Hvem vandt 1. Verdenskrig? - Krige, katastrofer og epidemier har altid hjulpet hinanden

Infektionssygdomme og krig har altid gået hånd i hånd. Tyfus og ”skyttegravsfeber” blev klassikere under første verdenskrig. I 1918 startede helt uventet en ny og meget alvorlig form for influenza (den spanske syge eller La Gripe). Den slog ca. 70 millioner mennesker ihjel, hvilket var flere end selve krigen gjorde, ligesom malaria gjorde under den amerikanske frihedskrig. Flere mener, den spanske syge var stærkt medvirkende til, at 1.verdenskrig stoppede. Marburgvirus epidemien i Den Demokratiske Republik Congo beskriver fint hvor mange faktorer, der spiller ind i sammenhængen mellem infektioner og krigslignende situationer, og hvordan politik og traditioner støder sammen med sikkerhedsspørgsmål og kan umuliggøre en målrettet indsats for at stoppe epidemien. En af de mest synlige konsekvenser af væbnede konflikter er de massive forflytninger af befolkninger, som bliver drevet på flugt af skyderier, vold og plyndringer samt svindende fødevareressourcer, og som ender i flygtningelejre. I disse lejre har mæslinger, diarré, lungebetændelse og i nogle tilfælde også kolera frit spil, hvilket forstærkes af den ofte meget lave vaccinationsdækning blandt børnene. Meget tyder på at dødelighedsniveauet under væbnede konflikter afspejler sundhedsvæsenets tilstand før konflikten startede. Konflikter afslører så at sige dybereliggende fejl og mangler i sundhedsvæsenet, der var tilstede før krigen, og som måske ligefrem har været et element i konflikten. De mest effektive redskaber til at sænke sygelighed og dødelighed i komplekse katastrofer inkluderer beskyttelse mod vold og overgreb, sikring af fødevarer, vaccinationskampagner, muligheder for håndvask, diarrékontrol, mor-barn sundhed og korrekt behandling af de hyppigste infektioner. Krige skaber flygtninge, og mobile befolkningsgrupper er sårbare uden socialt eller administrativt netværk. De er tvunget til at opholde sig i et nye miljøer med fremmede mikroorganismer og perfekte smittemuligheder. Her har epidemier frit spil, og det er oftest dem, der vinder krigene

Incidence and Cost of Rotavirus Hospitalizations in Denmark

Two models provide reliable estimates that can be used to assess vaccine need and effectiveness

The Application of New Molecular Methods in the Investigation of a Waterborne Outbreak of Norovirus in Denmark, 2012

In December 2012, an outbreak of acute gastrointestinal illness occurred in a geographical distinct area in Denmark covering 368 households. A combined microbiological, epidemiological and environmental investigation was initiated to understand the outbreak magnitude, pathogen(s) and vehicle in order to control the outbreak. Norovirus GII.4 New Orleans 2009 variant was detected in 15 of 17 individual stool samples from 14 households. Norovirus genomic material from water samples was detected and quantified and sequencing of longer parts of the viral capsid region (>1000 nt) were applied to patient and water samples. All five purposely selected water samples tested positive for norovirus GII in levels up to 1.8×10(4) genomic units per 200 ml. Identical norovirus sequences were found in all 5 sequenced stool samples and 1 sequenced water sample, a second sequenced water sample showed 1 nt (<0.1%) difference. In a cohort study, including 256 participants, cases were defined as residents of the area experiencing diarrhoea or vomiting onset on 12-14 December 2012. We found an attack rate of 51%. Being a case was associated with drinking tap-water on 12-13 December (relative risk = 6.0, 95%CI: 1.6-22) and a dose-response relation for the mean glasses of tap-water consumed was observed. Environmental investigations suggested contamination from a sewage pipe to the drinking water due to fall in pressure during water supply system renovations. The combined microbiological, epidemiological and environmental investigations strongly indicates the outbreak was caused by norovirus contamination of the water supply system

Respiratory syncytial virus-associated hospitalisation in adults with 2 comorbidities in two European countries:a modelling study

Background: Individuals with comorbidities are at increased risk of severe respiratory syncytial virus (RSV) infection. We estimated RSV-associated respiratory hospitalization among adults aged ≥45 years with comorbidities in Denmark and Scotland. Methods: By analyzing national hospital and virologic data, we estimated annual RSV-associated hospitalizations by 7 selected comorbidities and ages between 2010 and 2018. We estimated rate ratios of RSV-associated hospitalization for adults with comorbidity than the overall population. Results: In Denmark, annual RSV–associated hospitalization rates per 1000 adults ranged from 3.1 for asthma to 19.4 for chronic kidney disease (CKD). In Scotland, rates ranged from 2.4 for chronic liver disease to 9.0 for chronic obstructive pulmonary disease (COPD). In both countries, we found a 2- to 4-fold increased risk of RSV hospitalization for adults with COPD, ischemic heart disease, stroke, and diabetes; a 1.5- to 3-fold increased risk for asthma; and a 3- to 7-fold increased risk for CKD. RSV hospitalization rates among adults aged 45 to 64 years with COPD, asthma, ischemic heart disease, or CKD were higher than the overall population. Conclusions: This study provides important evidence for identifying risk groups and assisting health authorities in RSV vaccination policy making

Genome-wide Association Study of Susceptibility to Respiratory Syncytial Virus Hospitalization in Young Children <5 Years of age

Background: Worldwide, respiratory syncytial virus (RSV) infections are among the most common causes of infant hospitalization. Host genetic factors influencing the risk and severity of RSV infection are not well known. Methods: We conducted a genome-wide association study (GWAS) to investigate single-nucleotide polymorphisms (SNPs) associated with severe RSV infections using a nested case-control design based on 2 Danish cohorts. We compared SNPs from 1786 children hospitalized with RSV to 45 060 controls without an RSV-coded hospitalization. We performed gene-based testing, tissue enrichment, gene-set enrichment, and a meta-analysis of the 2 cohorts. Finally, an analysis of potential associations between the severity of RSV infection and genetic markers was performed. Results: We did not detect any significant genome-wide associations between SNPs and RSV infection or the severity of RSV. We did find potential loci associated with RSV infections on chromosome 5 in 1 cohort but failed to replicate any signals in both cohorts. Conclusions: Despite being the largest GWAS of severe RSV infection, we did not detect any genome-wide significant loci. This may be an indication of a lack of power or an absence of signal. Future studies might include mild illness and need to be larger to detect any significant associations

Seasonality of ventricular fibrillation at first myocardial infarction and association with viral exposure

AIMS:To investigate seasonality and association of increased enterovirus and influenza activity in the community with ventricular fibrillation (VF) risk during first ST-elevation myocardial infarction (STEMI). METHODS:This study comprised all consecutive patients with first STEMI (n = 4,659; aged 18-80 years) admitted to the invasive catheterization laboratory between 2010-2016, at Copenhagen University Hospital, Rigshospitalet, covering eastern Denmark (2.6 million inhabitants, 45% of the Danish population). Hospital admission, prescription, and vital status data were assessed using Danish nationwide registries. We utilized monthly/weekly surveillance data for enterovirus and influenza from the Danish National Microbiology Database (2010-2016) that receives copies of laboratory tests from all Danish departments of clinical microbiology. RESULTS:Of the 4,659 consecutively enrolled STEMI patients, 581 (12%) had VF before primary percutaneous coronary intervention. In a subset (n = 807), we found that VF patients experienced more generalized fatigue and flu-like symptoms within 7 days before STEMI compared with the patients without VF (OR 3.39, 95% CI 1.76-6.54). During the study period, 2,704 individuals were diagnosed with enterovirus and 19,742 with influenza. No significant association between enterovirus and VF (OR 1.00, 95% CI 0.99-1.02), influenza and VF (OR 1.00, 95% CI 1.00-1.00), or week number and VF (p-value 0.94 for enterovirus and 0.89 for influenza) was found. CONCLUSION:We found no clear seasonality of VF during first STEMI. Even though VF patients had experienced more generalized fatigue and flu-like symptoms within 7 days before STEMI compared with patients without VF, no relationship was found between enterovirus or influenza exposure and occurrence of VF