National Public Health Agencies Research Articles

The INPHET- a global approach to Environmental Public Health Tracking

Abstract Environment and health monitoring and information systems are fundamental infrastructure for evidence provision for policy making. The International Network for Public Health and Environment Tracking (INPHET) was formed by a community of environmental public health practitioners to address common interests and activities that advance environmental public health surveillance (EPHS) and data systems, and their uses to inform public health actions. Its main goal is to address the vast inequalities across countries and communities in their ability to monitor, assess, inform and mitigate environmental and health issues. INPHET supports the relevant role of environmental epidemiology as the pillar science providing evidence for decision making and interventions aiming at reducing and preventing environmental related diseases and contributes to an overall vision for public health. As a “Community of Practice”, INPHET focuses on sharing experiences and expertise; addressing common challenges for implementing and enhancing the science of EPHS/tracking; improving understanding of the link between the environment and health; and providing the appropriate evidence that informs public policy. The network, initiated in conference meetings in 2012-13 and formally launched in Modena, Italy in 2014, has carried out several activities which aim at sharing expertise and learning from different models of environmental and health data integration and surveillance systems that directly inform policy. These include Twinning cooperation with Euro-Asian and Balkan countries and sharing of expertise with African Public Health Agencies. Some experiences are presented in this workshop and highlight the EPHS/EPHT model adopted by several national public health agencies. It promotes that such integration and uses of environmental and health data is key for EPHS, including their accessibility and usability for communities of public health researchers, practitioners and policy makers.

Evolution of online health-related information seeking in France from 2010 to 2023

Abstract Background Given the rapid ongoing progression of the internet and increase in health information available online since 2010, it is important to understand how these changes impact online health information-seeking behaviour of the population and the way of managing one’s health. This study aims to describe the evolution of the use of internet to seek health-related information as well as the characteristics of online health information seekers. Methods We used data from the French nationally representative surveys Health Barometers. It is a cross-sectional repeated survey of random representative samples of the French population conducted by the French national public health agency since 1992 using computer-assisted telephone interviewing. It serves to measure the evolution of key indicators regarding health-related behaviors, attitudes, and opinions in the general population and includes individuals aged 18-75 years old selected through randomly generated phone numbers. In the 2010, 2014, 2017 and 2023 editions, the same question was asked about the internet use as a source of health information. Evolutions over time were assessed using chi-square tests. Associations with sociodemographic characteristics and health status were evaluated using logistic regression models. Results Although internet access increased steadily during this period, from 72.8% in 2010 to 95.2% in 2023, the use of the internet as a source of health information rose between 2010 and 2014 (from 37.3% to 67.9%), decreased significantly in 2017 (60.3%) and rose again in 2023 at 65.3 %. The study describes the characteristics of the online health information-seekers trough time. Conclusions The past decade was marked by a breakthrough of the use of internet in the general population and the use of internet to seek health information. The analysis of the digital health information-seekers serves the public health authorities in their mission to provide accessible information on public health. Key messages • This study aims to describe the evolution of Online Health-Related Information Seeking in France from 2010 to 2023 and the characteristics of digital health information-seekers. • The analysis of the digital health information-seekers serves the public health authorities in their mission to provide accessible information on public health.

Digital health literacy and associated socio-demographic characteristics in the French population

Abstract Background With the development of digital devices in the health field, digital health literacy has become an important issue in promoting and protecting people’s health. Digital health literacy was measured in a representative sample of the French adult population in order to assess its level and to identify the socio-demographic characteristics of individuals with the lowest literacy levels. Comparisons with works carried out in other European countries as well as implications for the implementation of digital interventions will be discussed. Methods Digital health literacy was assed using the HLS19-DIGI-HI Instrument. This 8-item scale measuring the skills related to dealing with digital health information was introduced in the 2023 Health Barometer survey, conducted by the French national public health agency. The survey included French-speaking individuals living in France, aged 18-85, selected through randomly generated phone numbers. 3007 persons were interviewed using a computer assisted telephone interview. A continuous score and categories were calculated to determine the level of Digital Health Literacy. Their associations with sociodemographic characteristics were studied using univariate and multivariate analysis. Results 1902 persons declared they used internet to search information or advice on health on internet in the last 12 months and completed the Digital health literacy questionnaire. 61 % of these individuals have a low level of digital health literacy (29 % “inadequate” and 32% “problematic”). Multiple sociodemographic characteristics were associated with lower levels of literacy in univariate and multivariate analysis. Conclusions These results are useful to better understand and assess the digital health literacy of the population according to their socio-demographic characteristics. They will provide a knowledge base to implement web-based interventions for promoting targeted digital health interventions, according to targeted audiences. Key messages • This study in large random sample of the French population showed frequent difficulties to deal with online health information. • Multiple sociodemographic characteristics were associated with digital health literacy and can help to support implementation of targeted digital health interventions.

A Systematic Review of Traumatic Brain Injury in Modern Rodent Models: Current Status and Future Prospects.

According to the Centers for Disease Control and Prevention (CDC), the national public health agency of the United States, traumatic brain injury is among the leading causes of mortality and disability worldwide. The consequences of TBI include diffuse brain atrophy, local post-traumatic atrophy, arachnoiditis, pachymeningitis, meningocerebral cicatrices, cranial nerve lesions, and cranial defects. In 2019, the economic cost of injuries in the USA alone was USD 4.2 trillion, which included USD 327 billion for medical care, USD 69 billion for work loss, and USD 3.8 trillion for the value of statistical life and quality of life losses. More than half of this cost (USD 2.4 trillion) was among working-age adults (25-64 years old). Currently, the development of new diagnostic approaches and the improvement of treatment techniques require further experimental studies focused on modeling TBI of varying severity.

Piecing together Pakistan's health system and global health security.

Pakistan's health system has a critical role to play in global health security, however, it faces numerous structural and systemic challenges while contributing to international health efforts. Understanding the dynamics of health system is essential for developing effective strategies to prevent, detect, and respond to health emergencies, ensuring regional stability, and the overall global health security This paper documents the strengths and weaknesses of Pakistan's health systems, the impact of the COVID-19 pandemic, challenges such as funding constraints and fragmented healthcare delivery, threats including antimicrobial resistance, and the importance of international collaboration. Anti-microbial particularly multi-drug resistance, food safety in emergencies, surge capacity of the frontline workforce, patient safety at the health care facilities to curtail healthcare associated infections, and strengthening the points of entry are still the areas that need special attention. To optimise the system's performance, governance and accountability mechanisms are necessary to be put in place under the auspices of national public health agency. Pakistan has the potential to transform its health system by addressing these critical areas and improve its preparedness and readiness for any future health emergency of this scale.

Blood levels of persistent organic pollutants among women in France in the 90's: Main profiles and individual determinants

Context and objectivesPersistent organic pollutants (POPs) are a group of organic chemical compounds potentially toxic to human health. The objectives of this study were 1) to describe the levels of POPs biomarkers in blood samples from French women collected during the 1990s and to compare them with levels measured in two more recent French studies, 2) to identify POPs exposure profiles, and 3) to explore their main determinants. Methods73 POPs biomarkers were measured in the blood of 468 women from the French E3N cohort (aged 45–73 years), collected between 1994 and 1999: 28 per- and polyfluoroalkyl substances, 27 organochlorine pesticides, 14 polychlorinated biphenyls and 4 polybrominated diphenyl ethers. POPs biomarker levels were described and compared with levels measured in two more recent French studies conducted by the French National Public Health Agency, the ENNS and Esteban studies. Principal component analysis was performed on POPs quantified in at least 75% of samples to identify the main exposure profiles. Linear regression models were used to estimate the associations between anthropometric, socio-demographic and lifestyle characteristics and exposure to these profiles. ResultsAmong the 73 biomarkers measured, 41 were quantified in more than 75% of samples. Levels of most pollutants that were also measured in the Esteban of ENNS studies have decreased over time. Six POPs exposure profiles were revealed, explaining 62.1% of the total variance. Most of the characteristics studied were associated with adherence to at least one of these profiles. ConclusionThis study highlighted that most of the pollutants for which a comparison was possible decreased over the 10 or 20 years following the E3N blood collection, and identified those which, on the contrary, tended to increase. The health effects of the profiles identified could be assessed in future studies. The determinants identified should be confirmed in larger populations.

Epidemic intelligence in Europe: a user needs perspective to foster innovation in digital health surveillance

BackgroundEuropean epidemic intelligence (EI) systems receive vast amounts of information and data on disease outbreaks and potential health threats. The quantity and variety of available data sources for EI, as well as the available methods to manage and analyse these data sources, are constantly increasing. Our aim was to identify the difficulties encountered in this context and which innovations, according to EI practitioners, could improve the detection, monitoring and analysis of disease outbreaks and the emergence of new pathogens.MethodsWe conducted a qualitative study to identify the need for innovation expressed by 33 EI practitioners of national public health and animal health agencies in five European countries and at the European Centre for Disease Prevention and Control (ECDC). We adopted a stepwise approach to identify the EI stakeholders, to understand the problems they faced concerning their EI activities, and to validate and further define with practitioners the problems to address and the most adapted solutions to their work conditions. We characterized their EI activities, professional logics, and desired changes in their activities using NvivoⓇ software.ResultsOur analysis highlights that EI practitioners wished to collectively review their EI strategy to enhance their preparedness for emerging infectious diseases, adapt their routines to manage an increasing amount of data and have methodological support for cross-sectoral analysis. Practitioners were in demand of timely, validated and standardized data acquisition processes by text mining of various sources; better validated dataflows respecting the data protection rules; and more interoperable data with homogeneous quality levels and standardized covariate sets for epidemiological assessments of national EI. The set of solutions identified to facilitate risk detection and risk assessment included visualization, text mining, and predefined analytical tools combined with methodological guidance. Practitioners also highlighted their preference for partial rather than full automation of analyses to maintain control over the data and inputs and to adapt parameters to versatile objectives and characteristics.ConclusionsThe study showed that the set of solutions needed by practitioners had to be based on holistic and integrated approaches for monitoring zoonosis and antimicrobial resistance and on harmonization between agencies and sectors while maintaining flexibility in the choice of tools and methods. The technical requirements should be defined in detail by iterative exchanges with EI practitioners and decision-makers.

A comparative analysis of non-pharmaceutical interventions for preventing the respiratory syncytial virus in 30 European countries.

Respiratory syncytial virus (RSV) is a leading cause of childhood respiratory infections. Non-pharmaceutical interventions (NPIs) can help to reduce RSV transmission and our aim was to provide an overview of recommended NPIs across Europe during the 2022-2023 epidemic season. The webpages of national European public health agencies and ministries were reviewed and the information they provided on RSV prevention was compared with the December 2022 guidelines from the European Centre for Disease Prevention and Control. We examined 30 countries, leading to 21 issued recommendations for RSV prevention through institutional channels, including six that were specific for the 2022-2023 season. The top five recommendations were: hand and respiratory hygiene (95%), avoiding crowded spaces (67%), staying at home when ill (62%), cleaning household items (57%) and limiting contact with sick people (57%). They also included: face masks (33%), ventilating indoor spaces (29%), properly disposing of contaminated material (13%) and keeping siblings home from preschool if there was a newborn infant in the family (10%). There was significant heterogeneity in the NPIs recommended by different countries during RSV epidemics. Ongoing evaluation is essential to optimise the effectiveness of NPIs and adapt to changing RSV patterns.

Understanding the factors affecting global political priority for controlling sexually transmitted infections: a qualitative policy analysis

IntroductionSexually transmitted infections (STIs) are a significant public health challenge, but there is a perceived lack of political priority in addressing STIs as a global health issue. Our study aimed...

Santé publique France's cross-sectoral response to the climate and environmental changes

Abstract Heat is one of the most rapidly changing climate-related health issues. The Intergovernmental Panel on Climate Change (IPCC) considered that current existing and planned adaptation measures will not be sufficient to limit the health impacts of heat in Europe. The French heat wave alert system, set up in 2004, was one of the first and most innovative in the world thanks to a close collaboration between the French weather service Météo-France, the national public health agency and the ministry of health. It also benefits from a reactive syndromic surveillance based on emergency room visits and general practitioners emergency consultations. Yet, it is now challenged by the increase in frequency and intensity of heat waves due to climate change. The impacts of recent years show that short-term responses based on timely behavioural changes during heat waves are now insufficient. Structural adaptation measures are an asset, and should not only consider adaptation to heat, but also wider opportunities for mitigation and reduction of inequities, in order to promote robust healthy environments that protect against climate disruption. This presentation will share how Santé publique France is developing a set of interdisciplinary studies and an advocacy strategy to encourage stakeholders involved in urban planning and housing to better take into account the impact of heat in their projects.

Comparison of predictors for long-term survival and healthcare costs of cancer patients in Scotland

Abstract Background New cancer treatments can improve prognosis, but may impact on the sustainability of health systems due to additional healthcare use by survivors of cancer. This study compared predictors of long-term healthcare costs with predictors of survival in a national cohort of people with cancer, with an aim of identifying factors associated with both improved survival and reduced costs. Methods This was a retrospective cohort study using linked administrative healthcare data from NHS Scotland. Participants were people diagnosed with a first malignant cancer (1st Jan 2009 to 31st Dec 2010). The outcomes were incident healthcare costs derived from inpatient episodes, outpatient visits and prescription costs. Univariable and multivariable Cox and GLM regressions were used to evaluate the predictors (age, sex, area deprivation, method of detection, pre-diagnosis costs, rurality, region, stage of detection, comorbidities). Results 55,807 individuals with cancer were followed over eight years after diagnosis and found to incur substantial healthcare costs (mean £29,460 at 2017 GBP, 95% CI £29,199 to £29,720). Variables negatively associated with costs tended to be positively associated with hazard of death, e.g., age > =80 (adjusted cost ratio 0.55, p < 0.001; adjusted hazard ratio 5.94, p < 0.001), stage IV (adjusted CR 0.69, p < 0.001; adjusted HR 3.14, p < 0.001), history of dementia (adjusted CR 0.51, p < 0.001; adjusted HR 1.69, p < 0.001). Only screening as a method of first detection was significantly associated with both lower costs (adjusted CR 0.85, p < 0.001) and lower hazard of death (adjusted HR 0.30, p < 0.001). Conclusions Screening was associated with both improved survival and reduced healthcare costs. These results support the current priorities of national public health agencies and research funders to focus investment on improving early diagnosis. Key messages • Factors associated with reduced post-diagnosis healthcare costs tended to be associated with poorer survival. • Screening was associated with reduced healthcare costs and better survival.

Genomic Surveillance Reveals the Rapid Expansion of the XBB Lineage among Circulating SARS-CoV-2 Omicron Lineages in Southeastern Wisconsin, USA.

SARS-CoV-2 caused a life-threatening COVID-19 pandemic outbreak worldwide. The Southeastern Region of Wisconsin, USA (SERW) includes large urban Milwaukee and six suburban counties, namely Kenosha, Ozaukee, Racine, Walworth, Washington and Waukesha. Due to the lack of detailed SARS-CoV-2 genomic surveillance in the suburban populations of the SERW, whole-genome sequencing was employed to investigate circulating SARS-CoV-2 lineages and characterize dominant XBB lineages among this SERW population from November 2021 to April 2023. For an unbiased data analysis, we combined our 6709 SARS-CoV-2 sequences with 1520 sequences from the same geographical region submitted by other laboratories. Our study shows that SARS-CoV-2 genomes were distributed into 357 lineages/sublineages belonging to 13 clades, of which 88.8% were from Omicron. We document dominant sublineages XBB.1.5 and surging XBB.1.16 and XBB.1.9.1 with a few additional functional mutations in Spike, which are known to contribute to higher viral reproduction, enhanced transmission and immune evasion. Mutational profile assessment of XBB.1.5 Spike identifies 38 defining mutations with high prevalence occurring in 49.8-99.6% of the sequences studied, of which 32 mutations were in three functional domains. Phylogenetic and genetic relatedness between XBB.1.5 sequences reveal potential virus transmission occurring within households and within and between Southeastern Wisconsin counties. A comprehensive phylogeny of XBB.1.5 with global sub-dataset sequences confirms the wide spread of genetically similar SARS-CoV-2 strains within the same geographical area. Altogether, this study identified proportions of circulating Omicron variants and genetic characterization of XBB.1.5 in the SERW population, which helped state and national public health agencies to make compelling mitigation efforts to reduce COVID-19 transmission in the communities and monitor emerging lineages for their impact on diagnostics, treatments and vaccines.

Perspectives on Advancing Countermeasures for Filovirus Disease: Report From a Multisector Meeting.

Although there are now approved treatments and vaccines for Ebola virus disease, the case fatality rate remains unacceptably high even when patients are treated with the newly approved therapeutics. Furthermore, these countermeasures are not expected to be effective against disease caused by other filoviruses. A meeting of subject-matter experts was held during the 10th International Filovirus Symposium to discuss strategies to address these gaps. Several investigational therapeutics, vaccine candidates, and combination strategies were presented. The greatest challenge was identified to be the implementation of well-designed clinical trials of safety and efficacy during filovirus disease outbreaks. Preparing for this will require agreed-upon common protocols for trials intended to bridge multiple outbreaks across all at-risk countries. A multinational research consortium including at-risk countries would be an ideal mechanism to negotiate agreement on protocol design and coordinate preparation. Discussion participants recommended a follow-up meeting be held in Africa to establish such a consortium.

Impact of a French social marketing campaign promoting pulse and whole grain consumption: results from a longitudinal cohort study.

Despite the health benefits, fiber intake is insufficient among French adults. To promote the consumption of pulses and whole grains, defined as priority food groups because they are rich in fiber, readily available, and affordable, the French National Public Health Agency implemented a social marketing campaign in 2019 to improve knowledge, self-efficacy, and consumption of pulses and whole grains. To evaluate the short-and long-term effects of this social marketing campaign. A 8-month prospective study was conducted on the Internet. A sample of 4,001 French adults was interviewed before the social media campaign (T0), immediately afterwards (T1), and after 8 months (T2). Analysis was performed on 2,422 adults responding at T1 and T2. Outcomes associated with campaign recall were investigated by mixed models with random effects using generalized estimating equations. Overall, 59.5% of subjects recalled the campaign. In multivariable-adjusted analyses, no significant difference was found in terms of knowledge, self-efficacy, and consumption of pulses and whole grains between those recalling and not recalling the campaign (value of p > 0.05). When the analyses were stratified by educational level (p-interaction<0.10), a significant positive association was found between campaign recall and variation of knowledge about whole grain fiber content in subjects with lower educational level (value of p = 0.002 at T1 and value of p = 0.008 at T2). For small consumers of pulses, subjects recalling the campaign improved both their knowledge (OR [95%CI] = 1.47 [1.14-1.90], value of p = 0.003 at T2) and consumption of pulses (1.44 [1.14-1.86], value of p = 0.002 at T1, 1.50 [1.16-1.94], value of p = 0.002 at T2). This first French social marketing campaign promoting pulses and whole grains had a positive impact on specific subgroups of particular interest in terms of public health (i.e., people with low educational level and small consumers of pulses). These results will allow us to improve the communication materials used for the second edition of this social marketing campaign.

Epidemic intelligence activities among national public and animal health agencies: a European cross-sectional study

Epidemic Intelligence (EI) encompasses all activities related to early identification, verification, analysis, assessment, and investigation of health threats. It integrates an indicator-based (IBS) component using systematically collected surveillance data, and an event-based component (EBS), using non-official, non-verified, non-structured data from multiple sources. We described current EI practices in Europe by conducting a survey of national Public Health (PH) and Animal Health (AH) agencies. We included generic questions on the structure, mandate and scope of the institute, on the existence and coordination of EI activities, followed by a section where respondents provided a description of EI activities for three diseases out of seven disease models. Out of 81 gatekeeper agencies from 41 countries contacted, 34 agencies (42%) from 26 (63%) different countries responded, out of which, 32 conducted EI activities. Less than half (15/32; 47%) had teams dedicated to EI activities and 56% (18/34) had Standard Operating Procedures (SOPs) in place. On a national level, a combination of IBS and EBS was the most common data source. Most respondents monitored the epidemiological situation in bordering countries, the rest of Europe and the world. EI systems were heterogeneous across countries and diseases. National IBS activities strongly relied on mandatory laboratory-based surveillance systems. The collection, analysis and interpretation of IBS information was performed manually for most disease models. Depending on the disease, some respondents did not have any EBS activity. Most respondents conducted signal assessment manually through expert review. Cross-sectoral collaboration was heterogeneous. More than half of the responding institutes collaborated on various levels (data sharing, communication, etc.) with neighbouring countries and/or international structures, across most disease models. Our findings emphasise a notable engagement in EI activities across PH and AH institutes of Europe, but opportunities exist for better integration, standardisation, and automatization of these efforts. A strong reliance on traditional IBS and laboratory-based surveillance systems, emphasises the key role of in-country laboratories networks. EI activities may benefit particularly from investments in cross-border collaboration, the development of methods that can automatise signal assessment in both IBS and EBS data, as well as further investments in the collection of EBS data beyond scientific literature and mainstream media.

Public face mask use during the COVID-19 pandemic in Auckland, New Zealand

AimPublic health officials recommended the use of face masks by the population to combat the transmission of COVID-19. Studies on self-reported behaviour are a poor substitute for assessing adherence to government recommendations. This study aimed to determine the percentage of pedestrians wearing masks in the Central Business District (CBD) and a suburb of Auckland, New Zealand (NZ).MethodsThis direct observational study of pedestrians crossing two busy intersections occurred between 22 August 2020 and 7 March 2022. Data collection occurred at three separate times during the day, in the morning (from 8 to 9 am), noon (from 12 to 1 pm) and afternoon (from 4 to 5 pm) for precisely one hour each time.ResultsOver 12 days of COVID alert level restrictions, we observed 30,855 pedestrians. Overall, 57.9% of pedestrians wore a mask outdoors. Masks-wearing was significantly higher in the CBD (64.0%) than in the suburb (38.7%), p < 0.001. Masks use was lower in the morning (51.1%) than at noon (56.1%) or afternoon (62.7%), p < 0.001, both in the CBD and the suburb.ConclusionThis was the first observational study in NZ examining the public’s mask use during the COVID-19 pandemic. From our observations, there may be opportunities for improvement in public face mask use rates to decrease the spread of COVID-19 in the population. In addition, our findings can inform national and international public health agencies about face mask uptake in public.

Learning from serosurveillance for SARS-CoV-2 to inform pandemic preparedness and response

Learning from serosurveillance for SARS-CoV-2 to inform pandemic preparedness and response

Spatial and seasonal determinants of Lyme borreliosis incidence in France, 2016 to 2021.

BackgroundLyme borreliosis (LB) is the most widespread hard tick-borne zoonosis in the northern hemisphere. Existing studies in Europe have focused mainly on acarological risk assessment, with few investigations exploring human LB occurrence.AimWe explored the determinants of spatial and seasonal LB variations in France from 2016 to 2021 by integrating environmental, animal, meteorological and anthropogenic factors, and then mapped seasonal LB risk predictions.MethodsWe fitted 2016-19 LB national surveillance data to a two-part spatio-temporal statistical model. Spatial and temporal random effects were specified using a Besag-York-Mollie model and a seasonal model, respectively. Coefficients were estimated in a Bayesian framework using integrated nested Laplace approximation. Data from 2020-21 were used for model validation.ResultsA high vegetation index (≥ 0.6) was positively associated with seasonal LB presence, while the index of deer presence (> 60%), mild soil temperature (15-22 °C), moderate air saturation deficit (1.5-5 mmHg) and higher tick bite frequency were associated with increased incidence. Prediction maps show a higher risk of LB in spring and summer (April-September), with higher incidence in parts of eastern, midwestern and south-western France.ConclusionWe present a national level spatial assessment of seasonal LB occurrence in Europe, disentangling factors associated with the presence and increased incidence of LB. Our findings yield quantitative evidence for national public health agencies to plan targeted prevention campaigns to reduce LB burden, enhance surveillance and identify further data needs. This approach can be tested in other LB endemic areas.

Risk of Admission to the Pediatric Intensive Care Unit for SARS-CoV-2 Delta and Omicron Infections.

The severity of SARS-CoV-2-related diseases in children remains unclear. This study aimed to describe the incidence of French pediatric intensive care units (PICUs) admissions with acute COVID-19, incidental positive SARS-CoV-2 test result, and multisystem inflammatory syndrome in children (MIS-C) during the delta and omicron variant periods. This study used the French PICU registry to obtain data on all patients admitted to 41 French PICUs diagnosed with acute COVID-19, incidental positive SARS-CoV-2 test result, or MIS-C between August 30, 2021 and April 20, 2022. Data regarding the total number of positive SARS-CoV-2 polymerase chain reaction results according to the type of variants were obtained from the French National Public Health Agency. Of 745 children, 244 (32.8%) were admitted for acute COVID-19, 246 (33.0%) for incidental positive SARS-CoV-2 test results, and 255 (34.2%) for MIS-C. The incidence of each group was higher with delta than with omicron. The incidence rate ratios with the delta variant were 7.47 (95% CI, 4.22-13.26) for acute COVID-19, 4·78 (95% CI, 2.30-9.94) for incidental positive SARS-CoV-2 test results, and 10.46 (95% CI, 5.98-18.31) for MIS-C compared to the omicron variant. The median age was 66 (7.7-126.8) months; 314 (42%) patients had comorbidities. Patients with acute COVID-19 and incidental positive SARS-CoV-2 test results had similar proportions of comorbidities. No patient with MIS-C died, whereas the mortality rates in the acute COVID-19 and incidental positive SARS-CoV-2 test results groups were 6.8% and 3.8%, respectively. The incidence of acute COVID-19, incidental positive SARS-CoV-2 test results, and MIS-C admitted to the PICU were significantly higher with the delta variant than with the omicron variant.

Call for Special Feature Papers: Threat Agnostic Approaches to Biodefense and Public Health.

Call for Special Feature Papers: Threat Agnostic Approaches to Biodefense and Public Health.