what is needed to close the implementation gaps?

Funding Information: SH is funded by the National Institute for Health Research (NIHR Advanced Fellowship NIHR300072), the Academy of Medical Sciences (SBF005\1111), and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) through an ESCMID Study Group for Infections in Travellers and Migrants (ESGITM) research grant. MP is supported by the National Institute for Health Research (NIHR Post-Doctoral Fellowship, PDF-2015-08-102). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the UK Department of Health. Funding Information: SH is funded by the National Institute for Health Research ( NIHR Advanced Fellowship NIHR300072 ), the Academy of Medical Sciences ( SBF005\1111 ), and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) through an ESCMID Study Group for Infections in Travellers and Migrants ( ESGITM ) research grant. MP is supported by the National Institute for Health Research ( NIHR Post-Doctoral Fellowship , PDF-2015-08-102 ). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the UK Department of Health. Publisher Copyright: © 2020 The AuthorsMigration to the European Union (EU)/European Economic Area (EEA) affects the epidemiology of infectious diseases, including tuberculosis (TB), HIV, hepatitis B/C, and parasitic diseases. Some sub-populations of migrants are also considered to be an under-immunised group and thus at risk of vaccine-preventable diseases. Providing high-risk migrants access to timely and efficacious screening and vaccination, and understanding how best to implement more integrated screening and vaccination programmes into European health systems ensuring linkage to care and treatment, is key to improving the health of migrants and their communities, alongside meeting national and regional targets for infection surveillance, control, and elimination. The European Centre for Disease Prevention and Control (ECDC) has responded to calls to action to improve migrant health and strengthen universal health coverage by developing evidence-based guidance for policy makers, public health experts, and front-line healthcare professionals on how to approach screening and vaccination in newly arrived migrants within the EU/EEA. In this Commentary, we provide a perspective towards developing efficacious screening and vaccination of newly arrived migrants, with a focus on defining implementation challenges and evidence gaps in high-migrant receiving EU/EEA countries. There is a need now to leverage the increasing momentum around migrant health to both strengthen the evidence-base and to advocate for universal access to health care for all migrants in the EU/EEA, including undocumented migrants. This should include voluntary, confidential, and non-stigmatising screening and vaccination that should be free of charge and facilitate linkage to appropriate care and treatment.publishersversionpublishe

Antimicrobial resistance monitoring and surveillance in the meat chain: A report from five countries in the European Union and European Economic Area

Background The emergence of antimicrobial resistance (AMR) in zoonotic foodborne pathogens (Salmonella, Campylobacter) and indicator microorganisms (E. coli, enterococci) is a major public health risk. Zoonotic bacteria, resistant to antimicrobials, are of special concern because they might compromise the effective treatment of infections in humans. Scope and approach In this review, the AMR monitoring and surveillance programmes in five selected countries within European Union (EU) and European Economic Area (EEA) are described. The sampling schemes, susceptibility testing for AMR identification, clinical breakpoints (clinical resistance) and epidemiological cut-off values (microbiological resistance) were considered to reflect on the most important variations between and within food-producing animal species, between countries, and to identify the most effective approach to tackle and manage the antimicrobial resistance in the food chain. Key findings and conclusions The science-based monitoring of AMR should encompass the whole food chain, supported with public health surveillance and should be conducted in accordance with ‘Zoonoses Directive’ (99/2003/EC). Such approach encompasses the integrated AMR monitoring in food animals, food and humans in the whole food (meat) chain continuum, e.g. pre-harvest (on-farm), harvest (in abattoir) and post-harvest (at retail). The information on AMR in critically important antimicrobials (CIA) for human medicine should be of particular importance

Sources of antibiotic resistance: zoonotic, human, environment

Antibiotic resistance is a global problem that must be managed under the One Health perspective. Retrospectively, it is assumed that microbial populations able to cope with compounds with antimicrobial activity and susceptible bacteria lived in equilibrium for a thousand years. This situation would change in the middle 1940s of the twentieth century when one of the most important revolutions of modern medicine started - the use of a natural antimicrobial compound, the penicillin, to treat infectious bacterial diseases. Over the years, the massive use of antibiotics in human and animal medicine, as well as in animal production for both growth promotion and infection prophylaxis/metaphylaxis, accelerated and shaped one of the most successful evolutionary case studies. As a result of an impressive combination of genome and community dynamics, bacteria with acquired antibiotic resistance are nowadays widespread across different environmental compartments (water, soil, wildlife) as well as in the human food chain (poultry, livestock, aquaculture, produce). Hence, the evolutionary success of these bacteria turned to represent a major threat to the human health. This review discusses some of the drivers and paths of antibiotic resistance dissemination across zoonotic, human, and environmental sources.info:eu-repo/semantics/acceptedVersio

Social marketing applied to HIV/AIDS prevention: the case of a five-year governmental response in Portugal

HIV infection has been a concerning health issue prioritised by health governmental institutions that has required the development of public health policies with an integrated social marketing intervention in an upstream dimension. A behaviour change strategy should invest in segmented communication for priority targets, in partnership with multiple stakeholders. This case explores and discusses the integrated social marketing programme developed by the Portuguese Ministry of Health to prevent HIV/AIDS in the period 2006–2011 and its long-term evaluation in behaviour change, comparing data from 2005 and 2017. This case shows the initial diagnosis; the social marketing strategy developed for different targets in partnership with civil society organisations, following a variety of theoretical frameworks; and effectiveness evaluation in epidemic outcomes. A guide is provided with questions for discussion.FCT - Fundação para a Ciência e a Tecnologia(UID/SOC/04521/2013

Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey.

BACKGROUND: In 2011-12, the European Centre for Disease Prevention and Control (ECDC) held the first Europe-wide point-prevalence survey of health-care-associated infections in acute care hospitals. We analysed paediatric data from this survey, aiming to calculate the prevalence and type of health-care-associated infections in children and adolescents in Europe and to determine risk factors for infection in this population. METHODS: Point-prevalence surveys took place from May, 2011, to November, 2012, in 1149 hospitals in EU Member States, Iceland, Norway, and Croatia. Patients present on the ward at 0800 h on the day of the survey and who were not discharged at the time of the survey were included. Data were collected by locally trained health-care workers according to patient-based or unit-based protocols. We extracted data from the ECDC database for all paediatric patients (age 0-18 years). We report adjusted prevalence for health-care-associated infections by clustering at the hospital and country level. We also calculated risk factors for development of health-care-associated infections with use of a generalised linear mixed-effects model. FINDINGS: We analysed data for 17 273 children and adolescents from 29 countries. 770 health-care-associated infections were reported in 726 children and adolescents, corresponding to a prevalence of 4·2% (95% CI 3·7-4·8). Bloodstream infections were the most common type of infection (343 [45%] infections), followed by lower respiratory tract infections (171 [22%]), gastrointestinal infections (64 [8%]), eye, ear, nose, and throat infections (55 [7%]), urinary tract infections (37 [5%]), and surgical-site infections (34 [4%]). The prevalence of infections was highest in paediatric intensive care units (15·5%, 95% CI 11·6-20·3) and neonatal intensive care units (10·7%, 9·0-12·7). Independent risk factors for infection were age younger than 12 months, fatal disease (via ultimately and rapidly fatal McCabe scores), prolonged length of stay, and the use of invasive medical devices. 392 microorganisms were reported for 342 health-care-associated infections, with Enterobacteriaceae being the most frequently found (113 [15%]). INTERPRETATION: Infection prevention and control strategies in children should focus on prevention of bloodstream infections, particularly among neonates and infants. FUNDING: None

Potential adjustment methodology for missing data and reporting delay in the HIV Surveillance System, European Union/European Economic Area, 2015

HIV remains one of the most important public health concerns in the European Union and European Economic Area (EU/EEA). Accurate data are therefore crucial to appropriately direct and evaluate public health response. The European Centre for Disease Prevention and Control (ECDC) and the World Health Organization Regional Office for Europe (WHO/Europe) have jointly coordinated enhanced HIV/AIDS surveillance in the European Region since 2008. The general objectives of the surveillance system in EU/EEA countries include monitoring of trends over time and across countries. Specific HIV-related objectives include the monitoring of testing patterns, late HIV diagnoses, defined by low CD4+ counts (<350 cells/mm3), and mortality, as well estimating HIV incidence and prevalence stratified by key populations, e.g. transmission category and migrant status [1]. To meet these objectives, the long-term strategy states that improving the quality of surveillance data is needed [2]. Achieving this in practice poses challenges, especially given the heterogeneous national surveillance systems in the EU/EEA and that the routinely collected data are known to suffer from important quality limitations. The limitations originating from national data collection systems may include under-reporting or duplication of cases, delays in reporting, incompleteness of data and misclassification. Accounting for some of these limitations (e.g. assessment of under-reporting) requires additional data such as cohort studies or registries, while other issues, such as incompleteness and reporting delay, may be addressed directly within the surveillance datasets. Missing data are a well-recognised problem within surveillance systems. When values for some variables are missing and cases with missing values are excluded from analysis, it may lead to biased and potentially less precise estimates [3,4]. In principle, whenever there are missing data or reporting delays, the accuracy of epidemiological distributions and trends should be interpreted with caution. Reporting delay, the time from case diagnosis to notification, can lead to problems when analysing the most recent years, given that the information on some cases or variables may not have been collected yet because of national reporting process characteristics. This phenomenon is common in disease surveillance and also applies to HIV [5-8]. Rough adjustments for reporting delay were already implemented in the past in Europe [8,9], but further refinement of the existing applied methodology is needed to address this issue across more countries’ data. The main purpose of this paper is to explore the issues of missing data and reporting delay in EU/EEA HIV surveillance data. We aim to quantify the extent to which these problems are present and to identify specific data characteristics that are relevant for data adjustments. Taking these characteristics into account, we also propose methods to adjust for missing data and reporting delay based on literature and existing national practices in EU/EEA countries.Peer Reviewe

Estimating HIV incidence and the undiagnosed HIV population in the European Union / European economic area

ECDC HIV/AIDS Surveillance and Dublin Declaration Networks participants: Portugal - Helena Cortes Martins (INSA).Each year, about 30,000 people are newly diagnosed with HIV in the 31 countries of the European Union/European Economic Area (EU/EEA). We aimed to estimate the number of people living with undiagnosed HIV in the entire EU/EEA and in four sub-regions.N/

Mapping HIV-related behavioural surveillance among injecting drug users in Europe, 2008.

The systematic collection of behavioural information is an important component of second-generation HIV surveillance. The extent of behavioural surveillance among injecting drug users (IDUs) in Europe was examined using data collected through a questionnaire sent to all 31 countries of the European Union and European Free Trade Association as part of a European-wide behavioural surveillance mapping study on HIV and other sexually transmitted infections. The questionnaire was returned by 28 countries during August to September 2008: 16 reported behavioural surveillance studies (two provided no further details). A total of 12 countries used repeated surveys for behavioural surveillance and five used their Treatment Demand Indicator system (three used both approaches). The data collected focused on drug use, injecting practices, testing for HIV and hepatitis C virus and access to healthcare. Eight countries had set national indicators: three indicators were each reported by five countries: the sharing any injecting equipment, uptake of HIV testing and uptake of hepatitis C virus testing. The recall periods used varied. Seven countries reported conducting one-off behavioural surveys (in one country without a repeated survey, these resulted an informal surveillance structure). All countries used convenience sampling, with service-based recruitment being the most common approach. Four countries had used respondent-driven sampling. Three fifths of the countries responding (18/28) reported behavioural surveillance activities among IDUs; however, harmonisation of behavioural surveillance indicators is needed

Estimating HIV incidence and number of undiagnosed individuals living with HIV in the European Union/European Economic Area, 2015

Helena Cortes Martins, Departamento de Doenças Infeciosas do Instituto Nacional de Saúde Doutor Ricardo Jorge, IPSince 2011, human immunodeficiency virus (HIV) incidence appears unchanged in the European Union/European Economic Area with between 29,000 and 33,000 new cases reported annually up to 2015. Despite evidence that HIV diagnosis is occurring earlier post-infection, the estimated number of people living with HIV (PLHIV) who were unaware of being infected in 2015 was 122,000, or 15% of all PLHIV (n=810,000). This is concerning as such individuals cannot benefit from highly effective treatment and may unknowingly sustain transmission.Members of the ECDC HIV/AIDS Surveillance and Dublin Declaration Monitoring Networks: Portugal: Kamal Mansinho, Helena Cortes Martins, Teresa Melo.info:eu-repo/semantics/publishedVersio