General Surveillance Research Articles

Data-driven testing program improves detection of COVID-19 cases and reduces community transmission

COVID-19 remains a global threat in the face of emerging SARS-CoV-2 variants and gaps in vaccine administration and availability. In this study, we analyze a data-driven COVID-19 testing program implemented at a mid-sized university, which utilized two simple, diverse, and easily interpretable machine learning models to predict which students were at elevated risk and should be tested. The program produced a positivity rate of 0.53% (95% CI 0.34–0.77%) from 20,862 tests, with 1.49% (95% CI 1.15–1.89%) of students testing positive within five days of the initial test—a significant increase from the general surveillance baseline, which produced a positivity rate of 0.37% (95% CI 0.28–0.47%) with 0.67% (95% CI 0.55–0.81%) testing positive within five days. Close contacts who were predicted by the data-driven models were tested much more quickly on average (0.94 days from reported exposure; 95% CI 0.78–1.11) than those who were manually contact traced (1.92 days; 95% CI 1.81–2.02). We further discuss how other universities, business, and organizations could adopt similar strategies to help quickly identify positive cases and reduce community transmission.

The prevalence of loneliness across 113 countries: systematic review and meta-analysis

ObjectivesTo identify data availability, gaps, and patterns for population level prevalence of loneliness globally, to summarise prevalence estimates within World Health Organization regions when feasible through meta-analysis, and to examine...

The Burden of Likely Rubella Infection among Healthy Pregnant Women in Abakaliki, Ebonyi State, Nigeria.

The first 140 days of pregnancy are critical as regards rubella virus infection because of the likelihood of a poor pregnancy outcome. This study was undertaken to investigate the likelihood of exposure to poor pregnancy outcomes due to seroprevalence of rubella among selected pregnant women attending Mile Four Hospital, Abakaliki, Ebonyi State, Nigeria. The seroprevalence of rubella immunoglobulin M (IgM) antibodies was investigated among pregnant women. A total of 187 sera samples collected from the women were screened for rubella virus IgM antibody using the enzyme-linked immunosorbent assay (ELISA). The results obtained were analyzed using SPSS. The chi square test was performed at a P value of 0.05 significance and at a 95% confidence interval. Of the 187 pregnant women, 35 (18.72%) were positive for the rubella virus. Pregnant women within 26–30 years of age had the highest prevalence (26.15%), while those aged 35–40 years had the least prevalence. Married women had the highest prevalence (20.0%), followed by singles (16.67%) and widows (15.38%), while divorced pregnant women recorded the least prevalence (9.20%). Pregnant women with no formal education were more predisposed to rubella virus (22.22%) infection compared to their educated counterparts. Occupationally, full-time housewives had the highest prevalence (24.26%). The infection rates seemed to wane as pregnancy advanced. The first trimester had the highest prevalence (21.88%), followed by the second trimester (18.84%) and the third trimester (17.44%). Pregnant women living in urban areas had higher IgM seroprevalence (20.18%) than those in rural areas (16.67%). Furthermore, grand multigravidas were more infected (22.73%) than primigravidas (14.52%) and multigravidas (20.39%). The seroprevalence of rubella in this study was high, and it calls for general surveillance and mass immunization of children and females of childbearing age in the area to help reduce the incidence of congenital rubella syndrome.

Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study

BackgroundValproate is a teratogenic drug that should be avoided during the preconception period and pregnancy. The aim was to explore general practitioners’ (GPs) prescription patterns over time, describe trends, and explore inter-practice variation within primary care.MethodsWe identified women of childbearing age (12–46 years old) in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network. We performed repeated cross-sectional analyses from 2004 to 2018 to determine rates of prescription and a retrospective cohort estimated the prevalence of use of valproate during pregnancy.ResultsIn 2004, 0.31% (95% Confidence Interval (95%CI):0.18 to 0.44%) women were prescribed valproate, decreasing to 0.16% (95%CI:0.07 to 0.24%) by 2018. Among women with epilepsy, the rate fell from 15.2% (95%CI:14.4 to 16.0%) to 8.8% (95% CI:8.2 to 9.7%) over the same period. In 2018, almost two thirds (62.2%) of women who were prescribed valproate had epilepsy only, whereas bipolar disorder and migraine accounted for 15.8% and 7.4% respectively. Contraceptive prescriptions did not increase over time, and only in 2018 was there greater odds of being prescribed contraception (OR 1.41, 95%CI:1.08 to 1.45). Just under a fifth (19.7%) of women were prescribed valproate during their pregnancy; two out of three of these pregnancies were preceded by folic acid prescription (5 mg). While some practices reduced their rate of valproate prescription, others did not.ConclusionsRegulatory guidelines have changed GPs' prescription patterns in women of childbearing potential for valproate but not for contraception. Further research is needed to identify the barriers of GPs and women of childbearing potential to undertaking contraception.

The dynamics of frailty development and progression in older adults in primary care in England (2006\u20132017): a retrospective cohort profile

BackgroundFrailty is a common condition in older adults and has a major impact on patient outcomes and service use. Information on the prevalence in middle-aged adults and the patterns of progression of frailty at an individual and population level is scarce. To address this, a cohort was defined from a large primary care database in England to describe the epidemiology of frailty and understand the dynamics of frailty within individuals and across the population. This article describes the structure of the dataset, cohort characteristics and planned analyses.MethodsRetrospective cohort study using electronic health records. Participants were aged ≥50 years registered in practices contributing to the Oxford Royal College of General Practitioners Research and Surveillance Centre between 2006 to 2017. Data include GP practice details, patient sociodemographic and clinical characteristics, twice-yearly electronic Frailty Index (eFI), deaths, medication use and primary and secondary care health service use. Participants in each cohort year by age group, GP and patient characteristics at cohort entry are described.ResultsThe cohort includes 2,177,656 patients, contributing 15,552,946 person-years, registered at 419 primary care practices in England. The mean age was 61 years, 52.1% of the cohort was female, and 77.6% lived in urban environments. Frailty increased with age, affecting 10% of adults aged 50–64 and 43.7% of adults aged ≥65. The prevalence of long-term conditions and specific frailty deficits increased with age, as did the eFI and the severity of frailty categories.ConclusionA comprehensive understanding of frailty dynamics will inform predictions of current and future care needs to facilitate timely planning of appropriate interventions, service configurations and workforce requirements. Analysis of this large, nationally representative cohort including participants aged ≥50 will capture earlier transitions to frailty and enable a detailed understanding of progression and impact. These results will inform novel simulation models which predict future health and service needs of older people living with frailty.Study registrationRegistered on www.clinicaltrials.gov October 25th 2019, NCT04139278.

Emigration and public health: the sanitary question in the control of Portuguese emigrants, 1890s-1950s

Human mobility represents a privileged field for analysing epidemic propagation, as well as identification and control practises at a world scale. Migrants are at the same time agents of disease dissemination and vulnerable persons highly exposed to epidemics in transit spaces such as city ports, ships, and settlement sites in the countries of origin. This paper aims to analyse how a country with a long and strong tradition in transatlantic and European migration, such as Portugal, incorporated concerns of Public Health in the policies and management of massive migration exits from the nineteenth century until the 1950s, particularly through the directives for the control and prevention of epidemics. In this way, we will analyse the intersection of two general state policies, epidemic control and migration surveillance.

First Identification of Reinfection by a Genetically Different Variant of SARS‐CoV‐2 in a Homeless Person from the Metropolitan Area of Santiago, Chile

The identification and tracking of SARS-CoV-2 infected patients in the general population are essential components of the global strategy to limit the COVID-19 viral spread, specifically for maintaining traceability and suppressing the resurgence of local outbreaks. Public health programs that include continuous RT-qPCR testing for COVID-19 in the general population, viral sequencing, and genomic surveillance for highly contagious forms of the virus have allowed for the identification of SARS-CoV-2 infections and reinfections. This work identified SARS-CoV-2 reinfection in a homeless person, which occurred 58 days after the first COVID-19 diagnosis. Genomic sequencing identified a different Nextstrain classification clade (20A and 20B) and PANGO lineage, with a divergence of 4 single nucleotide variants (SNVs) in S and ORF1ab genes, suggesting reinfection by different viral variants. This study is the first from the great metropolitan area of Santiago, Chile, one of the top ten countries in the world to live during the COVID-19 pandemic. We support the importance of performing intensive genomic surveillance programs in the whole population and high-risk groups, such as homeless people, nearly 20 thousand people in Chile, and have limited access to health care services and poor viral traceability.

Merging Super Resolution and Attribute Learning for Low-Resolution Person Attribute Recognition

In video surveillance, visual person attributes such as gender, backpack, type of clothing are crucial for person search or re-identification. For detecting and retrieving these attributes with high accuracy, the availability of high-quality videos is a necessity in general. However, this cannot be guaranteed in general surveillance videos or images; beside improving hardware technology, improving inference algorithms on low-resolution data is valuable. This paper attempts to propose two solutions in this direction: designing a combined neural network architecture from existing architectures, and a novel combination approach toward re-identification on low-resolution videos. The proposed architecture introduces a combined Neural Network architecture, called SRMAR, that jointly trains Super Resolution and Multi Attribute Recognition models for more effective recognition. Experiments on two benchmark datasets demonstrate the effectiveness and applicability of the proposed neural network architecture for low-resolution multi-attribute recognition. Furthermore, a higher-level linear combination scheme that optimally combines the proposed SRMAR architecture and multi-attribute recognition network is presented, yielding superior results in low-resolution person attribute recognition.

Physician risk perceptions and surveillance practices for tyrosine kinase inhibitor long-term effects in pediatric CML

Chronic myeloid leukemia (CML) is effectively treated with long-term tyrosine kinase inhibitor (TKI) therapy, yet little is known about risks of prolonged TKI exposure in young patients, and long-term effect monitoring is not standardized. We surveyed North American pediatric oncologists (n = 119) to evaluate perceived risk of and surveillance practices for potential toxicities associated with prolonged TKI exposure in children and adolescents/young adults (AYAs) with CML. Survey domains included general and specific risk perceptions and surveillance practices for asymptomatic patients on chronic TKI therapy. We analyzed data descriptively and explored relationships between risk perceptions and surveillance. Risk perceptions varied among oncologists but were similar across six categories (thyroid, cardiac, vascular, metabolic, fertility, psychologic), with less than one-third rating each risk as moderate or high in pediatric and AYA patients. More oncologists perceived moderate or high risk of growth abnormalities in children (62% pediatric, 14% AYA) and financial toxicity in all patients (60% pediatric, 64% AYA). A greater proportion of oncologists with moderate or high perceived risk of thyroid abnormalities reported testing thyroid function compared to those with lower perceived risk; patterns for metabolic risk/lipid tests and cardiac risk/tests were similar. In summary, we found that pediatric oncologists had variable risk perceptions and surveillance practices for potential toxicities associated with prolonged TKI exposure. Standardizing surveillance would help quantify risks and refine recommendations. Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2021.2017085 .

Meta-Regression of Herpes Zoster Incidence Worldwide.

IntroductionMany studies have been conducted worldwide to estimate herpes zoster (HZ) incidence rates. We synthesized studies of HZ incidence rates in the general population using meta-analysis models.MethodsA random effects meta-analysis was conducted to estimate HZ incidence from a published worldwide systematic literature review (SLR) including only individuals aged 50 years and older. Meta-regression was used to explore whether variability in incidence rates could be explained by a combination of study-specific characteristics including age, gender, continent and year of study data. The impact of adding additional covariates—case detection method (general practitioner surveillance, healthcare database, sentinel network, etc.), case definition (medical record-based, self-reported), study design (retrospective passive surveillance, retrospective active surveillance, etc.), incidence type (cumulative incidence/1000 persons or incidence rate/1000 person-years), patient type (outpatients or in- and out-patients) and latitude to the base model—was also assessed.ResultsSixty-one records from 59 studies were included in the analysis: 25, 20, 11 and 5 from Europe, North America, Asia and Oceania, respectively. There was variation in study methodology and outcomes. Heterogeneity of incidence rates was greatest among studies conducted in Asia. Meta-analysis showed that incidence increased with age, was lower in males compared to females, tended to be lower in Europe and North America compared to Asia and Oceania and increased with year of study data. The data-driven meta-regression model included continent, year of study data, gender, age and an age × gender interaction term. The difference in incidence between males and females was greater in younger ages (e.g., 50–59) compared to older age groups (e.g., 80+). None of the additional covariates contributed significantly to the model.ConclusionIncidence rates were shown to vary by age, gender, continent and year of study data.Graphical Plain Language Summary Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00567-8.

Price versus clinical guidelines in primary care statin prescribing: a retrospective cohort study and cost simulation model.

ObjectiveTo investigate the relative impact of generic entry and National Institute for Health and Care Excellence clinical guidelines on prescribing using statins as an exemplar.DesignRetrospective analysis of statin prescribing in primary care and cost simulation model.SettingRoyal College of General Practitioners Research and Surveillance Centre (RCGP R&SC) database and Prescription Cost Analysis (PCA) database.ParticipantsNew patients prescribed statins for the first time between July 2003 and September 2018.Main outcome measuresShares of new patients prescribed one of the five statins available in the British National Formulary, and cost of prescribing statins to new and existing patients in primary care in England.ResultsGeneral trends of statin’ prescriptions were largely driven by a decrease in acquisition costs triggered by patent expiration, preceding NICE guidelines which themselves did not seem to affect prescription trends. Significant heterogeneity is observed in the prescription of the most cost-effective statin acrossGPs. A cost simulation shows that, between 2004 and 2018, the NHS could have saved £2.8bn (around 40% of the £6.3bn spent on statins during this time) if all GP practices had prescribed only the most cost-effective treatment.ConclusionsThere is potential for large savings for the NHS if new and, whenever possible, ongoing patients are promptly switched to the first medicine that becomes available as generic within a therapeutic class as long as it has similar efficacy to still-patented medicines.

A comparison of BG Sentinel and CDC trap attractants for mosquito surveillance in urban and suburban areas of Montgomery and Prince George's Counties, Maryland, U.S.A.

Monitoring mosquito populations is crucial for vector-borne disease surveillance. Routine mosquito surveillance in many regions of the United States is performed either by vector abatement districts or public health departments. These surveillance programs often use multiple trap types and attractants to target key mosquito species, however setting different traps with varying attractants can be expensive and labor intensive. Because funding for mosquito control is highly variable throughout the U.S., some programs may be limited in their surveillance capabilities. To determine whether a single trap-attractant combination could provide specificity for key vector and nuisance species, as well as sensitivity for rare species, we compared the BG-Sentinel 2 and CDC miniature light traps paired with CO2, UV-LED, BG Lure, BG Sweetscent, octenol, or chicken feathers. Trapping was conducted biweekly from June/July-October 2019 and 2020 in Montgomery and Prince George's County, MD. BG traps collected significantly more Aedes albopictus than CDC traps when paired with BG Lure, Sweetscent, or octenol. BG/CO2 traps collected both the greatest number of total mosquitoes and Culex pipiens. BG/CO2, CDC/CO2, and CDC/UV traps provided the most diverse collections. Trapping with the CO2-baited BG-Sentinel is recommended as an effective strategy for general mosquito surveillance when resources are limited.

Adherence to the paediatric immunisation schedule in England

Both adequate coverage and adherence to paediatric immunisation schedules are required for optimal protection against vaccine preventable diseases. We studied the timeliness of routine paediatric vaccinations according to the NHS’s immunisation schedule and potential factors of schedule adherence. Immunisation data was obtained from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). We collected vaccine types, doses, and dates for all routine paediatric vaccines between 2008 and 2018: DTaP/IPV/Hib/HepB, DTaP/IPV/Hib, DTaP/IPV, dTaP/IPV, Td/IPV, MMR, PCV, MenB, MenC, MenACWY, Hib/MenC, RV, HPV. Adherence to the immunisation schedule was calculated for each vaccine and dose. Differences in adherence between genders, NHS regions, and IMD quintiles were analysed. Our study included 6′257′828 vaccinations in 1′005′827 children. Seventy-five percent of first doses were administered within one (for vaccines scheduled in the first year of life) or two months (for vaccines scheduled later in life) following the recommended age, 19% too late and 6% too early. About half of the subsequent doses were given timely. The time between first and second doses was too short for 36% of vaccinations while 13% of second doses were administered too long after the first dose. Third doses were administered timely for 45%, too short for 37%, and too long for 18% of vaccinations. Differences in immunisation schedule adherence between girls and boys were negligible, except for HPV, and differences between the four main NHS regions were small. Overall, immunisation schedule adherence improved slightly with decreasing deprivation according to the Index of Multiple Deprivation. Efforts are required to improve the timeliness of paediatric vaccinations and to assure adequate protection against vaccine preventable diseases. We propose developing a compound measure combining coverage and adherence to provide a better indication of the protection against vaccine preventable diseases in a community.

Can collected hygrothermal data illustrate observed thermal problems of the façade? – A case study from Greenland

Buildings are more vulnerable to faults in design and construction, when exposed to the extreme Greenlandic climate, however, most new materials and designs have not been tested for Arctic conditions. Thus even minor errors can result in failures like mould growth, discomfort, and unnecessary heat loss. Rekognizing the source of the error can be difficult, yet valuable. But how can it be identified whether the error lies in the design or quality of workmanship? This paper describes a case study from Nuuk, Greenland, where a new mineral wool insulation system was implemented. Residents were complaining about draft and cold areas. An investigation revealed that inaccurate use of the system caused several problems. Simulations of the exterior wall performance were conducted and compared to measurements. This paper discusses whether these measurements and simulations support the identified issues, and therefore if this kind of general surveillance of exterior walls can be used to determine the total performance of an exterior wall. The paper concludes that the collected data can support the issues of the complaints, and that the fundamental reasons for the problems are the design, the precision of the casted concrete and the lack of a wind barrier protecting the insulation.

The epidemiology of alopecia areata: a population-based cohort study in UK primary care.

SummaryBackgroundThere is a lack of population‐based information on the disease burden and management of alopecia areata (AA).ObjectivesTo describe the epidemiology of AA, focusing on incidence, demographics and patterns of healthcare utilization.MethodsPopulation‐based cohort study of 4·16 million adults and children, using UK electronic primary care records from the Oxford‐Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database, 2009–2018. The incidence and point prevalence of AA were estimated. Variation in AA incidence by age, sex, deprivation, geographical distribution and ethnicity was examined. Patterns of healthcare utilization were evaluated in people with incident AA.ResultsThe AA incidence rate was 0·26 per 1000 person‐years. AA point prevalence in 2018 was 0·58% in adults. AA onset peaked at age 25–29 years for both sexes, although the peak was broader in females. People of nonwhite ethnicity were more likely to present with AA, especially those of Asian ethnicity [incidence rate ratio (IRR) 3·32 (95% confidence interval 3·11–3·55)]. Higher AA incidence was associated with social deprivation [IRR most vs. least deprived quintile 1·47 (1·37–1·59)] and urban living [IRR 1·23 (1·14–1·32)]. People of higher social deprivation were less likely to be referred for specialist dermatology review.ConclusionsBy providing the first large‐scale estimates of the incidence and point prevalence of AA, our study helps to understand the burden of AA on the population. Understanding the variation in AA onset between different population groups may give insight into the pathogenesis of AA and its management.

Resistance Trend Estimation Using Regression Analysis to Enhance Antimicrobial Surveillance: A Multi-Centre Study in London 2009-2016.

In the last years, there has been an increase of antimicrobial resistance rates around the world with the misuse and overuse of antimicrobials as one of the main leading drivers. In response to this threat, a variety of initiatives have arisen to promote the efficient use of antimicrobials. These initiatives rely on antimicrobial surveillance systems to promote appropriate prescription practices and are provided by national or global health care institutions with limited consideration of the variations within hospitals. As a consequence, physicians’ adherence to these generic guidelines is still limited. To fill this gap, this work presents an automated approach to performing local antimicrobial surveillance from microbiology data. Moreover, in addition to the commonly reported resistance rates, this work estimates secular resistance trends through regression analysis to provide a single value that effectively communicates the resistance trend to a wider audience. The methods considered for trend estimation were ordinary least squares regression, weighted least squares regression with weights inversely proportional to the number of microbiology records available and autoregressive integrated moving average. Among these, weighted least squares regression was found to be the most robust against changes in the granularity of the time series and presented the best performance. To validate the results, three case studies have been thoroughly compared with the existing literature: (i) Escherichia coli in urine cultures; (ii) Escherichia coli in blood cultures; and (iii) Staphylococcus aureus in wound cultures. The benefits of providing local rather than general antimicrobial surveillance data of a higher quality is two fold. Firstly, it has the potential to stimulate engagement among physicians to strengthen their knowledge and awareness on antimicrobial resistance which might encourage prescribers to change their prescription habits more willingly. Moreover, it provides fundamental knowledge to the wide range of stakeholders to revise and potentially tailor existing guidelines to the specific needs of each hospital.

Review on strategies of space-based optical space situational awareness

Space-based optical (SBO) space surveillance has attracted widespread interest in the last two decades due to its considerable value in space situation awareness (SSA). SBO observation strategy, which is related to the performance of space surveillance, is the top-level design in SSA missions reviewed. The recognized real programs about SBO SAA proposed by the institutions in the U.S., Canada, Europe, etc., are summarized firstly, from which an insight of the development trend of SBO SAA can be obtained. According to the aim of the SBO SSA, the missions can be divided into general surveillance and space object tracking. Thus, there are two major categories for SBO SSA strategies. Existing general surveillance strategies for observing low earth orbit (LEO) objects and beyond-LEO objects are summarized and compared in terms of coverage rate, revisit time, visibility period, and image processing. Then, the SBO space object tracking strategies, which has experienced from tracking an object with a single satellite to tracking an object with multiple satellites cooperatively, are also summarized. Finally, this paper looks into the development trend in the future and points out several problems that challenges the SBO SSA.

Fast decliner phenotype of chronic obstructive pulmonary disease (COPD): applying machine learning for predicting lung function loss

BackgroundChronic obstructive pulmonary disease (COPD) is a heterogeneous group of lung conditions challenging to diagnose and treat. Identification of phenotypes of patients with lung function loss may allow early intervention...

Co-administration of routine paediatric vaccines in England often deviates from the immunisation schedule

Vaccine co-administration can facilitate the introduction of new vaccines in immunisation schedules and improve coverage. We analysed real life data to quantify the extent of routine paediatric vaccine co-administrations as recommended and as never recommended in the immunisation schedule in England, and assessed factors for recommended and never recommended vaccine co-administrations.Immunisation data for all scheduled routine paediatric vaccines between 2008 and 2018 was obtained from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC).We included 6′257′828 doses administered to 1′005′827 children. Twenty-one percent of vaccines were given separately, 79% were co-administered. Sixty-four percent of vaccines scheduled for co-administration were co-administered as recommended while 15% were administered separately. Among all vaccine co-administrations, 75% happened as recommended in the schedule, 4% were never recommended, while 21% deviated from the schedule. Vaccine co-administration according to the schedule varied greatly between vaccines. Forty-eight percent of English children received at least one of their vaccine co-administrations not as recommended in the immunisation schedule, with 19% of children receiving none of their co-administered vaccines as recommended. Late administration of one or more vaccines increased the odds for deviated co-administrations (OR 1.60) and strongly increased the odds for never recommended co-administrations (OR 5.34). Differences between genders, NHS regions, and IMD quintiles were statistically significant but small.Suboptimal co-administration rates for routine paediatric vaccines are a missed opportunity and should be optimised by concerted public health action.

How to Start Up a National Wildlife Health Surveillance Programme.

Simple SummaryA sound understanding of wildlife health is required to inform disease management and mitigation measures in order to help safeguard public, livestock, companion animal and wildlife health. Whilst multiple countries in Europe have schemes for wildlife health surveillance (WHS) in place that monitor the disease conditions that affect free-living wildlife, these vary in scope and scale. In 2018, the Network for WHS of the European Wildlife Disease Association hosted a meeting where representatives from countries with variable levels of current WHS were invited to share knowledge and experience of how their programmes began or were expanded. Through a series of presentations, the events that led to the start-up and expansion of WHS programmes were highlighted, such as the creation of action plans and collaboration through partnership formation. Challenges to development were identified, including limited funding and logistical difficulties around data sharing and the harmonisation of methods. Following a panel discussion, a series of practical recommendations were formulated, offering guidance on how to overcome key challenges for the instigation of national WHS programmes. It is hoped that this resource will provide a useful tool to help support the creation and expansion of WHS programmes in Europe and beyond.Whilst multiple countries in Europe have wildlife health surveillance (WHS) programmes, they vary in scope. In many countries, coordinated general surveillance at a national scale is not conducted and the knowledge of wildlife health status in Europe remains limited. Learning lessons from countries with established systems may help others to effectively implement WHS schemes. In order to facilitate information exchange, the WHS Network of the European Wildlife Disease Association organised a workshop to both collate knowledge and experience from countries that had started or expanded WHS programmes and to translate this information into practical recommendations. Presentations were given by invited representatives of European countries with different WHS levels. Events that led to the start-up and fostered growth spurts of WHS were highlighted, including action plan creation, partnership formation, organisation restructuring and appraisal by external audit. Challenges to programme development, such as a lack of funding, data sharing, infrastructural provision and method harmonisation, were explored. Recommendations to help overcome key challenges were summarised as: understanding and awareness; cross-sectoral scope; national-scale collaboration; harmonisation of methods; government support; academic support; other funding support; staff expertise and capacity; leadership, feedback and engagement; and threat mitigation and wildlife disease management. This resource may enable the development of WHS programmes in Europe and beyond.