National Case Definition Research Articles

Autochthonous and imported giardiasis cases: An analysis of two decades of national surveillance data, Germany, 2002 to 2021.

BackgroundGiardia duodenalis is a major cause of gastroenteritis globally, and is the most common food- and waterborne parasitic infection in Europe.AimTo describe the epidemiology of reported acute giardiasis cases in Germany and compare demographic and clinical characteristics between imported and autochthonous cases.MethodsWe conducted a descriptive analysis of giardiasis cases that fulfilled the national case definition and were reported between January 2002 and December 2021. We defined an imported case as having at least one place of exposure abroad in the 3-25 days before symptom onset. We analysed case numbers and incidence by age, sex, month reported and geographic region, both overall and stratified by autochthonous and imported cases.ResultsFrom 2002 to 2021, 72,318 giardiasis cases were reported in Germany, corresponding to a mean annual incidence of 4.4 per 100,000 population. Annual incidence gradually decreased since 2013, declining sharply during the COVID-19 pandemic in 2020-21. Of 69,345 cases reported between 2002 and 2019, 35% were imported. Incidence of autochthonous cases (overall yearly mean: 3.1/100,000) was highest in males and young children (< 5 years); imported cases were predominantly adults aged 20-39 years. We identified seasonal patterns for imported and autochthonous cases.ConclusionsGiardiasis in Germany is typically assumed to be imported. Our data, however, underline the importance of autochthonous giardiasis. Travel advice might reduce imported infections, but prevention strategies for autochthonous infections are less clear. Dietary, behavioural and environmental risk factors need to be further investigated to enhance infection prevention measures for autochthonous giardiasis.

Validation of Claims-Based Algorithm for Lyme Disease, Massachusetts, USA.

Compared with notifiable disease surveillance, claims-based algorithms estimate higher Lyme disease incidence, but their accuracy is unknown. We applied a previously developed Lyme disease algorithm (diagnosis code plus antimicrobial drug prescription dispensing within 30 days) to an administrative claims database in Massachusetts, USA, to identify a Lyme disease cohort during July 2000-June 2019. Clinicians reviewed and adjudicated medical charts from a cohort subset by using national surveillance case definitions. We calculated positive predictive values (PPVs). We identified 12,229 Lyme disease episodes in the claims database and reviewed and adjudicated 128 medical charts. The algorithm's PPV for confirmed, probable, or suspected cases was 93.8% (95% CI 88.1%-97.3%); the PPV was 66.4% (95% CI 57.5%-74.5%) for confirmed and probable cases only. In a high incidence setting, a claims-based algorithm identified cases with a high PPV, suggesting it can be used to assess Lyme disease burden and supplement traditional surveillance data.

Lessons from the re-emergence of imported measles cases following the COVID-19 pandemic in Victoria, Australia.

Australia was declared to have eliminated endemic measles in 2014; however, imported cases continue to pose a threat of outbreaks. International travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic led to a rapid decline in measles cases. The re-opening of the Australian international border to measles endemic regions returns the threat of outbreaks, which may be further compounded by disruptions in routine vaccinations during the COVID-19 pandemic. We consider lessons learned from the public health response to recent measles cases. This case series includes all confirmed measles cases meeting the national case definition reported to the Victorian Government Department of Health (the Department) between 1 January and 31 December 2022. The Department conducted active case finding and contact tracing of all cases in line with national guidelines. Cases were descriptively analysed. In 2022, six of the seven measles cases reported in Australia occurred in Victoria, all of whom resided in Australia and acquired their infection overseas. Three cases were unlinked, and three formed an epidemiologically-linked household cluster. One case was partially vaccinated, one was not eligible for vaccination, one had unknown vaccination status, and three were unvaccinated, one of whom was under 12 months old but would have been eligible for vaccination prior to travel to endemic regions. None of the cases led to secondary transmission within Australia. Following the COVID-19 pandemic, measles importations have re-commenced in Victoria. Although few measles cases occurred in 2022 and none resulted in onwards transmission, imported measles cases remain complex and require substantial public health follow-up. Delays in case diagnosis and flight contact tracing pose a significant risk for outbreaks of measles. Public health interventions are needed to maintain high vaccination rates, improve contact tracing, and ensure public health authorities and healthcare providers can rapidly identify and respond to imported measles cases.

Epidemiology of tetanus in Canada, 1995–2019

ObjectivesThis report aims to use tetanus hospitalization data to describe the epidemiology in Canada from 1995 to 2019 and to assess progress on national reduction targets, including validating that Canada has eliminated maternal and neonatal tetanus (MNT).MethodsTetanus hospitalizations and fatalities occurring between 1995 and 2019 were retrieved from the Canadian Institute for Health Information (CIHI) and Statistics Canada. Cases coded with ICD-10 codes A33, A34, or A35 as the primary diagnosis (or ICD-9 equivalents) were included. The Canadian national case definition was used for generic tetanus and definitions from the World Health Organization were referenced for MNT. R version 4.0.2 was used for analyses.ResultsFrom 1995 to 2019, 155 non-MNT, 6 neonatal, and 0 maternal tetanus cases were retrieved from CIHI. However, all 6 neonatal cases were excluded after validating with provincial/territorial public health officials. In the same time period, there were 91 national notifications of tetanus. Cases were distributed relatively equally across the country, with the exception of the territories, where zero cases were reported. Adults 75 and over had significantly higher incidence rates compared to younger age groups (p<0.001). Ten deaths were reported during the timeframe.ConclusionTetanus incidence remains low and hospitalization data reveal that Canada has met its reduction target of maintaining 5 cases or fewer annually in recent years. For MNT, Canada has successfully met the elimination target of zero cases. Continued vaccination efforts must be practiced for all age groups, including those aged 75 years and older, to sustain targets moving forward.

Measles outbreak investigation in Kasoshekumer kebele, Sinana district, South-Eastern Oromia, Ethiopia: A case-control study.

This study aimed at verifying the outbreak, preventing further transmission, and identifying the risk factors for the outbreak. A case-control study design was conducted from March 4, 2020 to April 30, 2020, in Kasoshekumer kebele of Sinana district. Thirty-seven carer-patient pairs and 74 controls were recruited in a 1:2 case-control ratio. Patients were selected using a national standard case definition of the Ministry of Health. Controls were selected from neighbors of patients and interviewed after the second incubation period from the last patient of the outbreak by a structured questionnaire similar to patients. All cases were included while controls were selected purposively for their exposure status. Vaccine efficacy, attack rate, and case fatality rate were conducted as a descriptive epidemiology. Multivariate analysis was used to identify associated factors. Out of 109 study participants, there were 37 cases and 72 controls. The mean age was 58.8 months with ±54 standard deviation. Thirty-one (83.8%) of the cases had a known contact history and 23 (62.2%) were unvaccinated. The age-specific attack rate was 36/1000 in <5 years and 53/100,000 in >15 years. The estimated vaccine efficacy was 73.7%. Having any type of socialization behavior (adjusted odds ratio = 6.8, confidence interval: 4.25, 11.4), maternal poor knowledge of measles prevention (adjusted odds ratio = 4.152, confidence interval: 1.226, 8.058), and being unvaccinated (adjusted odds ratio = 7.79, confidence interval: 2.281, 12.63) were associated factors for measles infection. Poor knowledge of the parents on vaccination and the less effort taken to deliver good attitude toward vaccination are resulting in measles outbreak. However, herd immunity can prevent the outbreak; if not, the community will continue to suffer from mortality and morbidity. A resilient immunization program with sustainable and equitable supply, delivery, monitoring, and evaluation is a fundamental action in prevention of measles outbreak. Increased awareness of vaccination and other prevention measures are also crucial to end the outbreaks.

WHO method for estimating congenital syphilis to inform surveillance and service provision, Paraguay.

ProblemIn Paraguay, incomplete surveillance data resulted in the burden of congenital syphilis being underestimated, which, in turn, led to missed opportunities for infant diagnosis and treatment.ApproachThe prevalence of congenital syphilis, as defined by the World Health Organization (WHO), was estimated for Paraguay using the WHO congenital syphilis estimation tool. This tool was also used to monitor progress towards the elimination of mother-to-child transmission of syphilis.Local settingThe burden of syphilis in Paraguay has historically been high: its prevalence in pregnant women was estimated to be 3% in 2018.Relevant changesThe incidence rate of congenital syphilis estimated using the WHO tool was around nine times the reported prevalence. Subsequently, Paraguay: (i) provided training to improve diagnosis and case reporting; (ii) strengthened information systems for case monitoring and reporting; and (iii) procured additional rapid dual HIV–syphilis and rapid plasma reagin tests to increase syphilis testing capacity. In addition, the Ministry of Health prepared a new national plan for eliminating mother-to-child transmission of syphilis, with clear monitoring milestones.Lessons learntHealth-care providers’ reporting and surveillance procedures for congenital syphilis may not adequately reflect national and international case definitions. Use of the WHO congenital syphilis estimation tool in Paraguay drew attention to congenital syphilis as a national public health problem and highlighted the importance of comprehensive national surveillance systems and accurate data. Ongoing use of the WHO tool can track progress towards the elimination of mother-to-child transmission of syphilis by helping improve syphilis service coverage and national surveillance.

Epidemiological and Clinical Features of COVID-19 in Hodeidah, Yemen

Background: Understanding the epidemiological and clinical features of the disease in different settings can help health system better manage cases and mitigate transmission risks.&#x0D; Objective: The study aimed to describe the epidemiological and clinical features of Coronavirus disease 2019 (COVID-19) namely the socio-demographic features, symptoms, severity of cases, seasonality of infection and risk factors of morbidity and mortality rate among peoples in Hodeiadh, Yemen.&#x0D; Methodology: A descriptive study (a case series) included 505 patients were diagnosed clinically and epidemiologically with COVID-19 according to national case definition between 1st June and 31st December 2020 at emergency department, Center of Tropical Medicine and Infectious Diseases (CTMID) in Al Thawara Public Hospital Authority, Hodeidah, Yemen. The patients, ranging in age from 3-80 years old, were triaged epidemiologically into suspected, probable and confirmed cases and clinically into mild, moderate, severe and critical cases. Epidemiological and clinical data were collected and described through calculations of medians, ranges, frequencies and percentages. Comparisons between qualitative variables were analyzed using Chi-squared test.&#x0D; Results: The results showed that 386/505 (76.43%) of suspected cases, and 70/505 (13.86%) of probable cases that were isolated and treated at home. A total of 49/505 cases (9.70 %) were confirmed and admitted in isolation department. On the other mean, 386 patients (76.43%) of mild and moderate cases, 70 patients (13.86%) of severe illness were treated at home. 21 patients of severe illness (4.16 %) and 28 patients (5.54%) of critical illness were treated at isolation department. 49 patients (9.7 %) needed admission in an intensive care unit (ICU). Most admitted cases had Acute Respiratory Distress Syndrome (ARDS) and the onset date of symptom were two weeks before hospitalization. Males were more exposed to COVID-19 namely 40/49 (81.63%) of cases. 33/49 (67.3%) of old age, 32/49 (65.3 %) had chronic diseases where the most prevalent were diabetes mellitus and diabetes mellitus associated with other chronic diseases 9/49 cases and 8/49 (18.36 % and 16.32 % respectively), followed by 6/49 (12.24%) of cardiac disorders and hypertension, 5/49 cases (10.20%) of respiratory disorders, 2/49 cases (4.08 %) of cardiac disorders associated with respiratory disorder and 2/49 cases (4.08 %) of renal failure. 2/49 cases (4.08 % ) of co-infection. Seasonal variation of COVID-19 cases was observed; there was higher frequency during the spring season, which accounted for 34/49 cases (69.4%), and lower frequency during the summer 4/49 cases (8.16%) and autumn 5/49 cases (10.2%) seasons. The overall case fatality rate (CFR) of confirmed cases was 23/49 (46.93%). Of these fatal cases, 15/49 cases (30.6 %) had chronic diseases, 7/49 cases (14.2 %) did not have any chronic diseases, and 1/49 cases (2.0%) had co-infection. However 19/23 cases (82.6 %) of deaths was over the age of 50 years. &#x0D; Conclusion: The research concluded that, old age, chronic diseases and co-infection were factors that contributed to excess morbidity and mortality among COVID-19 patients.

166. Congenital Syphilis in Minnesota, 2016-2020

BackgroundNationally, cases of congenital syphilis (CS) have increased over the past 5 years. We reviewed CS cases in Minnesota from 2016-2020.MethodsAll cases of syphilis, including CS, are reported to the Minnesota Department of Health (MDH), including accompanying data on maternal age, baby’s sex, race, test results, maternal stage and treatment of mother and child. Medical records and case interviews were reviewed; the 2018 national case definition was used to classify cases.ResultsDuring 2016-2020, there were 47 CS cases from 45 mothers, peaking in 2020 at a rate of 3.2/10,000 live births. 43 (91.5%) cases of CS had no clinical signs, 1 (2.1%) CS case was inadequately treated, and there were 2 deaths.The median maternal age was 28 (IQR 9, range 18-38). 13 (28.9%) identified as Black, non-Hispanic, 13 (28.9%) as American Indian/Alaska Native (AI/AN), 9 (20.0%) as White, non-Hispanic, 3 (6.7%) as Hispanic, 2 (4.4%) as Asian/Pacific Islander, and 5 (11.1%) Other/Unknown. Twenty-four (51.1%) cases occurred in the Minneapolis/St. Paul metropolitan area. 2 (4.4%) cases were primary, 1 (2.2%) was secondary, while 18 (40.0%) maternal cases were staged as early non-primary, non-secondary (ENPNS) and 24 (53.3%) were late unknown duration. 14 (31.1%) of mothers had their initial prenatal visit in the first trimester, 6 (13.3%) in the 2nd trimester, 11 (24.4%) in the 3rd, and 14 (31.1%) unknown. None of the maternal cases were HIV+, 2 were identified as positive for hepatitis C. 18 (40.0%) mothers had no or limited prenatal care, 21 (46.7%) had inadequate treatment for syphilis, and 18 (40.0%) had inadequate maternal testing. No cases reported substance use, but one case had a positive substance screen at delivery, and case interviews also documented a role of substance use and home instability in several other cases. ConclusionCase rates of CS are the highest ever seen in MN. There is disproportionate impact in persons of color and indigenous Minnesotans. Lack of access to prenatal care, missed opportunities for testing, and incomplete or insufficient treatment were found in maternal cases. More work needs to be done with communities at risk and with prenatal care providers to ensure adequate testing, identification and treatment for syphilis in women of child-bearing age.Disclosures All Authors: No reported disclosures

Prospective health surveillance for COVID-19 among health care workers at a university medical center in Taiwan, January to June 2020

BackgroundHealthcare personnel (HCP) at the front line of care are exposed to occupational hazards that place them at risk for infection, which then endanger patient safety and compromise the capability of the healthcare workforce. As of March 8, 2021 more than 420,170 HCP in US had been infected with SARS CoV-2 with 1388 deaths. In two Taiwan hospitals COVID-19 outbreaks involved HCP and resulted in shutdown of service. This report describes our prospective health surveillance of the HCP and COVID-19 containment measures in a teaching hospital in Taiwan during Jan. 1 through June 30, 2020.MethodsWe prospectively monitored incidents, defined as an HCP with the predefined symptoms, reported by HCP through the web-based system. HCP were managed based on an algorithm that included SARS CoV-2 RNA PCR testing. Infection prevention and control policy/practice were reviewed.ResultsThis hospital took care of 17 confirmed COVID-19 cases during the study period and the first Case was admitted on January 23, 2020. Among the 14,210 HCP, there were 367 incident events. Of 283 HCP tested for SARS CoV-2, 179 had predefined symptoms. These included 10 HCP who met the national case definition for COVID-19 infection and 169 based on Extended COVID-19 Community Screening program. The other 104 asymptomatic HCP were tested based on hospital policy. All of them had tested negative.ConclusionWe attribute our success in preventing COVID-19 infections among HCP to rapid, proactive, decisive, integrated national and institutional response in the early stages of the epidemic

SARS-CoV-2 Infections and Viral Isolations among Serially Tested Cats and Dogs in Households with Infected Owners in Texas, USA.

Understanding the ecological and epidemiological roles of pets in the transmission of SARS-CoV-2 is critical for animal and human health, identifying household reservoirs, and predicting the potential enzootic maintenance of the virus. We conducted a longitudinal household transmission study of 76 dogs and cats living with at least one SARS-CoV-2-infected human in Texas and found that 17 pets from 25.6% of 39 households met the national case definition for SARS-CoV-2 infections in animals. This includes three out of seventeen (17.6%) cats and one out of fifty-nine (1.7%) dogs that were positive by RT-PCR and sequencing, with the virus successfully isolated from the respiratory swabs of one cat and one dog. Whole-genome sequences of SARS-CoV-2 obtained from all four PCR-positive animals were unique variants grouping with genomes circulating among people with COVID-19 in Texas. Re-sampling showed persistence of viral RNA for at least 25 d-post initial test. Additionally, seven out of sixteen (43.8%) cats and seven out of fifty-nine (11.9%) dogs harbored SARS-CoV-2 neutralizing antibodies upon initial sampling, with relatively stable or increasing titers over the 2–3 months of follow-up and no evidence of seroreversion. The majority (82.4%) of infected pets were asymptomatic. ‘Reverse zoonotic’ transmission of SARS-CoV-2 from infected people to animals may occur more frequently than recognized.

COVID-19: first long-term care facility outbreak in the Netherlands following cross-border introduction from Germany, March 2020

BackgroundThe Dutch province of Limburg borders the German district of Heinsberg, which had a large cluster of COVID-19 cases linked to local carnival activities before any cases were reported in the Netherlands. However, Heinsberg was not included as an area reporting local or community transmission per the national case definition at the time. In early March, two residents from a long-term care facility (LTCF) in Sittard, a Dutch town located in close vicinity to the district of Heinsberg, tested positive for COVID-19. In this study we aimed to determine whether cross-border introduction of the virus took place by analysing the LTCF outbreak in Sittard, both epidemiologically and microbiologically.MethodsSurveys and semi-structured oral interviews were conducted with all present LTCF residents by health care workers during regular points of care for information on new or unusual signs and symptoms of disease. Both throat and nasopharyngeal swabs were taken from residents suspect of COVID-19, based on regional criteria, for the detection of SARS-CoV-2 by Real-time Polymerase Chain Reaction. Additionally, whole genome sequencing was performed using a SARS-CoV-2 specific amplicon-based Nanopore sequencing approach. Moreover, twelve random residents were sampled for possible asymptomatic infections.ResultsOut of 99 residents, 46 got tested for COVID-19. Out of the 46 tested residents, nineteen (41%) tested positive for COVID-19, including 3 asymptomatic residents. CT-values for asymptomatic residents seemed higher compared to symptomatic residents. Eleven samples were sequenced, along with three random samples from COVID-19 patients hospitalized in the regional hospital at the time of the LTCF outbreak. All samples were linked to COVID-19 cases from the cross-border region of Heinsberg, Germany.ConclusionsSequencing combined with epidemiological data was able to virtually prove cross-border transmission at the start of the Dutch COVID-19 epidemic. Our results highlight the need for cross-border collaboration and adjustment of national policy to emerging region-specific needs along borders in order to establish coordinated implementation of infection control measures to limit the spread of COVID-19.

The challenge of comparing EU Member States judicial data

The number of cases is measured through a broad range of quantitative variables used in various studies and policy papers as key indicators of the volume of activity of national courts. Additionally, these variables, together with other data (e.g. time needed to resolve a case, number of judges, etc.) are part of a broader discourse on the efficiency of justice systems. However, such discourse can be problematic when data is not actually comparable. To raise the attention on this very relevant but poorly explored topic, this paper analyses the comparability of the caseload data by focusing on apparently simple categories like civil and commercial litigious or non-litigious cases and administrative cases. The EU Justice Scoreboard and CEPEJ data and national case definitions in France, Italy, and Romania are used to assess the most relevant justice EU datasets. The findings point towards significant differences between analysed systems that suggest extreme caution should be exercised when using such data for scholarly, legislative or policy discourses.

Using a hepatitis B surveillance system evaluation in Fujian, Hainan, and Gansu provinces to improve data quality and assess program effectiveness, China, 2015

BackgroundMonitoring hepatitis B surveillance data is important for evaluating progress towards global hepatitis B elimination goals. Accurate classification of acute and chronic hepatitis infections is essential for assessing program effectiveness.MethodsWe evaluated hepatitis B case-reporting at six hospitals in Fujian, Hainan and Gansu provinces in 2015 to assess the accuracy of case classification. We linked National Notifiable Disease Reporting System (NNDRS) HBV case-reports with hospital information systems and extracted information on age, gender, admission ward and viral hepatitis diagnosis from medical records. To assess accuracy, we compared NNDRS reported case-classifications with the national HBV case definitions. Multivariable logistic regression was used to identify factors associated with misclassification.ResultsOf the 1420 HBV cases reported to NNDRS, 23 (6.5%) of the 352 acute reports and 648 (60.7%) of the 1068 chronic reports were correctly classified. Of the remaining, 318 (22.4%) were misclassified and 431 (30.4%) could not be classified due to the lack of supporting information. Based on the multivariable analysis, HBV cases reported from Hainan (aOR = 1.8; 95% CI: 1.3–2.4) and Gansu (aOR = 12.7; 95% CI: 7.7–20.1) along with reports from grade 2 hospitals (aOR = 1.6; 95% CI:1.2–2.2) and those from non-HBV related departments (aOR = 5.3; 95% CI: 4.1–7.0) were independently associated with being ‘misclassified’ in NNDRS.ConclusionsWe identified discrepancies in the accuracy of HBV case-reporting in the project hospitals. Onsite training on the use of anti-HBc IgM testing as well as on HBV case definitions and reporting procedures are needed to accurately assess program effectiveness and ensure case-patients are referred to appropriate treatment and care. Routine surveillance evaluations such as this can be useful for improving data quality and monitoring program effectiveness.

Determination of Rheumatoid Arthritis Incidence and Prevalence in Alberta Using Administrative Health Data.

ObjectiveThe objective of the study was to estimate the incidence and prevalence of rheumatoid arthritis (RA) in Alberta using administrative health data.MethodsWe identified RA cases in patients 16 years and older by applying a national case definition to linked administrative health data (ie, hospital discharge abstract records, physician claims, and health insurance registry records) using a unique personal identifier. Incidence and prevalence are reported for the 2015‐2016 fiscal year and a trend analysis from 2011‐2012 to 2015‐2016. Incidence and prevalence estimates were standardized using the 2011 Canadian census population.ResultsIn 2015‐2016, the overall crude incidence was 0.74 [95% confidence interval (CI): 0.71‐0.77] per 1000 and crude prevalence was 1.08% (95% CI: 1.07‐1.09). The women‐to‐men crude incidence and prevalence sex ratios were 2.04 and 2.19, respectively. People aged 65 to 79 years had the highest incidence of RA, and the highest prevalence was observed among those 80 years and older. From 2011‐2012 to 2015‐2016, the overall age‐standardized incidence decreased [0.97 (95% CI: 0.94‐1.01) to 0.79 (95% CI: 0.76‐0.82) per 1000], whereas age‐standardized prevalence remained constant [1.17 (95% CI: 1.15‐1.18) to 1.18 (95% CI: 1.17‐1.19)].ConclusionIn Alberta, there was a decreasing trend in RA incidence over the study period, whereas prevalence was stable. These estimates, combined with clinical data, will be used to measure system performance for quality improvement and to inform simulation modeling for planning the expected demand for health services for patients living with RA.

Cholera Outbreak in the Kasaï Oriental Province, Democratic Republic of Congo (DRC), 2018: The Case Fatality Rate in Mbuji-Mayi City and in the Rural Area

Cholera remains the major public health problem in the world. Cholera is endemic in DRC especially in its east part. In the Kasai Oriental province, cholera is epidemic area which registered major epidemic cyclically with high case fatality rate. The last one in 2018 started in Mbuji-Mayi city but later affected the whole province during 45 weeks with 5854 total suspected cases registered including 277 deaths (CFR: 4.7%). Our main objective was to describe this outbreak focusing on its higher CFR. We conducted quantitative descriptive study using data from the provincial line listing. Cholera was defined according to national and WHO case definition. Analyses were performed using Microsoft Excel 2010 and Epi-info7. Men were more affected (contracting or dying of) by cholera in the province. The proportion of men affected in rural area as well as the proportion of death was higher than in Mbuji-Mayi city. The outbreak started in Mbuji-Mayi with around CFR: 27.3% as well as in the rural area with CFR: 23.5% after three weeks. CFR was also high among men in Rural area as well as among persons aged 15years and above. The remote health zone situated in rural area registered the highest CFR. These were Cilundu and Kabeya-Kamwanga.

Monitoring measles outbreaks using emergency department data in France

Abstract Background Measles’ outbreaks still occur in industrialised countries and reactive monitoring of the disease is needed. In France, measles’ monitoring is based on a mandatory notification (MN). Methods In France, for each emergency department (ED) visit, an Electronic ED Abstract (EEDA) is transmitted to the OSCOUR® network included in national Syndromic Surveillance System. EEDA include the diagnosis at discharge using International Classification of Disease (ICD-10). This study aims to evaluate the correlation between the number of measles MN and the number of ED visits related to measles and to calculate the positive predictive value (PPV) of diagnosis at discharge of measles in ED. The study period covered the third wave of the 2008-2011 French outbreak. From 2010 to 2011, we analyzed EEDA transmitted from 32/53 ED of the PACA region and regional measles MN. Using weekly aggregated data, the correlation between the number of measles cases given by both MN and ED sources was assessed (Pearson coefficient). In the 4 ED (2 pediatric) of the teaching hospital of Marseille, electronic medical files coded as measles were reviewed to evaluate the PPV of the diagnosis coded according to the national MN case definition (gold standard). Results 2,949 MN were transmitted and 1,306/1.3 million visits in ED were coded as measles. The peak of the outbreak was reported the same week by EEDA and MN. The correlation between EEDA and MN was strong (0.91; p &amp;lt; 0.001). Hospitalization rate was 20.7% and 21.0% according to EEDA and MN (p = 0.81). Among 363 medical files coded as measles in the 4 ED, 14 cases (3.9%) did not fulfilled the national case definition (PPV: 96.1 [IC95%: 94.2-98.1]), 86 (23.7%) fulfilled criteria for “clinical case” and 263 (72.5%) for “confirmed case". Conclusions Most of the time, ED visits coded as measles fulfilled diagnosis criteria. Our results suggested that EEDA (better reactivity) could be complementary to MN (better completeness) to monitor measles. Key messages Most of the time, ED visits coded as measles fulfilled diagnosis criteria: PPV of coded medical diagnosis in ED for measles is high. Reactivity of ED data monitoring could usefully complete mandatory notification for measles surveillance.

Infectious Disease Notification Practices in Victoria, 2016-17.

Infectious disease surveillance in Victoria, Australia is based upon a legislated requirement for doctors and laboratories to notify suspected or diagnosed cases of specific conditions to the Department of Health and Human Services (DHHS). The department undertakes regular audits of notification practices in Victoria typically every two years. The objective of this particular audit was to describe notification practices in 2016 and 2017, assess the effect of enhanced surveillance programs (ESPs) on Indigenous status data completeness and provide a baseline assessment that can be used to monitor the impact of a recent legislative change to notification requirements for several of the notifiable diseases which came into effect on 1 September 2018. Notified cases reported to DHHS between 1 January 2016 and 31 December 2017 which met the confirmed and probable national case definitions were analysed by year, notifier type (doctor-only, laboratory-only, or both) and condition category (urgent versus routine). For three notifiable conditions (gonococcal infection and hepatitis B and hepatitis C of unspecified duration) Indigenous status completeness was compared pre- and post ESP commencement. The number of notified cases in Victoria increased 50% from 76,904 in 2016 to 115,318 in 2017 with a 277% increase in notified influenza alone. Almost half of cases were notified by both laboratory and doctor. Indigenous status was more likely to be complete following the introduction of ESPs (relative risk, RR 1.36 (95%CI: 1.33 - 1.40) p>0 .001). DHHS Victoria experienced a 1.5-fold increase in notified cases in 2017 compared with 2016, which was almost entirely attributable to influenza. For three notifiable conditions which had ESPs introduced during this period, Indigenous status reporting significantly improved. Indigenous identifiers on pathology request forms and data linkage are both interventions which are being considered to improve Indigenous status reporting in Victoria.

Antibody Titers Reactive With Rickettsia rickettsii in Blood Donors and Implications for Surveillance of Spotted Fever Rickettsiosis in the United States.

Since 2000, the reported prevalence of tick-borne spotted fever rickettsiosis has increased considerably. We compared the level of antibody reactivity among healthy blood donors from 2 widely separated regions of the United States and evaluated the impact of antibody prevalence on public health surveillance in one of these regions. Donor serum samples were evaluated by indirect immunofluorescence antibody assay to identify immunoglobulin G (IgG) antibodies reactive with Rickettsia rickettsii. The Georgia Department of Public Health (GDPH) analyzed characteristics of cases from 2016 surveillance data to evaluate the utility of laboratory surveillance for case assessment. Of the Georgia donors (n = 1493), 11.1% demonstrated antibody titers reactive with R. rickettsii at titers ≥64, whereas 6.3% of donors from Oregon and Washington (n = 1511) were seropositive. Most seropositive donors had a titer of 64; only 3.1% (n = 93) of all donors had titers ≥128. During 2016, GDPH interviewed 243 seropositive case patients; only 28% (n = 69) met inclusion criteria in the national case definition for spotted fever rickettsiosis. These findings suggest that a single IgG antibody titer is an unreliable measure of diagnosis and could inaccurately affect surveillance estimates that define magnitude and clinical characteristics of Rocky Mountain spotted fever and other spotted fever rickettsioses.

Culture‐positive shigellosis cases are epidemiologically different to culture‐negative/PCR‐positive cases

ObjectiveTo review the epidemiological differences between culture‐positive and culture‐negative (but ipaH PCR‐positive) cases of shigellosis in Sydney Local Health District (SLHD), NSW, to inform whether changes to the national case definition for shigellosis are required. MethodsAn audit of all cases of shigellosis (culture‐positive vs. culture‐negative/PCR‐positive) in SLHD from 1 January 2013 to 30 June 2015 was conducted and demographic, clinical and risk factors were analysed and compared between these groups. ResultsOf the 148 shigellosis cases notified to SLHD, 122 cases (85 culture‐positive vs. 37 culture‐negative) were included for analysis. Culture‐positive cases were more likely than culture‐negative/PCR‐positive cases to have experienced at least three symptoms (OR 3.18, 95%CI 1.3–7.5), been hospitalised (OR 4.2, 95%CI 1.4–13.2), and have had men‐who‐have‐sex‐with‐men exposure identified as the source of their infection (OR 28.7, 95%CI 6.2–132.6). ConclusionsThis study has identified that culture‐positive vs. culture‐negative/PCR‐positive shigellosis cases in NSW differ by clinical severity and risk factors for infection. Implications for public healthThe study findings warrant further research to determine the true diagnostic prevalence of Shigella in the culture‐negative/PCR‐positive group in the Australian context, in order to inform further changes to the national case definition for shigellosis.

Patients with laboratory evidence of West Nile virus disease without reported fever.

In 2013, the national surveillance case definition for West Nile virus (WNV) disease was revised to remove fever as a criterion for neuroinvasive disease and require at most subjective fever for non-neuroinvasive disease. The aims of this project were to determine how often afebrile WNV disease occurs and assess differences among patients with and without fever. We included cases with laboratory evidence of WNV disease reported from four states in 2014. We compared demographics, clinical symptoms and laboratory evidence for patients with and without fever and stratified the analysis by neuroinvasive and non-neuroinvasive presentations. Among 956 included patients, 39 (4%) had no fever; this proportion was similar among patients with and without neuroinvasive disease symptoms. For neuroinvasive and non-neuroinvasive patients, there were no differences in age, sex, or laboratory evidence between febrile and afebrile patients, but hospitalisations were more common among patients with fever (P &lt; 0.01). The only significant difference in symptoms was for ataxia, which was more common in neuroinvasive patients without fever (P = 0.04). Only 5% of non-neuroinvasive patients did not meet the WNV case definition due to lack of fever. The evidence presented here supports the changes made to the national case definition in 2013.