International Surveillance Networks Research Articles

Operational lessons learned in conducting an international study on pharmacovigilance in pregnancy in resource-constrained settings: The WHO Global Vaccine safety Multi-Country collaboration project

The WHO Global Vaccine Safety Multi-Country Collaboration study on safety in pregnancy aims to estimate the minimum detectable risk for selected perinatal and neonatal outcomes and assess the applicability of standardized case definitions for study outcomes and maternal immunization in low- and middle-income countries (LMICs). This paper documents the operational lessons learned from the study.A prospective observational study was conducted across 21 hospitals in seven countries. All births occurring at sites were screened to identify select perinatal and neonatal outcomes from May 2019 to August 2020. Up to 100 cases per outcome were recruited to assess the applicability of standardized case definitions. A multi-pronged study quality assurance plan was implemented. The impact of the COVID-19 pandemic on site functioning and project implementation was also assessed.Multi-layered ethics and administrative approvals, limited clinical documentation, difficulty in identifying outcomes requiring in-hospital follow-up, and poor quality internet connectivity emerged as important barriers to study implementation. Use of electronic platforms, application of a rigorous quality assurance plan with frequent interaction between the central and site teams helped improve data quality. The COVID-19 pandemic disrupted data collection for up to 6 weeks in some sites.Our study succeeded in establishing an international hospital-based surveillance network for evaluating perinatal and neonatal outcomes using common study protocol and procedures in geographically diverse sites with differing levels of infrastructure, clinical and health-utilization practices. The enhanced surveillance capacity of participating sites shall help support future pharmacovigilance efforts for pregnancy interventions.

Surveillance of Antifungal Resistance in Candidemia Fails to Inform Antifungal Stewardship in European Countries.

Background: The increasing burden of candidemia and the emergence of resistance, especially among non-Candida albicans strains, represent a new threat for public health. We aimed to assess the status of surveillance and to identify publicly accessible resistance data in Candida spp. blood isolates from surveillance systems and epidemiological studies in 28 European and 4 European Free Trade Association member states. Methods: A systematic review of national and international surveillance networks, from 2015 to 2020, and peer-reviewed epidemiological surveillance studies, from 2005 to 2020, lasting for at least 12 consecutive months and with at least two centers involved, was completed to assess reporting of resistance to amphotericin B, azoles, and echinocandins in C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, C. krusei, and C. auris. Results: Only 5 (Austria, Italy, Norway, Spain, and United Kingdom) of 32 countries provided resistance data for Candida spp blood isolates. Among 322 surveillance studies identified, 19 were included from Belgium, Denmark, Iceland, Italy, Portugal, Spain, Sweden, Switzerland, and United Kingdom. C. albicans and C. glabrata were the most monitored species, followed by C. parapsilosis and C. tropicalis. C. krusei was not included in any national surveillance system; 13 studies assessed resistance. No surveillance system or study reported resistance for C. auris. Fluconazole, voriconazole, caspofungin, and amphotericin B resistance in C. albicans, C. glabrata, and C. parapsilosis were the most common drug–species combination monitored. Quality of surveillance data was poor, with only two surveillance systems reporting microbiological methods and clinical data. High heterogeneity was observed in modalities of reporting, data collection, and definitions. Conclusion: Surveillance of antifungal resistance in Candida spp blood-isolates is fragmented and heterogeneous, delaying the application of a translational approach to the threat of antifungal resistance and the identification of proper targets for antifungal stewardship activities. International efforts are needed to implement antifungal resistance surveillance programs in order to adequately monitor antifungal resistance.

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.

Deciphering the epidemiology of invasive candidiasis in the intensive care unit: is it possible?

Invasive candidiasis (IC) has emerged in the last decades as an important cause of morbidity, mortality, and economic load in the intensive care unit (ICU). The epidemiology of IC is still a difficult and unsolved enigma for the literature. Accurate estimation of the true burden of IC is difficult due to variation in definitions and limitations inherent to available case-finding methodologies. Candidemia and intra-abdominal candidiasis (IAC) are the two predominant types of IC in ICU. During the last two decades, an increase in the incidence of candidemia has been constantly reported particularly in the expanding populations of elderly or immunosuppressed patents, with a parallel change in Candida species (spp.) distribution worldwide. Epidemiological shift in non-albicans spp. has reached worrisome trends. Recently, a novel, multidrug-resistant Candida spp., Candida auris, has globally emerged as a nosocomial pathogen causing a broad range of healthcare-associated invasive infections. Epidemiological profile of IAC remains imprecise. Though antifungal drugs are available for Candida infections, mortality rates continue to be high, estimated to be up to 50%. Increased use of fluconazole and echinocandins has been associated with the emergence of resistance to these drugs, which affects particularly C. albicans and C. glabrata. Crucial priorities for clinicians are to recognize the epidemiological trends of IC as well as the emergence of resistance to antifungal agents to improve diagnostic techniques and strategies, develop international surveillance networks and antifungal stewardship programmes for a better epidemiological control of IC.

Healthcare Associated Infections: An Interoperable Infrastructure for Multidrug Resistant Organism Surveillance.

Prevention and surveillance of healthcare associated infections caused by multidrug resistant organisms (MDROs) has been given increasing attention in recent years and is nowadays a major priority for health care systems. The creation of automated regional, national and international surveillance networks plays a key role in this respect. A surveillance system has been designed for the Abruzzo region in Italy, focusing on the monitoring of the MDROs prevalence in patients, on the appropriateness of antibiotic prescription in hospitalized patients and on foreseeable interactions with other networks at national and international level. The system has been designed according to the Service Oriented Architecture (SOA) principles, and Healthcare Service Specification (HSSP) standards and Clinical Document Architecture Release 2 (CDAR2) have been adopted. A description is given with special reference to implementation state, specific design and implementation choices and next foreseeable steps. The first release will be delivered at the Complex Operating Unit of Infectious Diseases of the Local Health Authority of Pescara (Italy).

Antimicrobial Resistance Phenomenon

Antimicrobial resistance (AMR) is one of the most serious global public health threats in this century. The first World Health Organization (WHO) Global report on surveillance of AMR, published in April 2014, collected for the first-time data from national and international surveillance networks, showing the extent of this phenomenon in many parts of the world and also the presence of large gaps in the existing surveillance. This mini-review focus on the story of antibiotics, antibacterial resistance (ABR) phenomenon, how does antibiotics resistance occur and spread and, what can be done to go over this problem.

Changes in the epidemiological landscape of invasive candidiasis.

The epidemiology of invasive candidiasis has evolved in recent years, warranting a review of the changes and the implications for current and future diagnosis and treatment. The overall burden of invasive candidiasis remains high, particularly in the expanding populations of patients at risk of opportunistic infection, such as the elderly or immunosuppressed. Progressive shifts from Candida albicans to non-albicans Candida spp. have been observed globally. The recent emergence of novel, multiresistant species, such as Candida auris, amplifies the call for vigilance in detection and advances in treatment. Among the current treatment options, fluconazole is still widely used throughout the world. Increased resistance to fluconazole, both acquired and naturally emerging, has been observed. Resistance to echinocandins is presently low but this may change with increased use. Improvement of diagnostic techniques and strategies, development of international surveillance networks and implementation of antifungal stewardship programmes represent major challenges for a better epidemiological control of invasive candidiasis.

Counterfeit Antimalarials and the Commodification of Health

Counterfeit and substandard medicines are a persistent threat to the global control and eradication of infectious diseases. The issue is particularly acute in developing countries due to the lack of local and international pharmaceutical surveillance networks that ultimately enables this industry to thrive . In this context, the inability to fulfill the fundamental right of individuals to access life-saving essential medicines is a critical public health challenge. Accordingly, this paper analyzes the crisis of counterfeit and substandard antimalarials in sub-Saharan Africa through a multidimensional framework. Of primary importance is the vulnerability of healthcare systems to market-driven forces which facilitates the emergence and sustainability of barriers in the access to high-quality antimalarials. Consequently, the proliferation of the informal drug market is contextualized by the dire need for affordable malaria treatment and cultural perceptions of the quality of care from formal sectors (e.g., clinics, hospitals). The impact of counterfeit antimalarials cannot be understated, ranging from increased morbidity, such as adverse effects from substandard product ingredients, to heightening the resistance of populations to the final line of antimalarial treatment (artemisinin-combination therapy). The ability of international humanitarian organizations and various levels of government to combat the issue of counterfeit medicines remains a daunting task, as the right to health has become a commodity.

Acute muscular sarcocystosis: an international investigation among ill travelers returning from Tioman Island, Malaysia, 2011-2012.

Through 2 international traveler-focused surveillance networks (GeoSentinel and TropNet), we identified and investigated a large outbreak of acute muscular sarcocystosis (AMS), a rarely reported zoonosis caused by a protozoan parasite of the genus Sarcocystis, associated with travel to Tioman Island, Malaysia, during 2011-2012. Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy. Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: "early" during the second and "late" during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy. Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses.

Catching Up on Fisheries Crime

This article describes international collaborative efforts aimed at improving the global capacity to address fisheries crime, with a particular focus on the International Monitoring, Control, and Surveillance (IMCS) network and INTERPOL activities. These 2 initiatives have emerged as a response to existing governance deficits and, combined, substantially improve the prospects for addressing illegal, unreported, and unregulated (IUU) fishing (FAO 2001) and associated crimes. I describe the development of these initiatives and provide some reflection on their challenges and opportunities. I use the term fisheries crime to include illegal fishing and associated crimes, although the efforts described here improve the prospects for addressing all aspects of IUU fishing activities, some of which may not constitute legal violations (FAO 2001).

SP29-3 Using time series analysis for surveillance of resistance and antimicrobial use. The ViResiST project

As antimicrobial resistance has been recognized as a big threat to public health, various surveillance systemsof antimicrobial resistance have been established at national and regional levels worldwide, although there is no global frameworkfor collaborative surveillance of antimicrobial resistance yet. Especially, antimicrobial resistance has been a serious public health threat in the Asian region, and it has become a global problembecause antimicrobial resistance can spread between countries or continents. Recent emergence and international spread of Escherichia coli that produce New Delhi Metallo-betalactamase-1 (NDM-1), from India to many countries worldwide, is one of the best examples of transmission of antimicrobial resistant pathogens, suggesting the importance of well-established surveillance system of antimicrobial resistance at international levels. In the Asian region, which comprises countries in different stages of economic development, the Asian Network of Surveillance of Resistant Pathogens (ANSORP) has been playing a key role in establishing an international surveillance network of antimicrobial resistance for the past 17 years. The ANSORP, which was organized in 1996, is an investigator-initiated, hospital-based, not-forprofit, non-governmental network for surveillance of antimicrobial resistance in major pathogens in the Asian region. The ANSORP has been operated by the Asia Pacific Foundation for Infectious Diseases (APFID), founded in 1999 to improve the global health through Asian initiatives by strengthening and coordinating national and international research-related activities on infectious diseases and antimicrobial resistance. The ANSORP has been expanded to the largest surveillance network in the Asian region, which includes over 120 hospitals in 14 countries (Korea, China, Hong Kong, Taiwan, Japan, the Philippines, Thailand, Vietnam, Indonesia, Malaysia, Singapore, India, Sri Lanka, and Saudi Arabia). The experts in the infectious diseases, pediatric infectious diseases, and clinical microbiology have collaborated and established a Local ANSORP Network in each country, collaborating with a ANSORP headquarter and a central reference laboratory in Seoul, Korea. The ANSORP has been conducting multinational surveillance studies for antimicrobial resistance of major human pathogens such as Streptococcus pneumoniae , Staphylococcus aureus , Enterococcus and Gram-negative bacilli, and infectious diseases including communityacquired pneumonia, hospital-acquired pneumonia, and pneumococcal diseases. The ANSORP has been trying to strengthen a surveillance network to get more reliable surveillance data and represent the current status of antimicrobial resistance in each country and the Asian region. In addition, the ANSORP has been collaborating with the Asia-Pacific Economic Cooperation (APEC) and the World Health Organization (WHO) to build future strategies to control and prevent antimicrobial resistance in the Asia Pacific region.

Viruses Acquired Abroad

Viral infections are imported by travelers and immigrants from tropical or subtropical regions. The primary care physician should be able to include these diseases in the differential diagnosis of various clinical conditions. This review is based on pertinent articles retrieved by a selective search of the literature, including guidelines from Germany and abroad. The available data on imported viral infections in Germany constitute low-level evidence, because most such infections are not reportable in this country. Useful data have, however, been collected by international surveillance networks. Imported viral infections usually present with fever, often also with a rash and elevated transaminases. An average of 230 cases occur in Germany each year; the most common diagnosis among them is dengue fever. An imported viral infection should also be included in the differential diagnosis of fever with arthralgia, as chikungunya virus causes an average of 38 such cases per year. On the other hand, in the past two years, there have been only five cases of imported viral infections causing encephalitis (West Nile virus and Japanese encephalitis virus). The primary care physician should take a thorough history so that specifically targeted laboratory tests can be ordered as soon as possible. If the suspicion of an imported viral infection is confirmed, the patient should be transferred to a specialized treatment center.

Applications of Syndromic Surveillance in Resource Poor Settings

AbstractPurpose: The aim of this study is to demonstrate how syndromic surveillance systems are being used in low‐resource settings, to identify key best practices and considerations, and to describe the use of syndromic surveillance as a feasible solution to meeting the disease surveillance requirements in the World Health Organization's International Health Regulations (2005). Methods: Information on established syndromic surveillance systems was collected from peer‐reviewed articles, conference proceedings and searches through reference lists of papers, from the years 1998‐2010. In addition, web pages of international health organizations, surveillance networks, and Ministries of Health were explored. After reviewing identified systems, eight were selected and examined in detail to extract transferable information. Results: The literature demonstrates the many successful syndromic surveillance efforts being implemented, and the variety of data sources, data transmission techniques, and analysis methodologies being instituted. Frequently, syndromic surveillance systems are a coordinated effort among several partners, supplement existing systems, incorporate both specific and non‐specific disease detection, and are used in conjunction with laboratory‐based surveillance. Conclusions: Though not without challenges, syndromic surveillance has the potential to serve as a valuable disease detection tool in resource‐limited settings. Further examination and evaluation of these systems will benefit global disease surveillance capacity.

Importance of Epidemiologic Surveillance in Contact Dermatitis: Spanish Surveillance System on Contact Allergies

The high prevalence of contact dermatitis means that this common medical problem has considerable personal, societal, and economic impact. Clinical and epidemiologic research is needed if we are to shed light on the real situation of contact dermatitis in Spain. In this article we will look at epidemiologic research from a practical point of view and analyze the role of the dermatologist in planning and designing studies. The advantages of multicenter studies are discussed, along with the roles of national and international surveillance networks. We present the Spanish Surveillance System on Contact Allergies, which serves as a bridge between Spanish dermatologists and the European Surveillance System on Contact Allergies. The present and future aims of the Spanish network are described.

184 - Effects of a weight-loss program on body composition and the metabolic profile in obese individuals displaying various obesity phenotypes

Introduction: A network is a group of people or organizations that are closely connected and work with one another. Reasons to build networks and multiple-disciplinary teamwork include: finding solutions to real-world complex problems, such as obesity and chronic diseases and their risk factors, and pooling resources and expertise. Methods: A literature review was undertaken to identify promotors and barriers for multiple-disciplinary teamwork success. results: To build good teamwork, there are eight themes to consider, as summarized by the acronym “TEAMWORK”: Team, Enthusiasm, Accessibility, Motivation, Workplace, Objective, Role, and Kinship. A number of examples are used from national and international riskfactor surveillance networks, including Rapid Risk Factor Surveillance System (RRFSS, Ontario), Canadian Alliance for Regional Risk Factor Surveillance (CARRFS, Canada), Americas’ Network for Chronic Disease Surveillance (AMNET, Latin America), and World Alliance for Risk Factor Surveillance (WARFS, global). Discussion: The proposed eight themes should help build efficient networks, which, in turn, should enhance capacity in risk factor surveillance and other public health files, by providing multipledisciplinary perspectives, and pooling resources and expertise.

Importancia de la vigilancia epidemiológica en el eczema de contacto. La Red Española de Vigilancia de Alergia de Contacto

The high prevalence of contact dermatitis means that this common medical problem has considerable personal, societal, and economic impact. Clinical and epidemiologic research is needed if we are to shed light on the real situation of contact dermatitis in Spain. In this article we will look at epidemiologic research from a practical point of view and analyze the role of the dermatologist in planning and designing studies. The advantages of multicenter studies are discussed, along with the roles of national and international surveillance networks. We present the Spanish Surveillance System on Contact Allergies, which serves as a bridge between Spanish dermatologists and the European Surveillance System on Contact Allergies. The present and future aims of the Spanish network are described.

Infection Prevention Research in Europe: Recent Advances and Future Priorities

During the past 2 decades, Europe has made substantial progress in the prevention and control of hospital‐acquired infections and antimicrobial resistance (e.g., through multicenter trials, international surveillance networks, and hand hygiene initiatives). This short overview highlights recent advances and future priorities in infection prevention research, including methodological challenges to be addressed.

Potential for greater coherence in EUROPEAN influenza surveillance

Ensuring coherence between national, regional and global surveillance systems poses substantial challenges. An influenza pandemic such as that experienced since 11 June 2009 places additional strain on surveillance systems. It is therefore in the interest of governments and public health for international surveillance networks to function effectively to make the best possible use of available resources, and provide robust data in a timely manner. Previously, influenza activity in Europe was monitored through the European Influenza Surveillance Scheme (EISS) and reported in weekly bulletins.1 In recent years, the EISS has been …

Bovine spongiform encephalopathy and variant Creutzfeldt-Jakob disease risk management strategies in the People's Republic of China

During the late 1970s, the People's Republic of China (PRC) launched a series of far-reaching economic reforms in rural areas of the country in order to develop a market economy; after three decades, these nationwide reforms have achieved enormous success. The country witnessed phenomenal growth in its economic development and became the second largest exporter in the world by 2005. With the growing economy, food safety in the PRC has become both an important domestic and international issue. To date, China has witnessed no domestic cases of either bovine spongiform encephalopathy (BSE) or variant Creutzfeldt-Jakob disease (vCJD), the human version of BSE. However, recent outbreaks of food poisoning from contaminated pork and chicken have prompted the government to promulgate additional measures designed to enhance food safety, including various BSE preventive measures. China established a national CJD surveillance program in year 2002, and participates in an international CJD surveillance network.

Trends in the Epidemiology of Human G1P[8] Rotaviruses: A Hungarian Study

Epidemiological trends of the globally most common rotavirus genotype, G1P[8], were investigated in Hungary during a 16-year period by sequencing and phylogenetic analysis of the surface antigens. Antigen shift among epidemiologically major G1P[8] strains was observed in 6 seasons, as indicated by changes in the sublineages of the G1 VP7 and the P[8] VP4 genes. The temporal clustering of some rotavirus VP4 and VP7 gene sublineages and the periodic emergence and/or resurgence of previously unrecognized rotavirus sublineages in the study population suggest a dynamic nature for these common strains. Recently established international strain surveillance networks may help to identify and track the spread of epidemiologically important rotavirus strains across countries and continents.