Experience of the implementation of administrative indicators of the quality and completeness of the electronic reports on cases notified to the electronic integrated disease surveillance system in Azerbaijan

Introduction. The Electronic Integrated Disease Surveillance System (EIDSS) supports current infectious disease surveillance and monitoring activities by integrating human and veterinary case data. It also enables direct data reporting to the World Health Organization (WHO). Consequently, ensuring the quality and completeness of data is a top priority at all levels, from primary health care institutions to the Ministry of Health. Reviewing and evaluating the effectiveness of EIDSS for infectious diseases against the stated objectives allows the development and implementation of evidence-based measures at the Ministry of Health level to maintain the continuous improvement of the population's health status. In Azerbaijan, the EIDSS was introduced in 2010. Subsequently, recognizing the need for ongoing monitoring of the surveillance database, a system of administrative indicators to assess the completeness and quality of electronic reports was established. The issues of timeliness, quality, and completeness of the database, especially concerning zoonotic infections, are pertinent in Azerbaijan. Aim. To evaluate the effectiveness of the implemented system of administrative indicators of the completeness and quality of filling out reports for zoonotic infections (brucellosis and anthrax). Material and methods. The EIDSS database of the Ministry of Health and the indicator scores for initially reported cases of brucellosis and cutaneous anthrax among people from 2018 to 2022 were analyzed. The conventionally assumed threshold value for surveillance indicators is 80% of all cases reported to the system. Results. In Azerbaijan, the burden of brucellosis among people averages 300±28 cases per year, and cutaneous anthrax averages 18±5 cases annually. Reporting is conducted by medical institutions at the first level, with laboratory confirmation of these zoonotic diseases carried out by the Special Dangerous Infections Control Centre, and epidemiological investigations following a One Health approach. The system of administrative indicators comprises three main blocks: monitoring the reporting of an emergency notification for a disease case, monitoring the investigation of a case, and monitoring laboratory results. The maximum score for these blocks is 1.25, 3.05, and 0.7, respectively. Over the years of observation, the country consistently achieved the designated maximum score for especially dangerous zoonotic infections among people. However, the indicator for case investigation monitoring reached its lowest point in 2020 (2.15), likely due to the added burden of the pandemic on all Centers for Hygiene and Epidemiology across the country. The indicator for monitoring laboratory results consistently met the target score each year, with a slight difference between confirmed cases (0.7) and cases with negative test results (0.5). Conclusions. The introduction of administrative indicators of the completeness and quality of filling in electronic reports showed the high efficiency of their use, despite the stable high incidence of brucellosis among people and the increase in cases of human cutaneous anthrax. It is recommended to apply the developed effective administrative indicators in subsequent versions of the electronic system and periodically conduct evaluation

The necessity for additional assessment of surveillance indicators of the timeliness of contacting a medical institution with suspected human anthrax in Azerbaijan

Introduction. Cutaneous anthrax in Azerbaijan is an endemic disease among people, particularly in regions with active cattle breeding. Over the period from 2018 to 2022, an average of 12-15 cases were recorded annually, primarily among the rural population. Notably, in 2022, the number of confirmed cases experienced a significant increase. Surveillance for anthrax, along with other infectious diseases, is conducted through the electronic surveillance system for infectious diseases (EIDSS).Aim. To assess the reason for the increase in the number of anthrax cases in Azerbaijan, utilizing surveillance timeliness indicators. Material and methods. We conducted an analysis of the electronic data-base in EIDSS of the Ministry of Health, focusing on initially reported cases of cutaneous anthrax among humans for the year 2022. The surveillance system was assessed, incorporating timeliness indicators, such as the date when the patient first sought care, the urgency of notification, case entry, initiation of epidemiological investigations, and the completeness of information in the fields related to collected and tested samples. The conventionally assumed threshold value for surveillance indicators is 80% of all cases reported to the system. Laboratory confirmation of samples from suspected cases is performed using both the PCR method and bacteriological methods. Methodological documents used for the evaluation included the “Rules for the Surveillance and Control of Especially Dangerous Infections” (Ministry of Health, Azerbaijan) and the “Updated Guidelines for Evaluating Public Health Surveillance Systems” (CDC, Atlanta).Results. In 2022, a total of 58 human cases of cutaneous anthrax were reported in EIDSS, with 25 cases confirmed by positive laboratory results. Further investigation into cases with negative laboratory results revealed that some patients had self-administered antibiotics and ointments before seeking medical attention. Despite clinical symptoms being present among cases with negative test results (e.g., papules in 91% of cases) and significant risk factors (such as handling meat in 24.2% of cases), there was a notable difference in the timeliness of seeking medical care (p<0.05). While the average time from the onset of symptoms to the first medical visit for confirmed cases was 4.5 days, it was 7.8 days for cases with negative laboratory results. The timeliness of emergency notification, case entry into EIDSS, and the initiation of epidemiological investigations for both confirmed cases and cases with negative test results did not significantly differ and exceeded the threshold level of 80% for all reported cases, as required in the country. The adequacy and completeness of filling in the fields of the laboratory module scored 100%. In the context of a One Health approach investigation, no cases were reported in EIDSS among animals. Conclusions. The evaluated timeliness indicators are equally high and exceeded the threshold level for both confirmed cases and cases with negative laboratory results. However, the revealed late appeal of the population with suspected anthrax and self-administration of antibiotics requires the adoption of appropriate measures to educate the population about the risk factors, prevention and effectiveness of timely contacting a medical institution

Impact of the COVID‐19 Pandemic on Influenza Circulation During the 2020/21 and 2021/22 Seasons, in Europe

Background: The emergence of SARS‐CoV‐2 in late 2019 saw the implementation of public health and social measures (PHSM) by countries across Europe to reduce its transmission and impact on populations. Consequently, countries reported changes in influenza circulation and extensive disruptions to routine surveillance systems.MethodsWe describe the epidemiology of influenza in Europe between Weeks 40/2020 and 39/2022 compared to the 2016/17 to 2019/20 seasons, to assess the impact of the COVID‐19 pandemic and PHSM on surveillance systems and influenza circulation.ResultsLow detections of influenza were observed through primary care sentinel sources during seasonal influenza periods (Week 40 to 20); 56 (of 39,457 specimens tested; < 1% positivity) in 2020/21 and 7261 (of 64,153 specimens tested; 11% positivity) detections in 2021/22 were observed, compared to an average of 18,383 (of 50,544 specimens tested; 36% positivity) detections in 2016/17 to 2019/20. Similarly, 11 (of 19,989 specimens tested; < 1% positivity) and 1488 (of 23,636 specimens tested; 6% positivity) detections were reported through SARI surveillance sources in 2020/21 and 2021/22, respectively, compared to an average of 2850 (of 10,389 specimens tested; 27% positivity) detections in 2016/17 to 2019/20. However, the 2021/22 interseasonal period saw unusual increases in influenza detections across surveillance site types when PHSM were easing.ConclusionIn conclusion, findings suggest that the restriction and easing of PHSM measures were associated with variations in influenza detections. Our observations of out‐of‐season influenza activity highlight the importance of an integrated respiratory surveillance strategy to monitor circulating respiratory viruses throughout the year to inform optimal prevention and control strategies.Data Availability Statement TESSy data are available upon request ([https://www.ecdc.europa.eu/ en/publications-data/european-surveillance-system-tessy])