The contact network of patients in a regional healthcare system

Yet in spite of advances in hospital treatment, hospitals continue to be a breeding ground for several airborne diseases and for diseases that are transmitted through close contacts like SARS, methicillin-resistant Staphylococcus aureus (MRSA), norovirus infections and tuberculosis (TB). Here we extract contact networks for up to 295,108 inpatients for durations up to two years from a database used for administrating a local public healthcare system serving a population of 1.9 million individuals. Structural and dynamical properties of the network of importance for the transmission of contagious diseases are then analyzed by methods from network epidemiology. The contact networks are found to be very much determined by an extreme (age independent) variation in duration of hospital stays and the hospital structure. We find that that the structure of contacts between in-patients exhibit structural properties, such as a high level of transitivity, assortativity and variation in number of contacts, that are likely to be of importance for the transmission of less contagious diseases. If these properties are considered when designing prevention programs the risk for and the effect of epidemic outbreaks may be decreased

Endemic Tularemia, Sweden, 2003

Tularemia cases have been reported in Sweden since 1931, but no cyclical patterns can be identified. In 2003, the largest outbreak of tularemia since 1967 occurred, involving 698 cases. Increased reports were received from tularemia-nonendemic areas. Causal factors for an outbreak year and associated geographic distribution are not yet understood

Report of the International Evaluation of the National Institute for Health and Welfare

THL is an extraordinary institution that any country would be very proud to have as a government agency for public health and welfare and as a source of expertise, evidence, counsel for policy making and the capacity to address Finland’s current challenges in health, welfare, inequalities therein, health threats and health and social care delivery as well as unanticipated future challenges. Both THL leadership and staff and the International Evaluation Group also recognize that Finland faces economic constraints and THL’s budget will need to reflect such circumstances. The IEG feels that efficiencies can be achieved in THL management and consolidation and that strategic planning with priority setting can properly target other areas for diminished emphasis and activity that can be cost-saving. However we urge the Government of Finland and the MSAH to carefully undertake such cost-saving and restructuring efforts to ensure that one of its component “jewels” maintains its excellence and critical capacity such that it continues to be able to provide the highest level of service to Finland and the health and well-being of the Finnish people. The final Report will be published later this year

Salmonella-associated Deaths, Sweden, 1997–2003

We examined excess deaths after infection with Salmonella in a registry-based matched cohort study of 25,060 persons infected abroad and 5,139 infected within Sweden. The domestically infected have an increased standardized mortality ratio, whereas those who acquired Salmonella infection abroad had no excess risk of death

The 2000 Tularemia Outbreak: A Case-Control Study of Risk Factors in Disease-Endemic and Emergent Areas, Sweden

A widespread outbreak of tularemia in Sweden in 2000 was investigated in a case-control study in which 270 reported cases of tularemia were compared with 438 controls. The outbreak affected parts of Sweden where tularemia had hitherto been rare, and these “emergent” areas were compared with the disease-endemic areas. Multivariate regression analysis showed mosquito bites to be the main risk factor, with an odds ratio (OR) of 8.8. Other risk factors were owning a cat (OR 2.5) and farm work (OR 3.2). Farming was a risk factor only in the disease-endemic area. Swollen lymph nodes and wound infections were more common in the emergent area, while pneumonia was more common in the disease-endemic area. Mosquito bites appear to be important in transmission of tularemia. The association between cat ownership and disease merits further investigation

Infection-related hospitalizations in breast cancer patients: risk and impact on prognosis

OBJECTIVES: Infections are a common cause of hospitalization in breast cancer patients. We studied the risk, clinical characteristics and outcomes of infection-related hospitalizations in this patient population. METHODS: A Swedish registry-based study including 8338 breast cancer patients diagnosed between 2001 and 2008, followed prospectively for infection-related hospitalizations until 2010. Standardized incidence ratios (SIRs) were calculated using background rates from the general female population. Associations with clinical characteristics and mortality were analyzed using flexible parametric survival models. RESULTS: In total, 720 patients experienced an infection-related hospitalization during a median follow-up of 4.9 years. Infection rates were highest within the first year of diagnosis (SIR = 5.61, 95% CI; 4.98-6.32), and site-specific risks were most pronounced for sepsis (SIR = 3.14, 95% CI; 2.66-3.71) and skin infections (SIR = 2.80, 95% CI; 2.24-3.50). Older age at diagnosis, comorbidities, markers of tumor aggressiveness, chemotherapy and axillary node dissection were independent predictors of infectious disease risk. Infection-related hospitalizations were also independently associated with overall and breast cancer-specific death. CONCLUSIONS: A significant number of breast cancer patients are hospitalized with an infection following diagnosis, which in turn predicts poor prognosis. The risk profile of infection-related hospitalizations is multifactorial, including patient, tumor and treatment-related factors.Swedish Research CouncilFORTEAccepte

Living with the COVID-19 pandemic: act now with the tools we have.

Fil: Bedford, Juliet. Anthrologica, Oxfordshire; Reino Unido.Fil: Enria, Delia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Virales Humanas; Argentina.Fil: Giesecke, Johan. Karolinska Institute, Stockholm; Suecia.Fil: Heymann, David L. Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine; Reino Unido.Fil: Ihekweazu, Chikwe. Nigeria Centre for Disease Control; Nigeria.Fil: Kobinger, Gary. Infectious Disease Research Centre, Université Laval, Faculty of Medicine; Canada.Fil: Lane, H Clifford. National Institute of Allergy and Infectious Diseases; Estados Unidos.Fil: Memish, Ziad A. J W Lee Center for Global Medicine, SNU College of Medicine, Department of Internal Medicine, Seoul National University Hospital; Corea del Sur.Fil: Oh, Myoung-Don. J W Lee Center for Global Medicine, SNU College of Medicine, Department of Internal Medicine, Seoul National University Hospital; Corea del Sur.Fil: Sall, Amadou Alpha. Institut Pasteur de Dakar; Senegal.Fil: Ungchusak, Kumnuan. Ministry of Health, Department of Diseases Control; Tailandia.Fil: Wieler, Lothar H. Robert Koch Institute; Alemania.The responses of countries to the COVID-19 pandemic have been disparate.1, 2 Many countries are reopening workplaces, schools, and social gatherings and striving to adapt their economies and resume international travel. Other countries are attempting to suppress transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by again restricting businesses, industries, and schools while hoping for future COVID-19 vaccines or treatments. The Strategic and Technical Advisory Group for Infectious Hazards (STAG-IH), the independent advisory group to the WHO Health Emergencies Programme, has reviewed information from countries around the world and has concluded that the most sound approach on the basis of current understanding is to deploy long-term strategies with a focus on preventing amplification of transmission, protecting those most at risk of severe illness, and supporting research to better understand the virus, the disease, and people's responses to them

Mortality following Campylobacter infection: a registry-based linkage study

BACKGROUND: Campylobacteriosis is one of the most commonly identified causes of bacterial diarrheal disease and a common cause of gastroenteritis in travellers from developed nations. Despite the widespread occurrence, there is little information on Campylobacter mortality. METHODS: Mortality among a cohort of Campylobacter cases were compared with the general population 0–1, 1–3, 3–12 and more than 12 month after the onset of the illness. The cases were sub-grouped according to if they had been infected domestically or abroad. RESULTS: The standardized mortality ratio for cases infected domestically was 2.9 (95% CI: 1.9–4.0) within the first month following the illness. The risk then gradually diminished and approached 1.0 after one year or more have passed since the illness. This initial excess risk was not attributable to any particular age group (such as the oldest). In contrast, for those infected abroad, a lower standardized mortality ratio 0.3 (95% CI: 0.04–0.8) was shown for the first month after diagnosis compared to what would be expected in the general population. CONCLUSION: Infection with Campylobacter is associated with an increased short-term risk of death among those who were infected domestically. On the contrary, for those infected abroad a lower than expected risk of death was evident. We suggest that the explanation behind this is a "healthy traveler effect" among imported cases, and effects of a more frail than average population among domestic cases

Emerging Genotype (GGIIb) of Norovirus in Drinking Water, Sweden

From May through June 2001, an outbreak of acute gastroenteritis that affected at least 200 persons occurred in a combined activity camp and conference center in Stockholm County. The source of illness was contaminated drinking water obtained from private wells. The outbreak appears to have started with sewage pipeline problems near the kitchen, which caused overflow of the sewage system and contaminated the environment. While no pathogenic bacteria were found in water or stools specimens, norovirus was detected in 8 of 11 stool specimens and 2 of 3 water samples by polymerase chain reaction. Nucleotide sequencing of amplicons from two patients and two water samples identified an emerging genotype designated GGIIb, which was circulating throughout several European countries during 2000 and 2001. This investigation documents the first waterborne outbreak of viral gastroenteritis in Sweden, where nucleotide sequencing showed a direct link between contaminated water and illness