Seasonality and the effects of weather on Campylobacter infections

Background Campylobacteriosis is a major public health concern. The weather factors that influence spatial and seasonal distributions are not fully understood. Methods To investigate the impacts of temperature and rainfall on Campylobacter infections in England and Wales, cases of Campylobacter were linked to local temperature and rainfall at laboratory postcodes in the 30 days before the specimen date. Methods for investigation included a comparative conditional incidence, wavelet, clustering, and time series analyses. Results The increase of Campylobacter infections in the late spring was significantly linked to temperature two weeks before, with an increase in conditional incidence of 0.175 cases per 100,000 per week for weeks 17 to 24; the relationship to temperature was not linear. Generalized structural time series model revealed that changes in temperature accounted for 33.3% of the expected cases of Campylobacteriosis, with an indication of the direction and relevant temperature range. Wavelet analysis showed a strong annual cycle with additional harmonics at four and six months. Cluster analysis showed three clusters of seasonality with geographic similarities representing metropolitan, rural, and other areas. Conclusions The association of Campylobacteriosis with temperature is likely to be indirect. High-resolution spatial temporal linkage of weather parameters and cases is important in improving weather associations with infectious diseases. The primary driver of Campylobacter incidence remains to be determined; other avenues, such as insect contamination of chicken flocks through poor biosecurity should be explored

Contamination Landscapes: Spatio-Temporal Record and Analysis of Pathogens in Clinical Settings

Nosocomial outbreaks require quick epidemiological clarification of possible chains of infection, since the pathogen usually has a head start that has to be caught up. Identification of people and areas at risk is crucial for efficient confinement. This paper describes a concept which can be applied to healthcare settings. The application skips the time-consuming and imperfect reconstruction of direct and indirect contacts. Indoor mobility of people and devices are instead measured precisely, and the mobility history is used to construct a spatio-temporal ‘landscape of infection’. This landscape allows for the calculation of a modelled ‘contamination landscape’ (CL) adding location-based prolongation of infectivity. In that way, the risk per person can be derived in case of an outbreak. The CL concept is extremely flexible and can be adapted to various pathogen-specific settings. The combination of advanced measurements and specific modelling results in an instant list of possible recipients who need to be examined directly. The modelled, pathogen-specific parameters can be adjusted to get as close as possible to the results of mass screenings

Antibiotikaverordnungen bei Atemwegsinfektionen im Kindesalter

Background!#!Pediatric outpatients with respiratory tract infections (RTIs) comprise an important target population for antibiotic stewardship (ABS) intervention.!##!Objectives!#!The aim of this qualitative study was to determine which clinical and contextual factors have a significant impact on antibiotic therapy (ABT) in pediatric patients with RTIs.!##!Materials and methods!#!An online survey was developed and carried out in Germany in cooperation with the Federal Association of Pediatricians and the German Society for Pediatric Infectious Diseases. Pediatricians and general practitioners were invited to participate.!##!Results!#!The survey yielded 555 complete response data sets. Diagnostic uncertainty, time constraints for repeated consultations, and fear of complications were identified by 50% of both medical specialties as contextual factors fostering ABT. The risk of serious complications (e.g., mastoiditis) was overestimated by the majority of participants. More than 40% of respondents lacked knowledge concerning official guidelines, and RTIs with fever lasting longer than three days appeared to be an important criterion for ABT for 30-40%. Fewer than 60% of physicians were using a point-of-care device to determine C‑reactive protein.!##!Conclusion!#!Although most participants acknowledged the growing prevalence of antibiotic-resistant pathogens as an important problem, this survey identifies targets for ABS in pediatric outpatients with RTIs. Ongoing education and training (e.g., better communication strategies in response to parental concerns) should become mandatory for those who prescribe ABT for children with RTIs

Contracting infectious diseases in Sub-Saharan African wetlands: A question of use? A review

Worldwide the pressure on water is increasing. In parts of Sub-Saharan Africa (SSA), natural wetlands constitute the only accessible water resources, providing water free of charge, agricultural potential and livelihoods in otherwise uninhabitable landscapes, which is why they are being used extensively. The degradation and contamination of water which result from the use of wetlands has the potential to spread disease-causing microorganisms and provide increased breeding habitats for disease vectors, Despite this importance, case studies are lacking and knowledge gaps remain about whether and how different kinds of wetland use influence the exposure to health risks and transmission of infectious diseases. This descriptive literature review aimed at identifying publications from peer-reviewed journals and book chapters that (i) address water-related infectious diseases in SSA wetlands and (ii) link those diseases to use-related exposures. The resulting overview includes 27 publications and shows that depending on the type of use, people in wetlands are exposed to different risk factors and water-related infectious diseases. Exposure to infectious agents depends on occupational characteristics, and time spent in wetlands. Disease transmission is driven by users’ contact to water, characteristics of pathogens and vectors of disease. The amount of available literature varies significantly. Whereas several publications have linked crop production and the domestic use of wetland water to contraction of diseases, fewer are available on health risks identified with pastoralism in wetlands and other uses. Some risk factors are well researched, such as irrigation schemes favouring schistosomiasis prevalence. For others, including proximity of pastoralists to their livestock and the associated trachoma risk, knowledge remains limited. This review establishes connections of selected diseases with different transmission pathways that are linked to specific risk factors, transmission pathways and resulting diseases. All of these have been integrated into a detailed conceptual framework which simplifies the complexity of the relationships, while at the same time identifying missing links which might provide stimulus for future research tackling the potential research gaps. It concludes that socio-cultural and behavioural considerations regarding the wetland users are not sufficiently evaluated and should receive increased attention in future investigations

Prescribing of antibiotics for respiratory tract infections in German outpatient pediatric care : Results of a survey of pediatricians and general practitioners

Hintergrund Ambulant behandelte Kinder mit Atemwegsinfektionen (AWI) sind eine wichtige Zielgruppe für Interventionen zum rationalen und verantwortungsvollen Einsatz von Antibiotika (Antibiotic Stewardship, ABS). Ziel der Studie Qualitative Studie zur Identifizierung von klinischen und kontextualen Faktoren mit signifikantem Einfluss auf die Antibiotikatherapie (ABT) bei Kindern mit AWI. Material und Methoden In Kooperation mit dem Berufsverband der Kinder- und Jugendärzte e. V. und der Deutschen Gesellschaft für Pädiatrische Infektiologie wurde ein Online-Survey entwickelt. Bundesweit wurden Pädiater und Allgemeinmediziner zur Teilnahme eingeladen. Ergebnisse 555 Antwortdatensätze waren auswertbar. Diagnostische Unsicherheit, fehlende Zeitressourcen für wiederholte Konsultationen und die Angst vor Komplikationen waren bei 50 % der Teilnehmenden wichtige Kontextfaktoren für eine ABT. Das Risiko schwerer Komplikationen (z. B. Mastoiditis) wurde von der Mehrheit der Teilnehmenden überschätzt oder war unbekannt. Mehr als 40 % kannten die Konsensusleitlinien der Fachgesellschaften nicht. Fieber, das länger als 3 Tage anhält, war für 30–40 % ein klinisches Argument für eine ABT. Weniger als 60 % nutzten eine Point-of-Care-Diagnostik zur Bestimmung des C‑reaktiven Proteins. Schlussfolgerung Die überwiegende Mehrheit der Teilnehmenden erkannte die Zunahme antibiotikaresistenter Erreger als wichtiges Problem. Dieser Survey zeigt Ansatzpunkte für ABS bei Kindern mit AWI. Die kontinuierliche Vermittlung von Kenntnissen zur adäquaten ABT sollte obligater Bestandteil der ärztlichen Fortbildung werden. Dazu gehören Kommunikationsstrategien in der Interaktion mit den Eltern. Für die Umsetzung einer rationalen Antibiotikatherapie wird in der Praxis ein größeres refinanziertes Zeitkontingent zur Beratung der Eltern benötigt.Background Pediatric outpatients with respiratory tract infections (RTIs) comprise an important target population for antibiotic stewardship (ABS) intervention. Objectives The aim of this qualitative study was to determine which clinical and contextual factors have a significant impact on antibiotic therapy (ABT) in pediatric patients with RTIs. Materials and methods An online survey was developed and carried out in Germany in cooperation with the Federal Association of Pediatricians and the German Society for Pediatric Infectious Diseases. Pediatricians and general practitioners were invited to participate. Results The survey yielded 555 complete response data sets. Diagnostic uncertainty, time constraints for repeated consultations, and fear of complications were identified by 50% of both medical specialties as contextual factors fostering ABT. The risk of serious complications (e.g., mastoiditis) was overestimated by the majority of participants. More than 40% of respondents lacked knowledge concerning official guidelines, and RTIs with fever lasting longer than three days appeared to be an important criterion for ABT for 30–40%. Fewer than 60% of physicians were using a point-of-care device to determine C‑reactive protein. Conclusion Although most participants acknowledged the growing prevalence of antibiotic-resistant pathogens as an important problem, this survey identifies targets for ABS in pediatric outpatients with RTIs. Ongoing education and training (e.g., better communication strategies in response to parental concerns) should become mandatory for those who prescribe ABT for children with RTIs

Wasser-, Sanitärversorgung und Hygiene unter den Roma Gemeinschaften in Europa: Situationsanalyse, kultureller Kontext und Verbesserungshindernisse

Die Roma bilden Europas gröβte ethnische Minderheit. Ihre Geschichte ist geprägt von Marginalisierung, Stimga, Dikriminierung, Verfolgung und Mord und bis heute erfahren Roma Vorurteile und soziale Exklusion. Roma Gemeinschaften leben oft in ärmlichen, beengten und qualitativ minderwertigen Wohnverhältnissen am Stadtrand. Oft fehlt ihnen Basisinfrastruktur, inklusive Wasser-, Sanitärversorgung und Hygiene (WASH). Dieser erste systematische Literaturreview, der 30 Publikationen aus den Jahren 2000 bis 2020 beinhaltet, hatte ein besseres Verständnis der Herausforderungen von Roma Gemeinschaften in Bezug auf WASH, damit verbundenen Risikofaktoren und Einflüssen kultureller Normen zum Ziel. Aus der Literaturübersicht folgt, dass Roma Gemeinschaften in Europa im Vergleich zur Mehrheitsbevölkerung hinsichtlich Zugang zu WASH, Abfallmanagement, Umwelthygiene und Wohnumgebung gröβere Herausforderungen erleben. Zu den wichtigsten Hindernissen für den Zugang zu WASH gehören Diskriminierung, soziale Ausgrenzung, mangelnde formale Bildung, Armut, geographische Faktoren, rechtliche und soziale Aspekte sowie kulturelle Wahrnehmung von Gesundheitsrisiken, mangelnder politischer Wille und mangelnde Beteiligung an Planungsprozessen. Außerdem sind Roma in nationalen Statistiken nicht ausreichend vertreten. Die Situation und der kulturelle Kontext von WASH unter Roma sind herausfordernd und komplex. Es besteht dringender Handlungsbedarf, und die Ergebnisse der Studie bieten breitere Anwendbarkeit auf ethnische und soziale Minderheiten in anderen Teilen der Welt. Künftige Forschungen zur Überwindung von Verbesserungshindernissen müssen umfassender angelegt sein und Mitglieder der Roma Gemeinschaft als wichtige Informanten einbeziehen. Ihre Beteiligung trägt zur Zuverlässigkeit der Daten, sozialer Gerechtigkeit und Solidarität bei, sowie zur gezielten Informationsverbreitung, praktikablen Empfehlungen und zur Umsetzung von Interventionen

Primary school teaching material supports water, sanitation, hygiene and health education and promotes healthy behaviour

Safe drinking water, sanitation and hygiene (WASH) are crucial preconditions for human health. Related knowledge and risk perceptions have the potential to motivate healthy behaviours and reduce disease risk. Schools, as platforms for learning and developing WASH habits, with children as multipliers and disseminators of knowledge to their households, are often targeted by WASH and health messaging interventions. However, such interventions are usually disconnected from the school education that the children already receive. We reviewed primary school teaching material for children in class 1 through 8 (age range of 6-13 years) in order to investigate: (i) how drinking water, sanitation and hygiene issues are represented in school book teaching materials; (ii) which WASH dimensions are addressed; (iii) whether there is a causal chain relating themes to each other and to disease risk; (iv) how WASH and health education relate to the real life WASH provision situation in Kenya; and (v) what potential WASH education holds for health interventions. We screened class 1 – 8 science text books for WASH related and disease risk topics and conducted a detailed content analysis of the themes covered. Our screening of school books revealed that WASH, environmental hygiene, WASH-related disease risks and transmission pathways and health promotion are addressed substantially in standard science books in Kenya. Children learn about drinking water (transport, quality, treatment, storage, conservation), sanitation (facilities, use, hygiene and behaviour), hygiene (personal, handwashing, food hygiene and storage), environmental hygiene and health promotion (waste management, disease prevention), and disease risk (WASH-related risks, transmission pathways of various communicable diseases). Thus, primary school teaching material supports water, sanitation, hygiene and health education and promotes healthy behaviour. We will gather your perspectives on the our considered discussion points, including: 1.Causal chain of WASH, disease exposure and prevention in science education 2.Science education versus real situation: Challenges in implementing knowledge 3.What about cultural context, marginalized remote groups and school drop out? 4.Comparison to WASH in school books in other countries 5.Implications for WASH interventions, health programming and messaging 6.Contextualization of our findings with the Covid-19 pandemi

Kenyan school book knowledge for water, sanitation, hygiene and health education interventions: Disconnect, integration or opportunities?

Background: Schools, depending on their access to and quality of water, sanitation and hygiene (WASH) and the implementation of healthy behaviours, can be critical for the control and spread of many infectious diseases, including COVID-19. Schools provide opportunities for pupils to learn about the importance of hygiene and WASH-related practice, and build healthy habits and skills, with beneficial medium- and long-term consequences particularly in low- and middle-income countries: reducing pupils’ absenteeism due to diseases, promoting physical, mental and social health, and improving learning outcomes. WASH services alone are often not sufficient and need to be combined with educational programmes. As pupils disseminate their acquired health-promoting knowledge to their (extended) families, improved WASH provisions and education in schools have beneficial effects also on the community. International organisations frequently roll out interventions in schools to improve WASH services and, in some cases, train pupils and teachers on safe WASH behaviours. How such interventions relate to local school education on WASH, health promotion and disease prevention knowledge, whether and how such knowledge and school books are integrated into WASH education interventions in schools, are knowledge gaps we fill. Methods: We analyzed how Kenyan primary school science text book content supports WASH and health education by a book review including books used from class 1 through class 8, covering the age range from 6 to 13 years. We then conducted a rapid literature review of combined WASH interventions that included a behaviour change or educational component, and a rapid review of international policy guidance documents to contextualise the results and understand the relevance of books and school education for WASH interventions implemented by international organisations. We conducted a content analysis based on five identified thematic categories, including drinking water, sanitation, hygiene, environmental hygiene & health promotion and disease risks, and mapped over time the knowledge about WASH and disease prevention. Results: The books comprehensively address drinking water issues, including sources, quality, treatment, safe storage and water conservation; risks and transmission pathways of various waterborne (Cholera, Typhoid fever), water-based (Bilharzia), vector-related (Malaria) and other communicable diseases (Tuberculosis); and the importance of environmental hygiene and health promotion. The content is broadly in line with internationally recommended WASH topics and learning objectives. Gaps remain on personal hygiene and handwashing, including menstrual hygiene, sanitation education, and related health risks and disease exposures. The depth of content varies greatly over time and across the different classes. Such locally available education materials already used in schools were considered by none of the WASH education interventions in the considered intervention studies. Conclusions: The thematic gaps/under-representations in books that we identified, namely sanitation, hygiene and menstrual hygiene education, are all high on the international WASH agenda, and need to be filled especially now, in the context of the current COVID-19 pandemic. Disconnects exist between school book knowledge and WASH education interventions, between policy and implementation, and between theory and practice, revealing missed opportunities for effective and sustainable behaviour change, and underlining the need for better integration. Considering existing local educational materials and knowledge may facilitate the buy-in and involvement of teachers and school managers in strengthening education and implementing improvements. We suggest opportunities for future research, behaviour change interventions and decision-making to improve WASH in schools

Burden of hospital admissions and resulting patient interhospital transports during the 2020/2021 SARS-CoV-2 pandemic in Saxony, Germany

Abstract Secondary transports of patients from one hospital to another are indicated for medical reasons or to address local constraints in capacity. In particular, interhospital transports of critically ill infectious patients present a logistical challenge and can be key in the effective management of pandemic situations. The state of Saxony in Germany has two characteristics that allow for an extensive evaluation of secondary transports in the pandemic year 2020/2021. First, all secondary transports are centrally coordinated by a single institution. Second, Saxony had the highest SARS-CoV-2 infection rates and the highest COVID-19 associated mortality in Germany. This study evaluates secondary interhospital transports from March 2019 to February 2021 in Saxony with a detailed analysis of transport behaviour during the pandemic phase March 2020 to February 2021. Our analysis includes secondary transports of SARS-CoV-2 patients and compares them to secondary transports of non-infectious patients. In addition, our data show differences in demographics, SARS-CoV-2- incidences, ICU occupancy of COVID-19 patients, and COVID-19 associated mortality in all three regional health clusters in Saxony. In total, 12,282 secondary transports were analysed between March 1st, 2020 and February 28th, 2021, of which 632 were associated with SARS-CoV-2 (5.1%) The total number of secondary transports changed slightly during the study period March 2020 to February 2021. Transport capacities for non-infectious patients were reduced due to in-hospital and out-of-hospital measures and could be used for transport of SARS-CoV-2 patients. Infectious transfers lasted longer despite shorter distance, occurred more frequently on weekends and transported patients were older. Primary transport vehicles were emergency ambulances, transport ambulances and intensive care transport vehicles. Data analysis based on hospital structures showed that secondary transports in correlation to weekly case numbers depend on the hospital type. Maximum care hospitals and specialized hospitals show a maximum of infectious transports approximately 4 weeks after the highest incidences. In contrast, standard care hospitals transfer their patients at the time of highest SARS-CoV-2 case numbers. Two incidence peaks were accompanied by two peaks of increased secondary transport. Our findings show that interhospital transfers of SARS-CoV-2 and non-SARS-CoV-2 patients differ and that different hospital care levels initiated secondary transports at different times during the pandemic