Trends In Notifications Research Articles

Trends in shigellosis notifications in England, January 2016 to March 2023.

We reviewed all diagnoses of Shigella species notified to the UK Health Security Agency from January 2016 to March 2023. An overall increase in notifications of shigellosis was seen between 2016 (n = 415/quarter) and 2023 (n = 1029/quarter). However, notifications dramatically declined between March 2020 and September 2021 during the COVID-19 pandemic (n = 208/quarter) highlighting the impact of travel and social distancing restrictions on transmission. S. sonnei diagnoses were more affected by lockdown restrictions than S. flexneri, most likely due to a combination of species-specific characteristics and host attributes. Azithromycin resistance continued to be associated with epidemics of sexually transmissible S. flexneri (adult males = 45.6% vs. adult females = 8.7%) and S. sonnei (adult males = 59.5% vs. adult females = 14.6%). We detected resistance to ciprofloxacin in S. sonnei from adult male cases not reporting travel at a higher frequency (79.4%) than in travel-associated cases (61.7%). Extensively drug-resistant Shigella species associated with sexual transmission among men almost exclusively had ESBL encoded by blaCTX-M-27, whereas those associated with returning travellers had blaCTX-M-15. Given the increasing incidence of infections and AMR, we recommend that enhanced surveillance is used to better understand the impact of travel and sexual transmission on the acquisition and spread of MDR and XDR Shigella species.

Respiratory syncytial virus infection notification trends and interpretation of the reported case data, 2018-2021, Japan.

In Japan, as elsewhere, the COVID-19 pandemic affected the notification trends of respiratory syncytial virus (RSV) infection. Here, we describe the epidemiological trends of RSV cases among children reported during 2018-2021 in Japan, based on the national surveillance system. Compared to 2018 and 2019, 2020 saw an unprecedented decrease in RSV notifications per sentinel site. However, 2021 experienced an unseasonably early and high peak in week 28 (peak week in 2018 and 2019: week 37) with a large resurgence in notifications, nationwide and across regions. Regarding age, compared to 2018 and 2019, the number and proportion of cases aged 2, 3, and ≥4-years increased substantially in 2021 but the number of cases aged <1 year decreased slightly. Furthermore, in 2021, the ratio of notifications per site from outpatient clinics to hospitals increased, suggesting a proportionate increase in clinically milder case diagnoses. Notably, RSV-attributed deaths from vital statistics also dropped substantially in 2020 and rebounded in 2021, but were fewer than in 2018 or 2019. While RSV incidence likely declined in 2020 (possibly from COVID-19 countermeasures) and increased in 2021, notifications in 2021 appeared to be associated with milder presentations. Given unpredictable RSV epidemiology, continuous monitoring and pluralistic assessments are imperative.

IJCM_256A: Trend in Tuberculosis Notification in Solapur district: Analysis from 2015 to 2022

Background: India contributes approximately 25% of the missing cases of tuberculosis (TB) globally. Even though ~50% of patients with TB are diagnosed and treated within India’s private sector, few are notified to the public healthcare system. India’s TB notification policy mandates that all patients with TB are notified through Nikshay (TB notification portal). We undertook this study to assess how mandatory notification has influenced the number of TB cases reported in the Nikshay portal from the private sector from Solapur district between 2015 and 2022. Objective: To evaluate the contribution of mandatory notification in enhancing TB notification in Solapur district between 2015 and 2022. Methodology: This study employed a quantitative observational approach, using record-based data extracted from the laboratory register and the Nikshay portal. The analysis period spanned from 2015 to 2022, allowing for an in- depth evaluation of TB notification trends before and after the implementation of the mandatory notification policy in 2018. Data was compiled and analysed using MS-Excel. Frequencies, means, and proportions used to effectively describe tuberculosis (TB) case notifications in both the private and public sectors were used. Results: Between 2015 and 2022, Solapur district experienced a variable but overall increasing trend in TB notification rates. In 2015, the TB notification rate was 58.15 per 100,000 population, which increased to 90.69 by 2022. The annual presumptive TB examination rates showed significant growth over the years. In 2015, the rate was 628 per 100,000 population, which escalated to 1965 by 2022. Conclusion: This rise is indicative of enhanced TB case detection, especially after the implementation of the mandatory notification policy and increase in presumptive TB examination rates is attributed to the rising use of advanced diagnostic methods such as CBNAAT and TrueNAT.

Evaluation of rapid alert system for food and feed (RASFF) data for mycotoxin contaminated dried figs originating from Türkiye

In this study, the Rapid Alert System for Food and Feed (RASFF) database was analysed to assess mycotoxin hazards in Turkish dried figs during the production years from 2002 to 2019. A comprehensive evaluation of influencing factors, such as weather conditions, agricultural and processing practices, as well as non-product related elements such as export quantities and regulatory changes, was carried out while analysing yearly and monthly notification trends. Years marked by drought conditions recorded the highest number of notifications. Notably, the years 2007 and 2012 corresponded with peaks in notifications (104 and 117, respectively), suggesting a potential relationship between drought conditions and increased notifications – a finding supported by existing literature on mycotoxin contamination. The mean total aflatoxin (AF) concentrations ranged from 13 μg/kg to 44 μg/kg. However, the considerable variability in the annual number of notifications (ranging from 2 to 106) and the presence of outliers in certain years limit the usefulness of mean total AF concentration data for trend analysis. Weather-related factors, along with agricultural practices, processing and storage conditions, can influence mycotoxin contamination of dried figs, highlighting the need for integrated and comprehensive control strategies. The observed correlation between specific weather conditions, such as drought, and RASFF notifications, and, consequently, mycotoxin contamination, warrants further exploration to better understand and predict this relationship. This study significantly contributes to the mycotoxin literature by providing a comprehensive analysis of mycotoxin hazards in Turkish dried figs. By examining the complex interplay of factors, from weather conditions to agricultural and processing practices and changes in export quantities and regulations, it addresses a crucial gap in the current understanding of mycotoxin risks and offers insights on the historical evolution of safety protocols within Turkish dried fig production. It thus provides a solid foundation for improving food safety practices and developing more effective policy frameworks.

Association between work sick-leave absenteeism and SARS-CoV-2 notifications in the Netherlands during the COVID-19 epidemic.

Alternative data sources for surveillance have gained importance in maintaining coronavirus disease 2019 (COVID-19) situational awareness as nationwide testing has drastically decreased. Therefore, we explored whether rates of sick-leave from work are associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) notification trends and at which lag, to indicate the usefulness of sick-leave data for COVID-19 surveillance. We explored trends during the COVID-19 epidemic of weekly sick-leave rates and SARS-CoV-2 notification rates from 1 June 2020 to 10 April 2022. Separate time series were inspected visually. Then, Spearman correlation coefficients were calculated at different lag and lead times of zero to four weeks between sick-leave and SARS-CoV-2 notification rates. We distinguished between four SARS-CoV-2 variant periods, two labour sectors and overall, and all-cause sick-leave versus COVID-19-specific sick-leave. The correlation coefficients between weekly all-cause sick-leave and SARS-CoV-2 notification rate at optimal lags were between 0.58 and 0.93, varying by the variant period and sector (overall: 0.83, lag -1; 95% CI [0.76, 0.88]). COVID-19-specific sick-leave correlations were higher than all-cause sick-leave correlations. Correlations were slightly lower in healthcare and education than overall. The highest correlations were mostly at lag -2 and -1 for all-cause sick-leave, meaning that sick-leave preceded SARS-CoV-2 notifications. Correlations were highest mostly at lag zero for COVID-19-specific sick-leave (coinciding with SARS-CoV-2 notifications). All-cause sick-leave might offer an earlier indication and evolution of trends in SARS-CoV-2 rates, especially when testing is less available. Sick-leave data may complement COVID-19 and other infectious disease surveillance systems as a syndromic data source.

APCP CONFERENCE ABSTRACTS: 2023

APCP CONFERENCE ABSTRACTS: 2023

Analysis of data from the rapid alert system for food and feed for the country-of-origin Slovakia for 2002–2020

The Rapid Alert System for Food and Feed (RASFF) plays a pivotal role in regulating food safety in the European Union by enabling the competent authorities in each Member State to issue warnings for removing unsafe or illegal items from the market. This article undertakes a comprehensive analysis of RASFF data on Slovak food from 2002 to 2020, to investigate the trends in notifications, actions executed, hazard categories, and product categories within the food industry. Our scrutiny of the RASFF data revealed fluctuations in the counts of alerts and information notifications across years, indicating periods of heightened hazard detection and enhanced transparency within the system. Various measures, including destruction, recall, notification, and prohibition, were employed to address these hazards and ensure the safety and compliance of food products. The hazard categories exhibited sporadic patterns, underscoring the necessity for ongoing surveillance and regulatory interventions. Specific product categories, such as dietetic foods, food supplements, and fortified foods, registered higher incidences of hazards in specific years, implying the need for intensified safety precautions. These findings highlight the importance of sustained efforts in maintaining food safety and managing risks within the industry.

Australian vaccine preventable disease epidemiological review series: tetanus 2003-2019.

Background We examined trends in tetanus notification, hospitalisation and death data from 2003-2019 to assess the impact of adult tetanus booster recommendations in Australia. Methods Tetanus notifications and deaths from the National Notifiable Diseases Surveillance System; hospitalisations from the Australian Institute of Health and Welfare National Hospital Morbidity Database; and deaths from the Australian Coordinating Registry were analysed by age group, sex, Aboriginal and Torres Strait Islander status and state/territory. Annual rates were calculated using Australian Bureau of Statistics mid-year estimated resident populations from 2003-2019 as denominators. To assess the impact of a recommended booster dose of reduced antigen content diphtheria-tetanus-acellular pertussis (dTpa) vaccine for adults aged ≥ 65 years, notification, hospitalisation and death rates of tetanus per 100,000 population were compared pre (2003-2012) and post (2013-2019) the recommendation's introduction. Results There were 63 notifications of tetanus from 2003-2019 with an average annual incidence rate of 0.02/100,000. Similar to previous studies, the burden of tetanus in the Australian population continues to disproportionately affect the elderly, with those aged ≥ 65 years encompassing 63% (40/63) of notifications and 100% (11/11) of the deaths observed in this timeframe. Following the introduction of a recommendation for those aged ≥ 65 years to receive a dTpa booster, average annual notification and hospitalisation rates in those aged ≥ 65 years were significantly lower (notifications: 0.11/100,000 in 2003-2012 and 0.05/100,000 in 2013-2019, p = 0.01; hospitalisations: 0.24/100,000 in 2003-2012 and 0.10/100,000 in 2013-2019, p = 0.01]). The average annual death rate was similar in the two periods (0.002/100,000), although based on small numbers. Conclusions The findings of this analysis suggest a positive impact from the 2013 recommendation. However, the burden is still disproportionately higher in those aged ≥ 65 years and strategies to improve vaccination coverage in older Australians are recommended.

Declining Trends in Crime Reporting and Victims’ Trust of Police in the United States and Major Metropolitan Areas in the 21st Century

Victims’ willingness to report crime and their opinions about the police are important indicators of police performance, police legitimacy, and trust in the justice system. This study examines two decades of trends in police notification and victims’ perceptions of the police in the United States and major metropolitan areas since 2000, using data from the National Crime Victimization Survey (NCVS). In contrast to previous studies indicating an increase in police notification in the 1980s and 1990s, the present study shows a progressive decline in police notification observed in the last two decades, especially since 2010. Furthermore, there has been a marked increase in victims’ mistrust of police responsiveness since the mid-2000s. Using multivariable regression models that control for potential changes in the characteristics of crime and survey methodology, we find that the victims’ rising distrust of the police is widespread in many metropolitan areas, in all racial/ethnic and socioeconomic groups, and especially so for victims of theft, burglary, and simple assault. In the discussion, we suggest that the changing policing strategies and the evolving economic, political, and social environments of the 21st century may help explain the trends identified by this research. Understanding victim reporting trends and victims’ opinions of the police may affect data and policy and help the justice system to better serve victims and enhance public safety.

Tuberculosis Notification in Jordan, 2016-2020.

The burden of tuberculosis (TB) in Jordan is largely unknown due to the paucity of high-quality data, under-reporting, and a lack of good quality vital registration system. This study aimed to assess the characteristics of TB patients in Jordan, determine the TB notification rate and assess the trend of TB notification in Jordan between 2016 and 2020. Methods: This study analyzed the TB Surveillance data in Jordan for the period 2016-2020. The obtained data included information on age, gender, nationality, marital status, date of symptoms onset and date of diagnosis, and site of TB. Results: During the period 2016-2020, a total of 1711 patients (989 women and 722 men) were diagnosed with and treated for tuberculosis. The mean (SD) age of patients was 30.1 (17.2) years. Almost half of them (48.4%) were Jordanians. The majority of non-Jordanian patients were from Syria, Philippines, and Bangladesh. Two thirds of patients (66.0%) had pulmonary TB and 34.0% had extra-pulmonary TB. Almost half (50.7%) of the patients were diagnosed within one month of the symptoms' onset. The average annual TB notification rate during 2016-2020 was 3.32 per 100,000 pop (4.08 per 100,000 women and 2.64 per 100,000 men). The average annual standardized notification rate was 4.13 per 100,000 pop (4.52 per 100,000 women and 3.52 per 100,000 men). The overall age-standardized notification rate increased from 3.88 per 100,000 pop in 2016 to 4.58 per 100,000 pop in 2019 and declined to 2.46 per 100,000 pop in 2020. The trend in TB notification differed significantly according to gender. While the notification increased in the last three years among women, it decreased significantly among men. Conclusions: While TB notification increased in the last three years among women, it decreased significantly among men. There is a need to ensure that the national TB plans set clear targets for reducing the burden of TB.

Hepatitis A notifications in the EU/EEA, 2010-2019: what can we learn from case reporting to the European Surveillance System?

BackgroundEuropean Union/European Economic Area (EU/EEA) countries annually report hepatitis A (HepA) notifications to The European Surveillance System (TESSy).AimTo describe EU/EEA HepA notifications from 2010 to 2019 and identify infection drivers and surveillance improvements.MethodsWe analysed demographic, clinical and transmission information of HepA confirmed cases from TESSy. We stratified countries by population susceptibility profile and performed time-series analysis to describe trends in notification rates, sex distribution and travel history.ResultsTwenty-nine EU/EEA countries reported 139,793 HepA cases. Six eastern EU countries reported >60% of these cases. EU/EEA notification rate during the study period was 3.2 cases per 100,000 population (range 2.7-5.6). Notifications peaked in 2014 and 2017, with marked differences in case demographic characteristics. Notification trends varied across different country susceptibility groups. In 2017, the proportion of males (74%) and case median age (31 years) increased steeply, while no changes occurred in 2014. Travel history showed seasonal case peaks following the summer. More than 47,000 hospitalisations were reported. Annual case fatality was < 0.2% for all years. Information on travel history, hospitalisation, death and mode of transmission was suboptimal.DiscussionApart from some countries in its east, the EU/EEA is characterised by low HepA incidence baseline and susceptible to recurrent large cross-border outbreaks. Analysis of European surveillance data highlighted the need for stronger prevention policies for eastern EU countries, men who have sex with men and travellers. Improving surveillance data-quality will enhance knowledge on food-borne, and travel-related exposures to inform more effective and tailored regional prevention policies.

Effect of COVID-19 pandemic restrictions on chlamydia and gonorrhoea notifications and testing in Queensland, Australia: an interrupted time series analysis

ObjectiveTo investigate trends in testing and notifications of chlamydia and gonorrhoea during the COVID-19 pandemic in Queensland, Australia.MethodsStatewide disease notification and testing data between 1 January 2015 and 31 December...

Spatial-temporal analysis of pulmonary tuberculosis among students in the Zhejiang Province of China from 2007-2020.

Pulmonary tuberculosis (PTB) is a serious chronic communicable disease that causes a significant disease burden in China; however, few studies have described its spatial epidemiological features in students. Data of all notified PTB cases from 2007 to 2020 in the student population were collected in the Zhejiang Province, China using the available TB Management Information System. Analyses including time trend, spatial autocorrelation, and spatial-temporal analysis were performed to identify temporal trends, hotspots, and clustering, respectively. A total of 17,500 PTB cases were identified among students in the Zhejiang Province during the study period, accounting for 3.75% of all notified PTB cases. The health-seeking delay rate was 45.32%. There was a decreasing trend in PTB notifications throughout the period; clustering of cases was seen in the western area of Zhejiang Province. Additionally, one most likely cluster along with three secondary clusters were identified by spatial-temporal analysis. Although was a downward trend in PTB notifications among students during the time period, an upward trend was seen in bacteriologically confirmed cases since 2017. The risk of PTB was higher among senior high school and above than of junior high school. The western area of Zhejiang Province was the highest PTB risk settings for students, and more comprehensive interventions should be strengthened such as admission screening and routine health monitoring to improve early identification of PTB.

Epidemiology of syphilis in the Nepean and Blue Mountains Local Health District between 1 October 2009 and 30 September 2019.

Syphilis is a nationally notifiable sexually transmitted infection (STI). Rates of syphilis notifications have been on the increase in Australia. Given these increases, we wanted to study the epidemiological trends of syphilis notifications in the Nepean Blue Mountain Local Health District (NBMLHD) over a ten-year period across different healthcare settings. All syphilis notifications in residents in the NBMLHD in the ten-year period between 1 October 2009 and 30 September 2019 were included in the study. Separate analyses were performed for all syphilis notifications, as well as for infectious syphilis and for syphilis acquired > 2 years ago or of unknown duration. We described age distribution and demographic profile and risk factors of all syphilis notifications. Notification trends were studied and crude incidence rates were calculated. Notifications were stratified by stage of syphilis, sex, and geographical location. In the study duration, a total of 342 notifications of syphilis were received. Of these, 187 were infectious syphilis and 155 were related to infections acquired > 2 years ago and/or of unknown duration. The majority of notifications were in men: 281 (82%). Overall, syphilis notifications increased over the ten-year study period. The crude incidence rates for infectious syphilis were significantly higher in the second five-year period overall (7.78/100,000 population per year compared to 5.28/100,000 population per year; incidence rate ratio (IRR): 1.47; 95% confidence interval (95% CI): 1.10-1.97; p < 0.01), as well as for males (14.44/100,000 population per year compared to 9.7/100,000 population per year; IRR: 1.49; 95% CI: 1.09-2.03; p < 0.01). There were significant increases in syphilis notifications in males < 35 years of age, from 39 such notifications in the first five-year period (27.5% of all syphilis notifications in this period) to 83 notifications in the second five-year period (42.1% of all notifications in this period), p < 0.05. In keeping with national trends, notifications in our study increased. Significant increases were noted in notifications among males under 35 years of age. This supports the continued investment in sexual health promotion activities aimed at young sexually active men. Expansion of screening activities to include women and older people would help detect any increase in cases in these groups. Increase in engagement with general practitioners will support them to provide opportunistic STI screens to sexually-active attendees. National screening recommendations remain applicable to this population.

Trends of Xpert MTB/RIF in the diagnosis of Mycobacterium tuberculosis and rifampicin resistance in Southwest Nigeria: A 4-year retrospective study

Objectives: In recent years, there has been an increased uptake of Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) for the diagnosis of tuberculosis (TB), with added benefits for detecting rifampicin-resistant TB (RR-TB). We set out to determine the trends in notification of MTB and RR-TB over 4 years in a tertiary hospital in Southwest Nigeria. Materials and Methods: This is a retrospective analysis of single early morning sputum/gastric washing sample for presumed TB in a tertiary health center between January 2016 and December 2019. Xpert MTB/RIF was used to detect (MTB) and RR-TB. Results: The mean age of the 4625 presumptive TB patients was 43.4 (18.8) years, with the majority aged 31–45 (30.6%). Males totaled 2247 (49.6%). Human immunodeficiency virus (HIV) coinfection was found in 756 (16.7%) of them. Using the Xpert MTB/RIF assay, the overall MTB notification was 12.9% (584/4526) and was associated with HIV status, P &lt; 0.001. MTB notification trends increased from 5.6% in 2016 to 23.8% in 2019, P &lt; 0.001. The overall yield of RR-TB was 7.5%. The proportion of RR-TB from TB cases declined from 28% in 2016 to 4.6% in 2019. Forty-two of the 44 cases of the RR-TB (42/572; 7.3%, [95% CI: 5.31, 9.75]) were new cases, with TB treatment failure and relapse cases accounting for 10.1% (2/11; 10.1%, [95% CI: 0.35, 42.5]) of all RR-TB cases (P &lt; 0.01). RR-TB was associated with being older than 45 years (adjusted odds ratio = 2.046, [95% CI: 1.046, 4.004]). HIV infection status and gender had no effect on RR-TB status. Conclusion: This study found an increase in MTB detection with Xpert MTB/RIF utilization. Ages &gt;45 years have 2–4-fold increased risk of developing RR-TB and should be targeted for drug resistance prevention.

Effect of COVID-19 on Tuberculosis Care in a District of Western Gujarat

Introduction: COVID-19 has had a devastating and disrupting effect on all health-care services across the globe, but tuberculosis (TB) services have been disproportionately affected. Downfall trend of TB notification, diagnosis, and treatment due to the COVID-19 pandemic in our district study was carried out. Aim: To assess COVID-19 effects on TB care during 2020-2021. Methodology: A cross-sectional study design comprising a secondary analysis of an existing dataset was carried out. Data on the total number of cases notified, diagnosed, and drug susceptibility in drug resistance and sensitivity were collected for 2020 and 2021. Result: A statistically significant difference in drug-resistant and drug-sensitive cases was observed during the first and second half of 2020 (P < 0.001). In 2021 similar to the earlier wave, there was a decline in case notification during the peak of the pandemic. Conclusion: We assessed that during COVID-19, TB care significantly plummeted in our district; however, with the rapid response plan gradually, there was a rise seen in TB notification, diagnosis, and treatment services.

Epidemiologic and genomic investigations of an unusual increase in Salmonella enterica serovar Paratyphi A infection among travelers returning from Myanmar in 2015

ObjectivesAn unusual increase in Salmonella enterica serovar Paratyphi A infection rate in Japanese travelers returning from Myanmar was observed in 2015. MethodsWe analyzed epidemiologic data of returned travelers with enteric fever from 2005-2019. We also analyzed 193 Salmonella Paratyphi A isolates, including 121 isolates with published genomes. ResultsAnnual notification trends showed a rapid increase in Salmonella Paratyphi A infection in travelers returning from Myanmar in 2015: 2-4 cases/100,000 travelers in 2012-2014 and 13 cases/100,000 travelers in 2015 (P <0.001). The genomic analyses revealed that 11 Myanmar-related isolates in 2015 formed a tight cluster in clade 3 with a single nucleotide variant (SNV) distance of 0-11 (primarily 0-7), yielding a wider SNV range than outbreak-associated isolates from Cambodia in 2013 (0-6 SNVs) or China in 2010 (0-5 SNVs). Although all Cambodia-related isolates in 2013 harbored the wild-type gyrA sequence, all Myanmar-related isolates in 2015 had a single, identical mutation (Ser83Phe) in the gyrA gene. ConclusionThe epidemiologic and molecular investigations suggested an increase in the infection rate with genetically closely related Salmonella Paratyphi A in travelers returning from Myanmar in 2015. Careful monitoring of the infection in Myanmar as an endemic country is warranted, considering the resumption of cross-border travel during the COVID-19 pandemic.

Trends in TB and HIV care and treatment cascade, Kenya, 2008-2018.

BACKGROUND: HIV infection is associated with high mortality among people with TB. Antiretroviral therapy (ART) reduces TB incidence and mortality among people living with HIV (PLHIV). Since 2005, Kenya has scaled up TB and HIV prevention, diagnosis and treatment. We evaluated the impact of these services on trends and TB treatment outcomes.METHODS: Using Microsoft Excel (2016) and Epi-Info 7, we analysed Kenya Ministry of Health TB surveillance data from 2008 to 2018 to determine trends in TB notifications, TB classification, HIV and ART status, and TB treatment outcomes.RESULTS: Among the 1,047,406 people reported with TB, 93% knew their HIV status, and 37% of these were HIV-positive. Among persons with TB and HIV, 69% received ART. Between 2008 and 2018, annual TB notifications declined from 110,252 to 96,562, and HIV-coinfection declined from 45% to 27%. HIV testing and ART uptake increased from 83% to 98% and from 30% to 97%, respectively. TB case fatality rose from 3.5% to 3.9% (P <0.018) among HIV-negative people and from 5.1% to 11.2% (P <0.001) among PLHIV on ART.CONCLUSION: TB notifications decreased in settings with suboptimal case detection. Although HIV-TB services were scaled-up, HIV-TB case fatality rose significantly. Concerted efforts are needed to address case detection and gaps in quality of TB care.

Protecting the health of people living in Ukrainian detention facilities

Protecting the health of people living in Ukrainian detention facilities

Interrupted time-series analysis of active case-finding for tuberculosis during the COVID-19 pandemic, Zambia.

ObjectiveTo evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic and the subsequent implementation of tuberculosis response measures on tuberculosis notifications in Zambia.MethodsWe used an interrupted time-series design to compare monthly tuberculosis notifications in Zambia before the pandemic (January 2019 to February 2020), after implementation of national pandemic mitigation measures (April 2020 to June 2020) and after response measures to improve tuberculosis detection (August 2020 to September 2021). The tuberculosis response included enhanced data surveillance, facility-based active case-finding and activities to generate demand for services. We used nationally aggregated, facility-level tuberculosis notification data for the analysis.FindingsPre-pandemic tuberculosis case notifications rose steadily from 2890 in January 2019 to 3337 in February 2020. After the start of the pandemic and mitigation measures, there was a −22% (95% confidence interval, CI: −24 to −19) immediate decline in notifications in April 2020. Larger immediate declines in notifications were seen among human immunodeficiency virus (HIV)-positive compared with HIV-negative individuals (−36%; 95% CI: −38 to −35; versus −12%; 95% CI: −17 to −6). Following roll-out of tuberculosis response measures in July 2020, notifications immediately increased by 45% (95% CI: 38 to 51) nationally and across all subgroups and provinces. The trend in notifications remained stable through September 2021, with similar numbers to the predicted number had the pandemic not occurred.ConclusionImplementation of a coordinated public health response including active tuberculosis case-finding was associated with reversal of the adverse impact of the pandemic and mitigation measures. The gains were sustained throughout subsequent waves of the pandemic.