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

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

Risk Factors for Being Seronegative following SARS-CoV-2 Infection in a Large Cohort of Health Care Workers in Denmark

Most individuals seroconvert after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but being seronegative is observed in 1 to 9%. We aimed to investigate the risk factors associated with being seronegative following PCR-confirmed SARS-CoV-2 infection. In a prospective cohort study, we screened health care workers (HCW) in the Capital Region of Denmark for SARS-CoV-2 antibodies. We performed three rounds of screening from April to October 2020 using an enzyme-linked immunosorbent assay (ELISA) method targeting SARS-CoV-2 total antibodies. Data on all participants’ PCR for SARS-CoV-2 RNA were captured from national registries. The Kaplan-Meier method and Cox proportional hazards models were applied to investigate the probability of being seronegative and the related risk factors, respectively. Of 36,583 HCW, 866 (2.4%) had a positive PCR before or during the study period. The median (interquartile range [IQR]) age of 866 HCW was 42 (31 to 53) years, and 666 (77%) were female. After a median of 132 (range, 35 to 180) days, 21 (2.4%) of 866 were seronegative. In a multivariable model, independent risk factors for being seronegative were self-reported asymptomatic or mild infection hazard ratio (HR) of 6.6 (95% confidence interval [CI], 2.6 to 17; P < 0.001) and body mass index (BMI) of ≥30, HR 3.1 (95% CI, 1.1 to 8.8; P = 0.039). Only a few (2.4%) HCW were not seropositive. Asymptomatic or mild infection as well as a BMI above 30 were associated with being seronegative. Since the presence of antibodies against SARS-CoV-2 reduces the risk of reinfection, efforts to protect HCW with risk factors for being seronegative may be needed in future COVID-19 surges. IMPORTANCE Most individuals seroconvert after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but negative serology is observed in 1 to 9%. We found that asymptomatic or mild infection as well as a BMI above 30 were associated with being seronegative. Since the presence of antibodies against SARS-CoV-2 reduces the risk of reinfection, efforts to protect HCW with risk factors for being seronegative may be needed in future COVID-19 surges