Mandatory Notification System Research Articles

Etiologies of Zoonotic Tropical Febrile Illnesses That Are Not Part of the Notifiable Diseases in Colombia.

In Colombia, tropical febrile illnesses represent one of the most important causes of clinical attention. Febrile illnesses in the tropics are mainly zoonotic and have a broad etiology. The Colombian surveillance system monitors some notifiable diseases. However, several etiologies are not monitored by this system. In the present review, we describe eleven different etiologies of zoonotic tropical febrile illnesses that are not monitored by the Colombian surveillance system but have scientific, historical, and contemporary data that confirm or suggest their presence in different regions of the country: Anaplasma, Arenavirus, Bartonella, relapsing fever group Borrelia, Coxiella burnetii, Ehrlichia, Hantavirus, Mayaro virus, Orientia, Oropouche virus, and Rickettsia. These could generate a risk for the local population, travelers, and immigrants, due to which they should be included in the mandatory notification system, considering their importance for Colombian public health.

Leveraging Google Trends to identify Indonesian tuberculosis trends before and after the implementation of a national mandatory notification system

BackgroundTuberculosis (TB) burden and the underreporting of TB remain major health challenges in Indonesia. Interest in the internet is growing extensively, and the introduction of the TB mandatory electronic notification system in 2017 engaged the public's interest to leverage digital traces regarding TB information in Indonesia. ObjectiveTo quantify the correlation between Google Trends data and Indonesian TB surveillance data before and after the implementation of a mandatory TB notification system. MethodsGoogle Trends searches on TB information were used. We used two sets of time series data, including before and after the launch of the TB notification system. Pearson's correlation was used to measure the correlation between TB search terms and official TB reports. ResultsThe moving average graph showed a linear pattern of TB information with TB reports after 2017. Pearson's correlation estimated a high correlation for TB definition, TB symptoms, and official TB reports with an R-value range of 0.97 to −1.00 (p ≤ 0.05) and showed an increasing trend in TB information searching after 2016. ConclusionGoogle Trends data can depict public interest in the TB epidemic. Validation of information-searching behavior is required to advocate the implementation of Google Trends for TB digital surveillance in Indonesia.

Epidemiology of healthcare-associated SARS-CoV-2 outbreaks in Germany between March 2020 and May 2022

Outbreaks in healthcare facilities played a pivotal role in the course of the coronavirus (COVID-19) pandemic. To investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks in hospitals, outpatient care, and rehabilitation facilities in Germany from March 2020 to May 2022. Data from the German mandatory notification system were used to describe outbreaks by number of cases and case fatality ratio (CFR), and outbreak cases by age and gender. Using Pearson correlation, the dynamics of cases in the general population were compared with cases in healthcare-associated infection (HAI) SARS-CoV-2 outbreaks before and after the start of the vaccination campaign. Additionally, a counterfactual scenario was used to estimate numbers of prevented HAI cases, using the phase before vaccination as baseline. By the end of May 2022, 8941 healthcare-associated outbreaks were observed with 73,626 cases: 51,504 in hospitals, 15,524 in outpatient care, and 6598 in rehabilitation facilities. Median number of cases per outbreak was 4 (range: 2-342) and cases were more frequently reported in women with 46,818 (63.6%). Overall CFR was 8.1%, higher in men (12.4%) than in women (5.7%). After the vaccination campaign was fully introduced, the association between increasing incidence in the general population and consecutive outbreak cases was decreased by a factor of 10. Furthermore, our counterfactual analysis suggests that more than 55,000 outbreak cases could have been prevented until the end of 2021. The vaccination campaign in combination with non-pharmaceutical measures was key to reduce number, size and CFR of healthcare-associated outbreaks.

Human Brucellosis in Greece, 2005-2020: A Persistent Public Health Problem.

Brucellosis remains an important zoonosis in various parts of the world. In Greece, brucellosis is endemic in sheep and goats. Since 1998, animal control measures include vaccination of sheep and goats older than 3 months of age in the mainland (vaccination zone) and slaughtering of infected livestock on the islands (eradication zone). We retrieved data from the mandatory notification system for 2005-2020 to describe the epidemiology in humans and assess current public health measures. Overall, 1786 notifications and an additional 111 cases related to an outbreak in 2008 (eradication zone) were recorded. The mean annual notification rate was 0.9/100,000 population (standard deviation [SD]: 0.35). A substantial mean annual decline in notification rate was reported in 2019 and 2020. A statistically significant decreasing trend of brucellosis notification rate was observed over the whole 16-year period (p < 0.001). The mean annual notification rate was significantly higher in the vaccination zone (1.2/100,000) (SD: 036) compared with the eradication zone (0.2/100,000) (SD: 0.14) (p < 0.001). Seventy percent of cases was male (n = 1175) and the highest mean notification rate was recorded in the 45-64 age group (1.3/100,000). The majority of cases (71%) reported animal contact and almost half of the cases (49%) were stockbreeders by occupation. Consumption of unpasteurized dairy products, mainly of their own production, was reported by 57% of cases; for 115 (6.5%) cases, animal exposure or consumption of unpasteurized dairy products were not recorded. Despite animal control measures, brucellosis remains endemic in Greece with cases in the vaccination zone, as well as the eradication zone. We recommend re-evaluation and strengthening of animal control programs and training of people working in stock breeding regarding disease transmission in co-operation with local farmers' associations.

Impact of previous macrolide use on invasive pneumococcal disease due to erythromycin-resistant serotypes in adults over 59 years of age

The major goals of the study were to describe the invasive pneumococcal disease (IPD) cases due to erythromycin-resistant serotypes and to evaluate the association between these cases and recent macrolide use in individuals aged over 59 years. We selected cases of IPD reported between 2007 and 2016 in persons aged over 59 years living in the Community of Madrid (CM). We followed the European Committee on Antimicrobial Susceptibility Testing (EUCAST). The explanatory variables (age, sex, year of onset of symptoms, clinical presentation, serotypes, vaccination status) were taken from the Mandatory Notification System for Infectious Diseases System and from the Vaccination Information System. The cases were classified as either included in the 13-valent pneumococcal conjugate vaccine (PCV13) or not (nonPCV13). Associations between cases due to erythromycin-resistant serotypes and previous macrolide use (total, long and short-term) were adjusted with a logistic regression multivariate analysis. A total of 1,831 cases were identified, of whom 408 were erythromycin-resistant serotypes. PCV13 cases were associated with previous macrolide use (OR: 5.07), particularly long-acting types (OR: 8.61). NonPCV13 cases were associated with the use of total macrolides (OR: 3.48) and long-acting macrolides (OR: 4.26) suggesting that PCV13 did not reduce the IPD cases in patients with previous use of macrolides. Our results confirmed that previous macrolide consumption was associated with the presence of IPD due to erythromycin-resistant serotypes. The risk was higher with the use of long-term macrolides.

Non-cholera Vibrio species - currently still rare but growing danger of infection in the North Sea and the Baltic Sea

HintergrundNicht-Cholera-Vibrionen nehmen im Rahmen des Klimawandels eine zunehmende Bedeutung als humane Pathogene ein, da die Prävalenz dieser Erreger im Meereswasser entscheidend von der Wassertemperatur abhängt. In den letzten Jahren konnten während der Sommermonate wiederholt größere Infektionsausbrüche in gemäßigten Klimazonen beobachtet werden.Ziel der ArbeitInformation einer breiten ärztlichen Leserschaft über potenziell lebensbedrohliche Krankheitsbilder, die durch Infektionen mit Nicht-Cholera-Vibrionen ausgelöst werden.Material und MethodenÜbersicht über aktuelle Literatur zu Infektionen mit Nicht-Cholera-Vibrionen im Allgemeinen und zur epidemiologischen Situation in Deutschland im Speziellen.ErgebnisseNicht-Cholera-Vibrionen verursachen vorwiegend Wund- und Ohrinfektionen nach Kontakt mit kontaminiertem Meereswasser sowie Gastroenteritiden nach dem Konsum nicht ausreichend gegarter Meerestiere. Da bis März 2020 keine Meldepflicht für diese Erreger in Deutschland bestand, muss von einer hohen Dunkelziffer ausgegangen werden. Immunsupprimierte sowie chronisch erkrankte Menschen haben ein deutlich erhöhtes Risiko für schwere Krankheitsverläufe. Schon bei klinischem Verdacht sollte eine kalkulierte antiinfektive Therapie erfolgen und bei Wundinfektionen eine chirurgische Sanierung erwogen werden.DiskussionAufgrund des fortschreitenden Klimawandels muss in den kommenden Jahren mit dem vermehrten Auftreten von Infektionen mit Nicht-Cholera-Vibrionen gerechnet werden. Ärzte sollten über diese potenziell lebensbedrohlichen Erkrankungen informiert sein, um Patienten einer entsprechenden Diagnostik und Behandlung zuzuführen.

Safe Driving - Assessment Mechanism to Reduce Morbidity and Mortality: A concept paper with reviewing a clinical case

Where a vehicle driver has multiple conditions or a condition that affects multiple body systems, there may be an additive or a compounding detrimental effect on driving abilities. An 81-year-old male motorcyclist was admitted to a tertiary care hospital following a road traffic accident. He has sustained only minor injuries. No significant past medical history. He has monocular vision since 1960 following accidental trauma to the right eye. He had obtained a heavy and light vehicle driving license in 1958, which is valid for life. Driving with monocular vision is permitted in many European countries and Sri Lanka. However, an important question remains - should the ability of driving be reviewed in an accident or any other condition which affects driving. This paper attempts to propose a referral mechanism to reduce morbidity and mortality in people with driving disabilities. Monocular vision affects vision in many ways. This might have serious implications both on the safety of the patient and the public. Driving with monocular vision is allowed in many countries. However proper evaluation of subsequent illnesses and referral mechanism is important in cases like this to reduce morbidity and mortality. In Sri Lanka there is no proper referral system for this. Therefore, we propose to introduce 1. Mandatory renewal of all driving licenses. 2. Mandatory notification system in conditions that affect driving 3. Issue a restrictive license and frequent review in relevant cases. This would be important in reducing injury risk to both the individual concerned and the public.

Surveillance data for human leishmaniasis indicate the need for a sustainable action plan for its management and control, Greece, 2004 to 2018.

BackgroundThe World Health Organization (WHO) lists human leishmaniasis as a neglected tropical disease; it is not under surveillance at European level.AimWe present surveillance data for visceral (VL) and cutaneous (CL) leishmaniasis for the period 2004 to 2018 in Greece to assess their public health importance.MethodsWe extracted data from the mandatory notification system to analyse separately imported and domestic cases of VL and CL. A case was defined by clinical manifestations compatible with VL or CL and laboratory confirmation.ResultsBetween 2004 and 2018, 881 VL (862 domestic, 19 imported) and 58 CL cases (24 domestic, 34 imported) were recorded. The mean annual notification rate of domestic VL was 0.5 per 100,000 (range: 0.12–1.43/100,000) with a statistically significant increasing trend (p = 0.013). Cases were reported by all regions. The highest notification rate occurred in the age group 0–4 years (1.3/100,000). Overall 24% (164/680) of the cases were immunocompromised and their proportion increased after 2010 (p < 0.001). The mean annual notification rate of domestic CL was 0.05 per 100,000 (range: 0.01–0.19/100,000) with the highest rate in the age group 5–14 years (0.03/100,000). Cases were recorded in six of the 13 regions. Among 34 imported CL cases, 29 were foreign nationals.ConclusionVL is endemic in Greece, with an increasing trend and a considerable burden of severe disease and young children being most affected. CL is rarely reported. A sustainable action plan is needed to reduce the burden of VL and prevent local transmission of CL.

Laboratory-based surveillance of invasive listeriosis in Northern Italy over a fourteen-year period: epidemiological and clinical results.

SummaryIntroductionInvasive listeriosis is a rare foodborne disease with a significant impact on public health worldwide, because of the severity of its clinical manifestations and high fatality rate. In this study, we provide a snapshot of epidemiology of listeriosis in Lombardy Region, Northern Italy, reviewing enhanced surveillance data collected over fourteen years, after the implementation of a voluntary laboratory-based surveillance system for the referral of clinical isolates of Listeria monocytogenes to a regional reference laboratory, since 2005.MethodsInvasive listeriosis cases data from 2005 to 2018 were extracted from the regional laboratory-based surveillance system database and compared with the regional mandatory notification disease system data.ResultsOver the fourteen-year period under study, 533 Listeria monocytogenes isolates were detected by the laboratory surveillance system, 55 of which from pregnancy-related cases. The median age of non-pregnancy-associated patients was 71 years, with 64.6% of cases observed in the elderly. Cases with underlying medical risk conditions accounted for 92.1%, and the fatality rate was 26.2%. By integrating data from the mandatory notification system and the laboratory-based surveillance system, a total of 935 cases were recorded. The collection of data through the laboratory surveillance system allowed to increase the surveillance sensitivity by 18%.ConclusionsOur results documented the growing epidemiological relevance of listeriosis through the analysis of two information sources, the regional mandatory notification system and the regional laboratory-based surveillance system. The data we obtained were consistent with the literature, except for pregnancy-related cases, which are often underdiagnosed. This study highlighted the importance of laboratory-based surveillance system, which led to a significant increase in the sensitivity of the mandatory notification system.

Epidemiology and surveillance of human (neuro)cysticercosis in Europe: is enhanced surveillance required?

To report on relevant national surveillance systems of (N)CC and taeniasis (the infection with the adult tapeworm) in the European Union/European Economic Area and to assess the magnitude of (N)CC occurrence by retrieving information on cases for the period 2000-2016. (N)CC cases were retrieved via national reporting systems, a systematic literature search, contact with clinicians and a search for relevant 'International Statistical Classification of Diseases and Related Health Problems' (ICD)-based data. Mandatory notification systems for (N)CC were found in Hungary, Iceland and Poland. Ten cases were reported in Poland and none in Hungary and Iceland. Through the systematic literature review and information given by clinicians, 263 individual and 721 aggregated (N)CC cases from 19 European countries were identified. ICD-based data were obtained from five countries. From 2000 to 2016, a total of 3489 cases (N)CC cases were coded: 832 in Italy, eight in Latvia, 357 in Portugal, 2116 in Spain and 176 in Sweden. Despite being classified as a possible eradicable disease, (N)CC is still diagnosed across Europe, yet its true extent and impact remain unclear.

1413. Surveillance of Variant Creutzfeldt Jakob Disease, Based on the Non-confirmatory Diagnostic Criteria of the EU Case Definition, Greece, 2014–2018

BackgroundVariant Creutzfeldt–Jakob disease (vCJD), is a form of CJD associated with consumption of tissues from cattle infected with bovine spongiform encephalopathy. Confirmation requires cerebral histopathologic examination, ascertaining spongiform change and extensive prion protein deposition with florid plaques. In Greece, the disease has been included in the Mandatory Notification System since 2004 however no reference laboratory has been available since 2009 due to low global occurrence. In 2014, the surveillance system was strengthened to also include possible and probable cases based on the non-confirmatory diagnostic criteria of the EU case definition. Hereby we present the results of the surveillance for 2014–2018.MethodsA new reporting form for CJD was introduced at the national level, including fields aligned with EU case definition criteria for vCJD (preconditions, clinical, diagnostic, and epidemiological). The non-confirmatory diagnostic criteria for the classification of probable and possible vCJD cases were based on examinations routinely available at hospitals, namely EEG and cerebral MRI. Reported CJD cases were assessed according to the fulfillment of required combinations of EU criteria for possible, probable, and confirmed vCJD cases.ResultsFrom 2014 to 2018, 37 CJD cases were reported, with a median age of 67 years (IQR: 58–73) concerning mostly females (71.3%, 95% CI: 56.7–85.9%). Among the reported cases, 6 (16.2%) fulfilled only the preconditions, 8 (21.6%) fulfilled the preconditions and the clinical criteria, 21 (56.8%) had a compatible EEG, and 7 (18.9%) had a compatible MRI brain scan. Confirmatory examination was not performed to any of the CJD cases; however, no case was classified as possible or probable vCJD based on the EU case definition.ConclusionNotification of CJD patients from 2014 to 2018 in Greece, yielded no vCJD cases. The possible re-emergence of vCJD renders continuous surveillance of the disease imperative. Current EU case definition can support the surveillance of vCJD, by screening CJD patients for possible and probable vCJD cases with the utilization of conventional diagnostic examinations, available in most hospitals.Disclosures All authors: No reported disclosures.

2631. Influenza-Associated Intensive Care Unit Hospitalizations and Deaths in Children, During 2010–2019 in Greece

BackgroundThe clinico-epidemiological characteristics of children with severe influenza-related intensive care unit (ICU) admissions in Greece during 2010–2019 are described.MethodsAll laboratory-confirmed influenza cases (real-time PCR), in children 0–16 years old, admitted to Pediatric ICUs throughout the country, are reported using a mandatory notification system to the National Public Health Organization of Greece. Case fatality rates (CFR) were analyzed according to age and presence of comorbidities.ResultsFrom October 2010 to April 2019, 131 influenza cases [7.2/100,000 children, 65 (49.6%) girls] with PICUs admissions were recorded. The majority of cases (n = 78; 60%) occurred in the age group 0–4 years-old [31 (24%) children were < 12 months-old]. Sixty-five (49.6%) children had underlying comorbidities (22 neurological disease, 12 congenital syndromes, 7 cancer, 5 chronic respiratory, 19 other). The most common diagnosis was febrile ARDS and 67 (51.14%) had severe pneumonia (40% viral, 7% bacterial). Seventy-five (57.2%) children required invasive ventilation. Influenza A accounted for 102 (77.86%) of cases; out of 86 (84.31%) subtyped, 68 (79%) were AH1N1pdm09, and 18 (21%) were AH3N2. Influenza B accounted for 29 (22.13%) of cases. All children received oseltamivir. Median length of stay was 10 days (range 1–90). A total of 32 deaths was recorded (CFR 24.4%, total rate: 1.76/100,000 children); 13 (40.1%) deaths occurred in children with no known co-morbidity. Mortality rates were higher in children aged > 4 years (18/53, 33.9% vs. 14/78, 17.9%, P = 0.04) while there was a trend for children with comorbidities (19/65, 29.2% vs. 13/66, 19.69%, P = 0.1). Only 4% of children were previously immunized against influenza.ConclusionAH1N1pdm09 accounted for the vast majority of severe cases and influenza associated deaths in children in Greece over the last 10 years. Severe disease occurred also in children with no comorbitidies. Longitudinal clinico-epidemiological data should be considered in shaping the national immunization program.Disclosures All authors: No reported disclosures.

Analysis of a 3-months measles outbreak in western Liguria, Italy: Are hospital safe and healthcare workers reliable?

BackgroundFrom January 2017 to June 2018 more than 7000 measles cases were reported in Italy, of which more than 400 among unvaccinated healthcare workers. We described a measles outbreak occurred in Western Liguria, Italy, characterized by a high involvement of healthcare workers and hospital visitors. MethodsSuspected measles cases and data regarding vaccination status and clinical management of the patients were collected by reviewing 3 different surveillance systems: the routine mandatory notification system, the National Integrated Surveillance System for Measles and Rubella and the regional reference laboratory for measles diagnosis. ResultsThirty-six cases were reported, with a median age of 31 years and >95% in unvaccinated subjects. One death occurred, 15 cases were hospitalized. Hospital transmission was confirmed or suspected in 12 cases; amongst this cases, 5 were healthcare workers (a gynaecologist, an obstetric nurse, a radiologist, a physiotherapist and a nurse working in an infectious disease ward), all certified unvaccinated. Phylogenetic analysis revealed the circulation of a single B3 genotype variant. ConclusionsOur experience highlighted the key role of nosocomial transmission and the need for targeted strategies, in particular (i) to implement a measles catch-up immunization campaign in susceptible groups, especially in healthcare workers, (ii) to intensify the check of immunisation status of healthcare workers and to offer vaccination for those who need it, (iii) to improve timeliness and completeness of surveillance systems. Efforts are needed to guarantee the safety of the hospital and the reliability of the healthcare workers. Only high vaccination coverage among HCWs can prevent the diffusion of measles in the hospital setting.

Do We Know the True Burden of Tick-Borne Encephalitis? A Cross-Sectional Study

Introduction: Tick-borne encephalitis (TBE) is an acute human arboviral infection of the central nervous system caused by a virus that is transmitted to humans mainly by tick bites. TBE is endemic in Europe and has become an increasingly important public health concern in recent years. Cases of TBE in Italy have occurred mainly in the north-east and central parts of the country. Vaccination is recommended for people who live in or visit areas at higher risk of tick bites. Objective: The aim of our study was to ascertain the burden of TBE in the Veneto Region (north-east Italy). Methods: Cases of TBE occurring in the region from January 1, 2007, to December 31, 2018, were extracted from the database of the mandatory notification system (MNS) and from hospital discharge records (HDRs) of admissions relating to a diagnostic code 063 according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Capture-recapture methods were used to estimate the completeness of each data source (as a percentage of cases). Records including diagnostic codes 322.9 (Meningitis, unspecified) and 323.9 (Unspecified cause of encephalitis, myelitis, and encephalomyelitis) were also extracted from the HDR database. Municipalities were grouped by location, based on their elevation above sea level, as “mountains,” “hills,” or “lowlands”. After selecting only the municipalities where cases of TBE had occurred, the proportion of cases of TBE out of the total cases of encephalitis and meningitis identified was calculated and used to estimate the number of cases of TBE potentially occurring in the municipalities that reported none. Then the observed and adjusted TBE rates per 100,000 population were calculated. Results: During the 12 years considered, a total of 281 cases of TBE were identified; 155 emerged from the HDRs and the MNS, 89 only from the MNS database, and 37 only from the HDRs. The degree of completeness of the data was 93.0% for the MNS and HDRs combined, 80.8% for the MNS alone, and 63.6% for the HDRs alone. The observed annual rate of TBE in the Veneto in recent years was calculated at 0.48 per 100,000 population, with the highest standardized rate in the province of Belluno (5.95 per 100,000 population). A significant rising trend in the number of cases observed in the latest period (2015–2018) was apparent for the mountainous areas in the region (average annual percent changes: 43.7 [95% CI 19.0–73.5]). The number of cases peaked in the mountains in the month of June (0.89 per 100,000), in hilly areas in July (0.23 per 100,000) and in the lowlands in October (0.04 per 100,000). Conclusions: Our findings seem to confirm an underreporting of the cases of TBE and inadequate TBE surveillance in the Veneto, despite the clinical severity of the disease and the fact that it is mandatory to report all cases. The routine integration of different databases is crucial to the successful implementation and assessment of targeted prevention strategies and fundamental to public health decision-making on this issue.

Incidence of Tuberculosis in Chinese Adults with Type 2 Diabetes: A Retrospective Cohort Study in Shanghai

Background: Both type 2 diabetes mellitus (T2DM) and tuberculosis (TB) bring heavy disease burden around the world. Their causal relationship, however, remains unclear. In this study, we estimated incidence of TB in Chinese T2DM patients and evaluated the effect of glucose level on TB risk based on the management data in Shanghai. Methods: A retrospective cohort study was built based on the diabetes management system in Shanghai and included 240 692 adults aged 35 or above, diagnosed with T2DM between January 1, 2010 and December 31, 2015 and free of TB at diagnosis. Baseline information was from the system which was routinely collected for each patient at diagnosis of T2DM. Incident TB cases were identified through record-linkage with the Shanghai TB Surveillance System and Mandatory Notification System using the unique identification card number of each individual. Incidence of TB in all diabetes patients and by subgroups were calculated and compared. Multivariable Cox regression models with restricted cubic splines were used to evaluate the association of fast plasma glucose (FPG) level with the risk of TB. Findings: A total of 439 incident TB cases were identified in the cohort after an average of 3·83 years of follow-up. The overall incidence was 51·3/100 000 in diabetes patients and remained higher than that in general population from 2010 to 2015, with range from 44·5 to 76·4/100 000 vs. 28·1 to 31·0/100 000. The incidence was higher in men than in women (86·2 vs. 22·1 per 100 000), and was highest in patients with body mass index (BMI) <18·5 kg/m2 (215·2/100 000) or FPG≥10 mmol/L (143·2/100 000). The risk of TB was observed increasing with FPG increasing, particularly among those with normal BMI. Interpretation: Our results suggest that the risk of TB may increase as FPG increasing in normally weighted diabetes patients. Individualized screening strategy should be provided in Chinese diabetes patients to prevent and control TB. Funding Statement: The Three-year Action Plan on Public Health, Phase Ⅳ, Shanghai, China (15GWZK0801); The Study on Comprehensive Prevention and Treatment Model of Tuberculosis, Shanghai, China (2018ZX10715012). Declaration of Interests: The authors declared that there is no conflict of interest. Ethics Approval Statement: This study was approved by the Ethical Review Committee of Shanghai Municipal Center for Disease Control and Prevention. Since this was a retrospective study and all patients’ information used was routinely collected through the management system and the TB mandatory notification system, the requirement for informed consent was exempted by the committee mentioned above.

Approaching measles elimination in Switzerland: changing epidemiology 2007–2018

Switzerland is aiming to eliminate measles, in line with the objectives of the World Health Organization (WHO). Physicians, laboratories and public health authorities have made great efforts to reach this goal. A continually increasing measles vaccination coverage and other preventive measures have made an impact: no major measles outbreak has been recorded since 2011. In order to evaluate progress towards elimination, measles epidemiology of a previous epidemic period (2007&ndash;2011) was compared with the current post-epidemic period (2012&ndash;July 2018) by analysis of data from the mandatory notification system. A decrease of 94% in the average annual incidence rate occurred between the two periods (from 133 to 9 cases per million inhabitants). This was accompanied by significant changes in the epidemiology that are expected and characteristic of countries with limited circulation of the measles virus. After analysing the performance of the Swiss surveillance system and the data provided, the WHO concluded that endemic measles transmission was interrupted in Switzerland in 2016 and 2017.

1724. Characteristics of the Ongoing Measles Outbreak in Greece in the Context of the Recent European-wide Epidemic and Public Health Measures

BackgroundMeasles is a highly contagious disease which still remains a cause of severe complications, including deaths worldwide, despite the existence of safe and effective vaccines. In the last 3 decades, the incidence of measles in Greece has constantly declined with only sporadic clusters or outbreaks (last outbreak in 2010–2011). We describe the characteristics of the ongoing measles outbreak and the Public Health response.MethodsAll measles cases are reported through the mandatory notification system (EU case definition 2012) to the Department of Surveillance and Intervention of the Hellenic Centre for Disease Control and Prevention. For laboratory confirmation patient sera were tested for IgM antibodies and pharyngeal swabs for the presence of measles virus RNA with RT-PCR. Sequencing of the measles nucleoprotein gene was applied in positively tested serological samples.ResultsFrom 9 May 2017 to 26 April 2018, 2,659 cases were reported in all 13 regions in Greece; 1,605 (60.4%) were laboratory confirmed. Most cases (n = 1,595; 60%) were Roma (73% children <10 years) followed by nonminority Greek nationals (n = 781; 29.4%, of whom 57% young adults 25–44 years), highlighting the immunity gap in Roma population. The vast majority of cases (80.5%) were unvaccinated. Ninety-four (3.5%) cases were healthcare workers (HCW); all were partially or not vaccinated. Genotype B3 was identified by molecular testing in all 88 cases tested. Severe complications were reported in 429 (16.1%) patients, most frequently pneumonia (43.8%) and hepatitis (21.2%). Three deaths were recorded in an 11-month-old immunocompromised Roma infant, a 17-year-old unvaccinated Roma, and a 35 year olds partially vaccinated individual from the general population. Extensive vaccination in refugee/migrant hosting sites prevented the emergence of a large number of cases. Mitigation efforts focused on closing the immunization gap in Roma population through emergency vaccination and raising awareness among HCWs to prevent further spread.ConclusionThe current outbreak highlights the need to achieve high vaccination coverage with 2 doses of MMR vaccine in the general population (children, adolescents, and young adults) and in hard-to-reach vulnerable populations like Roma and refugees.Disclosures All authors: No reported disclosures.

2192. Hepatitis A in Greece 2009–2017: Time for Setting New Priorities

BackgroundThe aim of this study was to present the epidemiological data and describe the outbreaks of hepatitis A identified over the period 2009–2017 in Greece.MethodsCases recorded through the mandatory notification system were classified in accordance with the European case definition. Data were analyzed by population group (general population, Roma, refugees / migrants, travelers to endemic countries, and MSM).ResultsBetween 2009 and 2017, 1,072 cases were reported to the Department of Epidemiological Surveillance and Intervention of the Hellenic Center for Disease Control and Prevention. The median annual number of reported cases was 86 (41–277). Reported cases exceeded the expected number in 2013, 2016 and 2017. In 2013 165 cases were reported [three times higher than the mean annual n reported for 2005–2012; 101 (61.6%) among Roma]. Three clusters were identified accounting for 50% of reported cases. Genotyping showed that clusters were due to hepatitis A virus subgenotype IA. In 2016, after the closure of the northern borders of Greece in March, 177 cases were reported among refugees (subgenotype IB, the majority of affected of Syrian origin). In 2017, an outbreak among men having sex with men (MSM) was recorded as part of a European HAV outbreak. One hundred and seventy-six male cases were recorded (median age; 38 years old, range; 21–55); 81 identified themselves as MSM. Genotyping data showed linkage to identified European clusters (subgenotype IA).ConclusionHepatitis A remains a significant Public Health threat in Greece. Preventive interventions should target populations with low access to healthcare, as well as MSM.Disclosures All authors: No reported disclosures.

Cancer Diagnosis and Treatment: The Need for Compulsory Registration

Background and context: According INCA 630,000 new cases of cancer will be diagnosed in 2018, however Brazil does not have a unified registration system for cases of cancer. The Cancer Information System (SISCAN) was supposed to be in operation in Brazil since 2013, but it is not used by several Brazilian municipalities. Without these records it is not possible to measure the actual dimension of cases of cancer (number of cases, stages, treatments, etc.); consequently, public policies aiming at actual oncologic needs are not developed, which leads to the waste of public resources and an increase in mortality rates. Aim: Implement a mandatory and unified cancer registration system in Brazil. Strategy/Tactics: Involvement of various stakeholders, such as political leaders, NGOs, the press, etc. Align several actions and projects executed by Federação Brasileira de Instituições Filantrópicas de Apoio à Saúde da Mama (FEMAMA) for the same goal. Share FEMAMA´s goal with other pressure groups. Program/Policy process: Prepare arguments for proposing a bill on the topic in question. Promotion in the media regarding the impact of the lack of a mandatory registration system; Align discourse with NGOs associated to FEMAMA so that they can act as representatives and regional influencers on this topic. Meeting with the Minister of Health In reference to World Cancer Day (WCD), NGOs associated to FEMAMA have submitted letters asking state Congresspeople to draft a bill creating mandatory cancer notification systems in their respective states; Organization of 13 debate cycles and 9 public hearings at state assemblies about the topic; Articulations with federal Congresspeople for proposing a bill on the topic in question; Organization of a conference attended by NGO representatives and female political leaders to discuss action proposals; Discussion of the project and joint actions executed alongside multisector group in Brazil. Outcomes: Favorable opinion from the Ministry of Health about FEMAMA´s goals; WCD: Actions organized in 15 Brazilian states with the engagement of 17 Congresspeople; Organization of debate cycles and public hearings on the topic in 13 Brazilian states; Enactment of a regulation implementing a mandatory cancer registration system in the Federal District since 2017; Submission of a proposal petition requesting the implementation of a mandatory cancer registration system in the State of São Paulo to the State Department of Health. Proposal of two bills submitted at the House of Representatives on the topic in question (PL 8478/2017 and PL 8470/2017); The bills (unified) were passed by the House of Representatives, and have been subsequently submitted to the Senate for analysis; What was learned: The articulations with several political leaders for the proposal of a bill for the implementation of a mandatory cancer registration system and the articulated engagement of NGOs leverages these actions and expands debate in the legislative, both on a national and on a state level.

Laboratory capacity of Greek hospitals for diagnosis of salmonellosis and surveillance systems' performance in the years of economic crisis, 2010-2016.

Austerity might have affected the capacity of public hospitals in Greece to diagnose salmonellosis (laboratory capacity) over the period 2010-2016, as well as the performance of the existing surveillance systems. The scope of this paper is to present data on laboratory capacity over these years, as well as the results of a two-source capture-recapture study (data from Mandatory Notification System and National Reference Laboratory System for Salmonella). The main findings were that: (a) laboratory capacity was high and steady besides the financial crisis, (b) the estimated number of laboratory-confirmed cases (n = 6017, 95% CI 5892-6142) resulted in an incidence rate (7.9 cases/100 000 population) almost twice than that reported by the two systems Mandatory Notification System (MNS); 4.1 and National Reference Laboratory System (NRLS); 4.5 cases/100 000 population, (c) underreporting was high for both systems (MNS; 47.5% and NRLS; 42.8%) and (d) differences by geographical region, size and type of hospital were identified. We suggest that (a) specific interventions are needed to increase completeness of the systems by type of hospital and geographical region, (b) record linkage can help in estimating the disease burden in a more valid way than each system separately and (c) a common electronic database in order to feed one system to the other could significantly increase completeness of both systems.