a retrospective analysis

Funding Information: Funding statement: No funding was obtained for this study. GVdA is supported by DGD-Belgium. PLC is supported by the University College London Hospitals Biomedical Research Centre. Publisher Copyright: © 2022 European Centre for Disease Prevention and Control (ECDC). All rights reserved.Background: Surveillance of human leishmaniasis in Europe is mostly limited to country-specific information from autochthonous infections in the southern part. As at the end of 2021, no integrated analysis has been performed for cases seen across centres in different European countries. Aim: To provide a broad perspective on autochthonous and imported leishmaniasis cases in endemic and non-endemic countries in Europe. Methods: We retrospectively collected records from cutaneous, mucosal and visceral leishmaniasis cases diagnosed in 15 centres between 2014 and 2019. Centres were located in 11 countries: Belgium, France, Germany, Italy, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the United Kingdom. Data on country of infection, reason for travelling, infecting species, age and sex were analysed. Results: We obtained diagnostic files from 1,142 cases, of which 76%, 21% and 3% had cutaneous, visceral, and mucosal disease, respectively. Of these, 68% were men, and 32% women, with the median age of 37 years (range: 0–90) at diagnosis. Visceral leishmaniasis was mainly acquired in Europe (88%; 167/190), while cutaneous leishmaniasis was primarily imported from outside Europe (77%; 575/749). Sixty-two percent of cutaneous leishmaniasis cases from outside Europe were from the Old World, and 38% from the New World. Geographic species distribution largely confirmed known epidemiology, with notable exceptions. Conclusions: Our study confirms previous reports regarding geographic origin, species, and traveller subgroups importing leishmaniasis into Europe. We demonstrate the importance of pooling species typing data from many centres, even from areas where the aetiology is presumably known, to monitor changing epidemiology.publishersversionpublishe

Predominance of influenza A(H3N2) virus genetic subclade 3C.2a1 during an early 2016/17 influenza season in Europe - Contribution of surveillance data from World Health Organization (WHO) European Region to the WHO vaccine composition consultation for northern hemisphere 2017/18

European region influenza surveillance Network author lisT - Portugal: Raquel Guiomar, Pedro Pechirra, Paula Cristóvão, Inês Costa, Patricia Conde (National Influenza and Other Respiratory Virus Reference Laboratory, Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge, Lisbon) and Ana Paula Rodrigues (Department of Epidemiology, National Instituteof Health Dr. Ricardo Jorge, Lisbon)Erratum in: Erratum to "Predominance of influenza A(H3N2) virus genetic subclade 3C.2a1 during an early 2016/17 influenza season in Europe - Contribution of surveillance data from World Health Organization (WHO) European region to the WHO vaccine composition consultation for northern hemisphere 2017/18" [Vaccine 35 (2017) 4828-4835]. [Vaccine. 2018 May 3;36(19):2740-2741. doi: 10.1016/j.vaccine.2017.12.039. Epub 2017 Dec 20]. Disponível em: https://doi.org/10.1016/j.vaccine.2017.12.039During the European 2016/17 influenza season, A(H3N2) viruses have predominated and the majority clustered in genetic subclade 3C.2a1. Genetic analyses showed that circulating viruses have undergone considerable genetic diversification of the haemagglutinin gene from the current vaccine virus A/Hong Kong/4801/2014 (clade 3C.2a), but the antigenic data that is limited by the challenges with the antigenic characterisation of currently circulating A(H3N2) viruses, showed no clear evidence of antigenic change. The recommended A(H3N2) vaccine component for the northern hemisphere 2017/18 influenza season remained unchanged. However, early and mid-season vaccine effectiveness (VE) estimates were suggestive of reduced VE against A(H3N2) viruses.info:eu-repo/semantics/publishedVersio

Guidelines for conducting birth defects surveillance

"In January of 1999, the National Birth Defects Prevention Network (NBDPN) established a Surveillance Guidelines and Standards Committee (SGSC) in order to develop and promote the use of standards and guidelines for birth defects surveillance programs in the United States. This set of guidelines is designed to serve as an important first step in the documentation of this process and as the vehicle for dissemination of the committee's findings. The Guidelines for Conducting Birth Defects Surveillance (henceforth referred to as The Surveillance Guidelines) were developed with three major long-term objectives in mind: To improve the quality of state birth defects surveillance data, including accuracy, comparability, completeness, and timeliness; To enhance the utility of state birth defects surveillance data for research on the distribution and etiology of birth defects; To encourage and promote the use of state birth defects surveillance data for the purposes of linking affected children with services and evaluation of those services. The technical guidelines that make up this document provide a way of improving the quality of birth defects surveillance data, which in turn enhances their use in support of the latter two objectives. Fundamental to quality is ensuring that procedures for all aspects of data definition, collection, management, and analysis are established and followed. Because state-based surveillance systems operate with different objectives and data needs, it is clear that, with respect to procedures and standards, 'one size does not fit all.' It is also clear, however, that common guidelines can provide a basis for the development of system-specific operating procedures and supporting manuals." - p. iIntroduction -- -- Chapter 1. The Whys and Hows of Birth Defects Surveillance - Using Data -- -- Chapter 2. Legislation -- Appendix 2.1. Sample State Legislation -- Appendix 2.2. Table of Birth Defects Legislation -- Appendix 2.3. Definitions Used to Determine Covered Entity Status Under the Privacy Rule -- Appendix 2.4. Office of Civil Rights (OCR) HIPAA Privacy Regulation Text -- -- Chapter 3.Case Definition -- Appendix 3.1. Birth Defects Included in the Case Definition of the National Birth Defects Prevention Network -- Appendix 3.2. NBDPN Abstractor's Instructions -- Appendix 3.3. Examples of Conditions Considered to Be Minor Anomalies -- Appendix 3.4. Conditions Related to Prematurity in Infants Born at Less Than 36 Weeks Gestation -- -- Chapter 4. Data Variables -- Appendix 4.1. Descriptions of Minimum (Core) Data Variables -- Appendix 4.2. Descriptions of Recommended Data Variables -- -- Chapter 5. Classification and Coding -- Appendix 5.1. Texas Disease Index -- Appendix 5.2. 6-Digit CDC Codes (updated 8/2007) -- -- Chapter 6. Case Ascertainment Methods -- Appendix 6.1. Data Source Described in Detail - Vital Records -- Appendix 6.2. Data Source Described in Detail - Hospital Data Sets -- Appendix 6.3. Data Source Described in Detail - Hospital and Patient Services Logs -- Appendix 6.4. Data Source Described in Detail - Genetic Services -- -- Chapter 7. Data Quality Management -- Appendix 7.1. Data Sources Descriptive Assessment Tool -- -- Chapter 8. Statistical Methods -- -- Chapter 9. Data Management and Security -- -- Chapter 10. Data Collaboration and Dissemination through the NBDPN -- -- Chapter 11. Data Presentation -- Appendix 11.1. Data Suppression -- Appendix 11.2. Use of Geographic Information Systems (GIS) to Map Data -- Appendix 11.3. Data Users Matrix -- Appendix 11.4. What Type of Chart or Graph Should I Use?edited by Lowell E. Sever."June 2004."Support for development, production, and distribution of these guidelines was provided by the Birth Defects State Research Partnerships Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention.Title from title caption (viewed on Jan. 6, 2012).Mode of access: Internet from the CDC web site as an Acrobat .pdf file ((7.6 MB, 627 p.).System requirements: Adobe Acrobat Reader.Includes bibliographical references.Text in PDF format.National Birth Defects Prevention Network (NBDPN). Guidelines for Conducting Birth Defects Surveillance. Sever, LE, ed. Atlanta, GA: National Birth Defects Prevention Network, Inc., June 2004

Decrease in antibiotic resistance of Streptococcus pneumoniae between 2003 and 2009 in France and changes in serotype distribution: Ongoing survey of the French Pneumococcus Surveillance Network

Background: The French regional pneumococcal observatories (ORP) network was created in 1995, it participates to the close monitoring of the trends in antimicrobial resistance and serotype distribution with the National Reference Centre for Pneumococci (NRCP) and the Institut de Veille Sanitaire (InVS). The aim of this survey was to assess the antibiotic resistance and the distribution of vaccine and non-vaccine serotypes in invasive pneumococcal disease (IPD) in adults and children as well in otitis in children in France in 2009. Methods: Antimicrobial susceptibility testing was performed on 5,194 isolates of S. pneumoniae recovered from cerebrospinal fluid (CSF), blood, middle ear fluid (MEF) and pleural fluid during the year 2009 by the 23 ORP. MICs of penicillin (P), amoxicillin (AMX) and cefotaxime (CTX) were determined by the agar dilution method and interpreted according to the Antibiotics Comity of the French Society of Microbiology breakpoints. Serotyping was performed at the NRCP with serotype-specific antisera, by latex agglutination test. Results: Results of susceptibility between 2003 and 2009 to P are presented in Table 1. The pneumococci with decreased susceptibility to penicillin G (PDSP) decreased significantly in all types of samples except for MEF’s isolates in children between 2007 and 2009. In the global population, the percentage of I+R (2003 vs 2009) decreased significantly for AMX (30.3% versus 9.6%) and for CTX (18.2% versus 10.5%). Strains highly resistant (MIC > 2 mg/L) remained rare: 0.4%, 1.1% and 0.2% for P, AMX and CTX respectively. The most frequent capsular types in CSF were 3, 7F, 19A, 6C, 23B for adults and 7F, 19A, 3, 33F and 15B for children. Serotypes included in the PCV-7 and PCV-13 vaccine accounted in children for 4% and 51% respectively and in adults for 12% and 48% respectively. By contrast, the serotype 19A remained highly predominant (80%) among MEF isolates. Conclusions: We observed a significant decrease of PDSP between 2003 and 2009 (50.2 to 33.0%). The decrease coincided with the introduction of PCV7 and with a general reduction in levels of antibiotic consumption in France. This continuous survey is necessary to underline modification in serotype distribution in France after PVC13 introduction (June 2010)

Dominant influenza A(H3N2) and B/Yamagata virus circulation in EU/EEA, 2016/17 and 2017/18 seasons, respectively

Members of the European Influenza Surveillance Network: Portugal (Figueiredo Augusto Gonçalo, Machado Jorge, Moreira Guiomar Raquel, Nogueira Paulo, Rebelo de Andrade Helena, Rodrigues Ana Paula)The yearly influenza epidemics during each winter season vary in burden and severity. During the 2016/17 and 2017/18 seasons, all-cause excess mortality was observed during periods of high influenza virus circulation. Our aim is to describe and compare the pattern of influenza virus circulation and related disease severity by number of patients and fatal cases in intensive care units (ICUs) across European Union/European Economic Area (EU/EEA) countries for the seasons 2016/17 and 2017/18. As influenza circulation progressed from a west to east direction across Europe in 2017/18, a better understanding of the current epidemiological situation might help to prepare countries in the eastern part of the World Health Organization (WHO) European Region for high influenza activity and severity.info:eu-repo/semantics/publishedVersio

Seasonality and geographical spread of respiratory syncytial virus epidemics in 15 European countries, 2010 to 2016

Respiratory syncytial virus (RSV) is considered the major pathogen causing severe lower respiratory tract infections among infants and young children [1]. RSV is the most common cause of hospitalisation for acute lower respiratory tract infection in children younger than 5 years and is estimated to cause between 66,000 and 199,000 deaths worldwide every year [2]. Its significance in causing substantial morbidity and hospitalisation in the first year of life has been affirmed in a recent study and a meta-analysis [3,4]. In England, average annual hospital admission rates are 35.1 per 1,000 children younger than 1 year and 5.31 per 1,000 children aged 1–4 years [5]. In addition to children, RSV causes a substantial disease burden in elderly people and patients with chronic obstructive pulmonary disease [6,7]. RSV causes seasonal epidemics worldwide [8], with one to two epidemics each year [9] following latitudinal gradients in timing, duration, seasonal amplitude and between-year variability [8,9]. In some studies, the seasonal periodicity has been connected to climatic factors [9-11], but a common factor that explains all observed periodicity has not been established. Meteorological conditions such as temperature and high relative humidity have been reported as important predictors of RSV epidemics [9,12]. In the United States (US) and Japan, annual national and regional variation of RSV season onset and end has been reported [13-15]. In the Nordic countries, a major outbreak often alternates with a minor one, with the minor peak in the spring and a major one the following winter [16-19], a phenomenon reported also in Croatia [20], Denmark [21] and Germany [22]. RSV antigenic groups A and B alternate in two-year cycles in Finland, with dominance of the group A viruses in years 1981–82, 1985–86 and 1989–90 and the group B viruses 1983–84 and 1987–88 [17,19], and different genotypes dominate the circulation in consecutive epidemics in Korea [23]. In Spain, no biennial rhythm has been detected but rather a stable annual epidemic with a peak between week 52 and week 1 and circulation 2–8 weeks earlier than influenza viruses [24]. Similarly, in the United Kingdom (UK), one stable epidemic per year is observed [5]. Immunoprophylaxis to prevent RSV infection with a neutralising monoclonal antibody, palivizumab, has been developed for administration to target groups on a monthly basis during the RSV season [25]. However, this drug is limited to high-risk infants, the cost prohibits its use in low- and middle-income countries and the data on effectiveness of the drug in children at high risk other than infants born at gestational age < 33 weeks and in children with chronic lung and heart diseases are limited [26]. The demonstrated high disease burden of RSV infection has created a longstanding interest in RSV vaccines. Approximately 60 RSV vaccine candidates are in preclinical to phase III clinical trials [27,28], with potential target groups including elderly people, pregnant women and infants. A vaccine is expected to enter the market within 5–10 years, presumably by 2025 [29]. As natural infection provides only limited protective immunity owing to evolution of the surface protein G and alternating dominance of antigenic groups A and B [30], most of the vaccine candidates target the fusion protein F, which is cross-reactive across RSV subtypes [27]. To circumvent issues with alternating strains, it has been also suggested to consider inclusion of both RSV A and B in a future RSV vaccine [30]. To plan optimal future vaccination strategies, it is critically important to understand who is affected by RSV and to identify which groups are at risk of more severe RSV infection requiring hospitalisation or intensive care. RSV infection is not notifiable in the European Union (EU) and European Economic Area (EEA), except in Ireland, but many countries have a long tradition of reporting laboratory-confirmed RSV infections at national and international level. The European Influenza Surveillance Network (EISN) collects RSV data for the purpose of interpreting the reports of influenza-like-illness (ILI); these data can also be used to analyse seasonality of RSV [31]. Inter-country comparative analysis of seasonal circulation of RSV across Europe is lacking as most of the published literature focuses on individual countries. Our study describes the seasonality of RSV in 15 countries in the EU/EEA, specifically the start and peak of the season, length of the season and geographical spread, as a baseline description of RSV circulation in Europe. We further aimed to test if the data reported through influenza surveillance systems in use in EU/EEA countries are appropriate to analyse RSV seasonality, including more countries and a more detailed analysis than previous studies.Peer Reviewe

Productivity losses due to influenza and influenza-like illness in Switzerland: results of the Swiss Sentinel Surveillance Network in a non-pandemic era

The incidence of influenza and influenza-like illnesses in Switzerland is generally high. Although related direct medical costs can be substantial, especially if hospitalisations occur, several studies suggested that indirect costs due to the loss of productivity may represent an even higher economic burden. The aim of this study was to assess the costs arising from lost productivity due to influenza and influenza-like illnesses in Switzerland.; Analyses were based on data collected in 2016 and 2017 by the Swiss Sentinel Surveillance Network of the Swiss Federal Office of Public Health (SFOPH). The available information covered details on the physicians collecting the data, patients' characteristics, symptoms, treatments, and inability to work (in terms of physician-recorded workdays lost for own sickness or caregiving). The cost of lost productivity, estimated using the human capital approach, was calculated as the number of workdays lost due to influenza-like illnesses multiplied by the mean salary for one working day. Salary differences across sex, age and region were considered. Extrapolation to the national level was performed by adjusting for the size of the Swiss population, the age and sex distribution, the regional distribution, the number of Sentinel general physician contacts and the specialisation of the physician.; At the Swiss national level, the estimated total yearly number of cases of inability to work due to influenza and influenza-like illnesses was 101,287 in 2016 and 86,373 in 2017. In subgroups defined by year, gender, region and age class, numbers of cases per 100,000 inhabitants ranged from 12 to 2396. The total number of workdays lost in Switzerland, considering degree of employment and visit day, were estimated to be 324,118 in 2016 and 278,121 in 2017. The number of workdays lost was generally higher in men (53.7% of the total in 2016 and 55.6% of the total in 2017) than women. The estimated total costs due to inability to work, calculated using a human capital approach and including the caregiving costs, were CHF 115 million in 2016 and CHF 103 million in 2017, equivalent to CHF 1.4 million per 100,000 inhabitants.; The costs of lost productivity due to influenza and influenza-like illnesses in Switzerland are substantial and may vary considerably between different years, regions and age classes. As the present analyses could not consider all causes of lost productivity (e.g., short-term inability to work not requiring a physician consultation, hospitalisations, early retirement, premature death), the total indirect costs due to influenza or influenza-like illnesses can be expected to be higher than the presented estimates

The European Diphtheria Surveillance Network (ESDN) a strong model to combat a rare disease and use resources efficiently, share knowledge openly, and give support effectively

Maria Paula Bajanca Lavado é a microbiologista responsável pela Diphtheria em Portugal e representa Portugal no ECDC no Grupo "The European Diphtheria Surveillance Network (EDSN)".BACKGROUND: As diphtheria is uncommon within the EU, complacency and minimal awareness is constantly observed. However, diphtheria is still seen sporadically in many EU countries and recent outbreaks have occurred worldwide. From the success of the EU-funded Diphtheria Network (DIPNET), the European Diphtheria Surveillance Network (EDSN) was established in 2010 under the auspices of ECDC, and continues to integrate epidemiologists and microbiologists. Microbiological activities have been tendered to the Health Protection Agency and managed as work packages; coordination; diagnostic external quality assurance (EQA) scheme; serology EQA; training workshops and molecular typing. The main objective is to strengthen laboratory diagnosis to ensure accurate and comparative diphtheria surveillance across Europe. METHODS: Thirty laboratory experts were nominated from the EU and EEA countries. Since February 2010, there have been two network meetings, two diagnostic EQAs, one serology EQA and two training workshops. RESULTS: The first diagnostic EQA generated unacceptable identification and toxigenicity reports of 14% and 10%, respectively from 26 countries. The two workshops provided the opportunity for non-DIPNET countries and those that performed poorly in the EQA to improve in diphtheria diagnostic methods; good feedback was received from all participants. Preliminary results of the second EQA revealed slight improvements in results where only 8% gave an unacceptable identification and 10% unacceptable toxigenicity reports (24 countries). CONCLUSIONS: All network members agree that EDSN should continue under ECDC, as this continues to provide the infrastructure essential for harmonised and improved public health management for diphtheria across the EU. However, EQA results emphasised that further training and EQA exercises should continue so as to maintain expertise, assess capabilities and aid standardisation for diphtheria diagnostics and ultimately surveillance

First Worldwide Proficiency Study on Variable-Number Tandem-Repeat Typing of Mycobacterium tuberculosis Complex Strains

Although variable-number tandem-repeat (VNTR) typing has gained recognition as the new standard for the DNA fingerprinting of Mycobacterium tuberculosis complex (MTBC) isolates, external quality control programs have not yet been developed. Therefore, we organized the first multicenter proficiency study on 24-locus VNTR typing. Sets of 30 DNAs of MTBC strains, including 10 duplicate DNA samples, were distributed among 37 participating laboratories in 30 different countries worldwide. Twenty-four laboratories used an in-house-adapted method with fragment sizing by gel electrophoresis or an automated DNA analyzer, nine laboratories used a commercially available kit, and four laboratories used other methods. The intra- and interlaboratory reproducibilities of VNTR typing varied from 0% to 100%, with averages of 72% and 60%, respectively. Twenty of the 37 laboratories failed to amplify particular VNTR loci; if these missing results were ignored, the number of laboratories with 100% interlaboratory reproducibility increased from 1 to 5. The average interlaboratory reproducibility of VNTR typing using a commercial kit was better (88%) than that of in-house-adapted methods using a DNA analyzer (70%) or gel electrophoresis (50%). Eleven laboratories using in-house-adapted manual typing or automated typing scored inter- and intralaboratory reproducibilities of 80% or higher, which suggests that these approaches can be used in a reliable way. In conclusion, this first multicenter study has documented the worldwide quality of VNTR typing of MTBC strains and highlights the importance of international quality control to improve genotyping in the future.Institute for Public Health and the Environment (RIVM), European Centre for Diseases Prevention and Control (ECDC

Effectiveness of Influenza Vaccine in Preventing Medically-Attended Influenza Virus Infection in Primary Care, Israel, Influenza Seasons 2014/15 and 2015/16

IntroductionInfluenza vaccine is recommended for the entire population in Israel. We assessed influenza vaccine effectiveness (VE) for the 2014/15 and 2015/16 seasons in Israel, for the first time. Methods: Combined nose and throat swab specimens were collected from patients with influenza-like illness (ILI) presenting to sentinel primary care clinics and tested for influenza virus by RT-PCR. VE of the trivalent inactivated vaccine (TIV) was assessed using test-negative case-control design. Results: During the 2014/15 season 1,142 samples were collected; 327 (28.6%) were positive for influenza, 83.8% A(H3N2), 5.8% A(H1N1)pdm09, 9.2% B and 1.2% A un-subtyped. Adjusted VE against all influenza viruses for this influenza season was -4.8% (95% confidence interval (CI): -54.8 to 29.0) and against influenza A(H3N2), it was -15.8% (95% CI: -72.8 to 22.4). For the 2015/16 season, 1,919 samples were collected; 853 (44.4%) were positive for influenza, 43.5% A(H1N1)pdm09, 57% B, 0.7% A(H3N2) and 11 samples positive for both A(H1N1)pdm09 and B. Adjusted VE against all influenza viruses for this influenza season was 8.8% (95% CI: -25.1 to 33.5), against influenza A(H1N1)pdm09, it was 32.3% (95% CI: (-4.3 to 56.1) and against influenza B, it was -2.2% (95% CI: (-47.0 to 29.0). Conclusions: Using samples from patients with ILI visiting sentinel clinics in Israel, we demonstrated the feasibility of influenza VE estimation in Israel