National Disease Surveillance Research Articles

Post-COVID-19 resurgence of scabies' cases in the Lazio Region, Italy: a new emerging public health threat?

Scabies represents a global health issue and in 2017 was added to the World Health Organization's list of neglected tropical diseases. In European and Middle Eastern countries, cases are sporadic while recent surveillance data have pointed out an increasing incidence among vulnerable populations. Regional cases for Lazio, Italy, reported from 2017 to 2023 to the national infectious disease surveillance system were analyzed. In Lazio, just after the coronavirus disease 2019 (COVID-19) pandemic onset, a significant and immediate reduction in the incidence of scabies was recorded (- 79.6%) followed by a progressive and relevant increase (143.4% from 2020 to 2021, 142.3% from 2021 to 2022 and 170.3% from 2022 to 2023). Consistently, the number of scabies outbreaks, after a decrease following the first COVID-19 wave, has progressively increased over time, mainly due to the occurrence of outbreaks in long term facilities (750% from 2020 to 2023). The increased incidence may also be driven by the "pseudo-resistance" phenomenon (under dosed/early-discontinued treatment, suboptimal adherence, reduced drug bioavailability), but also by reduced in-vitro susceptibility to the mainly used scabicides. The rapidly evolving epidemiology of scabies in our country, as documented also in other regions, calls for a comprehensive approach to effectively address the problem.

Trends in tuberculosis mortality among older adults in China, 2004-2021: a Joinpoint regression and age-period-cohort analysis.

Tuberculosis (TB) remains a major public health problem in China and globally, particularly among older adults. This study aimed to examine secular trends in TB mortality among older adults in China and the net effects of age, period, and cohort. Data from the National Disease Surveillance Points (DSPs) system were analyzed using Joinpoint regression to determine annual changes in TB mortality among individuals aged 60 years and older from 2004 to 2021. An age-period-cohort (APC) analysis using the intrinsic estimator (IE) method was conducted to estimate the independent effects of age, period, and cohort. The age-standardized TB mortality rate was 5.68 per 100,000, with higher rates observed in men, rural areas, and western regions. TB mortality among older adults declined overall from 2004 to 2021, although the rate of decline has slowed in recent years. The APC analysis revealed increased TB mortality with age, with the relative risk (RR) rising from 0.57 in the 60-64 age group to 1.53 in the 80-84 age group. The period effect decreased from 2007 to 2021, showing a higher risk effect in rural areas (RR = 1.51) than in urban areas (RR = 1.16) during 2007-2011, but this trend reversed in the period 2017-2021. The cohort effect generally declined, with the exception of certain demographic groups that showed an increase in the 1952-1956 and 1957-1961 birth cohorts. TB mortality among older adults in China decreased from 2004 to 2021, although the decline has slowed in recent years. Variations in age, period, and cohort effects highlight differences by gender, urban and rural areas, and regions, providing insights for targeted intervention strategies.

Epidemiological pattern of dengue fever in Afghanistan in the period 2021-22.

Dengue fever is considered as an emerging disease in Afghanistan. Since the first outbreak was reported in 2019, other outbreaks have been reported in the following years. The current study aims to describe the epidemiological features and clinical manifestations of suspected and confirmed cases of dengue fever detected by the National Disease Surveillance and Response (NDSR) Department of the Ministry of Public Health (MoPH) during 2021 and 2022 to prevent further spread and minimize its impact on the country's health system and on the limited number of health workers. Through a retrospective analysis of historical data related to suspected dengue fever cases in Afghanistan detected by the National Disease Surveillance and Response Department during 2021 and 2022, several variables were identified, including demographic characteristics, clinical features, clinical management, the outcome of infection, laboratory data, and epidemiological factors. All statistical analyses were developed using Microsoft 365 (Excel). The mean age of the 1977 reported suspected dengue fever cases was 30.4 ± 14.9 years, with males 70.7%. The epidemic curve showed a steep rise in cases in 2022, starting from week 39, with a peak reached in week 45, which was higher than that observed in 2021. The majority of cases (97.9%) were reported from Nangarhar Province, east of the country. Regarding symptoms, fever, headache, and muscle pain were expressed in nearly all cases. The reverse transcription polymerase chain reaction was positive in 379 cases out of 497 cases (76.3%). For the management of cases, 97.6% received antipyretics. Less than 5% of cases were admitted to health care units, with death reported in only two cases (case fatality rate of 0.1%). The number of suspected cases of dengue fever reported in Afghanistan was increasing. The trends for 2021 and 2022 followed almost the same pattern, with a higher peak in 2022. Understanding the epidemiological and clinical characteristics of dengue fever cases is fundamental for preparedness for upcoming seasons.

Impact of Immunization Strategies on Rubella Incidence During Progress Toward Rubella Control and Elimination - China, 2004-2023.

Since rubella was incorporated into the national disease surveillance system in 2004, rubella incidence has changed dramatically. This study analyzed the impact of immunization strategies on the age-specific and sex-specific incidence of rubella in China from 2004 to 2023 to inform efforts to accelerate rubella elimination. Annual rubella-containing vaccine (RCV) coverage levels, reported rubella cases and incidence, and vaccination status of cases were obtained from the National Immunization Program Information Management System, the National Notifiable Diseases Reporting System, and the Measles Surveillance System, and used to describe temporal trends. Incidence trends and annual percent changes (APC) by age group and sex were estimated using joinpoint regression. In 2008, RCV coverage was 51.5% for the first dose and 39.0% for the second dose, increasing to and stabilizing at 95% or above for both doses by 2012. There were 584,758 cases of rubella reported in China during 2004-2023. Joinpoint regression showed that rubella incidence initially increased, peaked in 2008, and then decreased (APC2004-2008=47.12%, APC2008-2023=-18.95%, P<0.05). Adolescents, aged 10-19 years, accounted for 67.8% of cases at a peak incidence in 2019 (APC2016-2019=103.70%, APC2016-2019=-89.76%, P<0.05); 77.8% of cases had no or unknown RCV history. The decrease in rubella incidence is closely associated with vaccination. Nationwide inclusion of RCV significantly impacted on the prevention and control of rubella. Targeted measures to address immunization gaps and maintain high surveillance sensitivity are necessary to promote rubella elimination.

From Paper to Digital: Performance and Challenges of the Electronic Hepatitis B Surveillance System in Ninh Binh, Northern Vietnam (2017-2022).

Hepatitis B remains a major public health issue in Vietnam. Mandatory reporting to the national electronic communicable disease surveillance system (eCDS) has been required since July 2016. We conducted an evaluation of the hepatitis B surveillance system in Ninh Binh, the province with the highest reported burden of hepatitis B in Northern Vietnam, between 2017 and 2022. Using the CDC's guidelines for evaluating public health surveillance systems, we assessed four key attributes: simplicity, timeliness, data quality, and acceptability. This retrospective evaluation included document reviews, analysis of hepatitis B data, and in-depth interviews with provincial-level healthcare staff involved in the reporting of hepatitis B cases. The results showed that the eCDS improved reporting frequency, provided more detailed case information, and enhanced data accessibility compared to the previous paper-based system. However, the system faced several challenges, including unclear objectives, difficulties in distinguishing acute from chronic cases, insufficient training for staff, lack of supervision for data quality, and technical software issues. Despite these challenges, stakeholders found the system acceptable but emphasized the need for improvements, including revising the system's objectives, automating case classification, enhancing training, securing funding for maintenance, and implementing regular data review processes.

Estimating the potential impact of pneumococcal vaccination for new residents entering care homes for older adults in England

BackgroundThe incidence of invasive pneumococcal disease (IPD) increases exponentially in older adults, with very high case fatality rates. In the UK, the 23-valent pneumococcal polysaccharide vaccine (PPV23) is offered to all adults at age 65. PPV23 has moderate vaccine effectiveness against 23 pneumococcal serotypes in older adults, with rapid waning after 5–10 years. The median resident age in care homes for older adults is 86 years, therefore no longer protected by their PPV23 dose, despite increased risk due to advanced age, underlying comorbidities and living in closed settings. We used national surveillance data to estimate the potential impact of vaccinating new care home residents with PPV23 additional to existing national immunisation programme for 65-year-olds. MethodsThe UK Health Security Agency conducts enhanced IPD surveillance in England. National IPD incidence of IPD and care home resident population and life expectancy data were used to calculate the numbers needed to vaccinate (NNV) new care home residents with PPV23 to prevent one IPD case compared to 65-year-olds receiving PPV23 as part of the national immunisation programme. The study did not involve collection of primary data and did not meet the UK Medical Research Council definition of research and therefore no ethical approval was required. Furthermore, UKHSA has legal permission to process confidential information for the purpose of national surveillance of communicable diseases without individual patient consent (Regulation 3 of Health Service Regulations 2002). FindingsIn 2022/23, there were 2574 IPD cases among 603 109 ≥65-year-olds including 1786 (69%) caused by PPV23 serotypes, after correcting for missing serotypes, among confirmed IPD cases. With national vaccine uptake of 71% and PPV23 effectiveness of 36%, the NNV was 3706 to prevent one IPD case in the national immunisation programme for 65-year-olds. Among 121 587 new residents entering English care homes annually, the NNV was 3026. InterpretationVaccinating residents when they enter care homes for older adults with PPV23 has potential to prevent more cases per dose than the national PPV23 programme for 65-year-olds. Pneumococcal conjugate vaccines, such as the recently licensed PCV20, are expected to have higher vaccine effectiveness with longer duration of protection so could prevent even more cases in this vulnerable population. FundingNone.

Preparing for outbreaks of vaccine preventable diseases: why are prisons invisible?

Abstract From 1 March 2023 to 29 February 2024, 30 EU/EEA Member States reported a total of 5 770 cases of measles, 4 864 (84.3%) of which were laboratory-confirmed. Th7e highest number of cases were reported by Romania- at the time of writing, 11,397 confirmed cases, including 12 deaths from 1 January 2023 to 7 April 2024. Measles is a highly infectious disease. The best mitigation is vaccination which is highly effective. Outbreaks in many countries have been driven by decreases in vaccine coverage with a two-dose measles-containing vaccine (MCV), especially evident since the COVID-19 pandemic. In many countries, vulnerable migrant populations, ethnic groups and communities experiencing social deprivation have been over-represented in cases and under-covered by vaccine programmes. We know that prisons contain such populations. Historic seroprevalence studies of prison populations, which themselves are scant, show that prison populations are under-vaccinated. Prisons are a setting that can cause disease amplification. Given these facts, it is perhaps surprising that many countries in Europe cannot provide specific surveillance data on either cases in prisons or vaccine coverage specifically in prison populations. Further, that prisons are not often cited as specific settings for vaccine catch-up programmes in national or regional programmes. This is despite evidence of measles cases and outbreaks historically and currently in several European countries. In the presentation we will ask why this ‘blind spot’ in national and international disease surveillance continues and what Member States could and should do to prevent the risk of mass outbreaks of measles in prisons, causing pressures on justice and health systems and risking wider community outbreaks. Finally, we will reflect on how this experience should alert us to the risk of other infectious diseases going undetected, unprevented, and under-studies in prisons, threatening our collective health security.

The status of violence against children in China, 2013-2021

Objective: This study aims to obtain the prevalence and features associated with Violence Against Children (VAC) in China and, thus, formulate a prevention strategy. Methods: The mortality-related data of VAC was sourced from the National Disease Surveillance Points System (DSP) during 2013-2021. We analyzed the DSP data regarding children aged 0-17 years old who died from violence. The hospital cases of VAC was sourced from the National Injury Surveillance System (NISS), 2013-2021. We analyzed the data from NISS with the parameter of "intentional injury" caused by VAC in children aged between 0-17 years. Using robust linear regression, we analyze the time trend in the proportion of violence incidence. To understand the variations in the incidence of different types of violence across genders, we apply the chi-square test and adjusted Pearson residuals. Results: The overall trend of death caused by VAC has declined; it was reduced to 0.14/100 000 in 2021 from 0.33/100 000 in 2013. In 2021, male VAC mortality (0.15/100 000) was higher than females (0.13/100 000). The proportion of VAC cases to all injury cases has declined from 3.34% in 2013 to 2.29% in 2021. Among 9 344 VAC cases supervised by hospitals in 2021, the number of males (7 503 cases) was around 4 times that of females (1 841 cases), and the top three modes of violence were blunt tools (64.77%), falls (7.46%) and sharp instruments (6.18%), and 45 cases of sexual violence included 38 girls and 7 boys. Conclusions: The declining death rate due to VAC may be related to the benign development of Chinese society. Prevention strategies targeting training in parenting skills and problem-solving should be prioritized.

The HOTspots Digital Surveillance: Conceptualisation to Clinical Deployment.

The HOTspots digital surveillance platform (HOTspots) is a critical technology of the HOTspots Surveillance and Response Program. It provides timely point-of-care access to pathology and demographic data from previously underserved regions. Co-designed with clinicians, epidemiologists, and health policy makers, the platform provides the evidence-base to empower efficient clinical management of patients with antimicrobial resistant (AMR) infections and supports national disease surveillance efforts in Australia. The pathway from conceptualisation to deployment for the HOTspots digital surveillance platform is described.

Healthcare costs and utilisation for diabetes mellitus among hospitalised patients in ireland: the national kidney disease surveillance system

Healthcare costs and utilisation for diabetes mellitus among hospitalised patients in ireland: the national kidney disease surveillance system

Use of routinely collected blood donation data for expanded HIV and Syphilis surveillance in Blantyre district, Malawi.

The World Health Organization recommends that all blood donations be screened for transfusion transmissible infections; these data are currently not incorporated into national disease surveillance efforts. We set out to use routinely collected data from blood donors in Blantyre district, Malawi to explore HIV and syphilis prevalence and identify sero-conversions among repeat donors. We conducted a retrospective cohort analysis of blood donation data collected by the Malawi Blood Transfusion Service from 2015 to 2021. All blood donations were routinely screened for HIV and syphilis. We characterized donor demographics as well as screening outcomes, including identifying sero-conversions among repeat donors who previously tested negative on their last donation. A total of 23,280 donations from 5,051 donors were recorded, with a median frequency of donations of 3 (IQR:2-6). Most donors were male (4,294; 85%) and students (3,262; 64.6%). Prevalence of HIV at first donation was 1.0% (52/5,051) and prevalence of syphilis was 1.6% (80/5,051); 52 HIV sero-conversions and 126 syphilis sero-conversions were identified, indicating an incidence rate per 1,000 person-years of 5.9 (95% CI: 4.7, 7.4) and 13.3 (95% CI:11.4, 15.4) respectively. Students had a lower prevalence of HIV and syphilis but higher risk of syphilis seroconversion. While blood donors are generally considered a low-risk population for HIV and syphilis, we were able to identify relatively high rates of undiagnosed HIV and syphilis infections among donors. Routinely collected data from national blood donation services may be used to better understand local HIV and syphilis epidemiology, with the potential to enhance disease surveillance systems. These findings may be used to identify priority prevention areas and populations in Blantyre district that can inform targeted interventions for improved disease prevention, testing and treatment.

Prevalence and associated factors of TB and HIV coinfections among adult inmates with presumptive pulmonary TB in a Kenyan prison

BackgroundTuberculosis (TB) is more than ten times higher in prisons compared to the general population, and HIV-infected persons are at increased risk of developing active TB and death. In the World Health Organization (WHO) African region, however, where the TB and HIV coinfections are highest, and prisons rarely factored in national disease surveillance, epidemiological data to inform TB control interventions in correctional facilities is limited. In this study, we assessed the prevalence of TB and HIV coinfections, as well as the factors associated with coinfections in our study setting.MethodsThis was a prospective cross-sectional study among 157 adult (≥ 18 years) prisoners presenting with symptoms of pulmonary TB at Shimo La Tewa Prison, Kenya, between January and June 2023. The study excluded those with a history of anti-TB drugs use or on treatment follow-up and collected demographic and clinical characteristics data using a questionnaire. Sputum samples were collected and processed immediately using Xpert® MTB/RIF assay or stored at 4 °C for three (3) days in case of delay.ResultsThe overall prevalence of TB among inmates with presumptive pulmonary TB was 10.2%, 95% CI 6.37–16.91% (16/157), HIV 19.1%, 95% CI 13.73–25.97% (30/157). All the TB cases were positive for HIV (16/16, 100%), translating to TB/HIV coinfection of 10.2%, 95% CI 6.37–16.91% (16/157), and there was no rifampicin resistance. TB and HIV coinfection cases were found among underweight (100%, 16/16) prisoners. The independent factors associated with TB and HIV coinfections were education level (adjusted OR = 0.17, p = 0.007), smoking history (adjusted OR = 3.01, p = 0.009) and illegal drug use history (adjusted OR = 4.55, p = 0.044).ConclusionWe report a high prevalence of pulmonary TB and HIV coinfections among adult inmates with presumptive pulmonary TB in Kenya, with education level, smoking status, and illegal drug use as the independent factors associated with the coinfection. The authority should take measures to protect HIV-positive prisoners from TB, focusing on education, nutrition, smoking, and illegal drug use.

National age-specific mortality trends for cervical and breast cancers in urban–rural areas of China from 2009 to 2021: a population-based analysis

BackgroundCervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women. This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021.MethodsAge-specific mortality data for cervical and breast cancers among Chinese women aged 20–84 years were obtained from China’s National Disease Surveillance Points system spanning the years 2009 to 2021. Negative binomial regression models were utilized to assess urban–rural differences in mortality rate ratios, while Joinpoint models with estimated average annual percent changes (AAPC) and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups.ResultsFrom 2009 to 2021, there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas. A rising trend in the screening age of 35–64 [AAPC: 4.0%, 95% confidence interval (CI) 0.5–7.6%, P = 0.026] for cervical cancer was noted in rural areas, while a stable trend (AAPC: − 0.7%, 95% CI − 5.8 to 4.6%, P = 0.78) was observed in urban areas. As for breast cancer, a stable trend (AAPC: 0.3%, 95% CI − 0.3 to 0.9%, P = 0.28) was observed in rural areas compared to a decreasing trend (AAPC: − 2.7%, 95% CI − 4.6 to − 0.7%, P = 0.007) in urban areas. Urban–rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer. Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments, with the most significant surge in mortality observed among the 35–54 age group across urban and rural areas, periods, and regions in China.ConclusionsSpecial attention should be given to women aged 35–54 years due to mortality trends and rural–urban disparities. Focusing on vulnerable age groups and addressing rural–urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.

COVID-19 Vaccine Effectiveness and Digital Pandemic Surveillance in Germany (eCOV Study): Web Application-Based Prospective Observational Cohort Study.

The COVID-19 pandemic posed significant challenges to global health systems. Efficient public health responses required a rapid and secure collection of health data to improve the understanding of SARS-CoV-2 and examine the vaccine effectiveness (VE) and drug safety of the novel COVID-19 vaccines. This study (COVID-19 study on vaccinated and unvaccinated subjects over 16 years; eCOV study) aims to (1) evaluate the real-world effectiveness of COVID-19 vaccines through a digital participatory surveillance tool and (2) assess the potential of self-reported data for monitoring key parameters of the COVID-19 pandemic in Germany. Using a digital study web application, we collected self-reported data between May 1, 2021, and August 1, 2022, to assess VE, test positivity rates, COVID-19 incidence rates, and adverse events after COVID-19 vaccination. Our primary outcome measure was the VE of SARS-CoV-2 vaccines against laboratory-confirmed SARS-CoV-2 infection. The secondary outcome measures included VE against hospitalization and across different SARS-CoV-2 variants, adverse events after vaccination, and symptoms during infection. Logistic regression models adjusted for confounders were used to estimate VE 4 to 48 weeks after the primary vaccination series and after third-dose vaccination. Unvaccinated participants were compared with age- and gender-matched participants who had received 2 doses of BNT162b2 (Pfizer-BioNTech) and those who had received 3 doses of BNT162b2 and were not infected before the last vaccination. To assess the potential of self-reported digital data, the data were compared with official data from public health authorities. We enrolled 10,077 participants (aged ≥16 y) who contributed 44,786 tests and 5530 symptoms. In this young, primarily female, and digital-literate cohort, VE against infections of any severity waned from 91.2% (95% CI 70.4%-97.4%) at week 4 to 37.2% (95% CI 23.5%-48.5%) at week 48 after the second dose of BNT162b2. A third dose of BNT162b2 increased VE to 67.6% (95% CI 50.3%-78.8%) after 4 weeks. The low number of reported hospitalizations limited our ability to calculate VE against hospitalization. Adverse events after vaccination were consistent with previously published research. Seven-day incidences and test positivity rates reflected the course of the pandemic in Germany when compared with official numbers from the national infectious disease surveillance system. Our data indicate that COVID-19 vaccinations are safe and effective, and third-dose vaccinations partially restore protection against SARS-CoV-2 infection. The study showcased the successful use of a digital study web application for COVID-19 surveillance and continuous monitoring of VE in Germany, highlighting its potential to accelerate public health decision-making. Addressing biases in digital data collection is vital to ensure the accuracy and reliability of digital solutions as public health tools.

Liver cancer in China: the analysis of mortality and burden of disease trends from 2008 to 2021

BackgroundLiver cancer is one of the most common cancers in China. To understand the basic death situation and disease burden change trend, we analyze the death information of liver cancer among Chinese residents from 2008 to 2021.MethodsData was collected from the Cause-of-Death Surveillance dataset of the National Cause-of-Death Surveillance System from 2008 to 2021. Excel 2016 was used for data entry and to calculate the Crude Mortality Rate (CMR), Age-Standardized Mortality Rate (ASMR), Potential Years of Life Lost (PYLL), and Potential Years of Life Lost Rate (PYLLR). SPSS 25.0 was used to statistically analyze CMR, ASMR, PYLL, and other indicators. Annual percent change (APC) and average APC(AAPC) was used for trend analysis and tested by t tests. Joinpoint 4.9.1.0 was used to calculate APC and AAPC. Age-Period-Cohort model was used to assess the effects of age, period, and birth cohort on liver cancer mortality.ResultsFrom 2008 to 2021, 491,701 liver cancer deaths were reported in the National Disease Surveillance Points System. The ASMR of liver cancer in Chinese residents decreased from 27.58/100,000 in 2008 to 17.95/100,000 in 2021 at an average annual rate of 3.40% (t = -5.10, P < 0.001). The mortality rate was higher in males than in females (all P < 0.001) and higher in rural areas than in urban areas (all P < 0.001). The mortality rate of liver cancer varied significantly among eastern, central, and western China (all P < 0.001). The PYLLR of liver cancer in Chinese residents decreased from 2.89‰ in 2008 to 2.06‰ in 2021 at an average annual rate of 2.40% (t = -5.10, P < 0.001). Males had a lower PYLLR than females, decreasing at average annual rates of 2.20% (t = -5.40, P < 0.001) and 2.90% (t = -8.40, P < 0.001), respectively. Urban areas had a lower PYLLR than rural areas, decreasing at average annual rate of 3.30% (t = -4.00, P < 0.001) and 2.50% (t = -11.60, P < 0.001), respectively. Eastern, central, and western China decreased at average annual rates of 3.40%, 2.30%, and 2.10%, respectively (t = -7.80, -3.60, -7.10, P < 0.001 for all). The risk of China liver cancer mortality increased with age, decreased with birth cohort.ConclusionsThe mortality and disease burdens of liver cancer in China decreased yearly and were higher in males and in people living in rural areas, with significant differences among those living in eastern, central, and western China.

The impact of COVID-19 vaccination on the risk of hospitalization in Fayoum healthcare workers

Background: Healthcare workers (HCWs) face several challenges including treating COVID-19 patients. The immunization of the population through vaccination is recognized as a public health priority. The aim of the study is to assess the impact of vaccination on the risk of hospitalization and mortality in HCWs due to COVID-19 infection. Methods: This study was conducted in Egypt in El Fayoum governorate on the HCWs from April 2021 to the end of the year 2021. A cohort retrospective approach was carried out using (the national electronic disease surveillance system) NEDSS and COVID-19 vaccine registration system. Hospitalization is determined by assessment of the cases according to the protocol of COVID-19 management of MOHP November 2020. Results: There was no association between hospitalization and both sex and residence (p=0.1, and 0.06 respectively). There was no statistical significant association between hospitalization and vaccination (time, status, or type). The p=0.2, 0.6, and 0.07 respectively. Age and the presence of comorbidities were statistically significant predictors with p=0.004 and 0.04, respectively, as increasing age and the presence of comorbidities will increase the likelihood of hospitalization by 1.04 and 1.9 folds, respectively. Conclusions: This study shows no significant association between vaccination and hospitalization of HCWs.

The characteristics and risk factors of fatal falls among adults aged 60 and above in Southwest China

Falls constitute a leading cause of unintentional injury deaths among older adults. This study aimed to examine the comprehensive characteristics of fatal falls among older individuals in Yunnan Province, China, to highlight the challenges faced in elderly care. A total of 22,798 accidental fall-related deaths were extracted from China's National Disease Surveillance Points System aged 60 and above between 2015 and 2019. Quantitative and textual data were analyzed to assess the incidence rates of initiating factors, locations, symptoms, and overall survival (OS) outcomes after falling. Hypertension emerged as the most significant intrinsic factor, especially among individuals aged between 70 and 79, female older adults, and urban residents (P < 0.001). Home was identified as the most common location where fatal falls occurred (61.19%). The head was the most commonly injured body region (58.75%). The median of OS for all fatal falls was 2 days (0.13, 30), of which deaths occurred within 24 h [9287 (49.36%)]. There were instances where timely discovery after falling did not occur in 625 cases; their median of OS was significantly shorter compared to those discovered promptly after falling (P < 0.001). Targeted interventions focusing on fall prevention and post-fall care are equally crucial for the well-being of older adults.

Epidemiologic changes of a longitudinal surveillance study spanning 51 years of scrub typhus in mainland China

Scrub typhus may be one of the world’s most prevalent, neglected and serious, but easily treatable, febrile diseases. It has become a significant potential threat to public health in China. In this study we used national disease surveillance data to analyze the incidence and spatial–temporal distribution of scrub typhus in mainland China during 1952–1989 and 2006–2018. Descriptive epidemiological methods and spatial–temporal epidemiological methods were used to investigate the epidemiological trends and identify high-risk regions of scrub typhus infection. Over the 51-year period, a total of 182,991 cases and 186 deaths were notified. The average annual incidence was 0.13 cases/100,000 population during 1952–1989. The incidence increased sharply from 0.09/100,000 population in 2006 to 1.93/100,000 population in 2018 and then exponentially increased after 2006. The incidence was significantly higher in females than males (χ2 = 426.32, P < 0.001). Farmers had a higher incidence of scrub typhus than non-farmers (χ2 = 684.58, P < 0.001). The majority of cases each year were reported between July and November with peak incidence occurring during October each year. The trend surface analysis showed that the incidence of scrub typhus increased gradually from north to south, and from east and west to the central area. The spatial autocorrelation analysis showed that a spatial positive correlation existed in the prevalence of scrub typhus on a national scale, which had the characteristic of aggregated distribution (I = 0.533, P < 0.05). LISA analysis showed hotspots (High–High) were primarily located in the southern and southwestern provinces of China with the geographical area expanding annually. These findings provide scientific evidence for the surveillance and control of scrub typhus which may contribute to targeted strategies and measures for the government.

How difficult is it to diagnose and report an occupational disease in a developing country? A modified delphi study

Aim: The roles of occupational medicine specialists are very important in the diagnosis and notification of occupational diseases. In this regard, the opinions of the parties are needed to identify the problems and propose solutions. Methods: This is a Modified Delphi exercise. It was conducted through an online survey in 2 rounds in Turkey between June 4, 2021 and August 31, 2021. The population of the research consists of occupational medicine specialists and sub-branch students in Turkey and some physicians working in the central organizational units of the Ministry of Health and the Ministry of Labor and Social Security regarding the diagnosis, registration and notification of occupational diseases. In both rounds, e-mails were sent to 127 people. The survey was sent via , and the response frequency was 27.5% and 18.1% in rounds 1 and 2, respectively. A survey form was created for the second round by evaluating the open-ended information obtained as a result of the first round using the thematic analysis method and making suggestions. This form was sent to participants via e-mail and questions were asked about participation in the proposals in the second round. Proposals with 70% or more participation were accepted unanimously. Results: The most important difficulties regarding the diagnosis and details of occupational diseases are; The lack of a national occupational disease surveillance system, the fact that the current occupational disease diagnosis and summary system is focused on pricing, and the difficulties people experience in diagnosis were determined. Conclusion: In order to increase the reporting of occupational diseases, a surveillance-oriented system should be switched instead of a compensation-based system. In addition, the deficiencies in manpower, financing, technical infrastructure and legislation in the occupational disease reporting system need to be rapidly revised.

First report of a Kudoa lutjanus outbreak in farmed Chicken Grunts Parapristipoma trilineatum.

As part of the National Disease Surveillance Program for Taiwanese Aquaculture, we investigated the causative agent of disease outbreaks in farmed Chicken Grunts Parapristipoma trilineatum. In this study, outbreak cases on two separate farms were noticed in coastal Pingtung County, Taiwan. In total, 50 juvenile fish showing clinical signs (such as emaciation and erratic swimming behavior) and broodstock (two females and two males) from both farms were collected to perform gross lesion assessment, histopathological examination, and molecular identification of the pathogen. Clinical symptoms were infected fish exhibited erratic swimming behavior, such as whirling and floating on the surface of the water. In the following months, cumulative mortality had reached 19% and 24%, respectively. The gross lesions in the infected fish included white oval cysts in the muscle, serosa of the internal organs, sclera of the eyes, and cerebral meninges. After conducting a wet mount examination of cysts using a light microscope, we observed a significant quantity of spores with morphological characteristics, suggesting their affiliation with the Myxosporea group. The spores were semiquadrate, with four tiny suture notches at the periphery; the mean spore length was 7.3 μm (SD = 0.5), and the mean spore width was 8.2 μm (SD = 0.6). The mean length and width of the pyriform polar capsules (nematocysts) were 3.6 μm (SD = 0.5) and 2.2 μm (SD = 0.5), respectively. The 18S and 28S ribosomal RNA sequences of these specimens were identical to those of Kudoa lutjanus. As this was the first time an outbreak of K. lutjanus in Chicken Grunts was confirmed, its reappearance with substantial mortality should serve as a warning to the aquaculture industry.