National Public Health Institute Research Articles

TBE In Czech Republic

The TBE virus (TBEV) was first isolated in the Czech Republic by a Czech scientist in 1948-1949 from both a patient and also from Ixodes ricinus ticks.1 However, even before 1948, etiologically unclear summer cases of viral meningoencephalitis had been reported, and likely, at least in part, they are attributable to the TBEV. These cases were reported mostly from patients in the districts of Beroun (Central Bohemia), Hradec Králové (East Bohemia), Vyškov (South Moravia), and occasionally from the neighborhood of Prague. The official reports of these probable cases of “tick-borne encephalitis” were registered in the database of the National Institute of Public Health in Prague since 1945.

Botulism Cases in Romania-An Overview of 14-Year National Surveillance Data.

Botulism is a priority disease worldwide because it has a very severe course of evolution that can lead to death. This paper aims to describe the main epidemiological characteristics of botulism cases confirmed in Romania over 14 years (2007-2020). We performed a retrospective study using the publicly available national surveillance data and reported to the National Institute of Public Health. A total of 325 cases of foodborne botulism were reported in Romania, with no infant or wound botulism. Most of the cases (125, 38.5%) were reported among young adults (25-44 years old), over half (205, 63%) of them living in rural areas. The incriminated food item was identified in 161 cases; in most cases (145, 90%) the food item was prepared in the household. The main food category was represented by meat and meat-based products (94, 68.6%). In almost all cases the identified type was BoNT/B (230/231, 99.5%). Fifteen deaths were recorded, and the case fatality rate was 4.6%. Botulism cases were reported annually in Romania. Surveillance data are essential for implementing control measures and adapting educational campaigns according to existing needs.

The future of public health doctoral education in Africa: transforming higher education institutions to enhance research and practice.

The African Union and the Africa Centers for Disease Control and Prevention issued a Call to Action in 2022 for Africa's New Public Health Order that underscored the need for increased capacity in the public health workforce. Additional domestic and global investments in public health workforce development are central to achieving the aspirations of Agenda 2063 of the African Union, which aims to build and accelerate the implementation of continental frameworks for equitable, people-centred growth and development. Recognising the crucial role of higher education and research, we assessed the capabilities of public health doctoral training in schools and programmes of public health in Africa across three conceptual components: instructional, institutional, and external. Six inter-related and actionable recommendations were derived to advance doctoral training, research, and practice capacity within and between universities. These can be achieved through equitable partnerships between universities, research centres, and national, regional, and global public health institutions.

National public health institutes in the Eastern Mediterranean Region: Insights from experts in the field

National public health institutes (NPHIs) are crucial to the effectiveness of public health systems, including delivering essential public health functions and generating evidence for national health policies, strategies and plans....

Development of a workforce self-assessment tool for public health emergency preparedness.

In collaboration with six European public health agencies as part of the PANDEM-2 consortium, we have developed and validated a self-assessment tool that captures the workforce capacities and capabilities needed at the institutional level within National Public Health Institutes (NPHIs) to deal with public health emergencies. The work carried out in this study included (i) a review of existing tools for workforce assessment, (ii) focus group discussions and interviews to map the experiences and needs of NPHI's, (iii) the development of a tool for NPHI's to assess their workforce capacity and capabilities in public health emergency preparedness (PHEP) and (iv) refinement of the assessment tool via a Delphi study. Capacity markers were identified to assess the workforce required for PHEP functions and the availability of surge capacity during a public health emergency. The tool also enables NPHIs to analyze gaps in PHEP staff competencies. The assessment scores can assist NPHI pandemic preparedness by identifying and prioritizing training and recruitment needs. In line with EU Regulation 2022/2371 on serious cross-border threats to health, article 11 Training of healthcare staff and public health staff, Member States (MS) are tasked with assessing current workforce capacity and capability gaps. The PANDEM-2 workforce self-assessment tool aligns with this requirement and will support effective planning and development to strengthen the public health workforce capacity in EU MS.

COVID-19 isolation and quarantine orders in Berlin-Reinickendorf (Germany): How many, how long and to whom?

Isolating COVID-19 cases and quarantining their close contacts can prevent COVID-19 transmissions but also inflict harm. We analysed isolation and quarantine orders by the local public health agency in Berlin-Reinickendorf (Germany) and their dependence on the recommendations by the Robert Koch Institute, the national public health institute. Between 3 March 2020 and 18 December 2021 the local public health agency ordered 24 603 isolations (9.2 per 100 inhabitants) and 45 014 quarantines (17 per 100 inhabitants) in a population of 266 123. The mean contacts per case was 1.9. More days of quarantine per 100 inhabitants were ordered for children than for adults: 4.1 for children aged 0-6, 5.2 for children aged 7-17, 0.9 for adults aged 18-64 and 0.3 for senior citizens aged 65-110. The mean duration for isolation orders was 10.2 and for quarantine orders 8.2 days. We calculated a delay of 4 days between contact and quarantine order. 3484 contact persons were in quarantine when they developed an infection. This represents 8% of all individuals in quarantine and 14% of those in isolation. Our study quantifies isolation and quarantine orders, shows that children had been ordered to quarantine more than adults and that there were fewer school days lost to isolation or quarantine as compared to school closures. Our results indicate that the recommendations of the Robert Koch Institute had an influence on isolation and quarantine duration as well as contact identification and that the local public health agency was not able to provide rigorous contact tracing, as the mean number of contacts was lower than the mean number of contacts per person known from literature. Additionally, a considerable portion of the population underwent isolation or quarantine, with a notable number of cases emerging during the quarantine period.

National COVID-19 preparedness and response plans: a global review from the perspective of services for maternal, newborn, child and adolescent health and older people

IntroductionInfectious disease outbreaks have historically led to widespread disruptions in routine essential health services. Disruptions due to COVID-19 responses led to excess deaths, including among women and children. This review...

Bibliometric analysis of peer-reviewed literature on perinatal depression in Mexico

Background. Perinatal depression (PND) is a clinical disease developed in any stage during the pregnancy and postpartum period with serious health and economic implications. Objective. The aim of this work was to analyze via bibliometrics indicators Mexico’s production on PND to provide a view of the academic landscape and a comprehensive reference for subsequent research in the country. Method. The Scopus and Web of Science (WoS) databases were used to perform a search for peer reviewed papers related to PND in México. The search was made following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The extracted data were processed with VOS Viewer to examine link strength and clusters associations of diverse bibliometrics variables. Results. A total of 132 records were retrieved and we included 70 studies in the bibliometric analysis after application of the exclusion criteria. The authors with more papers were Navarrete L., and Asunción Lara M. The institutions with more papers were the National Institute of Perinatology, Ramón de la Fuente National Institute of Psychiatry, and National Institute of Public Health of Mexico. A diminution of the research considered in PND is observed in the last two years. Four keyword clusters were identified related to PND: symptoms, prevalence, pregnancy. Discussion and conclusion. The scarce literature concerning PND in Mexico compared with other countries could be due the limited collaboration between the health institutes. An urgent need to increase research on PND in Mexico is evident to be applicable in the management of resources in the healthcare system.

Establishing Regional Centers of Excellence: Capacity Assessment of Fully-Established National Public Health Institutes in Africa

Establishing Regional Centers of Excellence: Capacity Assessment of Fully-Established National Public Health Institutes in Africa

Lobar pneumonia in a 3-year-old boy with a several-day history of influenza-like symptoms – a case report

Influenza is an acute viral respiratory disease, which is particularly common in the paediatric population. Every year it affects about 25% of children. According to the National Institute of Public Health – National Institute of Hygiene, almost three times as many cases of influenza were registered in the 2022/2023 infectious season compared to previous years. However, in the era of the influenza epidemic, diagnostic vigilance should be maintained, keeping in mind that the symptoms of some serious bacterial infections may initially mimic those of influenza. We present a case report of a 3-year-old boy with influenza-like symptoms, who was finally diagnosed with lobar pneumonia complicated by parapneumonic effusion. Early diagnosis and treatment spared the patient from invasive treatment for complications of pneumonia.

Tackling health emergencies in complex settings: the role of national public health institutes in the Eastern Mediterranean region

Tackling health emergencies in complex settings: the role of national public health institutes in the Eastern Mediterranean region

Prevalence of mental disorders and high rates of absenteeism from work among healthcare professionals in Slovenia: a retrospective study

ObjectivesTo investigate the prevalence of mental disorders and the higher rates of absenteeism from work among healthcare workers employed in Slovenia by analysing the prevalence of sick leave and medication...

Influence of air pollution on NSTEMI incidence and acute coronary syndrome mortality - the 10-year community-level analysis including 80 million patient-years. EP-PARTICLES study

Abstract Introduction During the last years, air pollution has emerged as an important modifiable cardiovascular risk factor. Most research focused on heavy-polluted agglomerations and big cities, neglecting its influence on cardiovascular health in smaller cities and villages. Purpose The study aimed to assess the spatio-temporal trends and the influence of air pollution on the non-ST-elevation myocardial infarction (NSTEMI) incidence and acute coronary syndrome (ACS) mortality in an urban and rural environment. Moreover, the study aimed to investigate whether there is a connection between the influence of air pollution on hospitalization and cause-specific mortality. Methods The analysis included data on 7 main air pollutants in 709 communities in Eastern Poland in 2011-2020. Mortality data were obtained from National Health Fund and daily air pollution concentrations for each community were obtained from National Public Health Institute. Time-stratified panel data Poisson regression techniques were used. The influence of each air pollutant was analysed at a single-day lag (0-6 days) and multi-day lag (0-1, 0-6, 0-30 days) and presented as an odds ratio (OR) with a 95% confidence interval (CI) for an increase in 10 μg/m3. Results Incidence of NSTEMI was associated with exposition to benzo-a-pyrene (BaP) on all analysed lag patterns (OR 1.121, 95% CI 1.075-1.168 for lag 0, OR 1.241, 95% CI 1.169-1.317 for lag 0-30) and to particulate matter with a diameter of <10 and <2.5 μm (PM10, PM2.5), CO and NO2 on the most of analysed lag patterns (OR 1.01, 95% CI 1.005-1.015 for PM10 on lag 0, OR 1.013, 95% CI 1.007-1.02 for PM2.5 on lag 0, OR 1.017, OR 1.002, 95% CI 1.001-1.003 for CO on lag 0, 95% CI 1.007-1.028 for NO2 on lag 0). O3 and SO2 had a protective influence on NSTEMI incidence on longer lags (OR 0.984, 95% CI 0.977-0.992 for O3 on lag 0-30, OR 0.978, 95% CI 0.963-0.993 for SO2 on lag 5) Mortality due to the ACS was associated with an increase in NO2 and CO concentrations on all lag patterns (OR 1.03, 95% CI 1.02-1.04 for NO2 on lag 0, OR 1.089, 95% CI 1.068-1.11 for NO2 on lag 0-30, OR 1.003, 95% CI 1.002-1.004 for CO on lag 0, OR 1.089, 95% CI 1.068-1.11 for CO on lag 0-30). PMs concentrations had a protective effect on ACS mortality on all lag patterns (OR 0.971, 95% CI 0.966-0.976 for PM10 on lag 0, OR 0.964, 95% CI 0.958-0.971 for PM2.5 on lag 0). Conclusions An increase in most of the major air pollutants concentrations have an influence on NSTEMI incidence. Different lag patterns for air pollutants suggest various mechanisms of detrimental effect. Cause-specific mortality analysis showed the results mostly opposite to incidence analysis. It suggests that a high rate of garbage codes may prevent high-quality population analysis focusing on cause-specific mortality. The development of air quality monitoring stations and the correct use of ICD-10 diagnoses may be crucial in drawing important conclusions from environmental studies.

The state of integrated disease surveillance in seven countries: a synthesis report

ObjectivesIntegrated disease surveillance (IDS) offers the potential for better use of surveillance data to guide responses to public health threats. However, the extent of IDS implementation worldwide is unknown. This study sought to understand how IDS is operationalized, identify implementation challenges and barriers, and identify opportunities for development. Study designSynthesis of qualitative studies undertaken in seven countries. MethodsThirty-four focus group discussions and 48 key informant interviews were undertaken in Pakistan, Mozambique, Malawi, Uganda, Sweden, Canada, and England, with data collection led by the respective national public health institutes. Data were thematically analysed using a conceptual framework that covered governance, system and structure, core functions, finance and resourcing requirements. Emerging themes were then synthesised across countries for comparisons. ResultsNone of the countries studied had fully integrated surveillance systems. Surveillance was often fragmented, and the conceptualization of integration varied. Barriers and facilitators identified included: 1) the need for clarity of purpose to guide integration activities; 2) challenges arising from unclear or shared ownership; 3) incompatibility of existing IT systems and surveillance infrastructure; 4) workforce and skills requirements; 5) legal environment to facilitate data sharing between agencies; and 6) resourcing to drive integration. In countries dependent on external funding, the focus on single diseases limited integration and created parallel systems. ConclusionsA plurality of surveillance systems exists globally with varying levels of maturity. While development of an international framework and standards are urgently needed to guide integration efforts, these must be tailored to country contexts and guided by their overarching purpose.

Providing strategic information during a public health emergency: lessons learned during the COVID-19 pandemic in Germany

Background:Timely strategic information is essential for decision makers to mount an effective public health response to infectious disease outbreaks, and public health actors must find an effective way to supply it. The Centre for International Health Protection at the Robert Koch Institute (Germany’s national public health institute) developed a three-pronged approach to processing and supplying strategic information on the international state of the COVID-19 pandemic to the German Federal Ministry of Health: monitoring and analysis of international public health and social measures (PHSM); screening, validating, analysing and reporting the global epidemiological situation; and in-depth analyses and syntheses of COVID-19 evidence. Aims and objectives:We discuss the approach taken by the Centre to provide strategic information and challenges and adaptations during the information provision process. We then distil lessons that will be critical to improve strategic information provision for evidence-informed decision making in future public health emergencies. Key conclusions:Several lessons can be derived from the Centre’s experience. Timeliness of evidence is essential for enabling decision makers to tailor a public health response to an outbreak, and requires sufficient and skilled staff to process evidence. Evidence formats should be adapted to decision makers’ information needs; this requires open channels of communication to understand needs. Access to high-quality international data hinges on data sharing across countries and the capacity to collect and process such data in many countries. Heeding the lessons will strengthen pandemic response.

Functional National Public Health Institutes are critical for the health security of Africa

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2.E. Workshop: Cross-sectoral action on climate change and health: Insights from national public health institutes

Abstract Climate change poses a significant threat to health and wellbeing worldwide and requires urgent action. The World Health Organization's COP26 report, ‘The Health Argument for Climate Action’, underscores the broad range of health impacts that countries already face, such as death and illness from increasingly frequent extreme weather events, increases in food-, water- and vector-borne diseases, and mental health issues (WHO, 2021). Addressing this complex challenge, however, offers an opportunity for progress towards better planetary health. National Public Health Institutes (NPHIs) play a valuable role in promoting the health and wellbeing of populations and are well-positioned to address the nexus of climate change and health, given their expertise in surveillance and monitoring, research and emergency response, and providing evidence-based recommendations to policymakers. The purpose of this workshop is to share concrete examples of ongoing efforts, challenges, and experiences by NPHIs related to climate change, health, and adaptation and mitigation measures. The objectives of the workshop are: to highlight the “health argument” for addressing climate change, as promoted by the World Health Organization; to showcase the cross-sectoral nature of NPHIs’ work; and to inspire other actors and stakeholders to consider how they could integrate and address climate change and health in their own disciplines, including also biodiversity loss, and related planetary health issues. We will cover examples spanning NPHIs’ engagement and support for cross-sectoral collaboration, forming effective networks to facilitate coordination, and ensuring health is at the centre of climate policies and actions. The workshop will feature presentations by NPHIs from France (Santé publique France), Germany (Robert Koch Institute), and the Netherlands (National Institute for Public Health and the Environment) as well as a presentation by the European Climate and Health Observatory. The perspective of the European Climate and Health Observatory offers Europe-wide insights as a provider of tools and knowledge that support actions from NPHIs and other health actors. The format of the workshop will be informative and interactive, with opportunity for Q&A and a discussion with the audience. By showcasing the role of NPHIs and the European Climate and Health Observatory, the workshop aims to increase awareness and understanding of the importance of applying a public health lens as a key component of climate change and health strategies. In conclusion, this workshop offers a unique opportunity to highlight how national and global actors engage in cross-sectoral efforts tackling climate change and ensuing health impacts that, in turn, may motivate other health actors, including those taking part in the workshop, to take essential action to promote planetary health. Key messages • Cross-sectoral collaboration is essential to tackle the health impacts of climate change. • NPHIs can offer examples to other health actors on how to integrate climate mitigation and adaptation efforts in their work and how to integrate health into climate measures in other sectors.

The Robert Koch Institute's cross-sectoral efforts to address climate change and health

Abstract The Robert Koch Institute (RKI) is Germany's national public health institute (NPHI). It recognises that climate change poses a significant threat to the health and wellbeing of people and that as an NPHI it has an important role to play. To reflect this, we have been strengthening our work on climate change and health in the institute, particularly in the last 18 months, guided by the “IANPHI Roadmap for Action on Health and Climate Change” amongst other resources. At the RKI, we see that our contribution on climate change and health is part of efforts together with an extensive landscape of actors, each with their own disciplinary and sector-specific expertise and resources. We have therefore been exploring our possible sector-specific contribution and further developing our cross-sectoral working in line with the institute's strategy for climate change and health. The RKI is also already underway with specific cross-sectoral exchange and projects on climate change and health. This includes taking part in the cross-sectoral German national agencies’ network on climate adaptation, carrying out a comprehensive and ambitious situation report on the evidence base on climate change and health in Germany, as well as through a cross-sectoral programme to develop new measurable climate adaptation goals as part of the German Adaptation strategy for Climate Change. This presentation will share how the RKI is developing and implementing its cross-sectoral contribution on climate change and health, and will include some lessons learnt and suggestions for how other health actors might be able to apply this learning for their own work. The presentation aims to: • illustrate how cross-sectoral work can be implemented and how use of the “health argument” can help with this; • stimulate thinking on how other health actors, including in the audience, might be able to engage in cross-sectoral working in their own fields and organisations.

Negotiating healthy food retail initiatives: An ethnographic study of a partnership with supermarkets

Abstract Background The health promotion literature advocates for partnerships with private actors, but scholars have called for detailed knowledge on the development of interventions in studies using such co-approaches. This study aims to increase our understanding of how such partnerships influence intervention development and content. In 2019, researchers at the National Institute of Public Health, Denmark, established a partnership with the food retailer Salling Group and the Danish Cancer Society, which will be the case used in this study. The vision of the partnership was to develop and test healthy food retail initiatives to make the healthy choice the easy choice for customers. Methods We performed a focused ethnographic study from the initiation of the partnership (2019) until the feasibility test of the initiatives (2021). We used participant observation of meetings and intervention development activities, interviews with partners, and document analysis of e-mail correspondences and project materials. We analysed data abductively with inspiration from a chronological narrative analytical approach and concepts of partnerships, negotiation, and institutional logics. Findings We identified six phases of the development process, characterized by randomness, compromises, fear, conflicting logics, and unforeseen events. We show how 1) a random meeting and initial verbal agreements between a few persons affect the mindset and decision-making of the partners, 2) conflicting logics can both hinder and facilitate the development of initiatives, and 3) the process is shaped by unforeseen events i.e., Covid-19 restrictions, and organisational changes. Conclusions This study highlights how fragile public-private partnerships are and the significance of each step taken. To succeed with effective health promotion in the retail setting partnerships may benefit from being flexible and investing time in forming a shared understanding based on discussions of different perspectives. Key messages • Partnerships between academics and non-academics are fragile and unpredictable. • Negotiation of healthy food retail initiatives is facilitated and hindered by differences in institutional logics.

Alarming issue of suicides and their indirect costs in Slovenia

Abstract Background Suicides represent a major public health problem and a heavy burden on healthcare systems. Suicide is not a disease, but it can be the final result of various diseases and conditions, including various mental illnesses (depression, psychosis, etc.) as well as alcohol and drug addiction. High premature mortality due to suicide has social and economic consequences for society. The purpose of the present study was to analyze for the first time in Slovenia the partial indirect costs of suicide, on average, for the period from 2008 to 2019. Methods At the Slovenian National Institute of Public Health we analyzed the lost income from work due to suicide based on routine health data of the deceased, for the period from 2008 to 2019. The study was conducted in collaboration with the Faculty of Economics of the University of Ljubljana. The National Transfer Accounts (NTA) methodology was used. The estimated economic costs of suicide were based on the calculation of indirect costs, which are related to lost productivity due to death. Results Partial indirect costs due to suicide amounted to EUR 8.2 million on average or around 0.2% of all healthcare expenditures, which amounts to 0.02% of gross domestic product in the studied period. Lost income from work due to death amounted to EUR 4.8 million, and unpaid household work lost due to death amounted to EUR 3.4 million, as an annual average for the period 2008-2019. Conclusions The range of indirect and direct costs, also from the point of view of various mental illnesses should be included in the calculation in the future, a list of selected illnesses prepared and the available resources and their limitations showed. By including additional economic costs, the burden of suicide would certainly be higher. Key messages • Suicide prevention must be the national priority in Slovenia. • By treating the diseases that can lead to suicide, the number of suicides and the direct and indirect costs could be partially lowered.