Epidemiology Of Illness Research Articles

Clinical characteristics and short-term prognosis of 22 cases with SARS-CoV-2 infection associated acute encephalopathy

Objective: To investigate the clinical features and short-term prognosis of patients with SARS-CoV-2 infection associated acute encephalopathy (AE). Methods: Retrospective cohort study. The clinical data, radiological features and short-term follow-up of 22 cases diagnosed with SARS-CoV-2 infection associated AE in the Department of Neurology, Beijing Children's Hospital from December 2022 to January 2023 were retrospectively analyzed. The patients were divided into cytokine storm group, excitotoxic brain damage group and unclassified encephalopathy group according to the the clinicopathological features and the imaging features. The clinical characteristics of each group were analyzed descriptively. Patients were divided into good prognosis group (≤2 scores) and poor prognosis group (>2 scores) based on the modified Rankin scale (mRS) score of the last follow-up. Fisher exact test or Mann-Whitney U test was used to compare the two groups. Results: A total of 22 cases (12 females, 10 males) were included. The age of onset was 3.3 (1.7, 8.6) years. There were 11 cases (50%) with abnormal medical history, and 4 cases with abnormal family history. All the enrolled patients had fever as the initial clinical symptom, and 21 cases (95%) developed neurological symptoms within 24 hours after fever. The onset of neurological symptoms included convulsions (17 cases) and disturbance of consciousness (5 cases). There were 22 cases of encephalopathy, 20 cases of convulsions, 14 cases of speech disorders, 8 cases of involuntary movements and 3 cases of ataxia during the course of the disease. Clinical classification included 3 cases in the cytokine storm group, all with acute necrotizing encephalopathy (ANE); 9 cases in the excitotoxicity group, 8 cases with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) and 1 case with hemiconvulsion-hemiplegia syndrome; and 10 cases of unclassified encephalopathy. Laboratory studies revealed elevated glutathione transaminase in 9 cases, elevated glutamic alanine transaminase in 4 cases, elevated blood glucose in 3 cases, and elevated D-dimer in 3 cases. Serum ferritin was elevated in 3 of 5 cases, serum and cerebrospinal fluid (CSF) neurofilament light chain protein was elevated in 5 of 9 cases, serum cytokines were elevated in 7 of 18 cases, and CSF cytokines were elevated in 7 of 8 cases. Cranial imaging abnormalities were noted in 18 cases, including bilateral symmetric lesions in 3 ANE cases and "bright tree appearance" in 8 AESD cases. All 22 cases received symptomatic treatment and immunotherapy (intravenous immunoglobulin or glucocorticosteroids), and 1 ANE patient received tocilizumab. The follow-up time was 50 (43, 53) d, and 10 patients had a good prognosis and 12 patients had a poor prognosis. No statistically significant differences were found between the two groups in terms of epidemiology, clinical manifestations, biochemical indices, and duration of illness to initiate immunotherapy (all P>0.05). Conclusions: SARS-CoV-2 infection is also a major cause of AE. AESD and ANE are the common AE syndromes. Therefore, it is crucial to identify AE patients with fever, convulsions, and impaired consciousness, and apply aggressive therapy as early as possible.

Occupational Accidents Among Search and Rescue Providers During Mountain Rescue Operations and Training Events.

We analyzed occupational accidents reported among Corpo Nazionale Soccorso Alpino e Speleologico (CNSAS) providers during mountain search and rescue operations and training events in Italy (1999 to 2019). We extracted anonymized data from the CNSAS accident database for all cases of injured mountain search and rescue providers that activated CNSAS insurance (1999 to 2019). We report epidemiological characteristics, mechanisms, type, and severity of injury or illness, clinical outcome, and recovery time. A total of 784 cases of injuries in CNSAS mountain search and rescue providers were recorded. Forty-one percent of the cases occurred during rescue operations and 59% during training events. Overall, trauma was the main cause of injury (96%), whereas only 4% of the cases were classified as medical or environmental illnesses. Moderate injury (National Advisory Committee for Aeronautics II to III) occurred in 80% of the reported accidents. Recovery time differed based on the degree of accident severity. Fatalities occurred in 2% of the cases reported and occurred during rescue operations only. In this long-term retrospective analysis, we showed that accidents occurred among mountain search and rescue providers both during rescue operations and training events. Given the high prevalence and associated costs, it is of pivotal importance to understand the epidemiology and characteristics of occupational injury and illness among this out-of-hospital workforce to better inform future prevention strategies.

Research on Psychological Wellbeing of Adolescent School Children: Perspective on Ethical Considerations

Adolescence is a distinctive and determinative stage in human life. Adolescent period serves as a transition between childhood and adulthood during which they acquire social, cognitive and emotional skills that determine their future. During these years, adolescent children undergo lot of physical and emotional changes. The quality of the environment where adolescents grow up shapes their physical and psychological well-being. Negative impact on mental health can happen due to encounters in homes, schools or social media which increases the risk of developing mental illness. This could be because of bullying, poverty, violence and mentally ill parents or siblings. In such cases, adolescents struggle to handle their psychological health and unless they get adequate care and support from parents, teachers and peer group, their psychological wellbeing gets affected. It is estimated that 1 in 7 adolescents worldwide experience mental health conditions. However, majority of these psychological issues go unnoticed and untreated. This article highlights various ethical issues in the Researchers’ Perspective when a study was planned to assess the psychological wellbeing of adolescent school children in an urban part of Tamil Nādu, India. Knowing the ethical concerns in conducting the research on psychological wellness of adolescents will help in planning more research studies for a better understanding of the epidemiology of mental illnesses among them.

Cultural Aspects of Mental Health in South Asians

South Asians tend to experience high rates of mental health disorders, which are often unaddressed. Factors including acculturative stress, social determinants, gender predisposition, and cultural beliefs must be considered in diagnostic assessment and determination. Mental health symptoms are generally interpreted as physical illnesses by South Asians, who typically present with somatic symptoms and tend not to seek the required psychological help due to perceived stigma. Treatment models incorporating social and culture-specific interventions (eg, use of native language, involvement of family members, inclusion of traditional and/or religious principles) have been shown to improve mental health outcomes in South Asians. More research focusing on violence, substance abuse, and socioeconomic factors—along with a clearer understanding of the epidemiology and conceptualizations of mental illness—is needed to develop interventions that promote the mental well-being of South Asians in the US. [ Psychiatr Ann . 2023;53(3):117–121.]

An Approach to Psychiatric Illness in Rheumatology Clinics.

Rheumatologists encounter patients with psychiatric illnesses daily in their practice; however, formal training in rheumatology does not sufficiently equip rheumatologists with guidance for managing common psychiatric illnesses. This study reviews common clinical situations involving psychiatric symptoms, their relationship with rheumatologic conditions, and their effects on clinical presentation and management. We illustrate key principles in a case-based format and reflect on the management of psychiatric components. Based on these discussions and a brief review of the epidemiology of psychiatric illnesses, we emphasize the prevalence and significance of these problems in daily practice.

Injury And Illness During A Four-day High School Netball Tournament: A Cross-sectional Study Of 1357 Players

BACKGROUND: Literature on the epidemiology of injury and illness in youth netballers is limited. PURPOSE: To determine incidence, types and severity of injuries and illness in netballers during a 4-day tournament. Association between severity of injury/illness and potential risk factors (RFs) was also determined. METHODS: Cross-sectional observational study at the 2019 Waterkloof High School netball tournament, South Africa. Injury data: body region, body area, specific diagnosis, tissue type, mechanism of injury and severity. Illness data: body system, presenting symptoms, specific diagnosis and severity. RF analyses included age, position played, match stage, previous injury, sleep, use of protective gear and recovery method. We report incidence of injury (encounters/1000 player-hours; 95% CI) and illness (encounters/1000 player-days; 95% CI). Days lost, i.e., severity (% time-loss) were categorised as slight (0-1d), minimal (2-3d), mild (4-7d), moderate (8-28d), and severe (29-84d). RESULTS: In total 1357 females (13-19 yrs) from 49 schools participated. Injury incidence per 6552 player-hours was 20.91 (17.41-24.41). The u/16 group had the highest number of injuries (29%). Most injuries occurred to ankle (29%) and foot (15%). Most frequent specific diagnosis was lateral ankle ligament sprain (26%). Commonly injured tissue types were ligament/joint capsule (48%) and skin/superficial tissue (19%). Mechanism of injury was primarily incorrect landing (23%). Injury severity was mainly slight (46%), with the moderate-severe category contributing 13%. RFs associated with injury severity were not significant. Illness incidence per 8232 player-days was 0.55 (0.25-0.85). Most frequently reported body systems were digestive (39%) and respiratory (15%) and symptoms were pain (31%) and vomiting (23%). Most players had <1-day illness time-loss (39%). Due to low number of illnesses, RF analyses could not be performed. CONCLUSIONS: Almost 1/3 of diagnosed injuries was lateral ankle ligament sprains. The digestive and respiratory systems contributed >50% of illness. Most players presenting with a medical encounter lost 0-1 days. No potential injury RFs had a significant relationship to severity. An urgent need exists to develop targeted injury and illness prevention strategies in youth netballers.

A Simulation Model to Evaluate the Potential Impact of Disease-Modifying Treatments on Burden of Illness in Alzheimer's Disease.

Alzheimer's disease (AD) is a progressive neurodegenerative disease that places a substantial burden on patients, caregivers, and society. The advent of disease-modifying treatments (DMTs) would represent a major advancement in the management of AD, particularly in early AD. It is important to understand the potential value of these therapies to individuals and society. A modeling framework was developed to estimate the potential clinical and economic burden of AD in the USA by simulating the impact, relative to that of usual care, of a DMT with hypothesized availability beginning from 2022. The model assessed AD epidemiology, disease progression, and burden of illness from 2020 to 2050. Model outcomes included the total number of Americans with mild cognitive impairment (MCI) due to AD and mild, moderate, or severe AD dementia in community or residential care settings and their associated care costs, including direct medical and non-medical costs for healthcare resource use and indirect costs for caregiving. A hypothetical DMT was compared to the usual care under different effect scenarios based on delay in onset of AD (1, 3, and 5years) and DMT uptake (25%, 50%, and 100%). A delay in the onset of AD by 5years would reduce the prevalence of AD in 2050 by 6%, 12%, and 25%, resulting in savings of $0.783, $1.566, and $3.132 trillion from 2022 to 2050 for the 25%, 50%, and 100% uptake scenarios, respectively. This analysis demonstrated that DMTs that provide even small delays in the onset of AD can lead to an increase in disease-free years and sizable savings in the cost of care, providing significant benefits to patients, caregivers, and society.

Poster 113: Epidemiology of Illnesses and Injuries in NCAA Water Polo Players

Objectives:Water polo is a sport with highly unique physical demands, some of which include treading water, swimming speed and endurance, wrestling strength, and ball coordination. It is an Olympic sport with variable popularity around the globe, with a notable following in regions of Europe. In the United States, water polo is most popular on the west coast, and Pac-12 teams have dominated NCAA water polo for decades. Partially owing to the sport’s scattered distribution around the world, there is a paucity of rigorous data on injuries and illnesses suffered by elite water polo players. The objective of this study is therefore to characterize health events in a large sample of NCAA Pac-12 water polo players over a period of 4.5 years, in order to better understand common pathology and be more equipped to prevent and manage injuries and illnesses in the future.Methods:Deidentified data was acquired from the Pac-12 Health Analytics Program database on all recorded health events from 4 men’s water polo teams and 5 women’s water polo teams from January 2017 to June 2021. Events were first sorted into injury and illness categories, followed by further analysis into body part, diagnosis, return-to-play, and injury event/general mechanism. Additional analysis includes injury/illness rates as percentage of totals, estimated athlete yearly risk, and risk ratios comparing male versus female risks with accompanying 95% confidence intervals for determining statistically significant differences.Results:For our sample of 142 male athletes and 165 female athletes, 917 health events were recorded over our 4.5-year observation period, with 729 being classified as injuries and 188 as illnesses. The shoulder was the most commonly injured body part (150 events, 20.6%), followed by the head/face (137 events, 18.8%), hand/wrist/forearm (85 events, 11.7%), and groin/hip/pelvis/buttock (83 events, 11.4%). Males had an estimated yearly risk of a shoulder injury of 15.7% compared to 11.6% for females, though this did not reach statistical significance (RR 1.35, 95% CI 0.96-1.9). Male water polo players were significantly more likely than females to injure their spine/neck (RR 2.1, 95% CI 1.2-3.5). The five most common diagnoses were concussion (83 events), shoulder strain/spasm (57 events), shoulder tendinopathy/impingement (52 events), groin/hip strain/spasm (42 events), and finger sprain (37 events). For all these injuries besides concussions, the majority of athletes lost no time away from sport. For concussions however, 75.9% lost time and returned later in the season, and 4.7% lost time and either returned the following season or were unable to return. Males were significantly more likely than females to suffer a concussion in practice (RR 3.3, 95% CI 1.2-8.8) and via contact with another player (RR 2.9, CI 1.3-6.4), though there was no significant difference in concussion risk overall (RR 1.2, CI 0.8-1.9). For illnesses, non-COVID-19 respiratory tract infection was the most common health event (61 events, 32.5% of illnesses, estimated yearly risk of 6.4%), followed by symptomatic COVID-19 (17 events, 9.0% of illnesses), and skin/soft tissue infection (13 events, 6.9% of illnesses). 12 males had symptomatic COVID-19 compared to 5 females, which was statistically significant (RR 2.8, 95% CI 1.01-7.7), however there was no significance difference in asymptomatic COVID-19 (6 males vs. 6 females, RR 1.2, 95% CI 0.4-3.5).Conclusions:This study sheds much-needed light on the epidemiology of injuries and illnesses in a large sample of elite NCAA water polo players. Some of the highlights include relatively high rates of shoulder, face, and finger injuries, as well as groin injuries, corresponding to exposed above-water body parts and water-treading demands respectively. Other notable findings include a high burden of time loss due to concussions compared to other common injuries, and a high rate of concussions occurring in practice and via player contact for men, representing a prospective target for reducing these injuries. Finally, this study equips players, coaches, trainers, and physicians with a broad outline of injuries and illnesses suffered by water polo players, allowing them to more efficiently manage injuries and develop prevention strategies in the future.

Descriptive epidemiology of orthopedic injury and illness during the Special Olympics of Pennsylvania Summer Games from 2008 to 2017

The Special Olympics Pennsylvania Summer Games attract over 2000 athletes each year. Volunteer medical staff ensures their safety throughout this period. However, few studies have examined the incidence of orthopedic injury and sickness in this group, especially with a large sample. Identify the incidence of orthopedic injury and Illness at the Special Olympics Pennsylvania Summer Games based on demographic criteria and identify the incidence of transports required for advanced care. Data was collected from logs provided by Special Olympics Pennsylvania. The data were analyzed and stratified by gender, age, sport, and type of encounter. We summarized the data and compared it to data from other years and the average. An average of 1971 athletes competed annually. On average, 10% (N=144) of competitors required medical care. Males comprised 58.2% (N = 837) of encounters, females 33.6% (N = 483), and in 8.1% (N = 117) of encounters gender was not identified/recorded. The mean age of participants was 29 years of age (range from 10 to 83). 56.6% (N= 813) of encounters required first aid management only. Injuries made up 31.7% (N = 455) of total encounters, and 11.8% (N=169) of encounters were classified as illnesses. Basketball was the sport with the most injuries, 49.5% (N = 711). An average of 9.8 transports was required annually. Special Olympics athletes suffer the same injuries as regular athletes, but they are also prone to various medical disorders that regular athletes are not.

Fever in the Returning Traveler.

It is predicted that approximately two billion tourist trips to foreign countries will be taken worldwide each year by 2030. Germany has long been among the most active countries in tourism. The frequency of illness among persons returning from developing and newly industrialized countries is 43-79%. The appropriate diagnosis of fever in returning travelers is a clinically important matter, as it can be a sign of a life-threatening illness. This review is based on publications (2001-2022) retrieved by a selective search in PubMed for studies on the epidemiology, diagnosis, and treatment of febrile illnesses in returning travelers, or on specific tropical diseases. Diarrhea, fever, and skin changes are the most common manifestations of disease after travel to tropical and sub - tropical areas. The diagnostic evaluation should be performed in a series of steps, beginning with a precise travel history and the identification of specific risk factors. Among travelers returning from sub-Saharan Africa, Plasmodium falciparum malaria is the most common cause of fever on presentation to centers for infectious diseases and tropical medicine, affecting approximately 50 per 1000 travelers. Among persons returning from travel to Southeast Asia, dengue fever is the most common infectious disease, affecting 50-160 per 1000 travelers. Further potentially dangerous diseases include chikungunya and zika fever, typhoid and paratyphoid fever, amoebic liver abscess, visceral leishmaniasis (kala-azar), leptospirosis, and, very rarely, imported cases of viral hemorrhagic fever. COVID-19 and influenza are important differential diagnoses. The differential diagnosis can be narrowed by thorough history-taking with particular attention to the patient's travel route, combined with a good knowledge of the geographic spread and incubation times of the main tropical diseases. Algorithms help clinicians to focus the diagnostic work-up and select the appropriate further laboratory tests and diagnostic procedures.

Incidence and outcomes of critical illness in Indigenous Peoples: a systematic review protocol

BackgroundIndigenous Peoples experience health inequities across the continuum of health services. Improvements for Indigenous patients and their families during vulnerable experiences with the healthcare system may have a significant impact on the patient experience and outcomes. Improved understanding of the occurrence of critical illness in Indigenous Peoples and their use of critical care services, as a strategic priority, may aid in the development of initiatives for improving health equity. A global focus was selected to learn from Indigenous populations’ experiences with critical care, as the understanding of critical illness among Indigenous Peoples in Canada is not well understood. This protocol outlines a systematic review focused on describing the incidence of critical illness and utilization of critical care services among Indigenous Peoples.MethodsOvid MEDLINE/PubMed, Ovid EMBASE, Google Scholar, and Cochrane Central Register of Controlled Trials will be searched. Relevant Canadian sites for gray literature (National Collaborating Centre for Indigenous Health, First Nations Health Authority, Canadian Institutes of Health Research Institute of Indigenous Peoples’ Health, National Association of Friendship Centres, the Alberta First Nations Information Governance Centre, Métis Nation of Alberta) will also be searched. We will include studies of adults (≥18 years) either without critical illness (i.e., general population) or with critical illness (i.e., admitted to an intensive care unit (ICU)). The exposure of interest will be Indigenous identity. Primary outcome measures are ICU admission and ICU mortality. Because heterogeneity in populations, comparisons, and outcome measures is anticipated, it is likely that the findings will be summarized using a narrative synthesis. A meta-analysis will be performed if there is sufficient evidence on one or more outcomes of interest.DiscussionThis systematic review will provide a better understanding of the epidemiology, risk factors, and outcomes of critical illness and utilization of critical care services among Indigenous Peoples. The knowledge generated will be applied to a broader program of work designed to create ethical space to co-design, implement, and evaluate a culturally competent, safe, and innovative model for critical care services for Indigenous People.Systematic review registrationPROSPERO CRD42021254661

Characterizing Health Events and Return to Sport in Collegiate Swimmers.

Background:There is limited literature characterizing the incidence, variety, and effects of injuries and illnesses observed in elite swimmers.Purpose:To describe the epidemiology of injuries and illnesses affecting elite intercollegiate competitive swimmers.Study Design:Descriptive epidemiology study.Methods:This retrospective study utilized a deidentified injury and illness database of National Collegiate Athletic Association Division I swimmers in the Pacific Coast Conference from the academic years 2016 to 2017 and 2019 to 2020. A health event was defined as an illness or musculoskeletal injury that was identified by an athletic trainer or team physician. Musculoskeletal injuries and nonmusculoskeletal injuries and illnesses were stratified by body location. Injuries were further characterized as career-ending, season-ending, missed time but the athlete returned to sport in the same season, or those that did not cause missed time. Relative risk (RR) was used to compare the percentage of athletes affected between women and men, with statistical significance being defined by a 95% CI not including 1.Results:Included were 641 collegiate swimmers (301 male, 340 female). There were 1030 health events among 277 women and 173 men, with 635 (61.7%) occurring in women and 395 (38.3%) in men. There were 540 musculoskeletal injuries reported, most of which involved the shoulder (n = 126; 23.3%), spine (n = 95; 17.6%), foot/ankle/lower leg (n = 81; 15.0%), knee/thigh (n = 67; 12.4%), and hand/wrist/forearm (n = 52; 9.6%). A total of 490 nonmusculoskeletal health events were reported and included events such as respiratory tract infections (n = 119; 24.3%), unspecified medical illness (n = 93; 19.0%), concussions (n = 58; 11.8%), ear infections (n = 25; 5.1%), and gastrointestinal illnesses (n = 24; 4.9%). Compared with male swimmers, female swimmers were at a higher risk of sustaining both musculoskeletal injury (RR, 1.5; 95% CI, 1.22-1.83) and nonmusculoskeletal injury/illness (RR, 1.32; 95% CI, 1.04-1.68). There were 58 documented concussions, with 8 (13.8%) being season-ending, but not career-ending and 14 (24.1%) being career-ending. Women had a higher rate of concussion (9.1% vs 4.3% for men; RR, 2.11; 95% CI, 1.13-3.96).Conclusion:This retrospective study identified the most common injuries and illnesses observed among elite collegiate swimmers. Awareness of the incidence and outcome of injuries and illnesses that affect competitive swimmers may allow for more targeted analyses and injury prevention strategies.

Sports Injury and Illness Epidemiology: Thailand Team Surveillance During the 30th Southeast Asian Games

Background: Injury and illness surveillance in sports is the first step of the injury prevention model that generates effective injury prevention measures. Objectives: To identify the incidence, severity, and causes of injuries and illness in the Thailand national team during the 30th Southeast Asian (SEA) Games. Methods: All medical encounters were documented using the International Olympic Committee (IOC) injury and illness surveillance system for multi-sport events. We recorded the daily occurrence of injuries and illnesses reported by Thailand’s medical teams over the 12 days of the competition period. Results: Among 980 Thai athletes (568 male and 412 female), that participated in the 30th SEA Games, a total of 105 injuries and illnesses were reported. There were 84 injuries and 21 illnesses which equated to an incidence of 86 injuries and 21 illnesses per 1000 athletes. The most commonly injured body part was the lower leg (14% of all injuries), followed by the shoulder and clavicle. Ligament sprain or rupture and contusion (25% of all injuries) were reported as the most common type of injury. Of all injuries, 56 were classified as needing medical attention (only), 26 caused performance restriction, and two caused complete-time loss. The most common athlete illness was respiratory illness (48% of all illnesses) followed by gastrointestinal illness (19% of all illnesses). One-third (7 out of 21) of athlete illnesses restricted the athlete's performance, and the remaining 14 only required medical attention. Conclusions: Overall, 8% of athletes incurred at least one injury during the competition, and 2% suffered from an illness. Lower leg injury and respiratory illness were the most common, which is similar to other multi-sport events. Based on the research data, injury prevention, especially of ligamentous sprain and lower limb injuries, should be the focus in multi-sport events.

677. Compliance and Performance Characteristics of Subject Collected Versus Health-care Worker Collected Nasal Swabs for Respiratory Viral Surveillance

Abstract Background Self-collection of mid-nasal swabs (SCNS) at home is a convenient alternative to health-care worker-collected nasal swabs (HCWC) for determining the pathogen-specific epidemiology of influenza-like illness (ILI). We evaluated the compliance and performance characteristics of SCNS vs. HCWC for respiratory pathogens during 2019-2020 flu season. Methods Adult Military Health System (MHS) beneficiaries were enrolled in an influenza vaccine effectiveness trial (PAIVED). Following vaccination, subjects were instructed on SCNS and completion of a symptom diary and were contacted weekly to ascertain ILI symptoms (fever, sore throat, and/or cough). In the event of an ILI, subjects completed the symptom diary and SCNS and were scheduled a clinic visit for HCWC. Swabs were tested with the Luminex NxTAG® Respiratory Pathogen Panel. We evaluated compliance with swab collection, positive percent agreement (PPA) of SCNS using PCR detection from either HCWC or SCNS as the reference standard, and agreement between paired swabs using the Cohen Kappa coefficient (Κ). Results 1808 ILI were reported by 972 participants enrolled during the study period. Compliance with HCWC was higher than SCNS (58% [1042] vs. 42% [766]; p&amp;lt; 0.001). SCNS were associated with a shorter interval from symptom onset (median: 4 days [IQR:2-6 days] vs. clinic collect: 7 days [IQR:4-9 days]; p &amp;lt; 0.001). 663 paired swabs were available for 609 participants (Table 1). The overall detection rate was higher in SCNS (36%) than HCWC (26%; p&amp;lt; 0.001) (Figure 1). The overall PPA was 85.7% and a PPA of approximately 80% of greater was observed for influenza, rhino/enterovirus, parainfluenza and respiratory syncytial virus. Agreement between paired swabs was poor due to the lower detection rates in HCWC. Table 1. Demographics and swab collection data for 609 participants who provided 663 paired swabs Figure 1. Detection by pathogen in 663 paired swabs Conclusion SCNS were associated with higher detection rates compared to HCWC, likely due to the shorter interval between symptom onset and swab collection. Strategies to improve compliance with SCNS and minimize the interval between symptom onset and swab collection are needed to optimize detection of respiratory pathogens in this MHS cohort. Disclosures Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) Jitu Modi, MD, GSK (Speaker's Bureau)

Prevalence, seasonal variation and nature of illness in youth floorball players: a prospective cohort study

Introduction: Acute illness presents a significant health burden to athletes, including training interference, impaired performance, time-loss from competition and increased subsequent injury risk. Although most youth participate in sport at recreational level, illness epidemiology in this population during a season or competition has not been well studied to direct prevention initiatives. We aim to provide a first detail profile of illness and illness symptoms by sex in Swedish youth floorball players during one season. Methods: This prospective cohort study was part of a Sport Without Injury ProgrammE cluster randomised controlled trial in floorball evaluating the efficacy of the Knee Control injury prevention exercise programme. Weekly illness data were collected from youth players during the 2017-2018 season (26 weeks) using the Oslo Sports Trauma Research Center questionnaire on health problems. Illness symptoms were grouped into clusters according to the 2020 International Olympic Committee consensus recommendations. Sex differences in average weekly illness prevalence was compared with a prevalence rate ratio and corresponding 95% CI, and proportion of reported illness symptoms with the chi-square test. Results: The mean age for 329 male and 142 female players was 13.3(SD 1.0) and 13.7(SD 1.5) years, respectively. The mean number of weekly reports per player was 14.4(SD 7.8) (13.5(SD 8.1) males vs 16.3(SD 6.8) females). 61% of players (60% males vs 64% females) reported at least one illness week during the season. The average weekly illness prevalence was 12%(95% CI 10.8-12.3%) for all players, and slightly higher in females (13%, 95% CI 11.6-14.3%) than males (11%, 95% CI 9.9-11.7%), prevalence rate ratio 1.20(95% CI 1.05-1.37, p=0.009). 49%(53% males, 43% females) of illness reports indicated time-loss from sport. Illness prevalence was highest in calendar weeks 4-7 (peak winter weeks) and ranged from 15%-18%(20%-23% females vs 12%-17% males) during this period. Upper/lower respiratory symptoms (fever (30%), sore throat (16%) and cough (14%) were common). More females (16% vs 3% males, p<0.001) reported difficulty of breathing/tight airways. 7% females and no males reported fainting. Discussion: Two third of players reported at least one illness. Flu-like symptoms dominated the season. Athletes, coaches, parents and support personnel need to be aware of risk of infections and educated about risk mitigation of viral infections. Improved awareness of self-monitoring of respiratory symptoms could help reduce the risk of spreading the infection to team members. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Acute Gastroenteritis on Cruise Ships - Maritime Illness Database and Reporting System, United States, 2006-2019.

Problem/ConditionGastrointestinal illness is common worldwide and can be transmitted by an infected person or contaminated food, water, or environmental surfaces. Outbreaks of gastrointestinal illness commonly occur in crowded living accommodations or communities where persons are physically close. Pathogens that cause gastrointestinal illness outbreaks can spread quickly in closed and semienclosed environments, such as cruise ships. CDC’s Vessel Sanitation Program (VSP) is responsible for conducting public health inspections and monitoring acute gastroenteritis (AGE) illness on cruise ships entering the United States after visiting a foreign port.Period Covered2006–2019.Description of SystemVSP maintains the Maritime Illness Database and Reporting System (MIDRS) for monitoring cases of AGE illness among passengers and crew sailing on cruise ships carrying ≥13 passengers and within 15 days of arrival at U.S. ports from foreign ports of call. Cruise ships under VSP jurisdiction are required to submit a standardized report (24-hour report) of AGE case counts for passengers and crew 24–36 hours before arrival at the first U.S. port after traveling internationally. If the cumulative number of AGE cases increases after submission of the 24-hour report, an updated report must be submitted no less than 4 hours before the ship arrives at the U.S. port. A special report is submitted to MIDRS when vessels are within 15 days of arrival at a U.S. port and cumulative case counts reach 2% of the passenger or crew population during a voyage. VSP declares an outbreak when 3% or more of the passengers or crew on a voyage report AGE symptom to the ship’s medical staff.ResultsDuring 2006–2019, a total of 37,276 voyage reports from 252 cruise ships were submitted to MIDRS. Of the 252 cruise ships, 80.6% were extra large in size (60,001–120,000 gross registered tons [GRT]), 37.0% and 32.9% had voyages lasting 3–5 days and 8–10 days, respectively, and 53.2% were traveling to a port in the Southeast region of the United States at the time the final MIDRS report was submitted. During 2006–2019, VSP received 18,040 (48.4%) 24-hour routine reports, 18,606 (49.9%) 4-hour update reports, and 612 (1.6%) special reports (2% and 3% AGE reports). Incidence rates decreased from 32.5 cases per 100,000 travel days to 16.9 for passengers and from 13.5 to 5.2 for crew. Among passengers, AGE incidence rates increased with increasing ship size and voyage length. For crew members, rates were significantly higher on extra-large ships (19.8 per 100,000 travel-days) compared with small and large ships and on voyages lasting 6–7 days. Geographically, passenger incidence rates were highest among ships underway to ports in California, Alaska, Texas, New York, Florida, and Louisiana. Among passengers, AGE incidence rates were significantly higher on ships anchoring in California (32.1 per 100,000 travel-days [95% confidence interval (CI) = 31.7–32.4]); among crew, they were significantly higher in the South region of the United States (25.9 [CI = 25.1–26.7]).InterpretationThis report is the first detailed summary of surveillance data from MIDRS during 2006–2019. AGE incidence rates decreased during this time. Incidence rates among passengers were higher on mega and super-mega ships and voyages lasting >7 days. AGE incidence among crew was higher on extra-large ships and voyages lasting 6–7 days. Ship size and voyage length are associated with AGE incidence rates, and more targeted effort is needed to prevent disproportionate AGE incidence rates among passengers and crew sailing in high-risk situations.Public Health ActionsMaritime AGE surveillance provides important information about the epidemiology of gastrointestinal illness among cruise ship populations traveling in U.S. jurisdictions. AGE illness is highly contagious and can be transmitted quickly within vessels. State and local public health departments in the United States can use data in this report to better inform the traveling public about the risk for AGE and the importance of their role in minimizing the risk for illness while traveling onboard cruise ships. Key elements for reducing exposure to AGE illness, limiting the spread of illness, and preventing AGE outbreaks are proper hand hygiene practices and prompt isolation of symptomatic persons. Passengers can work in collaboration with cruise lines to promote onboard public health by frequently washing their hands, promptly reporting AGE illness symptoms, and isolating themselves from other persons immediately after illness onset. Access to and proper use of handwashing stations can reduce the risk for illness transmission aboard cruise ships.

629Influenza-like illness surveillance in Australia: comparison of general practice data with laboratory-confirmed influenza notifications

Abstract Background Influenza is a respiratory infection responsible for 645,000 annual deaths worldwide. Surveillance systems provide valuable data for monitoring influenza in order to detect outbreaks and guide public health responses. This study aimed to investigate the epidemiology of influenza-like illness (ILI) using two Australian general practice databases (MedicineInsight and the Australian Sentinel Practice Research Network (ASPREN)) and compare them with laboratory-confirmed influenza from the National Notifiable Diseases Surveillance System (NNDSS). Methods All patients who had a consultation in MedicineInsight general practices or ASPREN and all laboratory-confirmed influenza reported by the NNDSS between 2015-2017 were included. Weekly ILI rates per 1,000 consultations (MedicineInsight/ASPREN) were compared with influenza notifications (NNDSS). Results Data was consistent among sources, with higher cases in 2017, among women and patients aged 20-49 years. The peak rate in MedicineInsight almost doubled in 2017 compared to 2015, while in ASPREN it was less pronounced. MedicineInsight ILI curves more closely resembled NNDSS patterns (shape, the start of the season, peaks) than ASPREN, although both were highly correlated with NNDSS (r = 0.90 to 0.97 and r = 0.88 to 0.98, respectively). Conclusions MedicineInsight and ASPREN provided consistent ILI results, both resembling confirmed influenza epidemic curves, suggesting the potential use of routinely collected electronic medical records (MedicineInsight) in influenza surveillance. MedicineInsight provides comprehensive medical data, such as underlying conditions, medications prescribed and vaccination status, which could be used to improve accuracy on influenza detection. Key messages Electronic medical records could be used to monitor ILI in combination with ASPREN for effective early detection of outbreaks.

The epidemiology of injury and illness amongst athletes at the Indian Ocean Island Games, Mauritius, 2019.

The Indian Ocean Island Games is a multi-sport event that occurs every four years and includes athletes from seven islands of the Indian Ocean, namely, Comoros, Reunion, Mayotte, Madagascar, Maldives, Seychelles, and Mauritius. This study aims to describe the injury and illness epidemiology of the athletes participating during the 2019 Indian Ocean Islands Games. This prospective cohort study recorded injury and illness cases from athletes who competed in these Games. All medical physicians received detailed instructions and training on data collection using an injury report form. All athletes (minors and adults) who provided consent, or consent given from the minors' guardians, were included in this study. Athletes who did not provide consent for this study were excluded. Athletes (n = 1 521; 531 women and 990 men) reported 160 injuries (injury incidence rate of 11%) and 85 illnesses (illness incidence rate of 6%). The percentage of distribution of injuries were highest in football and basketball. Most injuries occurred during competition, compared with training, joint sprains were the most common type of injury (28%), followed by muscle strains (19%). Men suffered most of the injuries (79% vs. 21% for women). Similarly, men sustained more illnesses than women (57% vs. 43%). Most illnesses affected the respiratory system (67%), and infection was the most common cause of illness (84%) in participating athletes. These findings are similar to previous events in other parts of the world. However, unique ailments, not previously reported on, were discovered. Epidemiological data from this study can be inferred to athletes who compete in similar multi-sport events in the Indian Ocean region.

Development and validation of an occupational health triage tool.

As work and health are closely interlinked, it is important to carefully monitor employees. However, limited resources restrict in-depth follow-up. This study was aimed to develop a low-cost screening instrument for employees' overall health status, that can be used across industries and that allows triaging workers to in-depth health surveillance in case of indications of health or functioning problems. We developed a new questionnaire-based algorithm built on multiple predictors to assess the need for further follow-up. We used a systematic review, Delphi panel (n = 9) and focus group (n = 5) to determine the predictors, tested for language pitfalls in a pilot study and evaluated the questionnaire's validity in two separate studies. Study 1 (n = 60) analysed the discriminatory power of the instrument by comparing it to the assessment of an occupational physician in a sample of employees from diverse occupational settings. Study 2 (n = 869) appraised the factor structure and internal consistency of the screening tool in a sample of employees from the hospital sector. Risk factors, current physical and mental health, functioning, absenteeism, job satisfaction and lifestyle were identified as the most relevant predictors. Study 1 showed the survey had good criterion validity (area under the curve = 0.72). Study 2 (N = 869, 28% response) demonstrated the internal consistency (Cronbach's α = 0.94), and a factor analysis confirmed a second-order factor structure with adequate model fit (comparative fit index = 0.96, root mean square error of approximation = 0.04 and standardized root mean square residual = 0.07). This questionnaire can be used to triage workers for occupational health follow-up and can, additionally, be useful to describe the epidemiology of work-related illness.

Sports Injury Epidemiology: Foundation of Evidence of, by, and for Athletic Trainers.

Sports Injury Epidemiology: Foundation of Evidence of, by, and for Athletic Trainers.