Risk factors for death from invasive pneumococcal disease, europe, 2010

We studied the possible association between patient age and sex, clinical presentation, Streptococcus pneumoniae serotype, antimicrobial resistance, and death in invasive pneumococcal disease cases reported by 17 European countries during 2010. The study sample comprised 2,921 patients, of whom 56.8% were men and 38.2% were >65 years of age. Meningitis occurred in 18.5% of cases. Death was reported in 264 (9.0%) cases. Older age, meningitis, and nonsusceptibility to penicillin were signifcantly asso ciated with death. Non-pneumococcal conjugate vaccine (PCV) serotypes among children 65 years of age, risk did not differ by serotype. These fndings highlight differences in case-fatality rates between sero types and age; thus, continued epidemiologic surveillance across all ages is crucial to monitor the long-term effects of PCVs

Will the European Union reach the United Nations Millennium declaration target of a 50% reduction of tuberculosis mortality between 1990 and 2015?

Abstract Background The Millennium Development Goals (MDG) provide targets for 2015. MDG 6 includes a target to reduce the tuberculosis (TB) death rate by 50% compared with 1990. We aimed to assess whether this target was reached by the European Union (EU) and European Economic Area countries. Methods We used Eurostat causes of death data to assess whether the target was reached in the EU. We calculated the reduction in reported and adjusted death rates and the annual average percentage decline based on the available data. Results Between 1999 and 2014, the TB death rate decreased by 50%, the adjusted death rate by 56% and the annual average percentage decline was 5.43% (95% confidence interval 4.94–6.74) for the EU. Twenty of 26 countries reporting >5 TB deaths in the first reporting year reached the target of 50% reduction in adjusted death rate. Conclusions The EU reached the MDG target of a 50% reduction of the TB death rate and also the annual average percentage decline was larger than the 2.73% needed to reach the target. The World Health Organization ‘End TB Strategy’ requires a further reduction of the number of TB deaths of 35% by 2020 compared to 2015, which will challenge TB prevention and care services in the EU

Parental smoking and lung function in children: an international study.

RATIONALE: Both prenatal and postnatal passive smoking have been linked with respiratory symptoms and asthma in childhood. Their differential contributions to lung function growth in the general children's population are less clear. OBJECTIVE: To study the relative impact of pre- and postnatal exposure on respiratory functions of primary school children in a wide range of geographic settings, we analyzed flow and volume data of more than 20,000 children (aged 6-12 yr) from nine countries in Europe and North America. METHODS: Exposure information had been obtained by comparable questionnaires, and spirometry followed a protocol of the American Thoracic Society/European Respiratory Society. Linear and logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results and mean effects were estimated using meta-analytic tools. MAIN RESULTS: Smoking during pregnancy was associated with decreases in lung function parameters between -1% (FEV1) and -6% maximal expiratory flow at 25% of vital capacity left (MEF25). A 4% lower maximal midexpiratory flow (MMEF) corresponded to a 40% increase in the risk of poor lung function (MMEF < 75% of expected). Associations with current passive smoking were weaker though still measurable, with effects ranging from -0.5% (FEV1) to -2% maximal expiratory flow (MEF50). CONCLUSIONS: Considering the high number of children exposed to maternal smoking in utero and the even higher number exposed to passive smoking after birth, this risk factor for reduced lung function growth remains a serious pediatric and public health issue

Risk Factors for Death from Invasive Pneumococcal Disease, Europe, 2010

We studied the possible association between patient age and sex, clinical presentation, Streptococcus pneumoniae serotype, antimicrobial resistance, and death in invasive pneumococcal disease cases reported by 17 European countries during 2010. The study sample comprised 2,921 patients, of whom 56.8% were men and 38.2% were >65 years of age. Meningitis occurred in 18.5% of cases. Death was reported in 264 (9.0%) cases. Older age, meningitis, and nonsusceptibility to penicillin were significantly associated with death. Non–pneumococcal conjugate vaccine (PCV) serotypes among children 65 years of age, risk did not differ by serotype. These findings highlight differences in case-fatality rates between serotypes and age; thus, continued epidemiologic surveillance across all ages is crucial to monitor the long-term effects of PCVs

Challenges and Opportunities in Routine Time Series Analysis of Surveillance Data

OBJECTIVE: To discuss challenges and opportunities in the introduction of an automated approach for time series analysis (TSA) regarding epidemiological methodology for generation of hypotheses, steps to be performed and interpretation of outputs. INTRODUCTION: ECDC long term strategies for surveillance include analysis of trends of communicable disease of public health importance for European Union countries to guide public health actions. The European Surveillance System (TESSy) holds data on 49 communicable diseases reported by 30 countries for at least the past five years. To simplify time related analysis using surveillance data, ECDC launched a project to enable descriptive and routine TSA without the need for complex programming. METHODS: Protocols for TESSy data were developed specifying hypotheses to be tested, types and format of variables needed for TSA for several diseases, including VTEC, and legionellosis. Stata scripts were developed to comply with the basic steps of TSA, including data aggregation, data checking, data description, analysis of trends and seasonality, residual analysis, simple modelling and long-term forecasting. TSA steps were presented as successive tabs in a TSA dialogue box in Stata. Before using the Stata TSA dialogue box, experts were offered a two-day training, and provided with an in-depth manual supporting use and interpretation of TSA outputs using the Stata TSA dialogue box. RESULTS: For VTEC, it was possible to identify a small increase in the trend and a seasonal pattern in surveillance data with an estimate of the start of the increased risk for infection in the beginning of the summer season [1]. For legionellosis, an increasing trend in the number of reported cases was observed in 2010 [2]. Feedback from the training showed that using the Stata TSA dialogue box enables a quick exploratory analysis even by non-Stata users who could focus on interpretation of results, rather than the programme writing. However, we emphasise that statistical knowledge of TSA as well as rigorous preparation of the datasets (including data quality checks) and generation of hypotheses, are essential to ensure appropriate analysis and meaningful interpretation of the results. CONCLUSIONS: Using the Stata TSA dialogue box saves time when performing rapid exploratory TSA of epidemiological data, avoiding the need for complex programming which is still needed for sophisticated TSA. Results of exploratory TSA analysis can trigger new hypothesis, for more advanced and sophisticated TSA. The introduction of a new technology (Stata TSA dialogue box) does not replace multi-disciplinary approach, knowledge and application of a methodological approach to TSA to produce meaningful results that can inform public health decision making. Further testing and training will be performed to enhance simplicity before appropriate dissemination of the Stata TSA dialogue box for a wider use

Challenges and Opportunities in Routine Time Series Analysis of Surveillance Data

This abstract presents challenges and opportunities encountered when performing routine time series analysis of surveillance data when introduction of automated processes. We launched a project to enable descriptive and routine TSA without the need for complex programming using a stata dialog box. This method was applied to several European surveillance datasets including VTEC and Legionellosis. Using the Stata TSA dialogue box saves time when performing rapid exploratory TSA of epidemiological data, but this does not replace multi-disciplinary approach, knowledge and application of a methodological approach to TSA to produce meaningful results that can inform public health decision making

Parental smoking and children's respiratory health: independent effects of prenatal and postnatal exposure

OBJECTIVES: Adverse effects have been reported of prenatal and/or postnatal passive exposure to smoking on children's health. Uncertainties remain about the relative importance of smoking at different periods in the child's life. We investigate this in a pooled analysis, on 53,879 children from 12 cross-sectional studies--components of the PATY study (Pollution And The Young). METHODS: Effects were estimated, within each study, of three exposures: mother smoked during pregnancy, parental smoking in the first two years, current parental smoking. Outcomes were: wheeze, asthma, "woken by wheeze", bronchitis, nocturnal cough, morning cough, "sensitivity to inhaled allergens" and hay fever. Logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results, and mean effects (allowing for heterogeneity) were estimated using meta-analytical tools. RESULTS: There was strong evidence linking parental smoking to wheeze, asthma, bronchitis and nocturnal cough, with mean odds ratios all around 1.15, with independent effects of prenatal and postnatal exposures for most associations. CONCLUSIONS: Adverse effects of both pre- and postnatal parental smoking on children's respiratory health were confirmed. Asthma was most strongly associated with maternal smoking during pregnancy, but postnatal exposure showed independent associations with a range of other respiratory symptoms. All tobacco smoke exposure has serious consequences for children's respiratory health and needs to be reduced urgently