity prevalence levels and trends vary substantially by gender and between European countries, with Malta and Eastern European countries having higher overweight and obesity rates. At European level, it has been estimated that over 950,000 deaths and over 16 million DALYs are attributable to dietary risks due to unhealthy diets. The main causes of death attributable to dietary risks include cardiovascular diseases (817,302), neoplasms (101,477) and diabetes and kidney diseases (32,009). The most important dietary factors contributing to cardiovascular diseases were diet high in sodium, sugar sweetened beverages, and processed meat, while metabolic disorders are also affected by low whole grain, fruit, nuts and seeds intake. Neoplasms affected by dietary risk factors involve the upper aerodigestive and low digestive tracts, and may be due to low intake of fiber, calcium and milk. Although similar, some differences across countries can be observed due to different dietary habits and food preferences. The presented findings emphasize the need of common guidelines that could be applied to all people living in Europe. While advocating for healthier dietary habits, policy orientation is needed to improve nutrition and prevent non-communicable diseases.

Epidemiology of human alveolar echinococcosis in Armenia

Abstract Background Since the 90s' E.multilocularis infection in foxes is rising and central-eastern European countries had seen first Alveolar echinococcosis (AE) human cases. AE is considered to be a very rare disease in Europe with average incidences of 0.03-0.20/100,000 inhabitants/year. Because of a suitable orography, this study aims to confirm whether there are human AE cases in Armenia, identify areas at risk, and also estimate AE annual incidence. Methods Retrospective AE case finding was carried out at main 6 multi-profile medical centers equipped with the most innovative diagnostic means. The medical records of all patients with liver surgery admitted between January 2008 and June 2020 were reviewed. A specific form was developed in EpiInfo v. 7.2. Annual national incidence was estimated using population denominators provided by the National Institute of Statistics (the population of Armenia is estimated at 2 963 243 people). Results From September 2019 until June 2020, overall 11 AE cases have been identified. All patients were diagnosed at advanced stages, with subsequent poor prognosis and costly treatment. Confirmation was based on tissue biopsy results. Age ranged from 19-59 years with a median of 39yrs. E. multilocularis was detected in rural communities, mostly in the Gegharkunik region (6 cases, 55%). Annual average incidence of AE was 0.033 varying between 0.032 in 2008 and 0.1 in 2017. For comparison with Armenia, an annual incidence in France was 0.026/100,000 in 2008 (the population of France is estimated at 65 273 511 people). Conclusions All cases were not notified by the surveillance system and the real prevalence of AE in the country is unknown. This young age could indicate widespread of infection in animals. Therefore, the burden of AE disease is difficult to estimate. The surveillance system in Armenia can be improved by the development of national guidelines for the prospective registry, AE awareness campaigns. Key messages First-time identification of human AE in Armenia calls for implementation of surveillance with a case definition and registry of all cases. AE is an emerging, and so far silent threat in Armenia.

Point of Care Testing for Infectious Disease in Europe: A Scoping Review and Survey Study.

Background: Point of care testing (POCT) for infectious diseases is testing conducted near the patient. It allows clinicians to offer the most appropriate treatment more quickly. As POCT devices have increased in accuracy and become more cost-effective, their use has grown, but a systematic assessment of their use for clinical and public health management of infectious diseases in EU/EEA countries has not been previously undertaken.Methods: A scoping review of the literature on POCT in EU/ EEA countries as at November 2019, and a survey of key stakeholders.Results: 350 relevant articles were identified and 54 survey responses from 26 EU/EEA countries were analysed. POCT is available for a range of infectious diseases and in all countries responding to the survey (for at least one disease). POCT is commonly available for influenza, HIV/AIDS, Legionnaires' disease and malaria, where it is used in at least half of EU/EEA countries. While POCT has the potential to support many improvements to clinical care of infectious diseases (e.g., faster diagnosis, more appropriate use of antimicrobials), the results suggest POCT is infrequently used to support public health functions (e.g., disease surveillance and reporting).Conclusion: Although POCT is in use to some extent in all EU/EEA countries, the full benefits of POCT in wider public health functions have yet to be realised. Further research on barriers and facilitators to implementation is warranted.

Radiologic follow-up in Fontan-associated liver disease in Europe: European Society of Paediatric Radiology survey demonstrates the need for a consensus protocol

Fontan surgery is a life-saving procedure for newborns with complex cardiac malformations, but it originates complications in different organs. The liver is also affected, with development of fibrosis and sometimes cirrhosis and hepatocellular carcinoma. There is no general agreement on how to follow-up these children for the development of liver disease. To understand the current practice on liver follow-up, we invited members of the European Society of Paediatric Radiology (ESPR) to fill out an online questionnaire. The survey comprised seven questions about when and how liver follow-up is performed on Fontan patients. While we found some agreement on the use of US as screening tool, and of MRI for nodule characterization, the discrepancies on timing and the lack of a shared protocol make it currently impossible to compare data among centers.

Climate change and infectious disease in Europe: Impact, projection and adaptation.

SummaryEuropeans are not only exposed to direct effects from climate change, but also vulnerable to indirect effects from infectious disease, many of which are climate sensitive, which is of concern because of their epidemic potential. Climatic conditions have facilitated vector-borne disease outbreaks like chikungunya, dengue, and West Nile fever and have contributed to a geographic range expansion of tick vectors that transmit Lyme disease and tick-borne encephalitis. Extreme precipitation events have caused waterborne outbreaks and longer summer seasons have contributed to increases in foodborne diseases. Under the Green Deal, The European Union aims to support climate change health policy, in order to be better prepared for the next health security threat, particularly in the aftermath of the traumatic COVID-19 experience. To bolster this policy process we discuss climate change-related hazards, exposures and vulnerabilities to infectious disease and describe observed impacts, projected risks, with policy entry points for adaptation to reduce these risks or avoid them altogether.