National Surveillance Reports Research Articles

Use of a meningococcal group B vaccine (4CMenB) in populations at high risk of gonorrhoea in the UK.

The meningococcal group B vaccine, 4CMenB, is a broad-spectrum, recombinant protein vaccine that is licensed for protection against meningococcal group B disease in children and adults. Over the past decade, several observational studies supported by laboratory studies have reported protection by 4CMenB against gonorrhoea, a sexually transmitted infection caused by Neisseria gonorrhoeae. Gonorrhoea is a major global public health problem, with rising numbers of diagnoses and increasing resistance to multiple antibiotics. In England, more than 82 000 cases of gonorrhoea were diagnosed in 2022, with nearly half of the cases diagnosed among gay, bisexual, and other men who have sex with men. There are currently no licensed vaccines against gonorrhoea but 4CMenB is estimated to provide 33-47% protection against gonorrhoea. On Nov 10, 2023, the UK Joint Scientific Committee on Vaccination and Immunisation agreed that a targeted programme should be initiated using 4CMenB to prevent gonorrhoea among individuals at higher risk of infection attending sexual health services in the UK. This decision was made after reviewing evidence from retrospective and prospective observational studies, laboratory and clinical data, national surveillance reports, and health economic analyses. In this Review, we summarise the epidemiology of invasive meningococcal disease and gonorrhoea in England, the evidence supporting the use of 4CMenB for protection against gonorrhoea, and the data needed to inform long-term programme planning and extension to the wider population.

The elimination of trachoma as a public health problem in Togo: Successes and challenges.

As of May 2022, 15 countries have declared that they have reached their trachoma elimination targets, but only 13 of them, including Togo, have been validated by the World Health Organization as having eliminated the disease as a public health problem. The aim of this study was to describe the broad interventions that have supported the elimination of trachoma as a public health problem in Togo from its inception in 2006 to the validation of its elimination in 2022. A review and compilation of data and information contained in the country's submission to World Health Organization for validation of trachoma elimination as a public health problem was conducted. Data from national and local surveillance systems and reports on actions taken after achieving the elimination target were also included. Togo has achieved the elimination of trachoma as a public health problem by 2022. The prevalence of follicular trachoma among children aged 1-9 years is <5% in all nationally defined administrative units suspected of having trachoma after stopping mass treatment for at least 2 years. The prevalence of trichiasis among persons aged 15 years and older is less than 0.2% in all administrative units previously endemic for trachoma and evidence of the ability to manage incident cases of emerging trichiasis in the community has been demonstrated. The key of the success in the elimination process was primarily the political commitment of the health authorities with financial and technical support from various international organizations. The elimination of trachoma as a public health problem in Togo is a real success story that can serve as an example for the elimination of other neglected tropical diseases in Africa. But regular monitoring and surveillance is essential to avoid the re-emergence of such disease in the country.

Tick-borne encephalitis epidemiology and surveillance in Poland, and comparison with selected European countries before and during the COVID-19 pandemic, 2008 to 2020.

BackgroundTick-borne encephalitis (TBE) is the most common viral central nervous system (CNS) infection in Poland. Previous research suggests that its incidence was underestimated in the pre-pandemic period. The COVID-19 pandemic caused a considerable burden on surveillance systems, which could further impact reporting.AimWe aimed to assess the completeness of reporting of TBE in the years 2008 to 2020 and explore the potential impact of the COVID-19 pandemic on reporting to the epidemiological surveillance system, compared with hospitalisations for TBEV and other viral neuro-infections.MethodsWe compared the Polish epidemiology of TBE and other viral infections of the CNS from national surveillance reports with data on hospitalisations from 2008 to 2020 and data from selected European countries.ResultsBetween 2008 and 2020, 3,016 TBE cases were reported to surveillance compared with 3,620 hospitalisations. There was an increasing trend in hospitalisations, while surveillance data demonstrated the opposite, with the largest discrepancy observed in the first pandemic year (354 hospitalisations vs 159 cases reported to surveillance). Serological testing for TBE was used more in the known endemic region of north-eastern Poland and less in non-endemic areas. Other European countries reported higher TBE case numbers and an increase during the COVID-19 pandemic, whereas Poland observed an opposite trend.ConclusionThe sensitivity of TBE surveillance in Poland requires improvement. There are considerable regional differences. Regions that test for TBE intensively report most cases. Policymakers should be made aware of the value of quality epidemiological data for planning prophylactic measures in risk areas.

Epidemiology of invasive meningococcal disease worldwide from 2010-2019: a literature review.

The epidemiology of invasive meningococcal disease (IMD) is unpredictable, varies by region and age group and continuously evolves. This review aimed to describe trends in the incidence of IMD and serogroup distribution by age group and global region over time. Data were extracted from 90 subnational, national and multinational grey literature surveillance reports and 22 published articles related to the burden of IMD from 2010 to 2019 in 77 countries. The global incidence of IMD was generally low, with substantial variability between regions in circulating disease-causing serogroups. The highest incidence was usually observed in infants, generally followed by young children and adolescents/young adults, as well as older adults in some countries. Globally, serogroup B was a predominant cause of IMD in most countries. Additionally, there was a notable increase in the number of IMD cases caused by serogroups W and Y from 2010 to 2019 in several regions, highlighting the unpredictable and dynamic nature of the disease. Overall, serogroups A, B, C, W and Y were responsible for the vast majority of IMD cases, despite the availability of vaccines to prevent disease due to these serogroups.

2204. Pathogen Co-infections and Trends in Influenza-like Illness in PAIVED

Abstract Background The Pragmatic Assessment of Influenza Vaccine Effectiveness in the Department of Defense (DoD) (PAIVED) is a multicenter, multiservice study assessing influenza vaccine effectiveness in active-duty service members, retirees, and dependents. In its fourth season (2021/22), PAIVED offers a unique opportunity to examine influenza-like illness (ILI) trends prior to and during the COVID-19 pandemic in a prospectively followed, well-defined cohort. Methods Over the past 4 influenza seasons, PAIVED has enrolled DoD beneficiaries who were randomized to receive egg-based, cell-based, or recombinant-derived influenza vaccine. Participants provided some basic demographic information and were then sent a weekly text or email that inquired about ILI symptoms, defined as 1) having cough or sore throat, plus 2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a daily symptom diary for one week and submitted a nasal swab for PCR-based pathogen detection. Table 1.Demographic characteristics of PAIVED participants over four seasonsFigure 1.Percent of PAIVED participants with influenza-like illness, SARS-CoV-2, influenza, and rhinovirus identified in swab samples collected over four seasons. Results Over the 4 seasons, 15,449 participants were followed for ILI (Table 1) with 3,407 participants reporting a total of 3,985 ILIs. For the 2021/22 season, ILI reports peaked in January (Figure 1). Overall, 4.7% of episodes had more than one pathogen identified (Table 2). Among the 122 coinfections identified to date, most were coinfections with rhinoviruses (91/122, 75%), including rhinovirus coinfections with seasonal coronaviruses (29, 24%), metapneumovirus (18, 15%), SARS-CoV-2 (17, 14%), and influenza (14, 11%). SARS-CoV-2 and influenza were found together in one sample. The lab data will continue to be processed for the current season (2021/22). Table 2.Pathogens identified in PAIVED nasal swabs over four seasons Conclusion ILI rates were lowest during the third year (2020/21), consistent with national influenza surveillance reports of influenza and outpatient ILI activity, suggesting that measures taken to reduce transmission of SARS-CoV-2 reduced the spread of other respiratory viruses. The emergence of the SARS-CoV-2 omicron variant in December 2021 was associated with higher ILI rates. Among those individuals for whom a sample was collected, coinfections were highest in 2018/19. Data collection and specimen analysis are ongoing for 2021/22. Disclosures Jitendrakumar Modi, MD, GlaxoSmithKline: I am a paid speaker for GSK. I do not speak for their flu brand. Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.

Resurgence of Respiratory Virus after Relaxation of COVID-19 Containment Measures: A Real-World Data Study from a Regional Hospital of Italy.

The SARS-CoV-2 virus spread in the Northern Hemisphere during the 2019/2020 influenza seasons and it persisted in the 2021/2022 season. A cocirculation of SARS-CoV-2 and influenza viruses was expected in Italy during the winter seasons. This study aims to investigate the prevalence of influenza and respiratory syncytial viruses observed in a hospital in Verona Province, Italy hospital during these past three winter seasons and to compare our data with national and global surveillance reports on the transmission of respiratory viruses in the preceding decade. Our findings clearly demonstrated the extremely low prevalence of influenza virus among hospitalized patients and outpatients during the first two COVID-19 winter seasons, with a reemergence of respiratory syncytial virus in the late 2021. Containment measures may have played an important role in temporarily stopping the circulation of respiratory viruses, but after relaxation, in 2021, we experienced an unusual increase of respiratory syncytial viruses at the beginning of the winter season.

The elimination of trachoma as a public health problem in Mexico: From national health priority to national success story

IntroductionMexico was the first country in the Americas and the third in the world to eliminate trachoma as a public health problem, as validated by the WHO in 2017.ObjectiveTo describe the critical elements that favored the elimination of trachoma as a public health problem in Mexico and the public health impact of this success.MethodologyA revision and compilation of data and information contained in the dossier presented by the country to PAHO/WHO to obtain the validation of trachoma elimination as a public health problem was conducted by a group of delegates from the national and local trachoma prevention and control program. Data from the national and local surveillance systems and reports of actions conducted after achieving the elimination goal were also included. Critical elements that favored the achievement of the elimination goal from 1896 to 2019 were extracted.ResultsMexico reached the elimination of trachoma in 2016 obtaining the validation in 2017. 264 communities were no longer endemic and 151,744 people were no longer at risk of visual impairment or possible blindness due to trachoma. The key to the success of this elimination process was primarily the local leadership of health authorities with sustained funding for brigades, increased access to potable water and sanitation, and key alliances with indigenous authorities, health authorities, and government institutions that contributed to the achievement of the goal. The SAFE strategy started implementation in Mexico in 2004 as a comprehensive package of interventions. SAFE stands for surgery, antibiotics, facial cleanliness, and improvement of the environmental conditions. These actions impacted drastically on the number of new cases trachmatous trichiasis (TT) and trachomatous inflammation-follicular (TF), which decreased from 1,794 in 2004 to zero in 2016.ConclusionsThe elimination of trachoma as a public health problem in Mexico is a true success story that may serve as a model example for the elimination of other neglected infectious diseases in the Americas.

Development and Validation of Machine Models Using Natural Language Processing to Classify Substances Involved in Overdose Deaths

Overdose is one of the leading causes of death in the US; however, surveillance data lag considerably from medical examiner determination of the death to reporting in national surveillance reports. To automate the classification of deaths related to substances in medical examiner data using natural language processing (NLP) and machine learning (ML). Diagnostic study comparing different natural language processing and machine learning algorithms to identify substances related to overdose in 10 health jurisdictions in the US from January 1, 2020, to December 31, 2020. Unstructured text from 35 433 medical examiner and coroners' death records was examined. Text from each case was manually classified to a substance that was related to the death. Three feature representation methods were used and compared: text frequency-inverse document frequency (TF-IDF), global vectors for word representations (GloVe), and concept unique identifier (CUI) embeddings. Several ML algorithms were trained and best models were selected based on F-scores. The best models were tested on a hold-out test set and results were reported with 95% CIs. Text data from death certificates were classified as any opioid, fentanyl, alcohol, cocaine, methamphetamine, heroin, prescription opioid, and an aggregate of other substances. Diagnostic metrics and 95% CIs were calculated for each combination of feature extraction method and machine learning classifier. Of 35 433 death records analyzed (decedent median age, 58 years [IQR, 41-72 years]; 24 449 [69%] were male), the most common substances related to deaths included any opioid (5739 [16%]), fentanyl (4758 [13%]), alcohol (2866 [8%]), cocaine (2247 [6%]), methamphetamine (1876 [5%]), heroin (1613 [5%]), prescription opioids (1197 [3%]), and any benzodiazepine (1076 [3%]). The CUI embeddings had similar or better diagnostic metrics compared with word embeddings and TF-IDF for all substances except alcohol. ML classifiers had perfect or near perfect performance in classifying deaths related to any opioids, heroin, fentanyl, prescription opioids, methamphetamine, cocaine, and alcohol. Classification of benzodiazepines was suboptimal using all 3 feature extraction methods. In this diagnostic study, NLP/ML algorithms demonstrated excellent diagnostic performance at classifying substances related to overdoses. These algorithms should be integrated into workflows to decrease the lag time in reporting overdose surveillance data.

Embracing the Nutritional Assessment in Cerebral Palsy: A Toolkit for Healthcare Professionals for Daily Practice.

Background: Nutritional status assessment (NSA) can be challenging in children with cerebral palsy (CP). There are high omission rates in national surveillance reports of weight and height information. Alternative methods are used to assess nutritional status that may be unknown to the healthcare professionals (HCP) who report these children. Caregivers experience challenges when dealing with feeding problems (FP) common in CP. Our aim was to assess the difficulties in NSA which are causing this underreport and to create solutions for registers and caregivers. Methods: An online questionnaire was created for registers. Three meetings with HCP and caregivers were held to discuss problems and solutions regarding NSA and intervention. Results: HCP mentioned difficulty in NSA due to a lack of time, collaboration with others, equipment, and childrens’ motor impairment. Caregivers experienced difficulty in preparing nutritious meals with adapted textures. The creation of educational tools and other strategies were suggested. A toolkit for HCP was created with the weight and height assessment methods described and other for caregivers to deal with common FP. Conclusions: There are several difficulties experienced by HCP that might be overcome with educational tools, such as a toolkit. This will facilitate nutritional assessment and intervention and hopefully reduce underreporting.

Epidemiology of 4963 deaths associated with COVID‐19 during three pandemic waves in a Latin American city with a high mortality rate, 2020–2021

To describe the characteristics of COVID-19-associated deaths in Barranquilla, Colombia, a city with a high mortality rate, and their changes between pandemic waves. The local Health Department obtained information on all laboratory-confirmed COVID-19 deaths reported from March 2020 to May 2021. Data were collected using national surveillance reports and death certificates. Four thousand nine hundred and sixty-three COVID-19-associated deaths were documented for a mortality rate of 389.4 deaths per 100,000 population. Sixty-two percent of all deaths occurred in people aged ≥65years and 58% in males. Only 7 COVID-19-associated deaths in children were reported. Comorbidities were found in 47.9% of cases. The number of deaths among people aged 50-64years increased significantly during the pandemic waves (from 25% to 29%). Conversely, the frequency of male sex (from 64.6% to 53.9%) and deaths with comorbidities (from 60.9% to 39.6%) decreased significantly between the waves of pandemic. Early mortality, defined as death within 48h after hospital admission, was higher during the first pandemic wave than in the others (29.5%, 9.7% and 10.5%), and time from hospital admission to death increased during waves (from 9 to 14days). The COVID-19-associated mortality rate was high and mainly affects older people, with comorbidities and male sex. Early mortality was higher during the first wave. Women and healthy people without comorbidities died more frequently after the first pandemic wave.

1338. Before and After: The Impact of the COVID-19 Pandemic on Influenza-Like Illness Trends in PAIVED

BackgroundThe Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) is a multicenter study assessing influenza vaccine effectiveness in active duty service members, retirees, and dependents. PAIVED recently completed its third year and offers a unique opportunity to examine influenza-like illness (ILI) trends prior to and during the COVID-19 pandemic in a prospective, well-defined cohort.MethodsDuring the 2018-19, 2019-20, and 2020-21 influenza seasons, PAIVED enrolled DoD beneficiaries presenting for annual influenza vaccination. After collecting baseline demographic data, participants were randomized to receive egg-based, cell-based, or recombinant-derived influenza vaccine. Weekly throughout the influenza season of enrollment, participants were surveyed electronically for ILI, defined as (1) having cough or sore throat, plus (2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a daily symptom diary for seven days and submitted a nasal swab for pathogen detection.ResultsOver the three seasons, there were 10,656 PAIVED participants: 1514 (14.2%) in 2018-19, 5876 (55.1%) in 2019-20, and 3266 (30.6%) in 2020-21. The majority were male (68-73% per year) with a mean age of 34±14.8 years at enrollment. 2266 participants reported a total of 2673 unique ILIs. The highest percentage of participants with ILI was in 2019-20 (28.2%), versus 19.6% in 2018-19 and 9.6% in 2020-21. Figure 1 depicts the percent of individuals reporting ILI by week of the season for each of the PAIVED seasons. Notably, after March 21, 2020, the weekly incidence of participants reporting ILI never exceeded 1%.Figure 1. Percent of PAIVED participants reporting ILI by week of season. ConclusionThe low incidence of reported ILI in PAIVED participants during the COVID-19 pandemic is consistent with national influenza surveillance reports of influenza and outpatient ILI activity, suggesting that mitigation measures taken to reduce transmission of SARS-CoV-2 reduced the spread of other respiratory viruses. Disclaimer Disclosures Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) Jitu Modi, MD, GSK (Speaker’s Bureau)

Abstract P6-11-04: Trends and variations in female breast cancer along the Texas-Mexico border trends and variations in breast cancer along the Texas-Mexico border

Abstract Background: Breast cancer is the leading cause of cancer death in Hispanic women. Compared to non-Hispanic Whites, Hispanic women are more likely to be diagnosed at later stages, with larger tumors and more likely to die from their cancer. The health disparities seen in the Hispanic population have been partially attributed to inadequate health insurance coverage and greater shortage of physicians, resulting in limited access to quality health care, lower cancer screening rates, and delays in treatment. The counties along Texas-Mexico border region, which occupy 1,254-miles of shared border and consist predominantly of a Hispanic population, share the worst health disparity statistics in the U.S. In this study, we investigate incidence and survival of breast cancer and explore whether these findings corroborate the trends seen in state and national surveillance reports. Methods: We used publicly available female breast cancer cases in Texas between 1995-2015 made available from the Texas Cancer Registry. Chi-square tests examined the association between each categorical variable and border county status. Crude and age-adjusted incidence rates overall, invasive, and noninvasive were created for the state overall and by border status. To assess survival, unadjusted and adjusted median OS (95% CI) was calculated for overall and invasive/non-invasive female breast cancer by border status using Kaplan Meier survival analysis. Cox proportional hazards multi-variables models were also used to identify risk-factors that are associated with the difference in cancer survival rates overall and by border status. Results: Adjusting for age, a decrease in the incidence ratio (IR) of overall and invasive female breast cancer is observed from 2000 to 2004 in border versus non-border counties followed by relative stability in the IR from 2005 to 2010. Without adjustment, relative to nonborder counties, border counties have a 7-month reduction in median overall survival (OS) for invasive cancer and 13-month reduction in median OS overall. After adjustment for age group, race, poverty level, grade and stage, Cox proportional hazard analysis revealed a lower hazard of death favoring border counties, 14% and 12%, respectively, for both invasive and noninvasive breast cancer (Table 1). Further stratification by neighborhood poverty level reveals no difference in the hazard of death amongst those within counties with poverty from 0-9.99%. However, for those belonging in lower poverty tracts, 10-19.9% and 20-100%, there is a 10% reduction in the hazard of death for both overall and invasive cancers that is statistically significant (Table 2). Conclusion: Prior studies have demonstrated later diagnosis and worse outcomes in Hispanic women with breast cancer. Disparities notwithstanding, our results indicate that women of all races in a low poverty level (&amp;gt;10%) and those living in the border counties have a significantly lower hazard of death. Further studies will examine the unexpected positive outcomes to identify potentially protective factors. Table 1Cancer TypeUnadjustedAdjustedHRp-valueHRp-valueOverall1.08&amp;lt; 0.00010.86&amp;lt;0.0001Invasive1.0450.00040.86&amp;lt; 0.0001Noninvasive1.080.09200.880.0158*adjusted for age group, race, poverty group, grade, stage, and year of diagnosis. Table 2Cancer TypePoverty Level0-4.9%5-9.9%10-19.9%20-100%HRp-valueHRp-valueHRp-valueHRp-valueOverall1.110.27961.040.48610.900.00090.90&amp;lt;.0001Invasive Cancer 1.110.32551.040.51960.900.0020.90&amp;lt;.0001 Citation Format: Fernando Cristobal Diaz, Elva Nora Osuna-Salazar, Candace Robledo, Michael Machiorlatti, Nabeel Sarhill, Henry Kwang. Trends and variations in female breast cancer along the Texas-Mexico border trends and variations in breast cancer along the Texas-Mexico border [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-04.

Mapping tweets to a known disease epidemiology; a case study of Lyme disease in the United Kingdom and Republic of Ireland

BackgroundAnalysis of social media is an emerging method with potential as a tool for disease surveillance. Twitter may offer a route for surveillance by using tweeting habits as a proxy for disease incidence. Previous work has focused on temporal patterns and have proven to be successful. However, the identification of geographical patterns has been limited by a combination of Twitter’s data collection policies and by exploring diseases that have a high prevalence and high levels of awareness with the public. We propose that, by performing a restricted geographical search strategy on a disease with a relatively low incidence, one may be able to explore spatial patterns. Here, Lyme disease in the United Kingdom and the Republic of Ireland is used as a case example. ObjectiveTo explore whether the tweeting habits of British and Irish Twitter users matched the known spatio-temporal epidemiology of Lyme disease in these respective countries. MethodsAll Tweets containing the word ‘Lyme’ were collected between the 1st of July 2017 and the 30th June 2018, restricted by geography (a 375-mile radius around the geographical centre of Great Britain) and by language (English-only tweets). Tweets were removed which referred to locations that included ‘Lyme’ within their name (e.g. Lyme Regis). Only original tweets were analysed. Daily and monthly time series were created and compared to national Lyme disease surveillance figures. A map of the number of Twitter users tweeting about Lyme disease per 100,000 population per local authority was created. This was formerly compared to national surveillance data for England and Wales using an exploratory spatial data analysis approach. ResultsDuring the study period, 13,757 original tweets containing the word ‘Lyme’, and excluding place names relating to Lyme, were collected. The mean number of daily tweets was 38 (range: 12–276). There was strong seasonality with the highest number of tweets in the summer, this matched the known epidemiology of Lyme disease. Of the 5212 of users who tweeted about Lyme disease, 51.8% had a user profile location that could be matched to a local authority in the United Kingdom or Republic of Ireland. The mean number of Twitter users tweeting about Lyme disease per 100,000 population per local authority was 3.7. The areas with the highest incidence were south-west England and the Highlands of Scotland. When comparing these figures to English and Welsh Lyme disease surveillance figures they showed a significant positive spatial correlation (p = 0.002). ConclusionsThe tempo-spatial pattern of Twitter users tweeting about Lyme disease matches the known disease epidemiology. The degree of geographical concordance between Twitter users’ locations and national surveillance reports, indicate that Twitter has the potential to be used in to identify potential disease hotspots based on the levels of social media ‘noise’. There is scope for further work to test the robustness of Twitter as an adjunct ‘measure of concern’ disease surveillance tool. However, caution must be taken as national media stories can skew data and Twitter users may not provide reliable facts in the data that they share on the platform.

Healthcare-associated infections in intensive care units in Taiwan, South Korea, and Japan: recent trends based on national surveillance reports

BackgroundSustainable systematic interventions are important for infection prevention and control (IPC). Data from surveillance of healthcare-associated infections (HAI) provides feedback for implementation of IPC programs. To address the paucity of such data in Asia, we searched for national HAI surveillance and IPC programs in this region.MethodsData were analysed from open access national surveillance reports of three Asian countries: Taiwan, South Korea and Japan from 2008 to 2015. National IPC programs were identified.ResultsThere were differences among the countries in surveillance protocols, hospital coverage rates, and national IPC policies and programs. Nevertheless, there was a 53.0% reduction in overall HAI over the 8-year period. This consisted of a decrease from 9.34 to 5.03 infections per 1000 patient-days in Taiwan, from 7.56 to 2.76 in Korea, and from 4.41 to 2.74 in Japan (Poisson regression, all p < 0.05). Across the three countries, Escherichia coli and Candida albicans were the major pathogens for urinary tract infection. Staphylococcus aureus, Acinetobacter baumannii and Enterococcus faecium were common bloodstream pathogens. For pneumonia, S. aureus, A. baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the predominant pathogens, with considerable country differences. There was a 64.6% decrease in the number of isolates of methicillin-resistant S. aureus, 38.4% decrease in carbapenem-resistant P. aeruginosa and 49.2% decrease in carbapenem-resistant A. baumannii (CRAB) in Taiwan (all p < 0.05), and similarly in Korea with the exception of CRAB (30.5 and 50.4% reduction, respectively, both p < 0.05).ConclusionWe found a significant decrease in HAI across the three countries in association with sequential multifaceted interventions such as hand hygiene, care bundles, and antimicrobial stewardships. Further regional collaboration could be forged to develop joint strategies to prevent HAI.

Japan nosocomial infections surveillance (JANIS): a model of sustainable national antimicrobial resistance surveillance based on hospital diagnostic microbiology laboratories

BackgroundAntimicrobial resistance (AMR) is now recognized as a major threat to public health, and surveillance of AMR is essential for successful containment. In 2000, Japan Nosocomial Infections Surveillance (JANIS) Clinical Laboratory (CL) division has been launched as a voluntary AMR surveillance funded by the Ministry of Health, Labour and Welfare and managed by the National Institute of Infectious Diseases. In this study, we aimed to propose a model of sustainable national AMR surveillance which provides not only national AMR surveillance reports but also benchmarking reports to each hospital to facilitate infection control practices.MethodsJANIS CL division collects comprehensive specimen-based data complies with JANIS data format from participating hospitals each month. It had targeted only blood and cerebrospinal fluid samples but was expanded to all types of specimens in 2007 at revision of JANIS. The JANIS system interprets the antimicrobial susceptibility according to the same criteria and conducts removal of duplicates to allow accurate comparison between hospitals. Monthly feedback reports are created automatically within 48 h, while quarterly and annual reports are generated after data validation.ResultsAt the beginning, 468 hospitals were enrolled in the JANIS CL division, but the number of hospitals that submitted data decreased to 210 (45%) in 2006. After surveillance revision in 2007, annual recruitment of hospitals was initiated and as of 2015, 1475 hospitals participated, and 1461 (99%) of them submitted data throughout the year. Nationwide surveillance data collected over the past decade revealed that the prevalence of methicillin-resistant Staphylococcus aureus has decreased since 2008, and that its prevalence is higher in the western part of Japan, where the number of hospitals per capita is higher than in the eastern part.ConclusionsJANIS CL division serves a model of sustainable national AMR surveillance system. Comprehensive data for all specimens promotes understanding of the sampling frequency and prevalence of AMR. As a well-established system for providing rich information to guide action both locally and nationally, JANIS may also be utilized for sharing AMR data globally.

Data quality and timeliness of outbreak reporting system among countries in Greater Mekong subregion: Challenges for international data sharing.

Cross-border disease transmission is a key challenge for prevention and control of outbreaks. Variation in surveillance structure and national guidelines used in different countries can affect their data quality and the timeliness of outbreak reports. This study aimed to evaluate timeliness and data quality of national outbreak reporting for four countries in the Mekong Basin Disease Surveillance network (MBDS). Data on disease outbreaks occurring from 2010 to 2015 were obtained from the national disease surveillance reports of Cambodia, Lao PDR, Myanmar, and Vietnam. Data included total cases, geographical information, and dates at different timeline milestones in the outbreak detection process. Nine diseases or syndromes with public health importance were selected for the analysis including: dengue, food poisoning & diarrhea, severe diarrhea, diphtheria, measles, H5N1 influenza, H1N1 influenza, rabies, and pertussis. Overall, 2,087 outbreaks were reported from the four countries. The number of outbreaks and number of cases per outbreak varied across countries and diseases, depending in part on the outbreak definition used in each country. Dates on index onset, report, and response were >95% complete in all countries, while laboratory confirmation dates were 10%-100% incomplete in most countries. Inconsistent and out of range date data were observed in 1%-5% of records. The overall timeliness of outbreak report, response, and public communication was within 1–15 days, depending on countries and diseases. Diarrhea and severe diarrhea outbreaks showed the most rapid time to report and response, whereas diseases such as rabies, pertussis and diphtheria required a longer time to report and respond. The hierarchical structure of the reporting system, data collection method, and country’s resources could affect the data quality and timeliness of the national outbreak reporting system. Differences in data quality and timeliness of outbreak reporting system among member countries should be considered when planning data sharing strategies within a regional network.

Respiratory Syncytial Virus Seasonality: A Global Overview.

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections in children. By the age of 1 year, 60%-70% of children have been infected by RSV. In addition, early-life RSV infection is associated with the development of recurrent wheezing and asthma in infancy and childhood. The need for precise epidemiologic data regarding RSV as a worldwide pathogen has been growing steadily as novel RSV therapeutics are reaching the final stages of development. To optimize the prevention, diagnosis, and treatment of RSV infection in a timely manner, knowledge about the differences in the timing of the RSV epidemics worldwide is needed. Previous analyses, based on literature reviews of individual reports obtained from medical databases, have failed to provide global country seasonality patterns. Until recently, only certain countries have been recording RSV incidence through their own surveillance systems. This analysis was based on national RSV surveillance reports and medical databases from 27 countries worldwide. This is the first study to use original-source, high-quality surveillance data to establish a global, robust, and homogeneous report on global country-specific RSV seasonality.

Acinetobacter spp. Infections in Malaysia: A Review of Antimicrobial Resistance Trends, Mechanisms and Epidemiology.

Acinetobacter spp. are important nosocomial pathogens, in particular the Acinetobacter baumannii-calcoaceticus complex, which have become a global public health threat due to increasing resistance to carbapenems and almost all other antimicrobial compounds. High rates of resistance have been reported among countries in Southeast Asia, including Malaysia. In this review, we examine the antimicrobial resistance profiles of Acinetobacter spp. hospital isolates from Malaysia over a period of nearly three decades (1987–2016) with data obtained from various peer-reviewed publications as well as the Malaysian National Surveillance on Antibiotic Resistance (NSAR). NSAR data indicated that for most antimicrobial compounds, including carbapenems, the peak resistance rates were reached around 2008–2009 and thereafter, rates have remained fairly constant (e.g., 50–60% for carbapenems). Individual reports from various hospitals in Peninsular Malaysia do not always reflect the nationwide resistance rates and often showed higher rates of resistance. We also reviewed the epidemiology and mechanisms of resistance that have been investigated in Malaysian Acinetobacter spp. isolates, particularly carbapenem resistance and found that blaOXA-23 is the most prevalent acquired carbapenemase-encoding gene. From the very few published reports and whole genome sequences that are available, most of the Acinetobacter spp. isolates from Malaysia belonged to the Global Clone 2 (GC2) CC92 group with ST195 being the predominant sequence type. The quality of data and analysis in the national surveillance reports could be improved and more molecular epidemiology and genomics studies need to be carried out for further in-depth understanding of Malaysian Acinetobacter spp. isolates.

Prevalence of trachomatous trichiasis in Australia: the National Eye Health Survey.

Australia is the only developed country to still have pockets of endemic trachoma. The research provides up-to-date, population-based prevalence data of later complications of trachoma amongst a national sample of Indigenous adults. To report the prevalence of trachomatous trichiasis (TT) in Indigenous Australians aged 40years and older. Population-based cross-sectional study. A total of 1738 (41% male) Indigenous Australians aged 40years or older, living amongst 30 randomly selected Australian sites, stratified by remoteness. Anterior segment examination was performed and trachoma grading for the presence of TT and corneal opacification (CO) was conducted using the WHO (WHO) simplified grading system. Prevalence of TT. A total of three (0.17%) participants had TT, and there were no confirmed cases of trachomatous CO in the NEHS. All three participants with TT were female and aged 40years or older. Although they had likely spent their childhoods in more remote areas, two of the three confirmed cases resided in an urban and outer regional area at the time of their examinations. Our data are in line with ongoing national trachoma surveillance reports that suggest the prevalence of late sequences of trachoma appear to be decreasing in Australia.

Status and methodology of publicly available national HIV care continua and 90-90-90 targets: A systematic review.

BackgroundIn 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) issued treatment goals for human immunodeficiency virus (HIV). The 90-90-90 target specifies that by 2020, 90% of individuals living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will receive antiretroviral treatment (ART), and 90% of those taking ART will be virally suppressed. Consistent methods and routine reporting in the public domain will be necessary for tracking progress towards the 90-90-90 target.Methods and findingsFor the period 2010–2016, we searched PubMed, UNAIDS country progress reports, World Health Organization (WHO), UNAIDS reports, national surveillance and program reports, United States President’s Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plans, and conference presentations and/or abstracts for the latest available national HIV care continuum in the public domain. Continua of care included the number and proportion of people living with HIV (PLHIV) who are diagnosed, on ART, and virally suppressed out of the estimated number of PLHIV. We ranked the described methods for indicators to derive high-, medium-, and low-quality continuum. For 2010–2016, we identified 53 national care continua with viral suppression estimates representing 19.7 million (54%) of the 2015 global estimate of PLHIV. Of the 53, 6 (with 2% of global burden) were high quality, using standard surveillance methods to derive an overall denominator and program data from national cohorts for estimating steps in the continuum. Only nine countries in sub-Saharan Africa had care continua with viral suppression estimates. Of the 53 countries, the average proportion of the aggregate of PLHIV from all countries on ART was 48%, and the proportion of PLHIV who were virally suppressed was 40%. Seven countries (Sweden, Cambodia, United Kingdom, Switzerland, Denmark, Rwanda, and Namibia) were within 12% and 10% of achieving the 90-90-90 target for “on ART” and for “viral suppression,” respectively. The limitations to consider when interpreting the results include significant variation in methods used to determine national continua and the possibility that complete continua were not available through our comprehensive search of the public domain.ConclusionsRelatively few complete national continua of care are available in the public domain, and there is considerable variation in the methods for determining progress towards the 90-90-90 target. Despite bearing the highest HIV burden, national care continua from sub-Saharan Africa were less likely to be in the public domain. A standardized monitoring and evaluation approach could improve the use of scarce resources to achieve 90-90-90 through improved transparency, accountability, and efficiency.