Global Surveillance Network Research Articles

A review of enterovirus-associated hand-foot and mouth disease: preventive strategies and the need for a global enterovirus surveillance network.

Enterovirus (EV)-associated hand, foot, and mouth disease (HFMD) is a significant public health issue worldwide, commonly occurring in children five years of age or younger. The leading causes of most HFMD cases are EVs, which are members of the Picornaviridae family. The typical clinical manifestations of EV-associated HFMD are febrile presentations with mucosal herpangina, oral ulcerations, and skin rashes on the hands and feet. The majority of HFMD cases resolve without consequence; however, a subset progresses to severe neurological and cardiopulmonary complications, which can be fatal. In the past two decades, EV-associated HFMD has received significant attention. In this review, we organize published papers and provide updates on epidemiology, pathogenesis, surveillance, and vaccine developments for EV-associated HFMD. The impact of EV-associated HFMD is increasing globally. Developing efficacious vaccines has become a priority for preventing EV infections without adequate treatment. Simultaneously, emerging EV infections (including EV-D68, EV-A71, Coxsackieviruses, and echoviruses) are increasing, highlighting the need to create a vigilant surveillance system for EV infections worldwide.

Optimization and performance analytics of global aircraft-based wastewater surveillance networks.

Aircraft wastewater surveillance has been proposed as a novel approach to monitor the global spread of pathogens. Here we develop a computational framework to provide actionable information for designing and estimating the effectiveness of global aircraft-based wastewater surveillance networks (WWSNs). We study respiratory diseases of varying transmission potentials and find that networks of 10 to 20 strategically placed wastewater sentinel sites can provide timely situational awareness and function effectively as an early warning system. The model identifies potential blind spots and suggests optimization strategies to increase WWSNs effectiveness while minimizing resource use. Our findings highlight that increasing the number of sentinel sites beyond a critical threshold does not proportionately improve WWSNs capabilities, stressing the importance of resource optimization. We show through retrospective analyses that WWSNs can significantly shorten the detection time for emerging pathogens. The presented approach offers a realistic analytic framework for the analysis of WWSNs at airports.

Feasibility of wastewater-based detection of emergent pandemics through a global network of airports.

Wastewater-based surveillance has been put into practice during the pandemic. Persistence of SARS-CoV-2 in faeces of infected individuals, and high volume of passengers travelling by air, make it possible to detect virus from aircraft wastewater, lending itself to the potential identification of a novel pathogen prior to clinical diagnosis. In this study, we estimated the likelihood of detecting the virus through aircraft wastewater from the probabilities of air travel, viral shedding, defecation, testing sensitivity, and sampling. We considered various hypothetical scenarios, with diverse sampling proportions of inbound flights, surveillance airports, and sources of outbreaks. Our calculations showed that the probability of detecting SARS-CoV-2 would increase exponentially against time in the early phase of the pandemic, and would be much higher if the 20 major airports in Asia, Europe, and North America cooperated to perform aircraft wastewater surveillance. We also found other contributors to early detection, including high sampling proportion of inbound flight at destination airports, small population size of the epicentre relative to the travel volume, and large volume of outbound travelers to major airports around the globe. We concluded that routine aircraft wastewater monitoring could be a feasible approach for early identification and tracking of an emerging pathogen with high faecal shedding rates, particularly when implemented through a global surveillance network of major airports.

The Role of Medical Microbiologists in Advancing the Frontiers of Travel Medicine

The essential role of medical microbiologists in the field of travel medicine becomes apparent amidst the escalating challenges faced by our world. This article highlights their indispensable contributions to safeguarding global health during travel. Medical microbiologists play a pivotal part in defending against infectious threats encountered during travel, identifying and characterizing novel pathogens, developing rapid diagnostic tools, and spearheading outbreak investigations for early detection and containment. Their active involvement in vaccine development and surveillance is critical for ensuring the safety of travelers, and they address vaccine hesitancy through educational initiatives and advocacy. Moreover, they combat the growing issue of antimicrobial resistance, influencing travel health guidelines and promoting prudent antimicrobial use to minimize resistance risks. Collaboration is paramount in tackling global health threats, and medical microbiologists facilitate the exchange of information, reinforcing global surveillance networks to respond effectively to emerging infections. Their role in training the next generation of experts ensures a sustainable and knowledgeable workforce in travel medicine. As we navigate the continually evolving landscape of travel, the expertise of medical microbiologists becomes increasingly vital. Their dedication to advancing travel medicine through research, education, and collaborative efforts ensures that travel remains a positive force, promoting exploration while mitigating health risks. Recognizing and supporting their endeavors contribute to building a safer and healthier future for travelers and communities worldwide.

Rotavirus genotypes in children under five years hospitalized with diarrhea in low and middle-income countries: Results from the WHO-coordinated Global Rotavirus Surveillance Network.

Rotavirus is the most common pathogen causing pediatric diarrhea and an important cause of morbidity and mortality in low- and middle-income countries. Previous evidence suggests that the introduction of rotavirus vaccines in national immunization schedules resulted in dramatic declines in disease burden but may also be changing the rotavirus genetic landscape and driving the emergence of new genotypes. We report genotype data of more than 16,000 rotavirus isolates from 40 countries participating in the Global Rotavirus Surveillance Network. Data from a convenience sample of children under five years of age hospitalized with acute watery diarrhea who tested positive for rotavirus were included. Country results were weighted by their estimated rotavirus disease burden to estimate regional genotype distributions. Globally, the most frequent genotypes identified after weighting were G1P[8] (31%), G1P[6] (8%) and G3P[8] (8%). Genotypes varied across WHO Regions and between countries that had and had not introduced rotavirus vaccine. G1P[8] was less frequent among African (36 vs 20%) and European (33 vs 8%) countries that had introduced rotavirus vaccines as compared to countries that had not introduced. Our results describe differences in the distribution of the most common rotavirus genotypes in children with diarrhea in low- and middle-income countries. G1P[8] was less frequent in countries that had introduced the rotavirus vaccine while different strains are emerging or re-emerging in different regions.

Lessons from a global antimicrobial resistance surveillance network.

The World Health Organization developed the Tricycle surveillance programme to obtain a global picture of antimicrobial resistance, especially in countries with limited surveillance capacity. The programme was developed within a One Health perspective. Tricycle provides a framework for applying a standardized technical protocol to determining the prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in three sectors: the human, animal and environment sectors. Regular use of the protocol would enable information to be obtained on time trends and on inter- and intraregional variations, thereby generating dynamic data on antibacterial resistance for decision-makers. To date, 19 countries have begun implementing the Tricycle protocol, while other countries will start implementation in the coming years. The Network for Enhancing Tricycle ESBL Surveillance Efficiency (NETESE) was established to support countries implementing the Tricycle protocol. Currently, NETESE includes representatives from 15 institutions in eight low- or middle-income countries at different stages of Tricycle protocol implementation, and from four European countries involved in devising the protocol. This paper describes the Tricycle protocol, reports the initial experiences of NETESE participants with its implementation and discusses future challenges and opportunities.

Securitising infectious disease outbreaks: The WHO and the visualisation of molecular life

AbstractFollowing its exceptional response to the 2003 severe acute respiratory syndrome (SARS) outbreak, the World Health Organization (WHO) gained new powers to securitise infectious disease outbreaks via the revised 2005 International Health Regulations (IHRs) and the ability to declare a Public Health Emergency of International Concern (PHEIC). This article investigates the declaration of a PHEIC in relation to the 2009 H1N1 flu pandemic, the 2014–16 Ebola outbreak, and the ongoing COVID-19 pandemic. It argues that the securitisation of these outbreaks was dependent upon global surveillance networks that utilised genetic technologies to visualise the molecular characteristics and spread of the pathogen in question. Genetic evidence in these cases facilitated the creation of a securitised object by revealing the unique and ‘untypable’ nature of the H1N1 and SARS-CoV-2 viruses and made visible the widespread prevalence of Ebola across the population of West Africa. The power of this evidence draws from a societal perception of science as producing objective ‘facts’ about the world that objectivise their objects of concern and empower political actors in the implementation of their security agendas. As a result, scientific evidence provided by genetic technologies now plays a necessary and indispensable role in the securitisation of infectious disease outbreaks.

Isolation and Identification of Novel Highly Pathogenic Avian Influenza Virus (H5N8) Subclade 2.3.4.4b from Geese in Northeastern China.

H5N8, a highly pathogenic avian influenza, has become a new zoonotic threat in recent years. As of December 28, 2021, at least 3,206 H5N8 cases had been reported in wild birds and poultry worldwide. In January 2021, a novel virus strain named A/goose/China/1/2021 was isolated during an H5N8 goose influenza outbreak in northeastern China. The PB2, PB1, HA, and M genes of A/goose/China/1/2021 were highly identical to those of H5N8 strains emerging in Kazakhstan and Russia in Central Asia from August to September 2020, while the remaining four genes had the closest homology to those of H5N8 viruses isolated in South Korea in East Asia from November to December 2020. We thus speculate that A/goose/China/1/2021 is likely a reassortant virus that formed in the 2020 to 2021 influenza season and that the migratory birds via the two migration routes of Central Asia and East Asia-Australia may have played an essential role in the genetic reassortment of this virus. The phylogenetic analysis indicated that the HA genes of H5N8 viruses belonging to group II of subclade 2.3.4.4b, including A/goose/China/1/2021, may be derived from strains in Central Asia. Given the complex global spread of H5N8 virus, our study highlights the necessity to strengthen the function of the global surveillance network for H5N8 virus and to accelerate the pace of vaccine development to confront the current challenges posed by H5N8 virus of subclade 2.3.4.4. IMPORTANCE H5N8, a highly pathogenic avian influenza, not only has an impact on public health, but also has a huge negative impact on animal health, food safety, safety, and even on the local and international economy. The migratory wild birds play a vital role in the intercontinental transmission of H5N8 virus. It is urgent that we should strengthen the function of the global surveillance network for H5N8 virus and accelerate the pace of vaccine development to confront the current challenges posed by H5N8 virus of subclade 2.3.4.4.

Human security and universal health coverage: Japan's vision for the G7 Hiroshima Summit

Human security and universal health coverage: Japan's vision for the G7 Hiroshima Summit

Infectious diseases genomic surveillance capacity in the Caribbean: a retrospective analysis of SARS-CoV-2

The ongoing coronavirus diseases 2019 (COVID-19) pandemic with its numerous variants of concern has shown the need to have a robust and complete global infectious diseases genomic surveillance network worldwide. Various clinical and research institutions have stepped up to perform SARS-CoV-2 sequencing thus enhancing the understanding of this virus' global evolution. However, given that genomic sequencing capacities and capabilities are not available in every region or country, significant gaps exist, which lead to geographic blind spots. One such region is the Caribbean. This paper measures the Caribbean region's SARS-CoV-2 genomic sequencing capacity and highlights the need to improve further regional genomics surveillance capacities and capabilities, which are essential for efficient health interventions for infectious diseases. A map showing SARS-CoV-2 sequences available for each Caribbean Island was constructed using SARS-CoV-2 genomic, epidemiological and populational data obtained from GISAID, the World Health Organization, the United Nations, and the World Bank. The number of reported SARS-CoV-2 cases and the proportion of cases sequenced in each Caribbean Island was then analysed by the Gross Domestic Product per capita and political status. As of August 6, 2022, the number of SARS-CoV-2 sequences from the Caribbean are underrepresented with only 40,190 (1.07%) of the over 3.76 million documented cases sequenced, which is further exacerbated by a disparity based not only on the country's income but also on its political status (sovereign country versus dependent or integrated) and accessibility to sequencing technologies. There are a limited number of sequencing centres based in the Caribbean islands with the majority located on the American and European continents. Using mobile sequencing technologies while concomitantly investing in data analysis training could lead to greater and more sustainable coverage. Considering the Caribbean region's dispersed heterogeneous populations, varying political regimes, and resource-constrained healthcare systems, further development of local next-generation sequencing capacity and capabilities in the Caribbean region is needed to achieve global public health goals. No funding source was required for this study.

Динаміка частоти госпіталізацій дітей віком до 5 років із ротавірусною інфекцією в умовах відсутності універсальної вакцинації проти ротавірусу (15-річне спостереження)

Purpose - to monitor the dynamics of the frequency of hospitalization of children under 5 years of age with rotavirus infection during 15 years in the absence of universal vaccination and to determine the burden of rotavirus infection and the feasibility of introducing a rotavirus vaccine into the National Vaccination Calendar. Materials and methods. Active surveillance of rotavirus infection among hospitalized children under 5 years of age was conducted according to a standard protocol prepared by WHO for the global rotavirus infection surveillance network. A comparison was made of the frequency of hospitalization of children under 5 years of age with rotavirus acute gastroenteritis (AGE) by sentinel years. Stool samples were collected within 2 days of hospitalization and sent to the virology laboratory for testing. Detection of rotavirus was carried out using ELISA. Genotyping of rotaviruses was carried out in WHO laboratories by the method of multiplex RT-PCR. Results. During 15 years (2007-2021) of observation, there were 7,821 children under the age of 5 who were hospitalized in connection with an acute intestinal infection at the Kyiv Surveillance Center. Rotavirus infection was determined in 3387 children (43.3%). A consistently high frequency of hospitalizations with rotavirus AGE was observed with a slight downward trend over the years (from 50-75% in the first years to 33-39% in 2018-2019). In 2021 (the 15th year of observation), the average annual frequency of rotavirus AGE decreased even more significantly and amounted to 21% (a 61% decrease compared to the first years of observation). The unexpected decrease in the frequency of rotavirus diarrhea among hospitalized children in the 15th year of observation in the absence of universal vaccination against rotavirus is difficult to explain. A number of factors could have contributed to the above-mentioned decrease, the most likely of which could be the coincidence in time with the epidemic of COVID-19, in which anti-epidemic measures are similar to those for intestinal infections. While the average annual frequency of hospitalizations with rotavirus infection decreased, the frequency of hospitalizations remained high in certain months of the year, starting from January to June, which increased the burden on inpatients in certain, mostly cold, months of the year. Further active monitoring of rotavirus infection is necessary to definitively resolve the issue of whether the decrease in the frequency of rotavirus infection by the 15th year is temporary or is a natural course of the epidemic process and will continue to occur. Conclusions. In Ukraine, in the absence of universal vaccination against rotavirus, during the 15-year (2007-2021) observation period, a consistently high frequency of rotavirus infection was noted among hospitalized children under 5 years of age with AGE, with a slight downward trend over the years. In the 15th year of follow-up (2021), there was an unusual decline in the proportion of rotavirus infection among hospitalized children, which may have been contributed to by a number of factors, the most likely of which could be the coincidence in the period with the COVID-19 epidemic, in which anti-epidemic measures are similar to those for intestinal infections. Even with a decrease in the average annual frequency of rotavirus AGE in the 15th year of observation, a consistently high rate of hospitalization with rotavirus gastroenteritis remains in certain months of the year, which increases the burden on inpatients. The significant burden of rotavirus infection among children under the age of 5 years old determines the expediency of including the rotavirus vaccine in the National Vaccination Calendar of Ukraine. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: findings from the Global Pediatric Diarrhea Surveillance network

IntroductionDiarrhoea remains a leading cause of child morbidity and mortality. Systematically collected and analysed data on the aetiology of hospitalised diarrhoea in low-income and middle-income countries are needed to prioritise...

Metagenomic Pathogen Sequencing in Resource-Scarce Settings: Lessons Learned and the Road Ahead.

Metagenomic next-generation sequencing (mNGS) is the process of sequencing all genetic material in a biological sample. The technique is growing in popularity with myriad applications including outbreak investigation, biosurveillance, and pathogen detection in clinical samples. However, mNGS programs are costly to build and maintain, and additional obstacles faced by low- and middle-income countries (LMICs) may further widen global inequities in mNGS capacity. Over the past two decades, several important infectious disease outbreaks have highlighted the importance of establishing widespread sequencing capacity to support rapid disease detection and containment at the source. Using lessons learned from the COVID-19 pandemic, LMICs can leverage current momentum to design and build sustainable mNGS programs, which would form part of a global surveillance network crucial to the elimination of infectious diseases.

Global influenza surveillance systems to detect the spread of influenza-negative influenza-like illness during the COVID-19 pandemic: Time series outlier analyses from 2015-2020.

BackgroundSurveillance systems are important in detecting changes in disease patterns and can act as early warning systems for emerging disease outbreaks. We hypothesized that analysis of data from existing global influenza surveillance networks early in the COVID-19 pandemic could identify outliers in influenza-negative influenza-like illness (ILI). We used data-driven methods to detect outliers in ILI that preceded the first reported peaks of COVID-19.Methods and findingsWe used data from the World Health Organization’s Global Influenza Surveillance and Response System to evaluate time series outliers in influenza-negative ILI. Using automated autoregressive integrated moving average (ARIMA) time series outlier detection models and baseline influenza-negative ILI training data from 2015–2019, we analyzed 8,792 country-weeks across 28 countries to identify the first week in 2020 with a positive outlier in influenza-negative ILI. We present the difference in weeks between identified outliers and the first reported COVID-19 peaks in these 28 countries with high levels of data completeness for influenza surveillance data and the highest number of reported COVID-19 cases globally in 2020. To account for missing data, we also performed a sensitivity analysis using linear interpolation for missing observations of influenza-negative ILI. In 16 of the 28 countries (57%) included in this study, we identified positive outliers in cases of influenza-negative ILI that predated the first reported COVID-19 peak in each country; the average lag between the first positive ILI outlier and the reported COVID-19 peak was 13.3 weeks (standard deviation 6.8). In our primary analysis, the earliest outliers occurred during the week of January 13, 2020, in Peru, the Philippines, Poland, and Spain. Using linear interpolation for missing data, the earliest outliers were detected during the weeks beginning December 30, 2019, and January 20, 2020, in Poland and Peru, respectively. This contrasts with the reported COVID-19 peaks, which occurred on April 6 in Poland and June 1 in Peru. In many low- and middle-income countries in particular, the lag between detected outliers and COVID-19 peaks exceeded 12 weeks. These outliers may represent undetected spread of SARS-CoV-2, although a limitation of this study is that we could not evaluate SARS-CoV-2 positivity.ConclusionsUsing an automated system of influenza-negative ILI outlier monitoring may have informed countries of the spread of COVID-19 more than 13 weeks before the first reported COVID-19 peaks. This proof-of-concept paper suggests that a system of influenza-negative ILI outlier monitoring could have informed national and global responses to SARS-CoV-2 during the rapid spread of this novel pathogen in early 2020.

Risk Factors for Mortality Among Children Younger Than Age 5 Years With Severe Diarrhea in Low- and Middle-income Countries: Findings From the World Health Organization-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks.

Diarrhea is the second leading cause of death in children younger than 5 years of age globally. The burden of diarrheal mortality is concentrated in low-resource settings. Little is known about the risk factors for childhood death from diarrheal disease in low- and middle-income countries. Data from the World Health Organization (WHO)-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks, which are composed of active, sentinel, hospital-based surveillance sites, were analyzed to assess mortality in children <5 years of age who were hospitalized with diarrhea between 2008 and 2018. Case fatality risks were calculated, and multivariable logistic regression was performed to identify risk factors for mortality. This analysis comprises 234 781 cases, including 1219 deaths, across 57 countries. The overall case fatality risk was found to be 0.5%. Risk factors for death in the multivariable analysis included younger age (for <6 months compared with older ages, odds ratio [OR] = 3.54; 95% confidence interval [CI], 2.81-4.50), female sex (OR = 1.18; 95% CI, 1.06-1.81), presenting with persistent diarrhea (OR = 1.91; 95% CI, 1.01-3.25), no vomiting (OR = 1.13; 95% CI, .98-1.30), severe dehydration (OR = 3.79; 95% CI, 3.01-4.83), and being negative for rotavirus on an enzyme-linked immunosorbent assay test (OR = 2.29; 95% CI, 1.92-2.74). Cases from the African Region had the highest odds of death compared with other WHO regions (OR = 130.62 comparing the African Region with the European Region; 95% CI, 55.72-422.73), whereas cases from the European Region had the lowest odds of death. Our findings support known risk factors for childhood diarrheal mortality and highlight the need for interventions to address dehydration and rotavirus-negative diarrheal infections.

Global Surveillance Networks and International Health Regulations in the Early Detection and Control of Epidemics

An elaborate global health system has been developed around the world as a bulwark against infectious disease threats. The system consists of various networks of formal and informal organizations serving different stakeholders. This network has different purposes, methods, resources and accountability; it consists of public institutions operating in different fields of influence (at local, national, regional or global level), profit-oriented and non-profit private sector organizations. The current global health system has done important work to protect and improve human health. However, the world continues to face long-standing and emerging or re-emerging infectious disease threats. These threats vary greatly in severity and probability of risk, and each requires separate struggle dynamics. In addition, as with morbidity and mortality rates, these infections have many complex social and economic effects and consequences that differ. It is discussed whether the global health system with its current situation can provide effective protection against a number of communicable disease threats. Due to the recent emerging threats of Ebola, Zika, dengue fever, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), COVID-19, and influenza epidemics, and the increasing threat of antimicrobial resistance, this system is being put to the test. Weak health systems, urbanization, globalization, climate change, civil wars and conflicts, and the changing nature of pathogen transmission between human and animal populations, uncontrolled population growth in some risk areas aggravate current concerns. "Human-induced outbreaks resulting from laboratory accidents" or deliberate biological attacks are considered as other potential risks, making international cooperation and coordination important. International epidemiological surveillance systems and international health regulation coverage are expanding their scope as early intervention practices and tools that are critical in preventing infectious diseases from reaching epidemic levels and minimizing global risks. Also, the effectiveness of early warning surveillance systems is being improved with the use of new technologies.

An Age of Emerging and Reemerging Pandemic Threats

Today, we are confronted with an unprecedented crisis this world has never experienced before. Infectious diseases remain among the leading causes of death and disability worldwide. Epidemics of new and old infectious diseases periodically emerge, greatly magnifying the global burden of infections. Humans are constantly exposed to a huge diversity of viruses, though those of others mammals are of greatest importance. Persistence of SARS-CoV-2 as an endemic virus may be fueled by pockets of susceptible individuals and waning immunity after infection or vaccination, changes in the virus through antigenic drift that diminish protection and re-entries from zoonotic reservoirs. Moreover, these viruses are very genetically diverse and new genotypes, strains and species evolve rapidly. The emergence of new human viruses is a long-standing and ongoing biological process. We must anticipate the emergence and/or discovery of more new human viruses in the coming years and decades. The spillover of viruses from animals to humans is the major source of pandemic risk. Life threatening situations demand extraordinary response and more stringent measures to contain the pandemic. The first line of defence against emerging viruses is effective surveillance. Rapid detection and identification of emerging pathogen leading to the rapid introduction of preventive measures can prove highly effective in combating outbreaks of novel diseases. A coordinated, global surveillance network is essential if we are to ensure rapid detection of novel viruses. Improving the situation will require both political will and considerable investment in infrastructure, human capacity and new tools. To ensure global preparedness, newer vaccines, diagnostics and antiviral agents are being developed. Infectious diseases can be prevented at a variety of points, depending on the infectious cycle for the particular disease. Disease prevention, health promotion, strengthening public health systems, translational research, focus on drug discovery, tailored therapies by personalized precision medicine, developing newer effective and affordable vaccines are crucial to prevent and control emerging pandemics. The need of the day is to prioritize diagnostic tests and strengthen laboratory response network. Effective communication is an indispensable tool. In a world of 7.8 billion people, countries have to be in a state of emergency preparedness to tackle emerging infectious diseases. There is a need to stop pandemics before they start.

Лонгітудинальне спостереження за ротавірусною інфекцією у дітей віком до 5 років, яких госпіталізували в два центри України в 2006–2015 роках

Актуальність. В Україні щорічно реєструється більше 50 тисяч захворювань на гостру кишкову інфекцію (ГКІ) у дітей. Статистичні дані щодо ротавірусної інфекції не відповідають дійсності через низьку можливість лабораторної діагностики в лікувальних закладах. Мета дослідження: визначити рівень навантаження ротавірусної інфекції, провести аналіз і дати характеристику ротавірусної інфекції дітей віком до 5 років, яких госпіталізували в два інфекційні стаціонари (Київ, Одеса), за період спостереження 2006–2015 роки. Матеріал та методи. Дослідження проводилося за стандартним протоколом, затвердженим Всесвітньою організацією охорони здоров’я. Визначення тяжкості перебігу захворювання проводилося за допомогою бальної шкали оцінки тяжкості клінічних проявів ротавірусного гастроентериту Vesikari. Результати. За період з грудня 2006 по грудень 2015 року було взято під спостереження 20 932 дитини віком до 5 років, яких госпіталізували в інфекційні відділення м. Києва і м. Одеси з діагнозом «гострий гастроентерит/гостра кишкова інфекція» і які відповідали критеріям включення в дослідження. Обстежено на ротавірус 18 384 (87,33 %) дитини віком до 5 років, тобто переважна більшість дітей, які надходили в стаціонар з ГКІ. Протягом усіх років спостереження причиною майже половини госпіталізацій дітей до 5-річного віку була ротавірусна інфекція. Звернуло на себе увагу, що в окремі роки в Києві частота госпіталізацій через ротавірусну інфекцію збільшувалася, навіть до 70 %. В Україні серед 6 країн Європейського регіону, що входять до глобальної мережі епіднагляду за ротавірусною інфекцією (Global Rotavirus Surveillance Network), спостерігалася найвища частота ротавірусної діареї серед госпіталізованих дітей до 5 років. При середній частоті в регіоні 24 % в Україні вона досягала 41 %. У всі роки спостереження половина випадків ротавірусної інфекції, що була причиною госпіталізації, припадала на перші 2 роки життя. У всі роки в обох центрах визначалися переважно 4 генотипи ротавірусів: G1P[8], G2P[4], G3P[8], G4P[8]. Генотип G9P[8] займав досить значні позиції в Києві, але були роки, коли він зовсім не визначався як в Києві, так і в Одесі. Цей генотип ротавірусу описано в складі типових комбінацій G та Р ротавірусів, що уражають людину у близько 90 % усіх випадків ротавірусної інфекції на багатьох територіях земної кулі. Відмічалася зміна лідерства окремих генотипів описаних вище ротавірусів за роками. При ротавірусній інфекції вірогідно більшою є частота епізодів діареї та блювання, тривалість блювання у днях також є довшою, ніж при ротанегативних ГКІ. Явища дегідратації також були тяжчими у групі ротавіруспозитивних дітей. Висновки. Ротавірусна інфекція впродовж 10 років спостереження в Україні незмінно залишалася основною причиною госпіталізації дітей віком до 5 років з ГКІ. ГКІ ротавірусної етіології характеризуються значно більш тяжкими проявами, ніж ГКІ, при яких ротавірус було виключено. Суттєвих змін у генотипах за цей період не було, лише періодично спостерігалася зміна домінуючого штаму. Отримані дані обґрунтовують введення універсальної вакцинації проти ротавірусної інфекції в Україні.

Global Rotavirus and Pneumococcal Conjugate Vaccine Introductions and the Association With Country Disease Surveillance, 2006-2018.

To inform the introduction of pneumococcal conjugate vaccine (PCV) and rotavirus vaccine, the World Health Organization (WHO) established the Global Invasive Bacterial Vaccine-Preventable Disease Surveillance Network (GISN) and the Global Rotavirus Surveillance Network (GRSN) in 2008. We investigated whether participation in these networks or other surveillance was associated with vaccine introduction. Between 2006 and 2018, among all WHO member states, we used multivariable models adjusting for economic status to assess (1) the association between surveillance for pneumococcal disease or rotavirus disease, including participation in GISN or GRSN and the introduction of the PCV or the rotavirus vaccine, respectively, and (2) the association between the rotavirus disease burden and the rotavirus vaccine introduction among 56 countries participating in GRSN from 2008 to 2018. Countries that participated in or conducted surveillance for invasive pneumococcal disease or rotavirus disease were 3.5 (95% confidence interval [CI], 1.7-7.1) and 4.2 (95% CI, 2.1-8.6) times more likely to introduce PCV or rotavirus respectively, compared to those without surveillance. Among countries participating in GRSN, there was insufficient evidence to demonstrate an association between countries with higher rotavirus positivity and vaccine introduction. Surveillance should be incorporated into advocacy strategies to encourage the introduction of vaccines, with countries benefiting from data from, support for, and coordination of international disease surveillance networks.

The Global Landscape of Pediatric Bacterial Meningitis Data Reported to the World Health Organization-Coordinated Invasive Bacterial Vaccine-Preventable Disease Surveillance Network, 2014-2019.

BackgroundThe World Health Organization (WHO) coordinates the Global Invasive Bacterial Vaccine-Preventable Diseases (IB-VPD) Surveillance Network to support vaccine introduction decisions and use. The network was established to strengthen surveillance and laboratory confirmation of meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.MethodsSentinel hospitals report cases of children <5 years of age hospitalized for suspected meningitis. Laboratories report confirmatory testing results and strain characterization tested by polymerase chain reaction. In 2019, the network included 123 laboratories that follow validated, standardized testing and reporting strategies.ResultsFrom 2014 through 2019, >137 000 suspected meningitis cases were reported by 58 participating countries, with 44.6% (n = 61 386) reported from countries in the WHO African Region. More than half (56.6%, n = 77 873) were among children <1 year of age, and 4.0% (n = 4010) died among those with reported disease outcome. Among suspected meningitis cases, 8.6% (n = 11 798) were classified as probable bacterial meningitis. One of 3 bacterial pathogens was identified in 30.3% (n = 3576) of these cases, namely S. pneumoniae (n = 2177 [60.9%]), H. influenzae (n = 633 [17.7%]), and N. meningitidis (n = 766 [21.4%]). Among confirmed bacterial meningitis cases with outcome reported, 11.0% died; case fatality ratio varied by pathogen (S. pneumoniae, 12.2%; H. influenzae, 6.1%; N. meningitidis, 11.0%). Among the 277 children who died with confirmed bacterial meningitis, 189 (68.2%) had confirmed S. pneumoniae. The proportion of pneumococcal cases with pneumococcal conjugate vaccine (PCV) serotypes decreased as the number of countries implementing PCV increased, from 77.8% (n = 273) to 47.5% (n = 248). Of 397 H. influenzae specimens serotyped, 49.1% (n = 195) were type b. Predominant N. meningitidis serogroups varied by region.ConclusionsThis multitier, global surveillance network has supported countries in detecting and serotyping the 3 principal invasive bacterial pathogens that cause pediatric meningitis. Streptococcus pneumoniae was the most common bacterial pathogen detected globally despite the growing number of countries that have nationally introduced PCV. The large proportions of deaths due to S. pneumoniae reflect the high proportion of meningitis cases caused by this pathogen. This global network demonstrated a strong correlation between PCV introduction status and reduction in the proportion of pneumococcal meningitis infections caused by vaccine serotypes. Maintaining case-based, active surveillance with laboratory confirmation for prioritized vaccine-preventable diseases remains a critical component of the global agenda in public health.The World Health Organization (WHO)-coordinated Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Network reported data from 2014 to 2019, contributing to the estimates of the disease burden and serotypes of pediatric meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis.