Notifiable Communicable Diseases Research Articles

The Rising Threat of Mucormycosis: Oman’s Experience Before and During the COVID-19 Pandemic

Mucormycosis is a rare, severe fungal infection mainly affecting immunocompromised individuals. Because of limited data on its epidemiology in Oman, we present this national, multicentric, retrospective review that includes all cases of proven mucormycosis between 2006 and 2022 in Oman. There were 51 cases of mucormycosis reported in Oman. The annual incidence of mucormycosis was 0.38–0.69 cases per million population before COVID-19. During the pandemic, the incidence rose significantly to 1.76 in 2020, 5.31 in 2021, then decreased to 0.87 per million population in 2022. Diabetes was observed in 82.4% (n = 42) of the cases, COVID-19 in 47.1% (n = 24), and other chronic diseases in 72.6%. The use of steroids was reported in 33.3% (n = 17) and many patients (64.7%, n = 33) had multiple risk factors. The overall mortality rate was 41.2% (n = 21) and most deaths occurred within a month of diagnosis. Mortality rate among patients diagnosed with COVID-19 was 58.3% (14/24). Survival analysis showed a statistically significant association between COVID-19 status and patient survival (p = 0.024). Annual incidence of mucormycosis in Oman rose during the pandemic. This study highlights the epidemiological features of mucormycosis and emphasizes the importance of its inclusion in the national notifiable communicable diseases priority list as well as the importance of enhancing diagnostic capacities to detect and improve patient outcomes.

Unveiling the Gaps: Analyzing Family Physicians' Perspectives on Infectious Disease Notification in Türkiye.

This study aimed to assess the opinions, attitudes, and behaviors of family physicians in Türkiye regarding mandatory communicable disease notification. Cross-sectional study. A national online survey in Türkiye. This study was conducted among 397 family physicians from different geographical regions in Türkiye. Family physicians' opinions, attitudes, and behaviors regarding infectious disease notification. The majority of family physicians (69.3%) felt inadequate in terms of knowledge about the notification system and 70.3% desired post-graduation training on communicable disease reporting. About one-third of the participants were dissatisfied with the current notification system. Reasons for under-reporting included lack of time, lack of feedback, and uncertainty about post-notification procedures. Factors significantly associated with higher infectious disease notification attitude scores (IDNAS) were receiving training on communicable disease reporting, feeling competent about reporting, and being satisfied with the reporting system (P <.001). However, physicians who admitted choosing a different ICD code to avoid filling out an infectious disease notification form had lower IDNAS scores (P <.001). This study highlights knowledge gaps and negative attitudes among family physicians in Türkiye regarding infectious disease reporting. Addressing these challenges requires continuous education and training programs. Feedback mechanisms should be improved to enhance physicians' engagement in the notification process. Reducing the workload of family physicians and simplifying the reporting process may also contribute to higher compliance with mandatory communicable disease reporting.

Investigating the characteristics of mumps outbreaks in Fujian Province, China

ObjectivesIdentifying the specifics and potential causes of mumps outbreaks in the Fujian Province during the period of 2017 to 2022. MethodsMumps cases reported by the National Notifiable Communicable Disease Report System (NNCDRS) in China during the observation period of the 5 years were investigated annually and by age to detect homogeneity of the spread of the disease over time. If specific age-peaks may appear, we investigated those figures by analysing group characteristics in mumps cases presented as outbreaks. Those characteristics include demography (age and sex), clinical symptoms, place and time identification, and vaccination status. Regarding the latter, it was hypothesized that cases manifesting an outbreaks and appearing in young adults should have a low vaccination coverage, and a long-lasting period since they received their vaccine. ResultsThe total number of mumps cases reported during the observation period was 15,294, leading to incidence rates ranging from 3.2/100,000 to 8.0/100,000 per year. In the older age-group the disease spread by year and age (9 to 15y old) manifested 20 outbreaks accounting for 710 cases, all happening during 2017 to 2019. Thereafter those outbreaks disappeared in that age-group. The group characteristics specified that all the outbreaks happened in school settings, with a median age of 13y (range 6 to 19y). Parotid gland enlargement was observed in 82.7 %. The median duration of the outbreaks was 28 days, varying from 14 to 74 days. Only 27.6 % of the cases received at least one dose of the MuCV vaccine, and among these vaccinated individuals, 94.9 % developed mumps more than 5 years after vaccination. The dramatic reduction in outbreaks after 2019 could be explained by the public health measures taken during the COVID period and/or the new vaccination policy implemented in 2008 (free vaccination, 1 dose) and 2020 (2 doses) of young children causing therefore a lower rate of circulation of the virus. ConclusionMumps outbreaks observed in young adults during 2017–2019 causing a disease peak, indicated a potential link to unsatisfactory vaccination coverage with prolonged interval since receiving the vaccine. As those disease peaks disappeared since 2020, close monitoring for new outbreaks in young adults is recommended that may initiate a new vaccination strategy for that age-group.

A-285 Adoption of 2023 CLSI Revised Aminoglycoside Clinical Breakpoints on Carbapenem Resistant Enterobacterales Isolates Identified at a Commercial Reference Laboratory in Korea, Republic of

Abstract Background The incidence of carbapenem resistant Enterobacterales (CRE) has been rapidly increasing as a nationally notifiable communicable disease since 2017 in Korea. The therapeutic options available for these pathogens are extremely limited. Several new drugs developed to treat CRE infections was recently introduced in Korea, but was not widely used. Instead, aminoglycoside is used as one of current available antimicrobials in CRE infections. The Clinical and Laboratory Standards Institute (CLSI) publishes revised aminoglycoside breakpoints in Enterobacterales in 2023. The purpose of this study was to evaluate the adoption of changing the aminoglycoside breakpoint in a commercial reference laboratory. Methods We retrospectively evaluated aminoglycosides (amikacin, gentamicin, tobramycin) for 1,393 CRE isolates not including surveillance culture identified by MALDI-TOF MS (Bruker Daltonik, Bremen, Germany) from January to December in 2023 at a commercial reference laboratory in Korea. Antimicrobial susceptibility testing was performed using a N415 card on the VITEK2 XL (bioMerieux, France). Susceptibilities of aminoglycoside were assessed based on previous breakpoints in CLSI M100-S32 in 2022 as well as the current breakpoints from the most recent CLSI MIC breakpoints in 2023. Results We evaluated 1,393 CRE isolates. Most isolates were Klebsiella pneumoniae [n=876 (62.9%)] and Escherichia coli [n=322 (23.1%)] followed by Citrobacter koseri [n=76 (5.5%)] The new aminoglycoside breakpoints reduced the percentage of strains that were previously judged to be susceptible by CLSI M100-S32 from 87.5% (1,219/1,393) to 71.2% (992/1,393) in amikacin, from 45.5 (634/1,393) to 44.8% (624/1,393) in gentamicin and from 23.3% (323/1,385) to 21.4% (297/1,385) in tobramycin, respectively. In meropenem resistant 56 isolates with MIC≤8 mg/L available of meropenem in combination with a second agent, frequently polymyxins or aminoglycosides, the new aminoglycoside breakpoints reduced the percentage of strains that were previously judged to be susceptible from 92.9% (52/56) to 64.3% (36/56) in amikacin and from 64.3% (36/56) to 60.7% (34/56) in gentamicin, respectively. There was no difference in tobramycin. Conclusions Our results show decreased susceptibility of aminoglycoside especially for amikacin in CRE isolates tested. Amikacin is commonly used to treat CRE infections, either alone or as part of combination therapy. Although our study has no correlation with clinical outcomes, we found microbiology laboratories should adopt the updated breakpoints.

Epidemiological and etiological characteristics of herpes pharyngitis in 3 prefectures in Jiangsu Province

Objective: To analyze the epidemiological and etiological characteristics of herpes pharyngitis (HA) in three prefectures of Jiangsu Province, and provide evidence for the prevention and control of HA in Jiangsu. Methods: Three surveillance sentinel hospitals in Wuxi, Suzhou and Yancheng were selected from May 2018 to December 2022, and information related to HA visits and hospitalized cases was regularly collected from the hospital inpatient management system by age groups. Enterovirus nucleic acid detection was performed by RT-PCR, and sequencing analysis, identification of genotype subtypes, and phylogenetic analysis were performed on the sequences of the gene encoding the coat protein VP1 of the main prevalent strains. Results: A total of 57 709 HA cases were recorded in the sentinel hospitals in in Wuxi, Suzhou and Yancheng, which was 1.76 times higher than the reported cases of hand, foot and mouth disease during the same period (57 709/32 831).The percentage of HA hospitalizations was 1.35% (781/57 709), and the percentage of hospitalizations showed an increasing trend from year to year (χ2=62.79, P<0.001 ).The incidence peak of HA was during May-July. The cases were mainly children aged 12-59 months (67.07%, 38 708/57 709), with the highest case number in age group 36-59 months (34.40%, 19 852/57 709). The HA positivity rate was 33.82% (644/1 904); enterovirus A was predominant (54.04%, 348/644); of these, Coxsackievirus (CV)A6 accounted for the highest percentage (52.59%, 183/348), while CVA16 and CVA4 accounted for 24.71% (86/348) and 15.23% (53/348), respectively. All 10 CVA4 HA endemic strains belonged to the C2 gene subtype, and all 6 CVA6 HA endemic strains belonged to the D3a gene subtype; and were genetically closer to and related to the strains in some areas of China (Fujian Province, Guangzhou City, Jiangxi Province, Yunnan Province, Tianjin City, etc.). Conclusions: The disease burden of HA was heavy in 3 areas in Jiangsu, children in age group 12-59-month were mainly affected, and the annual incidence peak of HA was during May-July. The pathogens causing HA varied, but predominated by enterovirus A and had low intra-typical differentiation, and no new evolutionary branches were found, suggesting that it is necessary to include HA in foot and mouth disease surveillance or regarded as a notifiable communicable disease.

Impact of the COVID-19 pandemic on infectious diseases reporting.

COVID-19 pandemic had impacted the reporting of notifiable communicable diseases. Since the beginning of the pandemic and the introduction of relate public health measures, notifications for most notifiable diseases have declined compared to previous years. In this study, we aim to quantify the changes in the incidences of notifiable infectious diseases during and after the pandemic in Siracusa Local Health Authority, Italy. We collected and analysed the infectious disease notifications made in two different three-years periods, 2017-2019 and 2020-2022 in Siracusa Local Health Authority, Italy. Descriptive statistics were used to find the percentages and the 95% confidence interval (CI). Exact "F-tests" was performed to compare the mean values between the studied periods to evaluate the hypothesis that the number of reported cases would not differ significantly between the two periods. Significance was assessed at the p < 0.05 level. The total number of notifications significantly decreased by 69.3% in the pandemic period compared to the pre-pandemic one, with the highest reduction of air-borne transmission diseases (-86.5%), followed by food-borne diseases (-68.2%) and sexually transmitted diseases (-39.3%). Conversely, an increase in number of notifications was found only for legionellosis. The COVID-19 pandemic had the potential to influence communicable disease reporting at multiple points. While the effects could vary considerably, the results would be expected to reduce the number and the detection of notifiable cases. Included would be changes in exposures, diagnostic testing, reporting to public health agencies, and public health investigations.

A study of the Communicable Disease Notification process functioning at a Tertiary care hospital in Srilanka

A study of the Communicable Disease Notification process functioning at a Tertiary care hospital in Srilanka

Enhancing the notification system for surveillance of infectious diseases in Qatar during the FIFA World Cup 2022: project overview

BackgroundIn 2022, the Surveillance Department of the Ministry of Public Health in Qatar adopted an integrated project called the Notification Enhancement Project (NEP) to enhance the infectious disease notification system. Efficient surveillance and notification promote early alerts and allow immediate interference in reducing morbidity and mortality from outbreaks. The project was designed to improve the knowledge, attitudes, practices, and notification processes of healthcare workers in Qatar by increasing their reporting rates.MethodsThe strategy for comprehensively enhancing notifications was based on the observation and evaluation of the current notification system, the implementation of interventions, and post-evaluation follow-up. To implement the project, we relied on three aspects: effective methods used in previous relevant studies through a literature review, feedback received from healthcare workers, and suggestions from public health surveillance experts from the Ministry of Public Health, Qatar. A preassessment was conducted through an online survey by the Ministry of Public Health. The effectiveness of the different interventions was assessed by analyzing the data of notified patients reported through the Disease Surveillance and Reporting Electronic System. Pre- and postintervention assessments were performed by comparing the percentage of patients notified by healthcare providers with that of patients confirmed by healthcare providers in the laboratory to compare the notification rates over three time periods between January and December 2022.ResultsThere was significant improvement in the infectious disease notification process. A comparison before and after the implementation of the interventions revealed an increase in the communicable disease notification rate among healthcare workers. Pre- and postintervention data were compared. Infectious disease notification activities by healthcare workers increased from 2.5% between January and May 2022 to 41.4% between November and December 2022.ConclusionThis study highlights the efficiency of different interventions in correcting the underreporting of infectious diseases. Our findings suggest that implementing the Notification Enhancement Project significantly improves notification rates. We recommend continuing interventions through constant education and training, maintaining solid communication with HCWs through regular reminder emails and feedback, periodic assessment of the electronic notification system, and engagement of healthcare workers and other stakeholders to sustain and expand progress achieved through continuous evaluation.

Epidemiological Profile of Communicable Diseases in Childhood within the Babylon Governorate, Iraq from 2017 to 2021

Background: Notifiable communicable diseases are a significant public health issue in Iraq, particularly among children. Aims: This study aimed to comprehensively assess the epidemiological profile of childhood communicable diseases in Babylon Governorate, Iraq, over the period 2017–2021 Methods and Material: Data from 11,925 cases of notifiable communicable diseases were collected from the health department in AL-Hilla City, Iraq, between 2017 and 2021. The data were analysed according to the mode of transmission, type of infection, and age and sex patterns. Results: The majority of the reported communicable diseases (85.4%) were droplet and airborne infections, with pneumonia being the most frequently reported respiratory infection (76.8%). The reported cases of pertussis, viral meningitis, bacterial meningitis, chickenpox, and mumps showed a significant decrease during the study period, while the incidence of measles had two peaks in 2019 and 2020. Viral hepatitis A and typhoid fever were the most frequently reported foodborne infections. Kala-azar was the most common arthropod-borne infection, while brucellosis and rabies were the most common zoonotic infections. Pneumonia and meningitis affected infants and children aged 1-4 years more commonly than other age groups, while pertussis affected infants and children aged 1-4 years more frequently than other age groups, with a female predominance. Measles affected infants and children aged 1-4 years more commonly than older age groups, with a male predominance. Conclusions: This study provides a comprehensive overview of the occurrence and trends of notifiable communicable diseases among children in AL-Hilla City, Iraq, between 2017 and 2021. The findings highlight the need for improved surveillance and prevention measures.

Interrupted time series analysis using the ARIMA model of the impact of COVID-19 on the incidence rate of notifiable communicable diseases in China

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic in China is ongoing. Some studies have shown that the incidence of respiratory and intestinal infectious diseases in 2020 decreased significantly compared with previous years. Interrupted time series (ITS) is a time series analysis method that evaluates the impact of intervention measures on outcomes and can control the original regression trend of outcomes before and after the intervention. This study aimed to analyse the impact of COVID-19 on the incidence rate of notifiable communicable diseases using ITS in China.MethodsNational data on the incidence rate of communicable diseases in 2009–2021 were obtained from the National Health Commission website. Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models was used to analyse the changes in the incidence rate of infectious diseases before and after the COVID-19 epidemic.ResultsThere was a significant short-term decline in the incidence rates of respiratory infectious diseases and enteric infectious diseases (step values of -29.828 and − 8.237, respectively), which remained at a low level for a long time after the decline. There was a short-term decline in the incidence rates of blood-borne and sexually transmitted infectious diseases (step = -3.638), which tended to recover to previous levels in the long term (ramp = 0.172). There was no significant change in the incidence rate of natural focus diseases or arboviral diseases before and after the epidemic.ConclusionThe COVID-19 epidemic had strong short-term and long-term effects on respiratory and intestinal infectious diseases and short-term control effects on blood-borne and sexually transmitted infectious diseases. Our methods for the prevention and control of COVID-19 can be used for the prevention and control of other notifiable communicable diseases, especially respiratory and intestinal infectious diseases.

An amplification-free, 16S rRNA test for Neisseria gonorrhoeae in urine.

An amplification-free, nanopore-based nucleic acid detection platform has been demonstrated for rapid, 16S rRNA sequence-specific detection of Neisseria gonorrhoeae at 10-100 CFU mL-1 in human urine against background bacterial flora at 1000 CFU mL-1. Gonorrhea is a very common notifiable communicable disease, antibiotic resistant strains have emerged, and the rate of reported gonococcal infections continues to increase. Since rapid clinical identification of bacterial pathogens in clinical samples is needed to guide proper antibiotic treatment and to control disease spread, it is important to engineer rapid, sensitive, selective, and inexpensive point-of-care (POC) diagnostic devices for pathogens such as N. gonorrhoeae. Our detector technology is based on straightforward conductometric detection of sustained blockage of a glass nanopore. Charge neutral, complementary peptide nucleic acid probes are conjugated to polystyrene beads to capture N. gonorrhoeae 16S rRNA selectively. In the presence of an electric field applied externally through a glass nanopore, the PNA-microbead conjugates that acquire substantial negative charge upon target hybridization are driven to the smaller diameter nanopore. At least partial blockage of the nanopore results in a sustained drop in ionic current that can be measured easily with simple electronics. The ability to detect N. gonorrhoeae over the range of 10 to 100 CFU mL-1 spiked in human urine was demonstrated successfully with estimated sensitivity and specificity of ∼98% and ∼100%, respectively. No false positives were observed for the control group of representative background flora (E. coli, K. pneumoniae, and E. faecalis) at 1000 CFU mL-1. Also, N. gonorrhoeae at 50 CFU mL-1 was successfully detected against 1000 CFU mL-1 of background flora in urine. These results suggest that this amplification-free technology may serve as the basis for rapid, inexpensive, low-power detection of pathogens in clinical samples at the POC.

Impact of national COVID-19 restrictions on incidence of notifiable communicable diseases in England: an interrupted time series analysis

BackgroundNon-pharmaceutical interventions (NPIs), such as travel restrictions, social distancing and isolation policies, aimed at controlling the spread of COVID-19 may have reduced transmission of other endemic communicable diseases, such as measles, mumps and meningitis in England.MethodsAn interrupted time series analysis was conducted to examine whether NPIs was associated with trends in endemic communicable diseases, using weekly reported cases of seven notifiable communicable diseases (food poisoning, measles, meningitis, mumps, scarlet fever and pertussis) between 02/01/2017 to 02/01/2021 for England.ResultsFollowing the introduction of COVID-19 restrictions, there was an 81.1% (95% CI; 77.2–84.4) adjusted percentage reduction in the total number of notifiable diseases recorded per week in England. The greatest decrease was observed for measles, with a 90.5% percentage reduction (95% CI; 86.8–93.1) from 42 to 5 cases per week. The smallest decrease was observed for food poisoning, with a 56.4% (95%CI; 42.5–54.2) decrease from 191 to 83 cases per week.ConclusionsA total reduction in the incidence of endemic notifiable diseases was observed in England following the implementation of public health measures aimed at reducing transmission of SARS-COV-2 on March 23, 2020. The greatest reductions were observed in diseases most frequently observed during childhood that are transmitted via close human-to-human contact, such as measles and pertussis. A less substantive reduction was observed in reported cases of food poisoning, likely due to dining services (i.e., home deliveries and takeaways) remaining open and providing a potential route of transmission. This study provides further evidence of the effectiveness of non-pharmaceutical public health interventions in reducing the transmission of both respiratory and food-borne communicable diseases.

Gaps in the communicable disease notification system; evidence from a major tertiary care hospital, Sri Lanka

Gaps in the communicable disease notification system; evidence from a major tertiary care hospital, Sri Lanka

Reasons for under-reporting of notifiable communicable diseases in the Kingdom of Bahrain: a health-centers based survey

Background: Poor compliance by physicians with communicable diseases reporting is a worldwide phenomenon. In Bahrain, there are limited data regarding thoroughness and completeness of the current communicable diseases reporting system. Objective: To identify reasons for noncompliance with reporting of notifiable communicable diseases by primary health care physicians practicing in the Ministry of Health (MoH) primary health care centers. Methods: This is a cross-sectional study. Two hundred and forty-one self-administered questionnaires were distributed to all primary health care physicians practicing in all primary care health centers of the Ministry of Health. The questionnaires included items regarding socio-demographic and practice-related characteristics, self-reported practice related to communicable diseases reporting and reasons for noncompliance with reporting requirements. Results: The response rate was 93%; the mean age of the respondents was 43 ±8.36 years. The period of experience in clinical practice ranged from 1 to 35 years with a mean of 12.84 ± 7.86 years. Lack of feedback on notified cases, forgot to notify, and not sure of diagnosis were cited by more than half of the physicians as reasons for noncompliance with communicable diseases reporting. Conclusion: The findings suggest that there are several reasons for noncompliance with reporting requirements. Revising the current notification procedure to resolve some of the reasons is vital to enhance communicable diseases reporting in Bahrain.

Hand, Foot and Mouth Disease (HFMD): Prevalence and its Spatial Relationship with Vaccine Refusal Cases in Terengganu, Malaysia

Hand, foot and mouth disease (HFMD) is a global public health problem with pandemic potential. The progressive increment of HFMD cases in Malaysia needs further investigation to identify the pattern of disease spread, including its proximity to vaccine refusal. We sought to estimate the prevalence of HFMD in Terengganu and determine the spatial relationship between HFMD and vaccine refusal cases. This study employed data from the national electronic communicable disease notification system and vaccine refusal database maintained by the Communicable Disease Control (CDC) Unit and Maternal and Child Health Care (MCH) Unit. Data from all cases recorded in 2016 were provided by the Terengganu State Health Department, Malaysia. The number of HFMD cases for each district was estimated using the points-in-polygons function in R software. The spatial relationship between HFMD cases and vaccine refusal cases was tested using the cross K-function test. A total of 811 HFMD cases was notified in 2016, with the overall prevalence at 80.2 cases per 100,000 population. Among all districts in Terengganu, the prevalence of HFMD ranged from 19.2 to 230.9 cases per 100,000 population, with the cases highly concentrated in three districts: Kuala Terengganu, Marang, and Dungun. There was evidence of a spatial cluster of HFMD cases based on the Nearest Neighbour Index, r = 0.27 (p-value &lt; 0.01). Moreover, the locations of HFMD cases were statistically and closely related to the areas of vaccine refusal cases (cross K test, p-value &lt; 0.010). The prevalence of HFMD from year to year was high. HFMD cases and vaccine refusal cases formed clusters in the districts with a high-density population. The proximity of HFMD cases and vaccine refusal cases in Terengganu warrants further investigation.

Epidemic situation and diagnosis of imported malaria before and after malaria elimination in Nanjing City, Jiangsu Province

To analyze the epidemiological characteristics and diagnosis of imported malaria before and after malaria elimination in Nanjing City of Jiangsu Province, so as to provide the scientific evidence for formulating the malaria control strategy after malaria elimination. Data pertaining to the epidemic situation and individual investigation of malaria in Nanjing City before (from 2012 to 2016) and after malaria elimination (from 2017 to 2020) were captured from the National Notifiable Communicable Disease Reporting System and the Information System for Parasitic Diseases Control and Prevention and were analyzed statistically. A total of 178 malaria cases were reported in Nanjing City from 2012 to 2020, and all were imported cases. There were 99 malaria cases reported before malaria elimination in Nanjing City, including 78 cases with Plasmodium falciparum malaria (78.79%), 5 cases with P. vivax malaria (5.05%), 10 cases with P. ovale malaria (10.10%), 3 cases with P. malariae malaria (3.03%) and 3 cases with mixed infections (3.03%), and 79 malaria cases reported after elimination, including 63 cases with P. falciparum malaria (79.75%), 5 cases with P. vivax malaria (6.33%), 9 cases with P. ovale malaria (11.39%), 2 cases with P. malariae malaria (2.53%). There was no significant difference in the proportion of each type of malaria cases in Nanjing City before and after malaria elimination (χ2 =2.400, P > 0.05). Malaria cases mainly acquired Plasmodium infections in African regions, and no significant difference was seen in the proportion of malaria cases returning to Nanjing City from African countries before and after malaria elimination (χ2 = 0.093, P > 0.05). The number of malaria cases peaked in Nanjing City in January and during the period from May to July before elimination, and there was no apparent seasonal variation in the distribution of malaria cases after elimination. The proportion of malaria cases living in Nanjing City was significantly greater after malaria elimination than before elimination (72.15% vs. 55.56%; χ2 = 5.187, P = 0.023). The proportions of businessmen and international students were both 5.05% before malaria elimination, and increased to 15.19% and 13.92% after elimination, respectively (χ2 = 5.229 and 4.229, both P values < 0.05). The percentage of definitive diagnosis of malaria at initial diagnosis was 18.75% in county-level hospitals before malaria elimination and increased to 61.11% after elimination (χ2 = 6.275, P = 0.012), while the proportion of malaria cases with definitive diagnoses in county-level hospitals was 4.04% before malaria elimination and increased to 13.92% after elimination (χ2 = 5.562, P = 0.018). During the period from 2012 to 2020, the proportion of malaria cases with definitive diagnoses within 1 to 3 days post-admission increased from 27.27% in Nanjing City before malaria elimination to 45.57% after elimination (χ2 = 6.433, P = 0.011). The epidemic situation of imported malaria remains serious in Nanjing City during the post-elimination stage, and malaria parasite infections predominantly occur in African regions. In addition, there are changes in regional and occupational distributions of malaria cases and the diagnostic capability of malaria increases in county-level hospitals in Nanjing City after malaria elimination. Further improvements in the malaria surveillance system and the diagnostic and treatment capability of malaria in medical institutions at each level are required to consolidate malaria elimination achievements in Nanjing City.

Notifiable diseases after implementation of COVID-19 public health prevention measures in Central Queensland, Australia

The implementation of public health measures to control the current COVID-19 pandemic (such as wider lockdowns, overseas travel restrictions and physical distancing) is likely to have affected the spread of other notifiable diseases. This is a descriptive report of communicable disease surveillance in Central Queensland (CQ) for six months (1 April to 30 September 2020) after the introduction of physical distancing and wider lockdown measures in Queensland. The counts of notifiable communicable diseases in CQ in the six months were observed and compared with the average for the same months during the years 2015 to 2019. During the study's six months, there were notable decreases in notifications of most vaccine-preventable diseases such as influenza, pertussis and rotavirus. Conversely, notifications increased for disease groups such as blood-borne viruses, sexually transmitted infections and vector-borne diseases. There were no reported notifications for dengue fever and malaria which are mostly overseas acquired. The notifications of some communicable diseases in CQ were variably affected and the changes correlated with the implementation of the COVID-19 public health measures. The current COVID-19 pandemic has led to some significant changes to local, regional and national public health practices including social distancing and wider lockdown. These measures have been previously reported to be associated with reductions in the incidence of gastrointestinal and respiratory diseases as well as of other airborne transmitted agents.1,2 A preliminary analysis was conducted assessing the impact of these measures on nationally notifiable diseases across Australia;3 however, the impact of these measures on communicable diseases within regional Australia is not well established. Like most regional areas, Central Queensland (CQ) has a lower population density and considerable distance from major cities; it will be informative to understand how these measures impact on notifiable conditions in this regional setting. We aimed to identify the patterns of change in reported notifiable conditions to the Central Queensland Public Health Unit (CQPHU), during a six-month period (1 April to 30 September 2020) following the implementation of COVID-19 measures. Here, we compare these notifications to the surveillance data for the same six-month period for the previous five years (2015 to 2019). The study encompasses all notifiable conditions reported from CQ, which covers approximately 226,000 population and is spread over 117,588 square kilometres. Communicable diseases data were retrieved from the Queensland Notifiable Conditions System (NoCS), an online epidemiological database, from 1 January 2015 to 30 September 2020. The data were collected under the Public Health Act 2005, a legislative authority that provides permission to access health information. Permission to publish was given by the Communicable Diseases Branch of Queensland. Data were extracted on selected notifiable diseases in Queensland: blood-borne viruses (BBV), gastrointestinal diseases, sexually transmissible infections (STIs), vaccine-preventable diseases (VPDs), vector-borne diseases, zoonotic diseases and other diseases. For each disease, the count for six months following the implementation of COVID-19 public health measures (1 April to 30 September 2020) was compared with the average for the same six-month period during the years 2015 to 2019. From 1 April to 30 September 2020, after the implementation of Queensland's COVID-19 preventive measures, there was a decrease seen in several diseases notifications reported to the CQPHU, mostly VPDs, when compared with the same months for each of 2015 to 2019 and for the 5-year average (2015-2019) for those months (Table 1). However, increases in notifications for April-September 2020 were observed in a greater number of other notifiable disease groups.

Tuberculosis and Notifiable Skin Diseases Amongst A Representative Cohort of Refugees in Germany (2014–16)

Abstract Until now, systematic surveillance for infectious diseases in refugees is still missing. For that reason, this study aims at illustrating the prevalence of tuberculosis (TB) and notifiable skin diseases in a representative cohort of refugees in Lippe, a district of the federal state of North Rhine-Westphalia, Germany. We collected data on notifiable communicable diseases (TB, scabies, and head lice) from refugees (n = 8946) based on a medical screening after their arrival from October 2014 until May 2016. Data were analysed using descriptive and bivariate methods. Overall, we found 63 of 8764 screened refugees to have an abnormal TB screening result (0.72%). Of 8946 screened refugees, only 51 individuals were found to have scabies (0.57%) and a further 49 were tested positive for head lice (0.55%). The absolute number of TB cases indicate only a moderate public health burden. However, communicable skin diseases can become a problem in crowded holding camps, where they can cause local outbreaks.

Physical distancing and non-respiratory notifiable diseases in the Northern Territory, March-May 2020.

Strict physical distancing measures and border controls have been introduced in the Northern Territory (NT), and across Australia, to reduce the spread of coronavirus disease 2019 (COVID-19). These measures have been associated with reduced incidence of other respiratory illnesses such as influenza. It is currently unclear what effect these measures have on non-respiratory communicable diseases. The incidence of notifiable non-respiratory communicable diseases within the NT, from 15 March to 15 May 2020, the period of most restrictive physical distancing, was monitored and is here compared with two control periods: (i) the 4 months immediately prior and (ii) the same two-month period from the preceding 5 years. During the study period, there was a decline in incidence of communicable enteric illnesses, particularly in shigellosis and rotavirus where person-to-person spread is the main transmission route. There was an increase in chlamydial conjunctivitis in areas with endemic trachoma, which is under further investigation. There was no observed increase in conditions associated with crowding, such as those related to group A streptococcal infection.

Re-examination of malaria diagnosis in Hubei Provincial Malaria Diagnostic Reference Laboratory from 2017 to 2019

To analyze the re-examination results of malaria cases captured from the National Notifiable Communicable Disease Reporting System in Hubei Provincial Malaria Diagnostic Reference Laboratory from 2017 to 2019, so as to pro- vide the scientific evidence for improving the malaria control capability in the province. Microscopy and nested PCR assay were performed to re-examine the diagnosis of malaria cases registered in the National Notifiable Communicable Disease Reporting System in Hubei Provincial Malaria Diagnostic Reference Laboratory from 2017 to 2019, and the coincidences of ma- laria diagnosis and malaria parasite species were evaluated. A total of 410 malaria cases were reported in Hubei Province from 2017 to 2019 according to the data retrieved from the National Notifiable Communicable Disease Reporting System. Among the 407 samples re-examined by Hubei Provincial Malaria Diagnostic Reference Laboratory from 2017 to 2019, the diag- nosis 374 malaria cases were confirmed, with an overall coincidence of 91.89% (374/407) for malaria diagnosis and 89.04% (333/374) for parasite species identification. The coincidence rates of malaria diagnosis and parasite species identification were 50.00% to 100.00% and 66.67% to 100.00% in 16 cities (prefectures) of Hubei Province during the re-examinations, which both varied in regions (χ2 = 40.46 and 42.30, both P values < 0.01). The coincidence rates of Plasmodium falciparum, P. vivax, P. malariae and P. ovale identification were 95.80%, 100.00%, 58.33% and 51.92% during the re-examinations, respectively (χ2 = 76.66, P < 0.01). The consistency rate between microscopic and nested PCR results was 89.83% (362/403). The overall diagnostic quality of malaria is high in medical institutions at all levels in Hubei Province; however, the diagnostic capability of malaria remains to be improved in some regions.