Prophylaxis Research Articles

Investigating Transmission Patterns and Genome Sequencing of SARS-CoV-2 in University College Dublin

Abstract Background This study describes the investigation and management of multiple outbreaks of SARS-Cov2 during the second and third wave of the pandemic at University College Dublin, Ireland from September 2020 to September 2021. Methods Relevant data were gathered as part of the public health outbreak investigations led by the UCD Internal Covid Control Team (ICCT) in collaboration with the public health teams of the Health Service Executive (HSE). Results are presented for PCR (polymerase chain reaction) confirmed cases and their close contacts, reported to the UCD ICCT between September 2020 to September 2021. Results There were 214 cases notified to ICCT. Among these, 153 cases were in residence on-campus cases. 73 epidemiologically linked clusters identified, where the number of cases linked with each cluster varied between 1 to 27. Additional cases during this period had no obvious epidemiological link to the identified clusters. Of 902 close contacts with PCR test results, 31.5% (n = 284) tested positive. 77% (n = 219) self-reported with mild to moderately symptoms while 23% (n = 65) self-reported as asymptomatic. Retrospective Whole Genome Sequence (WGS) analysis was undertaken after the outbreaks had subsided. The test positive cases were grouped into 6 clusters, and it was shown that many of the apparent sporadic cases were included in these clusters. Conclusions The proportion of close contacts testing positive varied significantly throughout the pandemic, with testing policy and type of exposure having the greatest impact. Whole genome sequencing can give a better understanding of webs of transmission to complement epidemiological investigations. It is now possible to undertake sequencing in real time where it can make a contribution to outbreak control and resolution. Public Health professionals should become familiar with WGS and bioinformatics as useful tools in their armory for the control of all communicable diseases not only SARS-CoV-2. Key messages • Combined epidemiological investigations and Whole Genome Sequencing (WGS) provide crucial insights into campus COVID-19 outbreaks, guiding effective control measures. • WGS integration enhances understanding of transmission patterns, identifies clusters, and equips public health professionals with data-driven approaches for outbreak management beyond SARS-CoV-2.

Use of specialist health care among Norwegian-born children with one immigrant parent

Abstract Background An increasing number of children grow up with one immigrant and one native born parent. We know little about health in this group. Our aim was to compare the risk of receiving diagnoses of physical health conditions in specialist health care among Norwegian-born children with one immigrant parent compared to Norwegian background children. Methods Data from Medical Birth Registry of Norway were linked to data from the Norwegian Patient Registry (diagnoses in specialist health care), and Statistics Norway (parental country of origin, education, and household income). We estimated hazard ratios (HR) with Cox proportional hazard regressions, with Norwegian background children as reference category, adjusted for sex, birth year, parental education, and household income. Results Children with an immigrant parent had lower hazards than Norwegian background children of diagnoses of most types of infections, but higher hazards of some, including tuberculosis, and skin infections. They also had higher hazards than Norwegian background children of receiving diagnoses of obesity and other nutritional deficiencies, and skin diseases, but lower hazards for other conditions, including chronic lower respiratory disease, disease of the digestive system, and visual or hearing impairment. The hazards of diagnoses of any neurological condition, sleeping disorders and epilepsy were lower among children with an immigrant mother, but higher among those with an immigrant father. Differences between children with one immigrant parent and Norwegian background could not be explained by differences in parental education or household income. Conclusions Children of one immigrant parent do not overall use specialist health care for physical health issues more than other children. Key messages • Awareness of diagnoses given most frequently to children of one immigrant parent can help promote timely diagnoses and adequate use of services, which is important for prevention of later illness. • Barriers to health care use among children of immigrants should be further researched.

Predictors for psychosocial consequences of screening for liver diseases in Germany: a LASSO approach

Abstract Background Medical screening is extensively used across various disciplines for early disease detection and prevention of severe progression aiming to reduce disease-specific burden, improve quality of life and promote health. However, screening is debated due to unclear evidence of its overall benefits from a public health perspective. Screening is associated with improved health behavior and cost-effectiveness. However, studies identified adverse effects of screening like psychosocial burden. Most results originate from cancer screening and it is unclear whether they are transferable to other contexts. Within a research program, a systematic screening procedure to detect patients with liver cirrhosis at early stage in an asymptomatic general population was evaluated. In this study, we aimed to identify patient characteristics that predict and explain variance in psychosocial outcomes of screened patients. Methods This study analyzed data from 523 participants who underwent a systematic liver disease screening in Germany from Jan 2018 to Feb 2021. We used bootstrapped LASSO regression with 10-fold validation to evaluate the influence of various predictors on the outcomes measured by the Psychological Consequences of Screening Questionnaire (PCQ). The constructs measured by the PCQ are social, physical and emotional dysfunction associated with screening. Results We identified lower severity of comorbidities, higher subjective social status, stronger social support, older age, better critical health communication skills and higher health literacy as relevant predictors of lower psychosocial dysfunction, indicating their protective role in preventing psychosocial burden of screening. Conclusions From a public health perspective, medical screening offers should take into account patients’ individual context regarding their subjective social status, health impairments, personal social networks and health literacy skills to reduce post-screening psychosocial burden. Key messages • Social support, age, health literacy and higher subjective social status were positively associated with lower psychosocial consequences of liver screening. • The findings indicate that liver screening should be carried out, taking into account the individual’s situation and resources available.

Estimation of individual lifetime cardiovascular disease risk and treatment benefit in patients with established atherosclerotic cardiovascular disease: the updated SMART-REACH2 model

Abstract Background The 2021 ESC Guidelines on Cardiovascular Disease (CVD) Prevention in Clinical Practice recommend using (lifetime) risk to guide preventive treatment intensification. Purpose Updating and systematically recalibrating the SMART-REACH lifetime prediction model for the estimation of lifetime risk of recurrent CVD in patients with established atherosclerotic CVD (ASCVD) to various European and international risk regions. Methods The updated SMART-REACH (i.e., SMART-REACH2) model was derived using data from 9,477 individuals between 40-90 years with coronary artery disease, cerebrovascular disease, peripheral artery disease, or abdominal aortic aneurysms included in the UCC-SMART cohort in whom 2,090 ASCVD events were observed during a median follow-up of 8.9 years (interquartile range 4.5–14.1). Coefficients for type of CVD, estimated glomerular filtration rate, non-high density lipoprotein cholesterol, systolic blood pressure, duration of CVD, C-reactive protein, current smoking, and presence of diabetes were derived using sex-stratified cause-specific Cox models with age as the time axis, adjusted for the competing risk of non-CVD mortality. Lifetables were used to estimate 10-year and lifetime CVD-risk and CVD-free life expectancy. The SMART-REACH2 model was externally validated in 121,701 patients from the NOR-COR, Nor-COAST, HUNT3, SWEDEHEART, Bialystok PLUS/Polaspire, REACH-EU, and REACH non-EU (Asia, Japan, Latin America, North America) covering 43 countries. The model was recalibrated to specific risk regions based on the expected-observed ratios from representative cohorts. Performance was assessed by calibration of predicted and observed risk and Harrel’s C-statistic for discrimination. Results 16,689ASCVD events were observed in the external validation cohorts. The model was visually well calibrated for the various risk regions. The pooled C-statistic across risk regions was 0.665 [95% confidence interval 0.640-0.691], with adequate performance in the separate regions (Figure 1). Using SMART-REACH2 to estimate potential gain in CVD-free life expectancy upon treatment initiation showed varying projections. For example, two comparable 55-year-old males from the low-risk region and very high-risk region would gain an estimated 2.2 and 3.9 CVD-free life years as a result of smoking cessation (Figure 2). Conclusion(s) By using larger and more contemporary data sources, considering geographical differences, and extending the age range, the updated SMART-REACH2 model provides an improved algorithm for the estimation of lifetime risk and CVD-free life expectancy for individuals with established ASCVD, facilitating shared decision-making for cardiovascular prevention as recommended by the 2021 ESC Prevention of CVD guidelines.C-statistics across global risk regionsCase vignette

A Qualitative Scoping Review of Community Firearm Violence in Low-Income Settings.

Firearm violence is a public health crisis in the United States that disproportionately impacts community members in low-income areas who witness and experience violence and violent victimization at elevated rates compared to other socioeconomic groups, often as result of community disinvestment and systemic racism (Smith et al., Soc Sci Med 246:112587, 2020). While quantitative reviews of firearm violence and related factors exist, a review of qualitative methods and findings regarding exposure to firearm violence has not yet been conducted. This scoping review sought to address a gap in the literature by summarizing the findings of qualitative studies on community firearm violence in low-income settings in the U.S. EBSCO databases, Criminal Justice Abstracts, National Criminal Justice Reference Service Abstracts, ProQuest, and PsycINFO were searched for studies that described the firearm related experiences of individuals and families in low-income communities. Thirty studies met the criteria for review. Findings were situated within the Centers for Disease Control and Prevention's (CDC) Social-Ecological Model as a framework for prevention (CDC, The social-ecological model: a framework for prevention, https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html , 2018; Dahlberg and Krug, World Report on violence and health, World Health Organization, Geneva, 2002). A critique of the literature, as well as implications and future directions of findings, are discussed. This study may inform future research questions and programs that center the voices of those most impacted by firearm violence.

2.G. Practice session: Africa and Europe: peer-to-peer HIS assessments for NCD, mental health and injuries surveillance

Abstract Public health surveillance is the basis for evidence-informed decision-making and health (systems) research, globally. Without robust data, public health challenges cannot be tackled. NCDs, mental health conditions and injuries (NCDI/MH) are among the biggest global public health challenges. Their risk and protective factors, including social, political and commercial determinants of health, transcend borders and require multi-disciplinary, multi-stakeholder and long-term responses. Since 2006, comparable national data on NCDI/MH are being collected in Europe on the basis of European Core Health Indicators (ECHI) and the European Health Interview Survey (EHIS). Currently, EU and WHO EURO are working together to set up a new Health Information Network. At EU level, a sustainable health information infrastructure is still lacking, despite extensive preparations in EU-funded projects. Part of these project activities were health information system (HIS) assessments, applying the WHO EURO Support tool to strengthen health information systems for peer-to-peer assessments. In the African region, the Africa Centres for Disease Control and Prevention (Africa CDC), founded in 2017, made NCDI/MH prevention and control a strategic priority. In 2021, it launched its first continental NCDs, Injuries Prevention and Control and Mental Health Promotion Strategy (2022-26) under which the organization supports its Member States. At the 3rd International Conference on Public Health in Africa (Zambia, Nov. 2023), Africa CDC presented a continental Guidance to strengthen NCDI/MH surveillance. The Guidance was developed in collaboration with Robert Koch Institute (RKI) and is based on desk reviews, surveys and national HIS assessments. Both Europe and Africa performed HIS assessments to strengthen NCDI/MH surveillance; standardized tools from WHO EURO and from the International Association of National Public Health Institutes (IANPHI) were used and adapted to fit peer-to-peer approaches and regional contexts. This workshop will present and discuss methodological approaches, experiences and lessons learned, thereby initiating knowledge exchange across continents. The presentations will address the following points: - From top-down to peer-to-peer: methods & tools used in HIS assessments - From paper to practice: the importance of site visits in HIS assessments - From educated guesses to evidence: outcomes of HIS assessments at country level - From evidence to action: translation of HIS assessment outcomes into HIS improvements - From pilot to scale-up: challenges, lessons learned, sustainability of HIS developments To our knowledge, this workshop is the first one at the EPH to bring together practitioners in HIS strengthening for NCDI/MH from Africa and Europe. The workshop offers a unique opportunity to engage with the audience and to explore options for international collaboration. Key messages • Interregional collaboration helps reduce health information inequalities, facilitating better global management of high burden health challenges, such as NCDs, mental health conditions and injuries. • Peer-to-peer HIS assessments in Africa and Europe strengthen NCDI/MH surveillance. They build evidence for policy advice, research and health education and add the benefit of forging expert networks.

What works in global health partnerships? Reflections on a Nigerian-German project collaboration

Abstract Background Global health partnerships for project implementation is a frequent way to address health challenges. Bringing stakeholders from different disciplines, professions, settings and countries together provides opportunity to look at health challenges from different perspectives, develop suitable ideas to tackle them and leverage diverse capacities. Problem In such diverse partnerships, cultural norms, practical realities and institutional practices create challenges for the development of good and equitable relationships. Methods In our project collaboration between the Nigerian Centre for Disease Control and Prevention and the German Robert Koch Institute on developing and implementing trainings in infection prevention and control, we demonstrated how a partnership can function. The collaboration followed a participatory approach and was informed by the following principles: - Plan, revise, adapt and implement all project activities as well as its contents participatorily; - A well-coordinated teamwork is key to facilitate operational performance; - Consider everyone as expert in its own domain of influence; - Constant and inclusive communication: maintaining transparency on all aspects and steps both in contents and organization and applying non-violent communication and active listening; - Provide space for reflection on roles and functions and for open discussion on needs and misunderstandings; - Appreciate team work as constantly evolving process of interaction and learning. Results We built a strong resilient team and could leverage team diversity to deliver on project objectives with exceptional quality, adaptability in a highly complex and frequently changing implementation setting. Lessons Working across cultures, disciplines, professions and countries means to develop a joint communication language and an understanding of the other. It is challenging and dynamic, requires additional space/time and attention, but offers personal growth and self-realization. Key messages • Using a participatory approach in teams can leverage team diversity to deliver on project objectives and bring about a high professional and personal self-realization. • There are concrete implementable ways of teamwork in international interdisciplinary global health collaborations that enhance quality of results in complex implementation settings.

Expanded geographic distribution for two Legionella pneumophila sequence types of clinical concern.

Legionella pneumophila serogroup 1 sequence types (ST) 213 and 222, a single-locus variant of ST213, were first detected in the early 1990s in the Midwest United States (U.S.) and the late 1990s in the Northeast U.S. and Canada. Since 1992, these STs have increasingly been implicated in community-acquired sporadic and outbreak-associated Legionnaires' disease (LD) cases. We were interested in understanding the change in LD frequency due to these STs and identifying genetic features that differentiate these STs from one another. For the geographic area examined here (Mountain West to Northeast) and over the study period (1992-2020), ST213/222-associated LD cases identified by the Centers for Disease Control and Prevention increased by 0.15 cases per year, with ST213/222-associated LD cases concentrated in four states: Michigan (26%), New York (18%), Minnesota (16%), and Ohio (10%). Additionally, between 2002 and 2021, ST222 caused at least five LD outbreaks in the U.S.; no known outbreaks due to ST213 occurred in the U.S. during this time. We compared the genomes of 230 ST213/222 isolates and found that the mean of the average nucleotide identity (ANI) within each ST was high (99.92% for ST222 and 99.92% for ST213), with a minimum between ST ANI of 99.50% and a maximum of 99.87%, indicating low genetic diversity within and between these STs. While genomic features were identified (e.g., plasmids and CRISPR-Cas systems), no association explained the increasing geographic distribution and prevalence of ST213 and ST222. Yet, we provide evidence of the expanded geographical distribution of ST213 and ST222 in the U.S.IMPORTANCESince the 1990s, cases of Legionnaires' disease (LD) attributed to a pair of closely related Legionella pneumophila variants, ST213 and ST222, have increased in the U.S. Furthermore, between 2002 and 2021, ST222 caused at least five outbreaks of LD in the U.S., while ST213 has not been linked to any U.S. outbreak. We wanted to understand how the rate of LD cases attributed to these variants has changed over time and compare the genetic features of the two variants. Between 1992 and 2020, we determined an increase of 0.15 LD cases ascribed to ST213/222 per year in the geographic region studied. Our research shows that these STs are spreading within the U.S., yet most of the cases occurred in four states: Michigan, New York, Minnesota, and Ohio. Additionally, we found little genetic diversity within and between these STs nor could specific genetic features explain their geographic spread.

Social vulnerability and disparities in incidence of diagnosed diabetes in the united states, 2004 to 2019

Abstract Introduction Vulnerable populations experience a higher burden of cardiovascular disease.(1) However, the incidence of cardiovascular risk factors, such as diabetes, within these populations, is incompletely characterized. Recently, the United States Centers for Disease Control and Prevention (US CDC) developed the Social Vulnerability Index (SVI) to categorize counties that may be vulnerable to worse health outcomes. The SVI is composed of 4 themes: socioeconomic status (Theme 1), household composition & disability (Theme 2), minority status & language (Theme 3), and housing type & transportation (Theme 4).(2) We sought to evaluate the association of the 4 SVI themes with county incidence of diagnosed diabetes. Method We used CDC data (2004-2019; reported for 94% of US counties), on county incidence of diagnosed diabetes. The SVI themes were scored from 0 to 1 (low to high vulnerability) based on national percentile ranking. We used weighted least squares regression with restricted cubic splines to model the relationship between SVI themes and incidence of diagnosed diabetes (median data 2004−2019), adjusting for median age, sex ratio, state, percent uninsured, food environment index, healthcare providers, and rurality.(3) The partial effects of SVI themes and diabetes incidence were reported as F-statistics (P-values) and diabetes incidence rate ratios (IRR [95% confidence interval]), which were plotted for all values compared with the 50th percentile (SVI 0.5). For each theme, we also present the IRR for a 0.5-point increase when moving over the lower (SVI score 0.5 vs. 0.0) and the upper (1.0 vs. 0.5) half of the SVI score distribution. Results The 4 SVI theme rank scores were significantly associated with diabetes incidence (all, P<.001). However, Theme 1 and 2 scores showed stronger associations with IRR than Theme 3 and 4 (Figure). For Theme 1, SVI score 0.5 vs. 0.0 was associated with a 15% higher incidence (IRR 1.15 [1.13–1.18]) and score 1.0 vs. 0.5 was associated with a 13% higher incidence (IRR 1.13 [1.11–1.16]). For Theme 2, SVI score 0.5 vs. 0.0 was associated with a 16% higher incidence (IRR 1.16 [1.14–1.18]), but there was no difference between rates for SVI score 1.0 vs. 0.5 (IRR 1.01 [0.99–1.03]). For Theme 3, there was no difference between SVI score 0.5 vs. 0.0 (IRR 0.98 [0.96–1.00]), but rates were 8% lower for SVI score 1.0 vs. 0.5 (IRR 0.92 [0.90–0.94]). For Theme 4, SVI score 0.5 vs. 0.0 was associated with a 3% lower incidence (IRR 0.97 [0.96–0.99]) and score 1.0 vs. 0.5 was associated with a 2% higher incidence (IRR 1.02 [1.01–1.04]). Conclusion In US counties, the strength and directionality of the association between SVI themes and diabetes incidence differed by theme and level of SVI scores. These themes, particularly socioeconomic status and household composition & disability may be leveraged to identify high-risk counties for primary prevention of diabetes, with implications for reduction in cardiovascular risk.

Quantifying Cardiovascular Disease Burden and Quality of Care Index across Four Visegrád Countries

Abstract Background Cardiovascular diseases (CVDs) have surged to become the leading cause of premature death in Europe. Yet, analyses examining the Quality of Care Index (QCI) and CVD burden within the 4-Visegrád (4V) nations remain notably sparse. This study aims to address this gap by comprehensively assessing both the QCI and CVDs burden across these countries. Methods The burden of CVDs was assessed using data extracted from the GBD-study 2019. We employed min-max normalization to standardize each health indicator, including Mortality-to-Incidence Rate, Prevalence-to-Incidence Rate, Disability-Adjusted Life Years-to-Prevalence rate, and Years of Life Lost-to-Years Lived with Disability. Subsequently, we utilized a weighted sum approach to aggregate the normalized values of the health indicators. The QCI was then derived as the sum of the products of normalized values and their corresponding weights. Results In 2019, age-standardized rates (per 100,000) significantly decreased compared to those in 1990. Ischemic heart disease remained the primary cause of death in all 4V countries, followed by stroke. Czechia exhibited the most substantial reduction in 2019 compared to the rates in 1990, with incidence and mortality rates decreasing by -252.55 and -308.95, respectively. Poland demonstrated the highest reduction, compared to the Central European average rates, in both incidence (-113.73; 95% CI: -125.08_-103.79) and death rates (-74.79; 95% CI: -73.53_-75.31) in 1990, and in 2019 (-175.22; 95% CI: -169.52_-178.29 and -41.55; 95% CI: -40.12_-40.64, respectively). Poland scored highest in QCI among the 4V countries, with Czechia scoring the lowest. Conclusions The findings underscore the imperative for continued efforts to boost cardiovascular healthcare and outcomes in the region. While the reduced ratio signals improvement, there remain avenues for refining disease management, prevention strategies, and access to care to further enhance patient outcomes. Key messages • Our study on 4V nations’ QCI and CVD burden underscores urgent need for sustained efforts in cardiovascular healthcare, with notable rate reductions since 1990. • Challenges persist in managing heart disease and stroke in the 4-Visegrád (4V) countries.

Burden and sociodemographic disparities in cardiovascular mortality rates associated with hypercholesterolemia in united states: a nationwide county-level analysis from 2010 to 2019

Abstract Background Hypercholesterolemia (HC), a major public health concern, has seen a rising prevalence in US adults and globally, leading to increased morbidity and mortality. Despite well-established links between HC and cardiovascular mortality (CVM), the specific impacts and disparities at the population level remain poorly understood. Purpose This study aims to assess the independent effects of HC on VM across the overall US population, examining variations across sociodemographic groups and geographic locations. Methods Age-adjusted county-level CV rates (ACVM per 100,000 individuals) between 2010 to 2019 were obtained using the Center for Disease Control and Prevention (CDC) database. Using the CDC surveillance system, HC rates per county were assessed as the proportion of adults (+18) with high total blood cholesterol. County health ranking project databases were utilized to acquire county characteristics and demographics. Poison generalized estimating equation models were employed to assess incidence rate ratios (IRR). Results Of 307,045,656 residents who lived in 3142 US counties in 2010, a total of 8,157,580 (2.7%) CV deaths occurred between 2010-2019. In a fully adjusted model*, high HC rates associated with high ACVM (Standardized IRR: 1.049; Figure 1). In subgroup analyses, HC rates associated with a greater ACVM among counties with high minority (IRR: 1.070) versus low (IRR: 1.043), and in rural areas (IRR: 1.052) versus urban (IRR: 1.041). Notably, this association was prominent in areas with high poverty (Q4 vs. Q1) (IRR: 1.062 vs. 1.035; p interaction <0.001; Figure 1). Further, higher ACVM rates related to HC were observed in the South and Northeast U.S. regions. Conclusions HC rates are independently associated with high ACVM across most sociodemographic groups and locations, with the most pronounced effect in areas with high poverty levels and minority populations. These findings call on targeted interventions and policymaking aimed at mitigating the prevalence of HC and cardiovascular burden, particularly in vulnerable populations.

Incentivization of Sexually Transmitted Infection Testing at a Large Public University

Abstract Background According to the United States (U.S.) Centers for Disease Control and Prevention, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in 2022, with notable increases in gonorrhea and chlamydia. The highest rates of chlamydia, gonorrhea, and syphilis were found in men and women of college age. This study compared free STI testing events to usual care with regard to patient socio-economic factors and testing positivity rates. Methods The Department of Student Health & Wellness at a large, public university offers routine testing at a low cost, flat rate, including chlamydia, gonorrhea, hepatitis C Ab, syphilis and HIV testing. Two weeks of free testing were held during calendar year 2023. Utilization and positivity rates between free testing and regular testing weeks were compared using Pearson’s chi squared and Fisher Exact tests. Results A total of 8705 tests were performed during routine testing weeks with associated cost averaging 174 tests per week as compared to 1177 tests for the free testing weeks averaging 589 tests per week. Testing uptake during free testing weeks was higher among females (65.6% (n = 772) vs. 55.1% (n = 4797); p < 0.001) and minorities such as, Black or African American [11.3% (n = 133) vs. 9.4% (n = 813); p = 0.02], Hispanic [11.4% (n = 134) vs. 9.2% (n = 798); p = 0.02] and Asian [13.1% (n = 154) vs. 8.8% (n = 763); p < 0.001] when compared to testing during regular weeks. Chlamydial infection positivity rate was lower during the free testing weeks [1.8% (n = 7)] vs. [3.9% (n = 123); p = 0.04]. Gonorrhea, hepatitis C, HIV, and Syphilis positivity rates did not differ between the two testing periods. Conclusions Free STI testing in the context of a large, public university Student Health Department shows increased utilization. The establishment of free testing weeks was associated with an increase in female students and minorities use of testing services at a large public university. Key messages • Incentivization can improve STI testing utilization among university students. • The establishment of STI free testing periods can increase the use of testing services among minority students and females.

Increased prevalence of coronary atherosclerosis in cancer survivors: a matched cross-sectional study with coronary CT angiography

Abstract Background Cancer and atherosclerosis share many risk factors. Although cardiovascular disease is highly prevalent among cancer survivors, it is unknown whether coronary atherosclerosis is present at a younger age in patients with a history of cancer. Purpose The purpose of this study is to evaluate the prevalence of coronary atherosclerosis in different age groups of patients with a history of cancer compared to matched controls. Methods Consecutive patients with a history of cancer aged >30 years who underwent evaluation for coronary artery disease with coronary computed tomography angiography (CCTA) between 2010 and 2023 were included in this cross-sectional study. Patients with a history of cancer were matched 1:2 to a control population without oncological history using propensity score matching. Patients were matched on age, gender, body mass index, hypercholesterolemia, hypertension, diabetes, use of statins and smoking status. The presence of atherosclerosis in the main coronary arteries was compared between the groups. Results The study population consisted of 313 patients with an oncological history and 626 matched control patients. The median age during CCTA scan was 59.4 [50.4-67.5] years and 66.1% of the patients were female. Coronary atherosclerosis was observed in 258 (82.4%) patients with a history of cancer compared to 461 (73.6%) control patients with a risk ratio of 1.12 [95% CI: 1.04-1.20], p<0.01. Mainly younger patients with a history of cancer aged between 30-59 years had a significant increased prevalence of coronary atherosclerosis with a risk ratio of 1.18 [1.04-1.33] compared to healthy controls (p=0.02). In our study population, thoracic radiotherapy was not associated with an increased prevalence of coronary atherosclerosis. Calcified plaques were observed more frequently in patients with a history of cancer (14.4% vs. 9.3% respectively, p=0.018). Conclusion Patients with a history cancer have a higher prevalence of coronary atherosclerosis as observed on CCTA compared to matched patients without cancer. This effect was most pronounced in younger patients aged 30-59 years. There is an unmet need to define strategies for cardiovascular disease monitoring and prevention in this growing patient population of patients with a history of cancer.Presence of coronary atherosclerosisRadiotherapy and atherosclerosis

Collection and use of patient-reported experience measures: approach to improve health care

Abstract Background Patient experience is one of the fundamental determinants of healthcare quality. There is progress in the collection of PREM in national level for hospitalized patients since 2020 in Latvia. Aim Analyze (2020.-2022.) in-patients Top-box rates about communication, share-decision making, patient safety and Net Promoter Score (NPS). Methods Project starting point was 2019. Agreement with EC, Sant’Anna School, Ministry of Health and Centre for Disease Prevention and Control of Latvia. Since 2020, the collection of PREM has been taking place regularly in hospitals (around 40% from all hospitals) and on average 20% response rate of those who agreed to participate in the survey. PREM questionnaire according to HCAHPS (Consumer Assessment of Healthcare Providers and Systems) standards, including Picker Institute patient experience questions. In line with OECD (Organization for Economic Co-operation and Development) recommendations, patient safety issues are also included. Top-box rates (most positive response) and percentiles (25th - 75th) were calculated. Results Totally 17019 adult (18 years and more) patient responses were analyzed with response rate 20.3% (n = 83983). 74.6% (67.5-78.2) during hospital stay doctors always explain things in a way you could understand and sufficiently involved in the decision-making process of treatment - 75.0% (70.1-81.4). During hospital stay 4.1% (n = 601) experienced patient safety incidents which were patient-reported. The most common groups were wrong patients, medication errors, incl. adverse drug reactions and falls. Hospitals achieved a NPS of 61 for 3 year period (2020.-2022.). Conclusions Collecting information about the patient experience may be the starting point for engaging patients and moving to more patient-centered health care. The results of these in-patient PREM data can be used to identify areas of improvement and make changes to better meet the needs and expectations of their patients. Key messages • It is a good practice for the implementation of new health care quality data - patient experience reported measures at the national level. • Feedback about the patient experience on regular basis provides insight into patient needs, preferences and values, which can help to improve the quality and safety of care.

Scoping Review of Pre-Exposure Prophylaxis and Post-Exposure Prophylaxis in HIV Prevention in Türkiye

Abstract Background Pre-Exposure Prophylaxis (PrEP) is a medical -antiretroviral- prevention method that reduces the risk of HIV transmission during sexual intercourse or injection drug use. Post-exposure prophylaxis (PEP) refers to taking medicine after risky exposure. The European Centre for Disease Prevention and Control (ECDC) has recommended the integration of PrEP into the existing HIV prevention packages since 2015. In Türkiye, first PrEP Guideline was published in 2022. The aim of this study is to evaluate the literature gap on the PrEP and PEP for HIV prevention research in Türkiye. Methods This study was conducted in October 2023. Searches were performed using the keywords ‘HIV, AIDS’ and ‘Pre-exposure prophylaxis, PrEP, Post-exposure prophylaxis, PEP’ in PubMed, Web of Science, Scopus, TRDizin, and Dergipark for all years. ‘Türkiye, Turkey, Turkish’ were added into the keywords in international indexes, without using country filters. Inclusion criteria were research on PrEP or PEP for HIV, research conducted in or using data from Türkiye, publications in English/Turkish. Exclusion criteria were non-HIV topics, non-Turkish data, non-English/Turkish publications. Lists were merged, duplicates were removed. Inclusion-exclusion criteria were conducted at title and abstract level. Full texts of the included articles examined for bibliometric characteristics, study types, and key results. Results 1014 publications yielded, 993 evaluated, and 17 fully reviewed. Four discussed Türkiye’s PrEP practices (2018-2023); three analyzed PEP regimens; three were reviews on PrEP/PEP in Türkiye (2016-2022). Two original research articles explored PrEP awareness among Türkiye’s men having sex with men (2022) and infectious disease physicians’ attitudes toward PrEP (2020). Studies showed gaps in PrEP information and service access. Conclusions There are limited studies published on PrEP and PEP in HIV prevention in Türkiye. This study highlights the need for local research on the topic. Key messages • Evaluation of Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) publications highlights gaps in HIV prevention research. • Limited literature on PrEP and PEP in HIV prevention emphasizing the need for further studies and improved access to PrEP information.

The EU Health Task Force, supporting preparedness and response in the European Union and globally

Abstract The COVID-19 pandemic revealed shortcomings in the European Union (EU) mechanisms for managing public health threats. In 2022, the European Centre for Disease Prevention and Control (ECDC) was mandated to establish the EU Health Task Force (EUHTF) to strengthen preparedness and response at country, EU and global levels. The EUHTF is coordinated by an ECDC Permanent Capacity and relies on pools of experts including ECDC experts, ECDC fellows and European public health experts that can be mobilized for specific assignments or broad public health emergencies. Members from EU/ Economic European Area (EEA) countries, EU agencies, the European Commission, WHO and non-profit organizations advise ECDC on the EUHTF establishment. From May 2023 to April 2024, the EUHTF addressed 13 requests for support from seven EU countries and three non-EU countries. The requests were related to preparedness (e.g. after-action reviews, simulation exercises, mass gathering preparation, capacity building) and emergency response activities (e.g. risk assessment, operational research during crisis, emergency and outbreak response). The EUHTF is operational and able to mobilize expertise from ECDC, the ECDC fellowship and EU/EEA countries. The EUHTF Pool of External Experts, comprised of public health professionals across various levels and institutions of the EU/EEA, is poised to offer comprehensive and robust expertise. Through these resources, the EUHTF is collaborating with and reinforcing the work of EU institutions and other international partners in strengthening preparedness and response. The EUHTF is a new and structured EU-level approach to public health crises, ensuring tailored in-country support to EU and non-EU countries in preparedness strengthening and crisis response.

5.C. Scientific session: Strengthen resilience against emerging vector-borne diseases through the ECDC Fellowship Programmes

Abstract Over the past decade, climate change has impacted the transmission of a wide range of vector-borne diseases (VBDs) in Europe, where locally transmitted outbreaks have occurred. It has been implicated in the observed expansion of competent disease vectors in Europe such as Aedes albopictus, which transmits diseases such as Zika, Dengue and Chikungunya. Climate may influence the life cycle of vectors, and the reproduction rate of viral particles inside vectors and human hosts, which means that upsurges in temperature can reduce the incubation period of these pathogens and the life cycle of vectors, thus boosting transmission risk through elevated vector populations. Moreover, globalization and international air travel contribute to pathogen and vector dispersion internationally. Risk mapping suggests further expansion of the species in northern Europe due to climate change. The above underscores the necessity for more proactive measures, such as developing an effective vector control program by monitoring the density and distribution of hosts and pathogens at urban, national, and cross-border levels. Additionally, establishing early warning systems based on integrated human and zoonotic and entomological surveillance is crucial to detect alerts promptly and comprehend where and when infections may emerge or spread. Furthermore, cross-border collaboration and harmonization of vector-borne surveillance systems across European countries may improve preparedness, control and response to mosquito-borne diseases. Preparedness and response require significant efforts from EU Member States and neighbouring countries. Only through a multidisciplinary approach, involving multiple sectors, can we truly prepare to address public health threats. To contribute to strengthening resilience against cross-border public health and emerging health threats in EU Member States and neighbouring countries, the European Centre of Disease Prevention and Control (ECDC) has established three fellowship training programmes. These programmes aim to create and maintain a network of highly qualified epidemiologists, microbiologists and public health professionals and strengthen the public health epidemiology workforce at EU and neighbor countries. This workshop will offer attendees a comprehensive overview of the ECDC’s fellowship programmes, describe how they function and explain their role in preparing for health threats. It will provide examples of three projects carried out by fellows on the implementation of preparedness, response and control measures for emerging vector-borne diseases in European countries at local, national and multinational levels. Those will set the scene for an in-depth analysis of the key challenges faced and can help promote awareness that integrated, multidisciplinary interventions are both feasible and effective in reducing the threat of vector-borne infectious diseases spreading in Europe and neighboring countries. Key messages • ECDC fellowship programmes aim to strengthen resilience against emerging public health threats in EU Member States and neighboring countries. • Fellows are engaged in national and cross-border integrated and multidisciplinary interventions to strengthen preparedness and mitigate the spread of emerging vector-borne diseases.

6.I. Round table: Strengthening preparedness for public health emergencies: lessons learned and future perspectives

Abstract In the face of intensifying global health threats, robust health security measures in Europe and worldwide have never been more pressing. The COVID-19 pandemic has underscored the critical need for coordinated action, adaptive strategies, and robust collaborative mechanisms to effectively respond to emerging infectious diseases and other public health emergencies. This workshop serves as a platform to examine the multifaceted landscape of health security actors, focusing on collaborative initiatives and lessons learned from recent crises. By convening experts and stakeholders from across Europe, the workshop aims to achieve several key objectives: i) To provide an overview of collaborative initiatives established to strengthen European and international health security. By showcasing successful models of cooperation, participants will gain insights into effective strategies for fostering collaboration among diverse stakeholders. ii) Emphasize the role of European and international institutions, such as the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO), in supporting states both in coordinating regional response efforts and in developing the necessary health workforce competencies and capabilities to respond to health emergencies. iii) Drawing on experiences from recent health emergencies, including outbreaks of high-risk pathogens, such as Ebola, the workshop will facilitate a critical examination of lessons learned. Through interactive discussions, participants will identify challenges, best practices, and opportunities for enhancing preparedness and response capacity. iv) By interactive presentations and panel discussions, the workshop will provide a platform for knowledge exchange and networking among participants. By sharing experiences, expertise, and innovative approaches, participants will contribute to a collective understanding of the challenges and opportunities in strengthening health security. This workshop seeks to illuminate key strategies, capacity-building efforts, and real-world lessons learnt that contribute to enhancing response capabilities to public health emergencies. Participants will gain a deeper understanding of emergency participation mechanisms, essential skills required, and available training resources to enhance preparedness. Key messages • Collaboration and adaptive strategies are essential for strengthening international health security in the face of emerging infectious diseases and other public health emergencies. • Lessons learned from recent crises provide valuable insights into effective response strategies and opportunities for enhancing preparedness and response capacity.

Building Resilience: Strengthening European public health workforce through ECDC Fellowship Programs

Abstract The European Centre for Disease Prevention and Control (ECDC) Fellowship programmes offer a two-year training in field epidemiology (EPIET) and in public health microbiology (EUPHEM) aiming to create and maintain a network of highly trained field epidemiologists and public health microbiologists and strengthen the public health epidemiology workforce in the European Union (EU) and beyond. The Mediterranean and Black Sea Programme for Intervention Epidemiology Training (MediPIET) also aims to strengthen the public health workforce in countries neighboring the EU. During the training, fellows who are based in different public health institutes in the EU and neighboring countries, set-up, implement and evaluate surveillance of communicable diseases, investigate outbreaks and conduct operational research directly linked to public health actions. The programmes facilitate knowledge exchange and collaboration across borders, building a foundation for participants and their institutions and promoting long-term collaboration through the alumni network. Participants from diverse disciplinary and cultural backgrounds enable interdisciplinary and multi-sectoral knowledge transfer, enhancing the effectiveness of public health responses. By facilitating collaboration and networking, exchanging experiences, disseminating best practices and assimilating lessons learned, these programmes contribute to addressing contemporary health challenges, including emerging vector-borne diseases and strengthening public health systems in Europe and neighboring regions. In the face of global challenges such as climate change and globalization, the fellowships exemplify how collaboration can strengthen Europe’s defenses against emerging health threats.

Antimicrobial resistance trends in Italian hospitals: insights from two point prevalence surveys

Abstract Background Antimicrobial resistance (AMR) presents a critical challenge to global healthcare systems, necessitating vigilant surveillance efforts. The European Centre for Disease Prevention and Control (ECDC) conducts point prevalence surveys (PPSs) to monitor AMR trends across European hospitals. This study focuses on comparing AMR patterns in Italian hospitals using data from two surveys: PPS2 (2016-2017) and PPS3 (2022-2023). Methods A total of 140 hospitals enrolling 28991 patients participated in PPS2, while 325 hospitals with 58506 patients contributed data to PPS3. Microbiological samples were collected and tested for antimicrobial susceptibility. Prevalence ratios (PR) with corresponding 95% confidence intervals (CI) were calculated to assess changes in resistance patterns between PPS2 and PPS3. Statistical significance was determined with p-value <0.05. Results Staphylococcus aureus showed a trend towards decreased oxacillin resistance, (PR: 0.77, 95% CI: 0.60 - 0.99). Enterococcus faecalis exhibited a non-significant decrease in glycopeptide resistance. Pseudomonas aeruginosa and Acinetobacter baumannii maintained stable carbapenem resistance between the two surveys. Escherichia coli and Klebsiella pneumoniae showed a decreasing trend in resistance to carbapenems and third-generation cephalosporins, but only Klebsiella pneumoniae was found to be significant (PR: 0.69, 95% CI: 0.55 - 0.88, p 0.004 and PR: 0.78, 95% CI: 0.66 - 0.94, p 0.01, respectively). Conclusions These findings underscore the importance of surveillance in monitoring AMR trends. Observed decreases, especially in Klebsiella pneumoniae, suggest potential improvements. However, the overall stability of resistance highlights the ongoing challenge of combating AMR. A multifaceted approach, including antimicrobial stewardship and One Health initiatives, is crucial to address this global health threat effectively. Key messages • Surveillance efforts are crucial to understand antimicrobial resistance (AMR) trends, as demonstrated by comparing data from two surveys in Italian hospital. • Results highlight the need for data-driven interventions, guiding future strategies within a One Health framework to address antimicrobial resistance comprehensively.