European Center For Disease Control Research Articles

SARS-CoV-2 Pandemic: A Comparison Between the Epidemiological Situation in Greece and Romania.

Introduction Since the onset of the SARS-CoV-2 pandemic, there seems to be scarce data targeting the comparison of epidemiological data among different countries. In an attempt to reveal and characterize the epidemiological profile in the Balkan peninsula,a cross-sectional study has been conducted, aiming to retrospectively collect all the existing information regarding the SARS-CoV-2 pandemic over a period of three years, starting from March 2020 until March 2023. The comparative analysis of the epidemiological features and the main indicators between Romania and Greece can generate a good overview of the factors that can influence public healthand create an adequate system of measures to limit the COVID-19 pandemic in the area. A retrospective comparative study aiming to detect and associate the main indicators determining the evolution of the SARS-CoV-2 pandemic data with the control measures adopted in Romania and Greece was performed. Methods Publicly available data were obtained from official sources such as the World Health Organization, the European Centre for Disease Control, the Romanian and Greek Ministries of Health,and the Romanian National Centre for Surveillance and Control of Communicable Diseases. The reported number of cases, in total and in conjunction with the age distribution, total number of deaths, and vaccination coverage, from the onset of the pandemic in March 2020 until March 2023, were collected. All officially reported cases of COVID-19 were included in this analysis. Reports with missing or incomplete values regarding the timeframe, age distribution, and vaccination status were excluded. Results During the timeframe of the study, from March 2020 until March 2023, Greece reported a higher number of confirmed SARS-CoV-2 cases as compared to Romania (5,910,103 cases and 3,352,356 cases, respectively).Still, in terms of the overall death toll, Romania recorded a higher mortality rate than Greece during the pandemic (67.773 deathsvs.36.372 deaths). Concerning both cumulative incidence rates and the 14-day case notification rate per 100.000 inhabitants, it is evident that Romania exhibited greater numbers throughout the course of the pandemic. Although it is not clearly stated, the compulsory vaccination ofelderly people that was set as a high priority in Greece may have contributed to the above results. In terms of the 14-day death notification rate per 100.000 inhabitants in 2020 and 2021, Romania showed a higher rate than Greece, while Greece reported a greater rate in 2022 and up until March 2023. Between 2020 and 2023, Greece presented both a higher number of vaccinated individualsand a higher vaccination coverage with two doses (7,034,695 individuals, 70% of the general population), as compared to Romania (6,467,804 individuals, 33.68% of the general population, p<0.0001). Conclusions Despite the similar restrictions and preventive actions adopted by Romania and Greece, some of the epidemiological data between the two countries tends to differ. It must not be ignoredthatevery nation should be considered a unique entity with distinct features, including individuals, customs, and policies, rather than being categorized with other countries based on geographic proximity or regionalization.

Multi-infection screening for migrant patients in UK primary care: Challenges and opportunities

BackgroundMigrants in Europe face a disproportionate burden of undiagnosed infection, including tuberculosis, blood-borne viruses, and parasitic infections and many belong to an under-immunised group. The European Centre for Disease Control (ECDC) has called for innovative strategies to deliver integrated multi-disease screening to migrants within primary care, yet this is poorly implemented in the UK. We did an in-depth qualitative study to understand current practice, barriers and solutions to infectious disease screening in primary care, and to seek feedback on a collaboratively developed digitalised integrated clinical decision-making tool called Health Catch UP!, which supports multi-infection screening for migrant patients. MethodsTwo-phase qualitative study of UK primary healthcare professionals, in-depth semi-structured telephone-interviews were conducted. In Phase A, we conducted interviews with clinical staff (general practitioners (GPs), nurses, health-care-assistants (HCAs)); these informed data collection and analysis for phase B (administrative staff). Data were analysed iteratively, using thematic analysis. ResultsIn phase A, 48 clinicians were recruited (25 GPs, 15 nurses, seven HCAs, one pharmacist) and 16 administrative staff (11 Practice-Managers, five receptionists) in phase B. Respondents were positive about primary care's ability to effectively deliver infectious disease screening. However, we found current infectious disease screening lacks a standardised approach and many practices have no system for screening meaning migrant patients are not always receiving evidence-based care (i.e., NICE/ECDC/UKHSA screening guidelines). Barriers to screening were reported at patient, staff, and system-levels. Respondents reported poor implementation of existing screening initiatives (e.g., regional latent TB screening) citing overly complex pathways that required extensive administrative/clinical time and lacked financial/expert support. Solutions included patient/staff infectious disease champions, targeted training and specialist support, simplified care pathways for screening and management of positive results, and financial incentivisation. Participants responded positively to Health Catch-UP!, stating it would systematically integrate data and support clinical decision-making, increase knowledge, reduce missed screening opportunities, and normalisation of primary care-based infectious disease screening for migrants. ConclusionsOur results suggest that implementation of infectious disease screening in migrant populations is not comprehensively done in UK primary care. Primary health care professionals support the concept of innovative digital tools like Health Catch-UP! and that they could significantly improve disease detection and effective implementation of screening guidance but that they require robust testing and resourcing.

Assessing the quality and completeness of reporting in health systems guidance for pandemics using the AGREE-HS tool.

During health emergencies, leading healthcare organisations, such as the World Health Organization (WHO), the European Centre for Disease Control and Prevention (ECDC), and the United States Centers for Disease Control and Prevention (CDC), provide guidance for public health response. Previous studies have evaluated clinical practice guidelines (CPGs) produced in response to epidemics or pandemics, yet few have focused on public health guidelines and recommendations. To address this gap, we assessed health systems guidance (HSG) produced by the WHO, the ECDC, and the CDC for the 2009 H1N1 and COVID-19 pandemics. We extracted HSG for the H1N1 and COVID-19 pandemics from the organisations' dedicated repositories and websites. After screening the retrieved documents for eligibility, five assessors evaluated them using the Appraisal of Guidelines Research & Evaluation - Health Systems (AGREE-HS) tool to assess the completeness and transparency of reporting according to the five AGREE-HS domains: "Topic", "Participants", "Methods", "Recommendations", and "Implementability". Following the screening process, we included 108 HSG in the analysis. We observed statistically significant differences between the H1N1 and COVID-19 pandemics, with HSG issued during COVID-19 receiving higher AGREE-HS scores. The HSG produced by the CDC had significantly lower overall scores and single-domain scores compared to the WHO and ECDC. However, all HSG scored relatively low, under the median of 40 total points (range = 10-70), indicating incomplete reporting. The HSG produced by all three organisations received a median score <4 (range = 1-7) for the "Participants", "Methods", and "Implementability" domains. There is still significant progress to be made in the quality and completeness of reporting in HSG issued during pandemics, especially regarding methodological approaches and the composition of the guidance development team. Due to their significant impact and importance for healthcare systems globally, HSG issued during future healthcare crises should adhere to best reporting practices to increase uptake by stakeholders and ensure public trust in healthcare organisations.

National action plans for antimicrobial resistance and variations in surveillance data platforms.

To assess how national antimicrobial susceptibility data used to inform national action plans vary across surveillance platforms. We identified available open-access, supranational, interactive surveillance platforms and cross-checked their data in accordance with the World Health Organization's (WHO's) Data Quality Assurance: module 1. We compared platform usability and completeness of time-matched data on the antimicrobial susceptibilities of four blood isolate species: Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Streptococcus pneumoniae from WHO's Global Antimicrobial Resistance and Use Surveillance System, European Centre for Disease Control's (ECDC's) network and Pfizer's Antimicrobial Testing Leadership and Surveillance database. Using Bland-Altman analysis, paired t-tests, and Wilcoxon signed-rank tests, we assessed susceptibility data and number of isolate concordances between platforms. Of 71 countries actively submitting data to WHO, 28 also submit to Pfizer's database; 19 to ECDC; and 16 to all three platforms. Limits of agreement between WHO's and Pfizer's platforms for organism-country susceptibility data ranged from -26% to 35%. While mean susceptibilities of WHO's and ECDC's platforms did not differ (bias: 0%, 95% confidence interval: -2 to 2), concordance between organism-country susceptibility was low (limits of agreement -18% to 18%). Significant differences exist in isolate numbers reported between WHO-Pfizer (mean of difference: 674, P-value: < 0.001, and WHO-ECDC (mean of difference: 192, P-value: 0.04) platforms. The considerable heterogeneity of nationally submitted data to commonly used antimicrobial resistance surveillance platforms compromises their validity, thus undermining local and global antimicrobial resistance strategies. Hence, we need to understand and address surveillance platform variability and its underlying mechanisms.

A comparative analysis of the effects of containment policies on the epidemiological manifestation of the COVID-19 pandemic across nine European countries

The COVID-19 pandemic has been a catastrophic event that has seriously endangered the world’s population. Governments have largely been unprepared to deal with such an unprecedented calamity, partially due to the lack of sufficient or adequately fine-grained data necessary for forecasting the pandemic’s evolution. To fill this gap, researchers worldwide have been collecting data about different aspects of COVID-19’s evolution and government responses to them so as to provide the foundation for informative models and tools that can be used to mitigate the current pandemic and possibly prevent future ones. Indeed, since the early stages of the pandemic, a number of research initiatives were launched with this goal, including the PERISCOPE (Pan-European Response to the ImpactS of COVID-19 and future Pandemics and Epidemics) Project, funded by the European Commission. PERISCOPE aims to investigate the broad socio-economic and behavioral impacts of the COVID-19 pandemic, with the goal of making Europe more resilient and prepared for future large-scale risks. The purpose of this study, carried out as part of the PERISCOPE project, is to provide a first European-level analysis of the effect of government policies on the spread of the virus. To do so, we assessed the relationship between a novel index, the Policy Intensity Index, and four epidemiological variables collected by the European Centre for Disease Control and Prevention, and then applied a comprehensive Pan-European population model based on Multilevel Vector Autoregression. This model aims at identifying effects that are common to some European countries while treating country-specific policies as covariates, explaining the different evolution of the pandemic in nine selected countries due to data availability: Spain, France, Netherlands, Latvia, Slovenia, Greece, Ireland, Cyprus, Estonia. Results show that specific policies’ effectiveness tend to vary consistently within the different countries, although in general policies related to Health Monitoring and Health Resources are the most effective for all countries.

Estimating hepatitis B virus prevalence among key population groups for European Union and European Economic Area countries and the United Kingdom: a modelling study

BackgroundHepatitis B virus (HBV) epidemiology in Europe differs by region and population risk group, and data are often incomplete. We estimated chronic HBV prevalence as measured by surface antigen (HBsAg) among general and key population groups for each country in the European Union, European Economic Area and the United Kingdom (EU/EEA/UK), including where data are currently unavailable.MethodsWe combined data from a 2018 systematic review (updated in 2021), data gathered directly by the European Centre for Disease Control (ECDC) from EU/EEA countries and the UK and further country-level data. We included data on adults from the general population, pregnant women, first time blood donors (FTBD), men who have sex with men (MSM), prisoners, people who inject drugs (PWID), and migrants from 2001 to 2021, with three exceptions made for pre-2001 estimates. Finite Mixture Models (FMM) and Beta regression were used to predict country and population group HBsAg prevalence. A separate multiplier method was used to estimate HBsAg prevalence among the migrant populations within each country, due to biases in the data available.ResultsThere were 595 included studies from 31 countries (N = 41,955,969 people): 66 were among the general population (mean prevalence (stackrel{-}{p}) 1.3% [range: 0.0-7.6%]), 52 among pregnant women (stackrel{-}{p}=1.1% [0.1–5.3%]), 315 among FTBD (stackrel{-}{p}=0.3% [0.0-6.2%]), 20 among MSM (stackrel{-}{p}=1.7% [0.0-11.2%]), 34 among PWID (stackrel{-}{p}=3.9% [0.0-16.9%]), 24 among prisoners (stackrel{-}{p}=2.9% [0.0-10.7%]), and 84 among migrants (stackrel{-}{p}=7.0% [0.2–37.3%]). The FMM grouped countries into 3 classes. We estimated HBsAg prevalence among the general population to be < 1% in 24/31 countries, although it was higher in 7 Eastern/Southern European countries. HBsAg prevalence among each population group was higher in most Eastern/Southern European than Western/Northern European countries, whilst prevalence among PWID and prisoners was estimated at > 1% for most countries. Portugal had the highest estimated prevalence of HBsAg among migrants (5.0%), with the other highest prevalences mostly seen in Southern Europe.ConclusionsWe estimated HBV prevalence for each population group within each EU/EAA country and the UK, with general population HBV prevalence to be < 1% in most countries. Further evidence is required on the HBsAg prevalence of high-risk populations for future evidence synthesis.

ASSESSING THE CURRENT THREAT OF MONKEYPOX EPIDEMIC EMERGENCE

The purpose of this study was to assess the presence of threats of a pandemic based on the analysis of the prevalence of monkeypox globally in modern conditions.&#x0D; Materials and methods. The article is devoted to the analysis of cases of monkeypox in the world in 2022 and the evaluation of its pandemic potential in modern conditions. Official data of the World Health Organization, Public Health Centre of Ukraine, European Centre for Disease Control and Prevention, Centres for Disease Control and Prevention, USA were analyzed.&#x0D; Results and discussion. Taking into account the increasing scale of the monkeypox outbreak in the world, on July 23, 2022, the General Director of the World Health Organization declared the monkeypox outbreak a public health emergency of international importance. During this period, more than 16 thousand cases of monkeypox were registered in 75 countries of the world.&#x0D; As of October 2, 2022, 68,900 laboratory-confirmed cases of monkeypox and 25 deaths have been reported to the World Health Organization from 106 countries worldwide. Ten countries reporting the highest cumulative number of cases in the world are: United States of America (37.3%), Brazil (11.4%), Spain (10.4%), France (5.8%), Great Britain (5.3%), Germany (5.3%), Peru (3.8%), Colombia (3%), Mexico (2.4%) and Canada (2%). The smallest number was recorded in: Turkey and Indonesia (0.001% each); Moldova, Greenland and Georgia (0.002% each); Monaco (0.004%); Ukraine, Japan and Cuba (0.005% each); China, Bulgaria, Lithuania, Latvia (0.007% each). In Ukraine, the first case of monkeypox was laboratory-confirmed in September 2022. As of October 27, 2022, 4 laboratory-confirmed cases of monkeypox by polymerase chain reaction testing were registered in Ukraine.&#x0D; Based on the analysis, the transmission of the monkeypox virus primarily occurs through person-to-person contact, often through sexual intercourse. Risk factors for monkeypox include being between the ages of 18 and 44, male gender, engaging in sexual contact with other men, participating in risky sexual behaviour, engaging in sexual contact without condom use, having a history of HIV infection or previous sexually transmitted infections (including syphilis). The following groups are considered at high risk: men who have sex with men, passengers in close proximity to an infected individual on airplanes, healthcare workers, close family members or friends, and anyone who has close contact with an infected person, regardless of gender or sexual orientation. There is a possibility of further spread of the monkeypox virus and the potential for the causative agent to evolve into a pathogen with greater epidemic potential than it currently possesses.&#x0D; People with monkeypox should avoid contact with animals during the entire period of isolation. In case of suspicion of disease in domestic animals, the veterinary service must be immediately notified.&#x0D; Conclusion. Currently, the pandemic potential of the virus is insignificant; monkeypox is less contagious compared to other infections that caused pandemics, it is transmitted only in conditions of close contact with a sick person, a contaminated object, or an infected animal. The cases are found in certain groups of behavioural risk. In order to better understand the variability of the epidemiology of monkeypox, the current and future trends in the development of the epidemic process of monkeypox, it is necessary to carry out constant surveillance.

A System-Oriented Dialogue Model to Design Community Partnerships for More Effective Sars-Cov-2 Prevention in Schools: The Case of Spain.

Objectives: The European Centre for Disease Control (ECDC) COVID-19 guidelines for non-pharmaceutical interventions (NPI) identify safety, hygiene and physical distancing measures to control SARS-Cov-2 transmission in schools. Because their implementation requires complicated changes, the guidelines also include "accompanying measures" of risk communication, health literacy and community engagement. Although these are considered crucial, their implementation is complex. This study aimed to co-define a community partnership that a) identifies systemic barriers and b) designs recommendations on how to implement the NPI to improve SARS-Cov-2 prevention in schools. Methods: We designed and piloted a System-Oriented Dialogue Model with the participation of 44 teachers and 868 students and their parents from six Spanish schools during 2021. The results were analysed using thematic analysis. Results: Participants identified 406 items addressing issues related to system characteristics, which is indicative of the complexity of the challenge. Using a thematic analysis, we defined 14 recommendations covering five categories. Conclusion: These findings could help in developing guidelines for initiating community engagement partnerships in schools to provide more integrated prevention interventions.

Clostridioides difficile infections were predominantly driven by fluoroquinolone-resistant Clostridioides difficile ribotypes 176 and 001 in Slovakia in 2018–2019

To investigate the epidemiology of Clostridioides difficile infection (CDI) in Slovakian hospitals after the emergence of ribotype 176 (027-like) in 2016. Between 2018 and 2019, European Centre for Disease Control and Prevention CDI surveillance protocol v2.3 was applied to 14 hospitals, with additional data collected on recent antimicrobial use and the characterization of C. difficile isolates. The mean hospital incidence of CDI was 4.1 cases per 10,000 patient bed-days. One hundred and five (27.6%) in-hospital deaths were reported among the 381 cases. Antimicrobial treatment within the previous 4 weeks was recorded in 90.5% (333/368) of cases. Ribotype (RT)176 was detected in 50% (n=185/370, 14 hospitals) and RT001 was detected in 34.6% (n=128/370,13/14 hospitals) of cases with RT data. Overall, 86% (n=318/370) of isolates were resistant to moxifloxacin by Thr82Ile in GyrA (99.7%). Multi-locus variable tandem repeat analysis showed clonal relatedness of predominant RTs within and between hospitals. Seven of 14 sequenced RT176 isolates and five of 13 RT001 isolates showed between zero and three allelic differences by whole-genome multi-locus sequence typing. The majority of sequenced isolates (24/27) carried the erm(B) gene and 16/27 also carried the aac(6')-aph(2'') gene with the corresponding antimicrobial susceptibility phenotypes. Nine RT176 strains carried the cfr(E)gene and one RT001 strain carried the cfr(C) gene, but without linezolid resistance. The newly-predominant RT176 and endemic RT001 are driving the epidemiology of CDI in Slovakia. In addition to fluoroquinolones, the use of macrolide-lincosamide-streptogramin B antibiotics can represent another driving force for the spread of these epidemic lineages. In C. difficile, linezolid resistance should be confirmed phenotypically in strains with detected cfr gene(s).

Diphtheria in asylum workers: forgotten but not gone!

Dear Editor, Human mobility and relocation are critical to the spread of infectious diseases. Diphtheria is understood as an ‘illness of the prevaccination times’ due to increased vaccine uptake globally. Therefore, many clinicians in most countries, including the United Kingdom, have hardly seen cases of diphtheria. However, infrequent cases and rarely epidemic outbreaks have been described, specifically in politically unbalanced regions where there are pockets of unvaccinated people, such as diphtheria outbreaks in Rohingya refugee campsites1. In the past, diphtheria outbreaks have also been registered in other conflict areas such as Yemen, Venezuela, and Germany2–4. Recently, there has been a rise in cases of diphtheria at immigrant shelters around Europe. More than 70 cases have been reported in England and detained at the Manston airport detection center in Kent in the past few days5. More than 40,000 asylum seekers have traversed the English Channel on boats this year. Manston, which was previously a military base, is intended to house barely 1600 individuals. However, in October, there were around 4000 migrants held there. Of these, one migrant worker died of diphtheria on November 19, after entering the United Kingdom 7 days earlier. He tested positive for the polymerase chain reaction testing6 Children in the United Kingdom are routinely immunized against infection, reducing the danger to the general population. Due to this high rate of diphtheria vaccination in the United Kingdom and the fact that the illness is principally propagated through close and extended contact with a patient, the risk of transmission of diphtheria to the general community is proposed to be relatively less5. However, many asylum applicants are denied this protection, as the majority of them have not been previously immunized, probably due to limited access to healthcare in their native countries. The European Center for Disease Control and Prevention has advised these places to take precautions, including immunizing asylum seekers before moving them elsewhere, to prevent overcrowding and poor ventilation. The government has advised migrants to take vaccines and antibiotics upon arrival6. Another school of thought suggests that the asylum seekers were in the incubation period and already infected before they arrived in England. This may be the result of prolonged lockdowns imposed during the coronavirus disease-2019 pandemic that substantially, hampered the implementation of vaccine schedules substantially as seen in the latest measles outbreak in India. Diphtheria is a major health problem in nations with low coverage of vaccination. It is a vaccine-preventable bacterial disease, although it is highly contagious and possibly lethal. In children under 5 years of age and adults over 40 years, the mortality rate may be as high as 20%. It can be asymptomatic or cause fever, headache, sore throat, ‘bark cough’, painful swallowing, difficulty breathing, blood-stained nasal discharge, skin ulcers, and lymphadenopathy. A thick, grayish ‘pseudomembrane’ is formed in the conjunctiva, nasal, and throat mucosa. Ocular involvement includes blepharoconjunctivitis and corneal ulcers7. Cardiac arrhythmias, heart blocks, myocarditis, and heart failure can occur due to the toxin’s effects in severe cases. Nerve palsy and kidney failure are also documented in some patients. This disease is spread by coughing, sneezing, or contact with utensils, bedding, or injuries from an infected patient. After being diagnosed by direct microscopy, culture, or multiplex polymerase chain reaction, the cornerstone of treatment includes antibiotics and antitoxins8,9. The way forward The WHO endorses global vaccination for Td (tetanus and diphtheria) for unvaccinated people 7 years of age and older. Unvaccinated contacts must receive a full course of diphtheria toxoid-containing vaccine, and incompletely vaccinated contacts should receive the remaining doses needed to complete their vaccination schedule. Erythromycin tablets can be distributed to all contacts of diphtheria patients10. Improved standards of housing, mass immunization, definitive diagnosis, timely treatment, and more efficient health support have also led to a decrease in the caseload of diphtheria worldwide, although not entirely. The government, along with local authorities, public health professionals, and microbiologists, should support affected persons and thwart the spread of infection in the broader interests of the public through constant epidemiological surveillance. Efficacy and adherence to the immunization program should be monitored periodically, along with the provision of booster doses. The availability of ample doses of diphtheria antitoxin for the rapid management of patients in such outbreaks must be ensured. Contact tracking and chemoprophylaxis of all contacts are the way forward. Robust protocols and contingency strategies to contain the outbreak must be part of the targeted action plan. Undoubtedly, the most effective approach would be to guarantee universal coverage of diphtheria through extended immunization programs. Health policy makers and physicians should not underestimate the value of primary and booster vaccinations against diphtheria among travelers to contain the spread of this disease. Ethical approval and informed consent Ethical approval and informed consent were not required for this study. Sources of funding There was no source of funding for this research. Authors contribution Equally contributed. Conflicts of interest disclosure The authors declare no conflict of interest. Guarantor Mubarick Nungbaso Asumah and Bijaya K. Padh. Data availability Data sharing is not applicable to this article as no new data were created.

Evaluating intra-action reviews at points of entry: ongoing learning opportunities during the COVID-19 pandemic

BackgroundLong-lasting crises, such as the COVID-19 pandemic, require proper interim evaluation in order to optimize response. The World Health Organization and the European Center for Disease Control have recently promoted the in(tra)-action review (IAR) method for this purpose. We systematically evaluated the added value of two IARs performed in the Dutch point of entry (PoE) setting.MethodsTwo online, 4-hour IAR meetings were organized in March 2021, for ports and airports respectively, to reflect on the ongoing COVID-19 response. Topics discussed were selected through a survey among participants. Participants were mainly self-selected by the (air)port public health service. Evaluation of the IAR method consisted of participant evaluation through a questionnaire, and hot and cold debriefs of the organizing team. Evaluation of the impact of the IAR was done through analysis of the meeting results, and a 3-month follow-up of the actions proposed during the meetings.ResultsThirty-nine professionals joined the IAR meetings. In the participant evaluation (n = 18), 89% agreed or totally agreed the IAR made it possible to identify challenges and problems in the COVID-19 response at PoE. Participants especially appreciated the resulting insight in regional and national partners. Regarding the online setting of the meeting, participants suggested to choose accessible and familiar online tools. After 3 months, all national actions and actions for ports had been executed; some regional actions for airports required further attention. A major result was a new meeting structure for all ports and the participating national authorities in which remaining and newly occurring issues were discussed.ConclusionsBased on the evaluations, we conclude that the IAR method can be of value during long-term crises, such as the COVID-19 pandemic response. Although it is challenging to dedicate time and effort to the organization and attendance of IAR meetings during crisis, the IAR method is feasible in an online setting if appropriate organizing and technical capacity is available. A participatory set-up supports the IAR method as a starting point for continuous exchange and learning during ongoing crises.

Development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue-endemic area.

Rio de Janeiro is a dengue-endemic city that experienced Zika and chikungunya epidemics between 2015 and 2019. Differential diagnosis is crucial for indicating adequate treatment and assessing prognosis and risk of death. This study aims to derive and validate a clinical rule for diagnosing chikungunya based on 3,214 suspected cases consecutively treated at primary and secondary health units of the sentinel surveillance system (up to 7 days from onset of symptoms) in Rio de Janeiro, Brazil. Of the total sample, 624 were chikungunya, 88 Zika, 51 dengue, and 2,451 were negative for all these arboviruses according to real-time polymerase chain reaction (RT-qPCR). The derived rule included fever (1 point), exanthema (1 point), myalgia (2 points), arthralgia or arthritis (2 points), and joint edema (2 points), providing an AUC (area under the receiver operator curve) = 0.695 (95% CI: 0.662-0.725). Scores of 4 points or more (validation sample) showed 74.3% sensitivity (69.0% - 79.2%) and 51.5% specificity (48.8% - 54.3%). Adding more symptoms improved the specificity at the expense of a lower sensitivity compared to definitions proposed by government agencies based on fever alone (European Center for Disease Control) or in combination with arthralgia (World Health Organization) or arthritis (Pan American Health Organization, Brazilian Ministry of Health). The proposed clinical rule offers a rapid, low-cost, easy-to-apply strategy to differentiate chikungunya fever from other arbovirus infections during epidemics.

The Problem of Antibiotic Resistance Control: A Possible Alternative to Antimicrobials in Veterinary Medicine

Aim of Study: The study included prospects for using autogenous immunobiological drugs as an alternative to antimicrobials. Materials and Methods: For the analysis databases of WHO–World Health Organization, WOHA–World Organization for Animal Health, FAO–Food and Agricultural Organization, CDC–Center for Control and of disease prevention in the USA, ECDC– European Center for Disease Control and Prevention, EFSA–European Food Safety Authority, as well as informational Internet resources of scientific journals, normative legal acts of Ukraine. The Results: According to the results of the conducted analysis, the global spread of microorganisms resistant to the action of antimicrobial drugs was established, which jeopardizes the possibility of effective treatment of infectious diseases. In Ukraine, as in other developed countries of the world, strict regulation of the circulation of antimicrobials has been adopted at the legislative level, which inevitably leads to the limitation of their use. International experience shows that restrictions on the use of antimicrobial agents should be compensated by measures aimed at increasing the level of biosafety. The use of autogenous immunobiological drugs for the specific prevention of infectious diseases of bacterial etiology can be a reasonable alternative to antibiotics in veterinary medicine. Conclusions: The introduction of new rules for the circulation of veterinary antimicrobial drugs will significantly affect the level of use of antimicrobial drugs. A reasonable alternative to antimicrobial agents is the use of autogenous immunobiological agents.

High Influenza Vaccine Effectiveness and Absence of Increased Influenza-like-Illness Epidemic Activity in the 2021-2022 Influenza Season in Catalonia (Spain) Based on Surveillance Data Collected by Sentinel Pharmacies.

Influenza surveillance and influenza vaccination are the key activities for preventing and controlling influenza epidemics. The study assessed the influenza surveillance and influenza vaccination data obtained from sentinel pharmacies of Catalonia, Spain, in the 2021-2022 influenza season. The sentinel pharmacies were selected from all community pharmacies to report all influenza-like illness (ILI) cases detected during the 2021-2022 influenza season and collect influenza surveillance and influenza vaccination data. The ILI cases were identified based on European Centre for Disease Control (ECDC) criteria. The moving epidemic method (MEM) was used to assess the ILI epidemic activity. The screening method was used to assess influenza vaccination effectiveness in patients aged 65-or-more years old. The sentinel pharmacies reported 212 ILI cases with a negative COVID-19 test and a total number of 412 ILI cases. An absence of increased ILI epidemic activity was observed in the 2021-2022 influenza season based on two criteria: (1) Number of ILI cases reported per week in the 2021-2022 influenza season significantly lower than the MEM-based epidemic threshold. (2) Mean number of ILI cases reported per week in the 2021-2022 influenza season significantly lower than during the ILI/influenza epidemic periods detected from 2017 to 2020 using the same methodology. Influenza vaccination was effective in preventing ILI among patients aged 65-or-more-years old. The absence of the influenza epidemic during the 2021-2022 influenza season could be explained by influenza vaccination and COVID-19 prevention measures (wearing face masks, social distancing). The sentinel pharmacies provided influenza surveillance data not provided by traditional influenza surveillance systems.

Monitoring European data with prospective space–time scan statistics: predicting and evaluating emerging clusters of COVID-19 in European countries

BackgroundCoronavirus disease 2019 (COVID-19) has become a pandemic infectious disease and become a serious public health crisis. As the COVID-19 pandemic continues to spread, it is of vital importance to detect COVID-19 clusters to better distribute resources and optimizing measures. This study helps the surveillance of the COVID-19 pandemic and discovers major space–time clusters of reported cases in European countries. Prospective space–time scan statistics are particularly valuable because it has detected active and emerging COVID-19 clusters. It can prompt public health decision makers when and where to improve targeted interventions, testing locations, and necessary isolation measures, and the allocation of medical resources to reduce further spread.MethodsUsing the daily case data of various countries provided by the European Centers for Disease Control and Prevention, we used SaTScan™ 9.6 to conduct a prospective space–time scan statistics analysis. We detected statistically significant space–time clusters of COVID-19 at the European country level between March 1st to October 2nd, 2020 and March 1st to October 2nd, 2021. Using ArcGIS to draw the spatial distribution map of COVID-19 in Europe, showing the emerging clusters that appeared at the end of our study period detected by Poisson prospective space–time scan statistics.ResultsThe results show that among the 49 countries studied, the regions with the largest number of reported cases of COVID-19 are Western Europe, Central Europe, and Eastern Europe. Among the 49 countries studied, the country with the largest cumulative number of reported cases is the United Kingdom, followed by Russia, Turkey, France, and Spain. The country (or region) with the lowest cumulative number of reported cases is the Faroe Islands. We discovered 9 emerging clusters, including 21 risky countries.ConclusionThis result can provide timely information to national public health decision makers. For example, a country needs to improve the allocation of medical resources and epidemic detection points, or a country needs to strengthen entry and exit testing, or a country needs to strengthen the implementation of protective isolation measures. As the data is updated daily, new data can be re-analyzed to achieve real-time monitoring of COVID-19 in Europe. This study uses Poisson prospective space–time scan statistics to monitor COVID-19 in Europe.

Healthcare-Associated COVID-19 across Five Pandemic Waves: Prediction Models and Genomic Analyses.

Background: Healthcare-associated SARS-CoV-2 infections need to be explored further. Our study is an analysis of hospital-acquired infections (HAIs) and ambulatory healthcare workers (aHCWs) with SARS-CoV-2 across the pandemic in a Belgian university hospital. Methods: We compared HAIs with community-associated infections (CAIs) to identify the factors associated with having an HAI. We then performed a genomic cluster analysis of HAIs and aHCWs. We used this alongside the European Centre for Disease Control (ECDC) case source classifications of an HAI. Results: Between March 2020 and March 2022, 269 patients had an HAI. A lower BMI, a worse frailty index, lower C-reactive protein (CRP), and a higher thrombocyte count as well as death and length of stay were significantly associated with having an HAI. Using those variables to predict HAIs versus CAIs, we obtained a positive predictive value (PPV) of 83.6% and a negative predictive value (NPV) of 82.2%; the area under the ROC was 0.89. Genomic cluster analyses and representations on epicurves and minimal spanning trees delivered further insights into HAI dynamics across different pandemic waves. The genomic data were also compared with the clinical ECDC definitions for HAIs; we found that 90.0% of the ‘definite’, 87.8% of the ‘probable’, and 70.3% of the ‘indeterminate’ HAIs belonged to one of the twenty-two COVID-19 genomic clusters we identified. Conclusions: We propose a novel prediction model for HAIs. In addition, we show that the management of nosocomial outbreaks will benefit from genome sequencing analyses.

Training needs assessment of European healthcare workers on vaccinology and vaccine acceptance

Abstract Background Healthcare workers (HCWs) are at the frontline of interaction with those that are taking decisions around vaccination. They need adequate training. The general aim of this systematic review is to assess HCWs’ training needs on vaccinology and vaccine acceptance. This work was performed for the European Centre for Disease Control (ECDC) under the specific contract No 1ECD.12108 ID.12922 implementing the framework contract number ECDC/2021/005. Methods The search was performed using MEDLINE, Scopus and Google Scholar databases in February 2022. The following inclusion criteria were used: date (from 01/01/2011 to 24/02/2022); language (English, Italian, Portuguese, Spanish, French and Romanian); geographic location of the study (Europe). Appraisal tool for Cross-Sectional Studies (AXIS checklist) was used to assess the methodological quality of the included papers. Results The scientific literature search retrieved 640 results on PubMed, 556 on Scopus and 15 on Google Scholar. In total, 1211 records were identified. After the duplicate removal and the title/abstract assessment, 132 publications were assessed for eligibility. Finally, after the full-text assessment, only 25 articles were included. As regards for the quality assessment, all studies were judged of moderate-good quality. The majority of studies stressed the need to deepen general knowledge of vaccine preventable diseases, vaccine efficacy, vaccination schedule and adverse effects of vaccines. Conclusions Considering their role in the community, especially as source of information and trust for vaccine acceptance, educational initiatives in vaccinology and vaccine hesitancy should be prioritized for HCWs, aimed at increasing their knowledge, awareness, and attitudes. An important heterogeneity of educational backgrounds, activities performed and training needs of the HCWs involved in vaccination at European level was one of the main critical issue to be addressed for future actions. Key messages

Monkeypox and the safety of the blood supply.

Monkeypox virus (MPXV), typically endemic in Africa, is currently an international public health crisis following its rapid and expansive spread. Diagnostic testing, treatment with antivirals, and vaccines are currently available, which provide a significant opportunity to slow and contain the infection. Transfusion-transmission of MPXV has not been reported but donor centers and hospitals should be aware of the potential risks. MPXV is an orthopoxvirus that is causing an expanding worldwide outbreak of monkeypox in 2022, with spread to more than 32,000 individuals and 82 non-endemic countries at time of this writing. Classic monkeypox is characterized by a prodrome of fever, headache, and lymphadenopathy, followed by the development of mucocutaneous lesions from which virus is shed at high levels. Mortality outside of Africa during the current outbreak has been significantly less than previously reported rates for the two major clades of MPXV (Central Africa, Clade I; and West Africa Clade IIa and IIb). The 2022 outbreak strain is predominantly Clade IIb.1 To date, the vast majority of reported infections have been in men who have sex with men (MSM) in Western Europe and the United States, although diagnostic testing has been limited to date and there may be biases in test seeking behaviors.2 Diagnostic testing is generally performed using PCR testing of skin lesion swabs, which often carry >108 copies/swab. Similar to variola virus (smallpox), MPXV is thought to spread from the site of inoculation systemically via monocytic cells through lymphatic as well as hematogenous routes.3 Viral DNAemia is common in both animal models as well as human cases. Recent reports of human monkeypox cases have detected approximately 105 viral DNA copies/ml whole blood, which mirrors that seen in animal models.4-6 The relationship of DNAemia to infectious viremia is not established. Notably, MPXV has never been cultured from the blood of humans but has been cultured from the blood of prairie dogs in experimental infection.6, 7 Diagnostic testing in the United States is authorized by the Food and Drug Administration, and is done by MPXV DNA detection by real-time PCR amplification. It is widely available in public health and commercial laboratories. The preferred sample is a swab obtained from the skin lesion. Testing on alternative samples, for example, blood, saliva, or cerebrospinal fluid is not yet validated. Smallpox vaccines are being recommended as pre- and postexposure prophylaxis of monkeypox for defined populations. JYNNEOS, a replication incompetent, live attenuated, modified Ankara vaccinia vaccine is FDA-approved for pre-exposure or post-exposure prophylaxis for MPXV, though it has not been directly tested for efficacy in humans for monkeypox or smallpox. Its effectiveness against monkeypox is inferred from immunogenicity data in humans and efficacy data in animal challenge studies suggesting approximately 85% effectiveness in preventing monkeypox cases. ACAM2000 is an FDA-approved, replication competent, live attenuated vaccinia virus vaccine available from the US Strategic National Stockpile for the prevention of smallpox. This vaccine is contraindicated in immunocompromised individuals and those with eczema, given a concerning side effect profile and the possibility of viral transmission, thus potential blood donors with exposure to this vaccine are recommended for deferral. ACAM2000 is not widely recommended at this early stage of the outbreak, except in rare individuals with contraindications to JYNNEOS. Transfusion transmission of MPXV has not been recognized. The presence of infectious virus in blood components from infected but otherwise qualified donors has not been studied, nor has its survival after contemporary processing and storage. The impact of universal leukoreduction is unknown, as is the capacity of parenteral inoculation to establish infection in humans. Disease transmission by intravenous inoculation has been successful in animals, including nonhuman primate models.8 Donors must be well on the day of donation, undergo a limited skin examination and have their temperature taken in the donor room. In the United States, MSM are specifically deferred for 3 months after the most recent sexual contact to reduce the risk of collecting HIV infected window period donations. This interval is believed to be beyond the duration of a putative infectious viremia and high adherence to this donor criterion effectively mitigates risk where donors continue to be directly questioned about MSM activity. Currently, the Food and Drug administration recommends no donor deferral for donors receiving prophylactic JYNNEOS vaccine (in contrast to ACAM2000) and has required no other interventions.9 Pathogen reduction processes in wide use are active against orthopoxviruses.10 In much of the world, the MSM deferral has been discarded and replaced by individual donor risk assessments. These recognize the importance of other behaviors, as opposed to sexual preference, in disease transmission risk, for example, multiple recent and new sex partners and sexual practices. In the context of the current epidemiology of the outbreak, overwhelmingly affecting MSM, it may be necessary in such venues to add specific inquiries regarding potential exposures to monkeypox, as has been recommended by the European Centers for Disease Control.11 The FDA considers that current donor screening strategies are sufficient to determine blood donor eligibility and does not recommend additional questions to evaluate possible exposure to MPXV.12 Whether this will change during the evolution of the epidemic remains undetermined and the recent description of asymptomatic infections13 and transmission beyond MSM will demand vigilance. Despite the fact that there are no cases of transfusion transmitted MPXV, the potential for MPXV viremia brings the theoretical risk of transmission through transfusion. There are currently no specific recall and lookback recommendations. Until more evidence is available to definitively determine the risk of transmission through transfusion, it may be prudent to counsel, clinically observe, and consider serial investigational and appropriate diagnostic testing of recipients of a unit from a donor who developed MPXV within 3 weeks after the donation. The authors have disclosed no conflicts of interest.

Severe acute hepatitis of unknown causes in children - Current findings, questions, opinions, and recommendations, a mini-review.

ABSTRACTSince October 2021 in Alabama, the United States, and March 2022 in central Scotland, the United Kingdom, the number of cases of severe acute hepatitis of unknown etiology/causes in children was found to increase, and the total number of cases has reached 920 worldwide by June 22 this year, 45 cases (5%) required liver transplantation, and 18 cases (2%) died according to World Health Organization (WHO). To understand the basic characteristics of this disease/syndrome, a literature search was performed at PubMed, websites of WHO, UK Health Security Agency, and US and European Centers for Disease Control and Prevention, and more than 20 reports were enrolled as references for this review. The main clinical manifestations are anorexia, vomiting, fatigue, jaundice, and so forth. Most of the cases seemed to have a self‐limited course of the disease, about 6% of cases may develop life‐threatening acute liver failure. The disease seems to be transmissible from person to person. Human adenovirus was detected in up to 75% of cases, but this virus seems not to be the only and major etiologic agent, other cofactors probably are involved. Researchers proposed many hypotheses concerning the etiology and pathogenesis, and many important works and studies are ongoing. This mini‐review is aimed at summarizing, reviewing, and further understanding the characteristics of the disease, raising some clinically relevant questions, and trying to discuss some questions that may be related to the treatment of the disease for consideration.

Pediatric Cases with Acute Severe Hepatitis of Unknown Origin: Summary of Special Session “Acute Severe Hepatitis of Unknown Etiology in Children” at the 32nd ECCMID in Lisbon, Portugal

Following the increase in number of pediatric cases with acute severe hepatitis of unknown etiology (ASHep-UE), in collaboration with European Center for Disease Control (ECDC) and the United Kingdom Health Security Agency (UKHSA), a special late breaking session “Hepatitis of unknown origin” was (...)