Implementation of the One Health approach to fight arbovirus infections in the Mediterranean and Black Sea Region: Assessing integrated surveillance in Serbia, Tunisia and Georgia

Background In the Mediterranean and Black Sea Region, arbovirus infections are emerging infectious diseases. Their surveillance can benefit from one health inter-sectoral collaboration; however, no standardized methodology exists to study One Health surveillance. Methods We designed a situation analysis study to document how integration of laboratory/clinical human, animal and entomological surveillance of arboviruses was being implemented in the Region. We applied a framework designed to assess three levels of integration: policy/institutional, data collection/data analysis and dissemination. We tested the use of Business Process Modelling Notation (BPMN) to graphically present evidence of inter-sectoral integration. Results Serbia, Tunisia and Georgia participated in the study. West Nile Virus surveillance was analysed in Serbia and Tunisia, Crimea-Congo Haemorrhagic Fever surveillance in Georgia. Our framework enabled a standardized analysis of One Health surveillance integration, and BPMN was easily understandable and conducive to detailed discussions among different actors/institutions. In all countries, we observed integration across sectors and levels except in data collection and data analysis. Data collection was interoperable only in Georgia without integrated analysis. In all countries, surveillance was mainly oriented towards outbreak response, triggered by an index human case. Discussion The three surveillance systems we observed prove that integrated surveillance can be operationalized with a diverse spectrum of options. However, in all countries, the integrated use of data for early warning and inter-sectoral priority setting is pioneeristic. We also noted that early warning before human case occurrence is recurrently not operationally prioritized

Seasonal and inter-seasonal RSV activity in the European Region during the COVID-19 pandemic from autumn 2020 to summer 2022

© 2023 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.Background: The emergence of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in early 2020 and subsequent implementation of public health and social measures (PHSM) disrupted the epidemiology of respiratory viruses. This work describes the epidemiology of respiratory syncytial virus (RSV) observed during two winter seasons (weeks 40–20) and inter-seasonal periods (weeks 21–39) during the pandemic between October 2020 and September 2022. Methods: Using data submitted to The European Surveillance System (TESSy) by countries or territories in the World Health Organization (WHO) European Region between weeks 40/2020 and 39/2022, we aggregated country-specific weekly RSV counts of sentinel, non-sentinel and Severe Acute Respiratory Infection (SARI) surveillance specimens and calculated percentage positivity. Results for both 2020/21 and 2021/22 seasons and inter-seasons were compared with pre-pandemic 2016/17 to 2019/20 seasons and inter-seasons. Results: Although more specimens were tested than in pre-COVID-19 pandemic seasons, very few RSV detections were reported during the 2020/21 season in all surveillance systems. During the 2021 inter-season, a gradual increase in detections was observed in all systems. In 2021/22, all systems saw early peaks of RSV infection, and during the 2022 inter-seasonal period, patterns of detections were closer to those seen before the COVID-19 pandemic. Conclusion: RSV surveillance continued throughout the COVID-19 pandemic, with an initial reduction in transmission, followed by very high and out-of-season RSV circulation (summer 2021) and then an early start of the 2021/22 season. As of the 2022/23 season, RSV circulation had not yet normalised.Peer reviewe

Correction: Rates and risk factors for human cutaneous anthrax in the country of Georgia: National surveillance data, 2008-2015.

[This corrects the article DOI: 10.1371/journal.pone.0192031.]

Rates and risk factors for human cutaneous anthrax in the country of Georgia: National surveillance data, 2008-2015.

Anthrax is endemic in the country of Georgia. The most common cutaneous anthrax form accounts for 95% of anthrax cases and often is self-resolving. Humans are infected from processing contaminated animal products, contacting sick animals, or by insect bites.We aimed to describe the burden of human cutaneous anthrax and associated risk factors using the national surveillance data.We extracted all human cutaneous anthrax cases from Electronic Integrated Disease Surveillance System (EIDSS) from 1 January 2008 to 31 December 2015. We conducted descriptive analyses to characterize the number of confirmed, probable and suspected cases by age groups, gender, ethnicity, year and geographic area.Out of 911 reported cutaneous anthrax cases, 299 (33%) were rejected. Out of remaining 612 cases, 437 (71%), 172 (28%), and 3 (<0.004%) were classified as confirmed, probable and suspected cases of cutaneous Anthrax, respectively; 467 (76.3%) were male. Georgians accounted for 56% (343/612) of cutaneous anthrax cases. Handling animal products (aOR 4.36, 95% CI 2.61-7.26) and living near pastoralist routes (aOR 2.74, 95%CI 1.57-4.76) were associated with cutaneous anthrax.This study provides eight-year trends for cutaneous anthrax in humans in the country of Georgia. A comprehensive explanation for the observed rise and fall of the incidence rates of human cutaneous anthrax in 2008-2015 remains to be clarified but is likely associated with discontinuation of mandatory national livestock vaccination in 2008 coupled with weakened human and animal national health systems which were disrupted after the Soviet Union collapsed. Our analysis identifies living near pastoralist routes, handling animal products and travel to endemic areas within two weeks before the disease onset as risk factors for cutaneous anthrax. The evidence underscores the importance of One Health recommendations to activate anthrax awareness campaigns, supervise the destruction of known anthrax carcasses, record global position system coordinates of sites and disinfect infected soils and introduce a participatory health education tool on anthrax

Successful implementation of electronic disease reporting in Georgia

ObjectiveThe objective of this study was to evaluate several aspects of theelectronic disease reporting system and its abilities used in Georgia.Also, the study assessed if the system abilities are tailored to thenational surveillance requirements. User attitudes (system strengthand weaknesses) toward the system was also surveyed.IntroductionThe Ministry of Health of Georgia accepted the ElectronicIntegrated Disease Surveillance System (EIDSS) as an officialdisease reporting system in 2012. The Georgian government adoptedelectronic reporting for both veterinary and human diseases in2015. We conducted a comparative assessment of progress in theimplementation of electronic reporting.MethodsA face-to-face initial survey was conducted in 2012, a follow-upsurvey (through telephone interviews) was performed in 2016. Theinitial survey was conducted in regions that had EIDSS installedand the follow-up survey was conducted in all regions. Standardizedquestionnaires were used and data was analyzed in Epi Info.ResultsOut of 450 trained EIDSS users, 32% were interviewed in theinitial survey and 25% (of 550) EIDSS trained users were interviewedin the follow-up survey. Of 147 respondents in the initial survey and138 in the follow-up survey, 44% and 79%, believed that they wereusing EIDSS effectively, respectively. The follow-up survey showeda 23% increase in respondents who acknowledge an improvement ofthe electronic reporting; acceptance of EIDSS increased from 80.3%to 97.8%. Of those interviewed in the follow-up survey, 19.7%mentioned that the main success in development of the system is dueto improved collaboration between institutes. However, 17.36% of therespondents in the follow-up survey reported non-sufficient qualitydata.ConclusionsOur study suggests that the acceptance and use of EIDSS hasnoticeably improved, indicating the successful implementation ofelectronic reporting. Recommendations have been made to furtherimprove the data quality by conducting regular data cleaning andadditional user training. We recommend the continuation of EIDSStraining

Cutaneous Anthrax surveillance by Person, Place, and Time in Georgia (2008-2013)

National surveillance of cutaneous anthrax cases in Georgia (EIDSS 2008-2013) appears secondary to epizoonotic events that are more likely to occur in populations that work with unvaccinated sheep and cattle. Six-year mean incidence rates per 100,000 were 1.32 for Georgian nationals and 9.31 for Azerbaijani nationals. The contrast between groups was pronounced in Kvemo Kartli and Kakheti where a large proportion of Azeris pastoralists live and migrate along animal corridors. One Heath recommendations include promotion of anthrax awareness campaigns, the destruction of carcasses, mapping and disinfect infected soils, and introduce a participatory health education anthrax tool

Cutaneous Anthrax surveillance by Person, Place, and Time in Georgia (2008-2013)

National surveillance of cutaneous anthrax cases in Georgia (EIDSS 2008-2013) appears secondary to epizoonotic events that are more likely to occur in populations that work with unvaccinated sheep and cattle. Six-year mean incidence rates per 100,000 were 1.32 for Georgian nationals and 9.31 for Azerbaijani nationals. The contrast between groups was pronounced in Kvemo Kartli and Kakheti where a large proportion of Azeris pastoralists live and migrate along animal corridors. One Heath recommendations include promotion of anthrax awareness campaigns, the destruction of carcasses, mapping and disinfect infected soils, and introduce a participatory health education anthrax tool

Successful implementation of electronic disease reporting in Georgia

ObjectiveThe objective of this study was to evaluate several aspects of theelectronic disease reporting system and its abilities used in Georgia.Also, the study assessed if the system abilities are tailored to thenational surveillance requirements. User attitudes (system strengthand weaknesses) toward the system was also surveyed.IntroductionThe Ministry of Health of Georgia accepted the ElectronicIntegrated Disease Surveillance System (EIDSS) as an officialdisease reporting system in 2012. The Georgian government adoptedelectronic reporting for both veterinary and human diseases in2015. We conducted a comparative assessment of progress in theimplementation of electronic reporting.MethodsA face-to-face initial survey was conducted in 2012, a follow-upsurvey (through telephone interviews) was performed in 2016. Theinitial survey was conducted in regions that had EIDSS installedand the follow-up survey was conducted in all regions. Standardizedquestionnaires were used and data was analyzed in Epi Info.ResultsOut of 450 trained EIDSS users, 32% were interviewed in theinitial survey and 25% (of 550) EIDSS trained users were interviewedin the follow-up survey. Of 147 respondents in the initial survey and138 in the follow-up survey, 44% and 79%, believed that they wereusing EIDSS effectively, respectively. The follow-up survey showeda 23% increase in respondents who acknowledge an improvement ofthe electronic reporting; acceptance of EIDSS increased from 80.3%to 97.8%. Of those interviewed in the follow-up survey, 19.7%mentioned that the main success in development of the system is dueto improved collaboration between institutes. However, 17.36% of therespondents in the follow-up survey reported non-sufficient qualitydata.ConclusionsOur study suggests that the acceptance and use of EIDSS hasnoticeably improved, indicating the successful implementation ofelectronic reporting. Recommendations have been made to furtherimprove the data quality by conducting regular data cleaning andadditional user training. We recommend the continuation of EIDSStraining

Implementation of a sentinel surveillance system for influenza-like illness (ILI) and severe acute respiratory infection (SARI) in the country of Georgia, 2015-2016

Objectives: Due to reports of substandard influenza preparedness, the country of Georgia developed two influenza surveillance systems. This paper describes these surveillance systems in their capacity to detect influenza. Methods: Two surveillance systems for influenza operate in Georgia: an influenza-like illness (ILI) sentinel surveillance system for out-patient cases, based in the capital, Tbilisi, and a severe acute respiratory infection (SARI) sentinel surveillance system for in-patient cases with five sentinel sites â one in Tbilisi, and four in Kutaisi. Patients in these surveillance systems provide samples for laboratory testing, including influenza confirmation. Results: From 2015-2016, 825 cases were surveilled in the ILI surveillance system and 1367 cases were surveilled in the SARI surveillance system, with 222 (26.9%) and 451 (33.0%) positive for influenza, respectively. Influenza positivity varied by age with adults 30-64 years having highest proportion of influenza-positive cases at 42.2%. Conclusions: The sensitivity of the surveillance systems to influenza was relatively high compared to neighboring countries. These findings show the importance of influenza surveillance in the country of Georgia. Keywords: Surveillance, Influenza, Severe acute respiratory illnes