European Centre For Disease Prevention And Control Research Articles

Global Measles Surveillance: Trends, Challenges, and Implications for Public Health Interventions.

Measles, a highly contagious disease primarily affecting children, carries serious health risks, including complications and mortality. Vaccination remains the most effective preventive measure against measles transmission. The COVID-19 pandemic has exacerbated challenges in surveillance and immunization efforts, leaving millions of people exposed to preventable diseases such as measles. Globally accelerated immunization campaigns are critical for achieving regional elimination goals and mitigating the risk of outbreaks. Our team has developed an open-access database for global measles monitoring, facilitating standardized data collection and analysis. The analysis of measles cases from 2011 to 2023 reveals fluctuating trends, with notable increases in Africa in 2019 and 2023, indicating potential gaps in control strategies. Using an automated signal detection tool developed by the European Centre for Disease Prevention and Control (ECDC) team, we identified significant variations between World Health Organization (WHO) regions, underscoring the importance of continuous monitoring to detect epidemiological changes early. These results underscore the need for robust surveillance systems and accelerated vaccination efforts to safeguard public health.

Level of implementation of multimodal strategies for infection prevention and control interventions and prevalence of healthcare-associated infections in Northern Italy

BackgroundIn November 2022, Italy participated in the third edition of the European Centre for disease prevention and control (ECDC) point prevalence survey (PPS) of healthcare-associated infections (HAIs) in acute-care hospitals. A questionnaire based on the WHO infection prevention and control assessment framework (IPCAF) was included, which aims to investigate multimodal strategies for the implementation of IPC interventions.MethodsA PPS was conducted using the ECDC PPS protocol version 6.0. The Regional health authority of the region of Piedmont, in north-western Italy, chose to enlist all public acute-care hospitals. Data were collected within one day per each ward, within 3 weeks in each hospital, at hospital, ward and patient level. A score between 0–1 or 0–2 was assigned to each of the 9 items in the IPCAF questionnaire, with 14 points representing the best possible score. HAI prevalence was calculated at the hospital-level as the percentage of patients with at least one HAI over all included patients. Relations between HAI prevalence, IPCAF score, and other hospital-level variables were assessed using Spearman's Rho coefficient.ResultsIn total, 42 acute-care hospitals of the region of Piedmont were involved, with a total of 6865 included patients. All participant hospitals reported they employed multimodal strategies to implement IPC interventions. The median IPCAF overall score was 11/14 (interquartile range, IQR: 9.25–12). The multimodal strategy with the highest level of adherence was education and training, followed by communication and reminders. Strategies with the lowest level of adherence were safety climate and culture of change, and system change. Overall HAI prevalence was 8.06%. A weak to moderate inverse relation was found between IPCAF score and HAI prevalence (Spearman’s Rho -0.340, p 0.034). No other significant correlation was found.ConclusionsThis study found a high self-reported overall level of implementation of multimodal strategies for IPC in the region. Results of this study suggest the relevance of the multimodal approach and the validity of the IPCAF score in measuring IPC programs, in terms of effectiveness of preventing HAI transmission.

An investigation of multivariate data-driven deep learning models for predicting COVID-19 variants

The Coronavirus Disease 2019 (COVID-19) pandemic has swept almost all parts of the world. With the increasing number of COVID-19 cases worldwide, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has mutated into various variants. Given the increasingly dangerous conditions of the pandemic, it is crucial to predict the number of COVID-19 cases. Deep Learning and Long Short-Term Memory (LSTM) have predicted disease progress with reasonable accuracy and small errors. LSTM training is used to predict confirmed cases of COVID-19 based on variants identified using the European Centre for Disease Prevention and Control (ECDC) COVID-19 dataset containing confirmed cases identified from 30 European countries. Tests were conducted using the LSTM and Bidirectional LSTM (BiLSTM) models with the addition of Recurrent Neural Network (RNN) as comparisons on hidden size and layer size. The obtained result showed that in testing hidden sizes 25, 50, 75, and 100, the RNN model provided better results, with the minimum Mean Squared Error (MSE) value of 0.01 and the Root Mean Square Error (RMSE) value of 0.012 for B.1.427/B.1.429 variant with a hidden size of 100. Further testing layer sizes 2, 3, 4, and 5 shows that the BiLSTM model provided better results, with a minimum MSE value of 0.01 and an RMSE of 0.01 for the B.1.427/B.1.429 variant with a hidden size of 100 and layer size of 2.

Epidemic intelligence in Europe: a user needs perspective to foster innovation in digital health surveillance

BackgroundEuropean epidemic intelligence (EI) systems receive vast amounts of information and data on disease outbreaks and potential health threats. The quantity and variety of available data sources for EI, as well as the available methods to manage and analyse these data sources, are constantly increasing. Our aim was to identify the difficulties encountered in this context and which innovations, according to EI practitioners, could improve the detection, monitoring and analysis of disease outbreaks and the emergence of new pathogens.MethodsWe conducted a qualitative study to identify the need for innovation expressed by 33 EI practitioners of national public health and animal health agencies in five European countries and at the European Centre for Disease Prevention and Control (ECDC). We adopted a stepwise approach to identify the EI stakeholders, to understand the problems they faced concerning their EI activities, and to validate and further define with practitioners the problems to address and the most adapted solutions to their work conditions. We characterized their EI activities, professional logics, and desired changes in their activities using NvivoⓇ software.ResultsOur analysis highlights that EI practitioners wished to collectively review their EI strategy to enhance their preparedness for emerging infectious diseases, adapt their routines to manage an increasing amount of data and have methodological support for cross-sectoral analysis. Practitioners were in demand of timely, validated and standardized data acquisition processes by text mining of various sources; better validated dataflows respecting the data protection rules; and more interoperable data with homogeneous quality levels and standardized covariate sets for epidemiological assessments of national EI. The set of solutions identified to facilitate risk detection and risk assessment included visualization, text mining, and predefined analytical tools combined with methodological guidance. Practitioners also highlighted their preference for partial rather than full automation of analyses to maintain control over the data and inputs and to adapt parameters to versatile objectives and characteristics.ConclusionsThe study showed that the set of solutions needed by practitioners had to be based on holistic and integrated approaches for monitoring zoonosis and antimicrobial resistance and on harmonization between agencies and sectors while maintaining flexibility in the choice of tools and methods. The technical requirements should be defined in detail by iterative exchanges with EI practitioners and decision-makers.

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

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

Evaluation of infection prevention and control programmes according to the European Centre for Disease Prevention and Control and the World Health Organization in Spain 2012–2022: indicators of core component 1

Key and core components of effective infection prevention and control programmes (IPCP) issued by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) have been described. WHO core component 1 relates to the structure, organization and management of IPCP. The objective of this study was to assess the status and the time trends of some indicators of core component 1 of IPCP in acute hospitals in Spain throughout the period 2012-2022. Hospital-level data from the Spanish point prevalence survey for years 2012-2022 were analyzed. Core component 1 indicators were calculated and tested for association to healthcare-associated infections (HAIs). In addition, trends were also examined. Overall, 67.0% and 57.2% of Spanish hospitals reported having an annual IPC plan and an annual IPC report that was approved by the hospital managing director, respectively. The global median number of full-time equivalent (FTE) IPC nurses per 250 beds for the period was 0.87 and the global median number of FTE IPC doctors was 0.70. The rates of blood cultures and stool tests for Clostridioides difficile were 39.9 and 6.1 per 1000 patient-days, respectively. No significant correlation was found between core component 1 indicators and HAI prevalence. Spain is currently at a basic level on the structure, organization and management of IPC programmes. Profound differences were found between hospitals depending on size and type.

Invasive Listeriosis in Europe – A Case Review

Abstract Listeria monocytogenes bacilli are a known cause of non-invasive gastrointestinal listeriosis with diarrhea, less frequently they cause invasive infections: meningitis and encephalitis, bacteremia and its complications: endocarditis, intraocular inflammation of the eye and others. The risk of human infection is mainly associated with consuming food contaminated with these bacteria. According to the European Food Safety Authority (EFSA), infections with L. monocytogenes etiology caused the highest hospitalizations and deaths among zoonotic diseases reported in 2022. A report by the European Center for Disease Prevention and Control (ECDC) reported 0.44 cases of listeriosis per 100,000 population in 2021, with the highest incidence rate for people over 64 years old at 1.7. The study aimed to review and describe cases of invasive listeriosis diagnosed in adult patients in Europe between 2010 and 2023. Fifty-two cases of the disease were included, of which 19 were meningitis, 13 showed bacteremia, nine were associated with endocarditis and 10 with intraocular inflammation. One case had a clinical form of hepatitis. Only seven cases of L. monocytogenes infection were related to consuming contaminated food. Eleven cases ended in the death of patients. Invasive listeriosis is a difficult-to-treat infection with a significant mortality rate. It requires decisive action by monitoring the prevalence and extent of food contamination with these microorganisms and preventing epidemic outbreaks. Research on listeriosis should focus on improving the clinical treatment of severe cases of infection and studying the complex mechanisms of their pathogenesis.

Healthcare-associated infections and antimicrobial use in acute care hospitals in Greece, 2022; results of the third point prevalence survey

BackgroundThe burden of healthcare-associated infections (HAIs) and the extent of antimicrobial use (AU) are periodically recorded through Point Prevalence Surveys (PPS) in acute care hospitals coordinated by the European Centre for Disease Prevention and Control (ECDC). In previous PPSs, Greece demonstrated increased HAI and AU prevalence: 9% and 54.7% in 2011–2012, and 10% and 55.6% in 2016–2017, respectively. The 2022 PPS aimed to estimate HAIs and AU indicators among inpatients, especially amid the COVID-19 pandemic.MethodsA cross-sectional study was conducted in 50 hospitals during October-December 2022, in Greece. Patients admitted before 8.00 a.m. of the survey day were observed. Patients with at least one HAI or receiving at least one antimicrobial agent were included. Data were collected by hospital infection control teams. Hospital and ward-level variables were analysed.ResultsFrom 9,707 inpatients, 1,175 had at least one HAI (12.1%), and 5,376 were receiving at least one antimicrobial (55.4%). Intensive care unit patients had the highest HAI (45.7%) and AU (71.3%) prevalence. Of the 1,408 recorded HAIs, lower respiratory tract (28.9%), bloodstream (20%), and urinary tract infections (13.1%) were the most common. Among 1,259 isolates, Klebsiella (20.5%) and Acinetobacter (12.8%) were most frequently identified. Resistance to first-level antibiotic markers was 69.3%. Among the 9,003 antimicrobials, piperacillin-tazobactam (10.9%), and meropenem (7.7%) were frequently prescribed. The ratio of broad-spectrum to narrow-spectrum antibiotics was 1.4. As defined by the 2021 WHO AWaRe (Access, Watch, Reserve) classification, restricted classes of Watch and Reserve agents comprised 76.7% of antibiotics. Usual indications were treatment of community-acquired infections (34.6%) and HAIs (22.9%). For surgical prophylaxis, cefoxitin was commonly used (20.2%), and typical courses (75.7%) lasted more than one day. HAI and AU prevalence were positively associated with bed occupancy (p = 0.027) and secondary hospitals (p = 0.014), respectively.ConclusionsThe 2022 PPS highlighted the increasing trend of HAI prevalence and high AU prevalence in Greece, the emergence of difficult-to-treat pathogens, and the extensive use of broad-spectrum antimicrobials. Strengthening infection control and antimicrobial stewardship programs in hospital settings is essential.

Barriers to HIV testing and possible interventions to improve access to HIV healthcare among migrants, with a focus on migrant women: Results from a European survey.

According to European Centre for Disease Prevention and Control (ECDC) reports, women and migrants are more likely to have delayed HIV diagnosis (CD4 <350 cells/mm3 ). As a follow-up to a previously published systematic review revealing a range of barriers to HIV testing among migrant women, the aim of the present study was to identify barriers to HIV testing from the perspective of service providers and to formulate possible interventions to improve access to HIV healthcare among migrants in Europe, with an emphasis on migrant women. Between November 2021 and February 2022 an online survey, consisting of 20 questions, was forwarded to 178 stakeholders and non-governmental organizations (NGOs) working with migrant populations in 33 countries from the World Health Organization (WHO) European region. Forty-three responses from 14 countries were analysed. Most respondents (70%) judged migrants' access to healthcare as worse than that for the resident native population. Only 2/11 prevention interventions were available to all in at least 50% of participating countries. The three main barriers to accessing healthcare for migrant women and reasons for late HIV diagnosis among migrant women were stigma and discrimination, language barriers, and cultural barriers. Many HIV prevention interventions are not free of charge for all within Europe. The results of this survey show that migrant women face many barriers to accessing healthcare and that these might contribute to late HIV diagnosis. Simplification of access to free healthcare for all, more awareness raising about HIV screening and prevention among migrant women, and more migrant-focused outreach programmes are suggested to improve migrant women's access to HIV healthcare in Europe.

Multinational collaboration in solving a European Salmonella Braenderup outbreak linked to imported melons, 2021.

A genomic cluster of Salmonella Braenderup ST22, a serovar of Salmonella enterica subsp. enterica which causes symptoms of gastrointestinal illness, was notified by Danish authorities to the European Centre for Disease Prevention and Control (ECDC) on 3 May 2021. By 6 July 2021, S. Braenderup outbreak cases (n=348) had been reported from 12 countries in the European Union/European Economic Area (EU/EEA) and the United Kingdom (UK), including 68 hospitalised cases. With support from affected EU/EEA countries, and in partnership with the European Food Safety Authority (EFSA), ECDC established an international outbreak investigation team to rapidly identify the source and prevent outbreak spread. Consumption information was shared with affected countries through a standard line list, revealing that 124 of 197 cases (63%) reported having eaten (any) melons within 7 days prior to disease onset. The speed and completeness of the investigation, which identified the outbreak vehicle as galia melons imported from Honduras in June 2021, was a direct result of extensive collaboration and information sharing between countries' national food safety and public health authorities. This article describes the outbreak and the benefits, successes, and challenges of multi-country collaboration for consideration in future large foodborne outbreaks across Europe.

Job vacancy at the European Centre for Disease Prevention and Control (ECDC).

Job vacancy at the European Centre for Disease Prevention and Control (ECDC).

The Need for European Surveillance of CDI.

Since the turn of the millennium, the epidemiology of Clostridioides difficile infection (CDI) has continued to challenge. Changes in clinical presentation, severity of disease, descriptions of new risk factors and the occurrence of outbreaks all emphasised the importance of early diagnosis and standardised surveillance systems. However, a lack of consensus on case definitions, clinical guidelines and optimal laboratory diagnostics across Europe has led to the underestimation of CDI and impeded comparison between countries. These inconsistencies have prevented the true burden of disease from being appreciated.Acceptance that a multi-country CDI surveillance program and optimised diagnostic strategies are required has built the foundations for a more robust, unified surveillance. The concerted efforts of the European Centre for Disease Prevention and Control (ECDC) CDI networks led to the development of the European surveillance protocol and an over-arching long-term CDI surveillance strategy for 2014-2020, which has been followed by the development of surveillance systems in at least 20 European countries. However, surveillance activities in individual countries have slowed during the COVID-19 pandemic as resources were diverted to the global health crisis. A renewed and strengthened focus on CDI surveillance and prevention is therefore urgently needed post COVID-19.

Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis

Epidemiological data are crucial to monitoring progress towards the 2030 Hepatitis C Virus (HCV) elimination targets. Our aim was to estimate the prevalence of chronic HCV infection (cHCV) in the European Union (EU)/European Economic Area (EEA) countries in2019. Multi-parameter evidence synthesis (MPES) was used to produce national estimates of cHCV defined as: π=πrecρrec+πexρex+πnonρnon; πrec, πex, and πnon represent cHCV prevalence among recent people who inject drugs (PWID), ex-PWID, and non-PWID, respectively, while ρrec, ρex, and ρnon represent the proportions of these groups in the population. Information sources included the European Centre for Disease Prevention and Control (ECDC) national operational contact points (NCPs) and prevalence database, the European Monitoring Centre for Drugs and Drug Addiction databases, and the published literature. The cHCV prevalence in 29 of 30 EU/EEA countries in 2019 was 0.50% [95% Credible Interval (CrI): 0.46%, 0.55%]. The highest cHCV prevalence was observed in the eastern EU/EEA (0.88%; 95% CrI: 0.81%, 0.94%). At least 35.76% (95% CrI: 33.07%, 38.60%) of the overall cHCV prevalence in EU/EEA countries was associated with injecting drugs. Using MPES and collaborating with ECDC NCPs, we estimated the prevalence of cHCV in the EU/EEA to be low. Some areas experience higher cHCV prevalence while a third of prevalent cHCV infections was attributed to PWID. Further efforts are needed to scale up prevention measures and the diagnosis and treatment of infected individuals, especially in the east of the EU/EEA and among PWID. ECDC.

Antimicrobial resistance of clinical bacterial isolates according to the WHO’s AWaRe and the ECDC-MDR classifications: the pattern in Ghana’s Bono East Region

IntroductionAntimicrobial resistance (AMR) remains a significant health challenge globally and nations have the responsibility to maintain a constant surveillance of AMR, particularly for the emergence of multidrug-resistant (MDR) isolates to existing antibiotics. Against this backdrop, we applied the WHO’s AWaRe (ACCESS, WATCH, and RESERVE) antibiotics classification and the European Centre for Disease Prevention and Control (ECDC)’s multidrug resistance definition for AMR isolates from clinical specimens.MethodThis study reviewed bacterial culture and antibiotic sensitivity test outcomes. These results were then grouped according to the AWaRe and ECDC-MDR classifications.ResultsIn all, the culture and sensitivity results of the 3,178 clinical specimens were investigated, of which 59.5% were from female patients. The pathogens were isolated from 1,187 specimens (37.4%). The WHO’s ACCESS antibiotics, tetracycline, showed a relatively high level of insusceptibility, particularly among Gram-positive (GP) isolates (ranging from 66.7% to 76.7%), along with augmentin (ranging from 44.7% to 81.3%) and cloxacillin (ranging from 50.0% to 78.1%). However, the Gram-negative (GN) isolates showed a relatively high level of susceptibility to amikacin, augmentin, and nitrofurantoin. The WHO’s WATCH antibiotics, cefuroxime, ceftriaxone, cefotaxime, and ciprofloxacin showed a relatively high level of non-responsiveness among the GN isolates, particularly Proteus (ranging from 31.4% to 78.4%), Pseudomonas (ranging from 21.4% to 96.4%), and Enterobacter (ranging from 62.5% to 100%) spp. Among the WHO’s RESERVE antibiotics, resistance to ceftazidime was commonly associated with the GN coliform isolates: Eschericha coli, Klebsiella, and Citrobacter spp. Insusceptibility to meropenem was frequently observed in Staphylococcus spp., E. coli, coliforms, and Proteus spp. Out of the 1,187 isolates, 15.5% (184) were GAT (gentamycin, ampicillin, and tetracycline) MDR, of which 61% (112/184) were from specimens of female patients. The most predominant GAT-MDR isolates were Staphylococcus spp., E. coli, coliforms, and Klebsiella spp.ConclusionIn conclusion, the study revealed a relatively high level and diverse range of AMR. However, MDR in accordance with the ECDC definition was relatively low. There is, therefore, a need to have further research on AMR to inform national criteria for MDR in Ghana.

Job vacancies at the European Centre for Disease Prevention and Control (ECDC).

Job vacancies at the European Centre for Disease Prevention and Control (ECDC).

Models of good practice to enhance infectious disease care cascades among people who inject drugs: a qualitative study of interventions implemented in European settings

BackgroundPeople who inject drugs (PWID) in Europe are at an increased risk of HIV/AIDS, chronic viral hepatitis B (HBV) and C (HCV), and tuberculosis (TB). We aimed to complement the evidence base on interventions optimising their care cascade with evidence from models of good practice (MoGPs) implemented in the EU/EEA and countries from the Eastern European region.MethodsA model of good practice (MoGP) was defined as (a package of) interventions with proven effectiveness in certain settings that are likely to be replicable and sustainable in other settings or countries. Fifteen MoGPs, identified by the European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) following a call launched in 2020, have been analysed. For the 15 MoGPs, a qualitative content analysis was conducted of (i) intervention characteristics and (ii) enabling factors. Information was extracted and summarised for community-based testing, linkage to care and adherence to treatment.ResultsMoGPs emerged from projects implemented in Belarus, Norway, Portugal, the Republic of Moldova, Spain, and the UK alongside the multi-country HepCare project (Ireland, Romania, Spain, the UK) targeting either HCV (6/15) or HIV/AIDS (4/15), alone or combined with HBV, and/or TB (5/15). All MoGPs used packages of interventions, with decentralisation of services (15/15), cooperation among service providers (14/15), integrated services (10/15), peer interventions (12/15), and case management (4/15) reported across all stages of the care cascade. The synthesis of enablers shows that when replicating interventions in other settings, consideration should be given to national (legal) frameworks, characteristics of and proximity between healthcare and service providers, and establishing relations of trust with PWID.ConclusionTo improve the cascade of care for PWID in European settings, care structures and pathways should be simplified, based on cooperation and multidisciplinary. MoGPs can provide implementation-based evidence on interventions alongside evidence from peer-reviewed literature to optimise the care cascade among PWID.

2488. Healthcare-associated infections in acute care hospitals in Greece, results of the third Point Prevalence Survey, April – December 2022

Abstract Background The burden of healthcare-associated infections (HAIs) in European acute care hospitals is estimated through periodic Point Prevalence Studies (PPS) coordinated by European Centre for Disease Prevention and Control (ECDC). In 2016, Greece had the highest HAI prevalence among European countries (10%). The current PPS aimed to estimate the prevalence of HAIs among inpatients, especially in the context of COVID-19 pandemic. Methods A cross-sectional study was conducted between April and December 2022, according to ECDC PPS protocol v.6.1, in a representative sample of 50 Greek hospitals across all country regions. Patients admitted in wards before 8.00 am of the study day were screened for inclusion. Infection control teams collected hospital characteristics (e.g., total beds, infection control markers), wards (specialty, bed occupancy) and active HAIs (type, origin, microbiological results). Active HAIs included present HAIs or past HAIs that are still being treated. ECDC HelicsWin.Net software v.4.4.0, was used for data entry and analysis. Results Overall, 12.1% inpatients (1,175 of a total 9,707) had at least one active HAI. Among the 1,408 HAIs, the most commonly observed were lower respiratory tract infections (28.9%), bloodstream infections (20%), among which 4.6% were catheter-related, and urinary tract infections (13.1%), as shown in table 1. HAI prevalence was higher in patients of intensive care units (45.7%), compared to medical (13.5%) and surgical ones (8.2%). Laboratory data were available for 58.9% of HAIs and 1,259 microorganisms were identified. Klebsiella species (20.5%), Acinetobacter species (12.8%), P. aeruginosa (10.2%), Candida species (7.9%) and S. aureus (6.3%) were frequent isolates. Antimicrobial susceptibility patterns varied depending on the pathogen (table 2). Conclusion This study shows the increased burden of HAIs among inpatients and the emergence of difficult-to-treat pathogens in Greek hospitals. Subsequent prevalence studies will provide additional evidence regarding the trend in HAI prevalence among inpatients and support the identification of modifiable practices. The invigoration of infection control and antimicrobial stewardship programs in these settings is essential. Disclosures All Authors: No reported disclosures

The Role of Stakeholders' Understandings in Emerging Antimicrobial Resistance: A One Health Approach.

The increasing misuse of antibiotics in human and veterinary medicine and in agroecosystems and the consequent selective pressure of resistant strains lead to multidrug resistance (AMR), an expanding global phenomenon. Indeed, this phenomenon represents a major public health target with significant clinical implications related to increased morbidity and mortality and prolonged hospital stays. The current presence of microorganisms multi-resistant to antibiotics isolated in patients is a problem because of the additional burden of disease it places on the most fragile patients and the difficulty of finding effective therapies. In recent decades, international organizations like the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) have played significant roles in addressing the issue of AMR. The ECDC estimates that in the European Union alone, antibiotic resistance causes 33,000 deaths and approximately 880,000 cases of disability each year. The epidemiological impact of AMR inevitably also has direct economic consequences related not only to the loss of life but also to a reduction in the number of days worked, increased use of healthcare resources for diagnostic procedures and the use of second-line antibiotics when available. In 2015, the WHO, recognising AMR as a complex problem that can only be addressed by coordinated multi-sectoral interventions, promoted the One Health approach that considers human, animal, and environmental health in an integrated manner. In this review, the authors try to address why a collaboration of all stakeholders involved in AMR growth and management is necessary in order to achieve optimal health for people, animals, plants, and the environment, highlighting that AMR is a growing threat to human and animal health, food safety and security, economic prosperity, and ecosystems worldwide.

Ventilator-associated pneumonia in Polish intensive care unit dedicated to COVID-19 patients

BackgroundHealthcare-Associated Infections (HAI) are most frequently associated with patients in the Intensive Care Unit (ICU). Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), led to ICU hospitalization for some patients.MethodsThe study was conducted in 2020 and 2021 at a hospital in southern Poland. The Healthcare-Associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC) was used for HAI diagnosis. The aim of this case-control study was to retrospectively assess the epidemiology of HAIs in ICU patients, distinguishing between COVID-19 and non-COVID-19 cases.ResultsThe study included 416 ICU patients: 125 (30%) with COVID-19 and 291 (70%) without COVID-19, p < 0.05. The mortality rate was 80 (64%) for COVID-19 patients and 45 (16%) for non-COVID-19 patients, p < 0.001. Ventilator-Associated Pneumonia (VAP) occurred in 40 cases, with an incidence rate density of 6.3/1000 patient-days (pds): 14.1/1000 pds for COVID-19 patients vs. 3.6/1000 pds for non-COVID-19 patients. Odds Ratio (OR) was 2.297, p < 0.01. Acinetobacter baumannii was the most often isolated microorganism in VAP, with 25 cases (incidence rate 8.5%): 16 (18.2%) in COVID-19 patients vs. 9 (4.4%) in non-COVID-19 patients. OR was 4.814 (1.084–4.806), p < 0.001.ConclusionsPatients treated in the ICU for COVID-19 faced twice the risk of VAP compared to non-COVID-19 patients. The predominant microorganism in VAP cases was Acinetobacter baumannii.

4.C. Round table: The role of EU bodies and European Health Union policies, and implications for the Pandemic Treaty

Abstract As the CoViD-19 pandemic unfolded, policy- and decision-makers within and beyond European borders became acutely aware of the urgent need to revisit policies and cross-border collaboration to increase preparedness. CoViD-19 lessons, regional autonomy, the way EU bodies functioned at times of crisis but also at times of peace, and EU's role in global health were all considered. In 2022, a new EU body, the Health Emergency Preparedness and Response (HERA) Authority became operational “to prevent, detect, and rapidly respond to health emergencies, through intelligence gathering and building the necessary response capacities.” In March 2022, the Council of the EU adopted the decision to authorise the opening of negotiations for an international agreement on these topics, i.e., ‘The Pandemic Treaty’. Upon ratification, the treaty will become a legally binding instrument to determine coordination of public-private partnerships, towards discovery, and research and development (R&amp;D) for vaccines, diagnostic and medicinal products. Negotiations started in the summer of 2022, with the Intergovernmental Negotiating Body (INB4) drafting the treaty in the WHO framework, the ‘Zero Draft’ presented in Nov 2022, progress to be reported to the World Health Assembly (WHA76) (May 2023), and a final draft agreement to be delivered in May 2024. In March 2023, HERA and the European Centre for Disease Prevention and Control (ECDC), and HERA and the European Medicines Agency (EMA) formalised agreements to clearly delineate working arrangements “to strengthen cooperation and to coordinate their work in support of health emergency preparedness and response in the area of medical countermeasures”. The increasing level of complexity, with rapid policy developments necessitates better understanding of the role of EU bodies and policies play, equipping public health professionals and of the tools to participate in these exchanges at national and cross-border levels, ultimately ensuring public health priorities and interests are served. This RT aims to provide an overview of recent developments for these bodies (HERA, EMA, ECDC), how they interact with WHO, and implications of the recently presented EU Global Health Strategy (EUGHS) (Nov 2022) and EU General Pharmaceutical Legislation (EUGPL) (Apr 2023). Panellists and Chairs include representatives to these bodies and legal experts to help elucidate key aspects. Brief interventions followed by discussion will explore: • The role of EU bodies in relation to the treaty • EU priorities, incl. regional autonomy, and related legislation, i.e., EUGPL and EUGHS • Key treaty articles and implications for European public health and global public health • The relevance of existing instruments, e.g., International Health Regulations, the Nagoya Protocol, the UN Biodiversity Convention • The guiding principles and rights in the Zero Draft Active audience interaction is envisioned via polls to prioritise topics and submit questions. Key messages • The global and European public health landscapes are rapidly being transformed. Comprehensive understanding of bodies and policies at interplay by public health professionals is key. • Current developments involve key deliberation and consultation steps at national, EU-wide and global levels. The public health community must be informed and engaged to safeguard public health. Speakers/Panelists Ricardo Mexia INSA - National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal Debjani Muller HTAi, Edmonton, Canada Sujitha Subramanian UK Dimitra Lingri National Organization for Health Care Services Provision, Athens, Greece