High #impact of #COVID19 in long-term care #facilities, suggestion for #monitoring in the #EU/EEA, May 2020 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020

ECDC Public Health Emergency Team1, Kostas Danis2, Laure Fonteneau2, Scarlett Georges2, Côme Daniau2, Sibylle Bernard-Stoecklin2, Lisa Domegan3,4, Joan O’Donnell4, Siri Helene Hauge5, Sara Dequeker6, Eline Vandael6, Johan Van der Heyden6, Françoise Renard6, Natalia Bustos Sierra6, Enrico Ricchizzi7, Birgitta Schweickert8, Nicole Schmidt8, Muna Abu Sin8, Tim Eckmanns8, José-Artur Paiva9, Elke Schneider10

Affiliations: 1 The members of the ECDC Public Health Emergency Team are listed at the end of the article; 2 Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France; 3 European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; 4 Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland; 5 Norwegian Institute of Public Health, Oslo, Norway; 6 Sciensano, Brussels, Belgium; 7 Regional Health and Social Agency – Emilia Romagna, Bologna, Italy; 8 Robert Koch-Institute, Berlin, Germany; 9 Directorate General of Health, Lisbon, Portugal; 10 European Agency for Safety and Health at Work, Bilbao, Spain

Correspondence:  Cornelia Adlhoch

Citation style for this article: ECDC Public Health Emergency Team, Danis Kostas, Fonteneau Laure, Georges Scarlett, Daniau Côme, Bernard-Stoecklin Sibylle, Domegan Lisa, O’Donnell Joan, Hauge Siri Helene, Dequeker Sara, Vandael Eline, Van der Heyden Johan, Renard Françoise, Bustos Sierra Natalia, Ricchizzi Enrico, Schweickert Birgitta, Schmidt Nicole, Abu Sin Muna, Eckmanns Tim, Paiva José-Artur, Schneider Elke. High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020. Euro Surveill. 2020;25(22):pii=2000956. https://doi.org/10.2807/1560-7917.ES.2020.25.22.2000956

Received: 18 May 2020;   Accepted: 02 Jun 2020

 

Abstract

Residents in long-term care facilities (LTCF) are a vulnerable population group. Coronavirus disease (COVID-19)-related deaths in LTCF residents represent 30–60% of all COVID-19 deaths in many European countries. This situation demands that countries implement local and national testing, infection prevention and control, and monitoring programmes for COVID-19 in LTCF in order to identify clusters early, decrease the spread within and between facilities and reduce the size and severity of outbreaks.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: SARS-CoV-2; COVID-19; Institutional outbreaks; EU.

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Where are the #ECDC and the #EU-wide #responses in the #COVID19 pandemic? (Lancet, summary)

[Source: Lancet, full page: (LINK). Summary, edited.]

Where are the ECDC and the EU-wide responses in the COVID-19 pandemic?

Jacint Jordana, Juan Carlos Triviño-Salazar

Published: May 13, 2020 | DOI: https://doi.org/10.1016/S0140-6736(20)31132-6

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As the EU continues to face the COVID-19 pandemic, an unprecedented transboundary crisis, its member states resort to measures within the boundaries of the nation state. This situation questions the capacity of the EU to deploy public health instruments to cope with pandemics. One such instrument, the European Centre for Disease Control (ECDC), seems to show a discreet involvement in this crisis, suggesting emerging isolationist behaviours of the member states.

(…)

Keywords: SARS-CoV-2; COVID-19; Society; Politics; EU.

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#COVID and the #convergence of three #crises in #Europe (Lancet Pub Health, summary)

[Source: Lancet Public Health, full page: (LINK). Summary, edited.]

COVID and the convergence of three crises in Europe

Kayvan Bozorgmehr, Victoria Saint, Alexandra Kaasch, David Stuckler, Alexander Kentikelenis

Open Access | Published: April 03, 2020 | DOI: https://doi.org/10.1016/S2468-2667(20)30078-5

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As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic hits Europe, it converges and interacts with three global crises that will make it spread even further: governance, economics, and migration.1 Although these crises have different roots, all three reflect a lack of mechanisms to produce and protect essential public goods for an effective policy response. Understanding how these crises intersect and the scope of a potential transnational Europe-wide response is crucial.

(…)

Keywords: SARS-CoV-2; COVID-19; Poverty; Society; Migrants; EU.

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Rapidly Increasing Cumulative #Incidence of #Coronavirus Disease (#COVID19) in the #EU / #EEA and the #UK, 1 January to 15 March 2020 (Euro Surveill., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Euro Surveill  2020 Mar 19 [Online ahead of print]

Rapidly Increasing Cumulative Incidence of Coronavirus Disease (COVID-19) in the European Union/European Economic Area and the United Kingdom, 1 January to 15 March 2020

Pete Kinross 1, Carl Suetens 1, Joana Gomes Dias 1, Leonidas Alexakis 1, Ariana Wijermans 1, Edoardo Colzani 1, Dominique L Monnet 1, European Centre For Disease Prevention And Control Ecdc Public Health Emergency Team 2

Affiliations: 1 European Centre for Disease Prevention and Control, Solna, Sweden. 2 The members of the ECDC Public Health Emergency Team are listed at the end of this article.

PMID: 32186277 DOI: 10.2807/1560-7917.ES.2020.25.11.2000285

 

Abstract

The cumulative incidence of coronavirus disease (COVID-19) cases is showing similar trends in European Union/European Economic Area countries and the United Kingdom confirming that, while at a different stage depending on the country, the COVID-19 pandemic is progressing rapidly in all countries. Based on the experience from Italy, countries, hospitals and intensive care units should increase their preparedness for a surge of patients with COVID-19 who will require healthcare, and in particular intensive care.

Keywords: SARS-CoV-2, COVID-19, coronavirus disease; coronavirus, EU/EEA, United Kingdom, Europe.

Keywords: COVID-19; SARS-CoV-2; EU.

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Potential #scenarios for the #progression of a #COVID19 #epidemic in the #EU and the EEA, March 2020 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Potential scenarios for the progression of a COVID-19 epidemic in the European Union and the European Economic Area, March 2020

Helen C Johnson1,2, Céline M Gossner1,2, Edoardo Colzani1, John Kinsman1, Leonidas Alexakis1, Julien Beauté1, Andrea Würz1, Svetla Tsolova1, Nick Bundle1, Karl Ekdahl1

Affiliations :1 European Centre for Disease Prevention and Control, Solna, Sweden; 2 These authors contributed equally
Correspondence:  Céline M. Gossner

Citation style for this article: Johnson Helen C, Gossner Céline M, Colzani Edoardo, Kinsman John, Alexakis Leonidas, Beauté Julien, Würz Andrea, Tsolova Svetla, Bundle Nick, Ekdahl Karl. Potential scenarios for the progression of a COVID-19 epidemic in the European Union and the European Economic Area, March 2020. Euro Surveill. 2020;25(9):pii=2000202. https://doi.org/10.2807/1560-7917.ES.2020.25.9.2000202

Received: 27 Feb 2020;   Accepted: 04 Mar 2020

 

Abstract

On 31 December 2019, the Chinese health authorities reported a cluster of 27 pneumonia cases of unknown aetiology in Wuhan city, Hubei Province, China. The causative agent was later identified as a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the first weeks of 2020, the number of cases increased and cases were soon reported outside of China.

The aim of this paper was to provide a general scenario planning framework that can be used by European Union and European Economic Area (EU/EEA) countries in preparation for a possible widespread epidemic of coronavirus disease 2019 (COVID-19).

Keywords: European Union; SARS-CoV-2; COVID-19.

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#Decreasing and stabilising #trends of #antimicrobial #consumption and #resistance in #Escherichia coli and #Klebsiella pneumoniae in segmented regression analysis, #EU / #EEA, 2001 to 2018 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Decreasing and stabilising trends of antimicrobial consumption and resistance in Escherichia coli and Klebsiella pneumoniae in segmented regression analysis, European Union/European Economic Area, 2001 to 2018

Germán Peñalva 1, Liselotte Diaz Högberg 2, Klaus Weist 2, Vera Vlahović-Palčevski 3, Ole Heuer 2, Dominique L Monnet 2, ESAC-Net study group 4, EARS-Net study group 5

Affiliations: 1 Department of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocio, CSIC, University of Seville, Spain; 2 European Centre for Disease Prevention and Control, Solna, Sweden; 3 Department of Clinical Pharmacology, University Hospital Rijeka / Medical Faculty and Faculty of Health Studies, University of Rijeka, Rijeka, Croatia; 4 ESAC-Net study group participants are listed at the end of the article; 5 EARS-Net study group participants are listed at the end of the article

Correspondence:  Liselotte Diaz Högberg

Citation style for this article: Peñalva Germán, Högberg Liselotte Diaz, Weist Klaus, Vlahović-Palčevski Vera, Heuer Ole, Monnet Dominique L, ESAC-Net study group, EARS-Net study group. Decreasing and stabilising trends of antimicrobial consumption and resistance in Escherichia coli and Klebsiella pneumoniae in segmented regression analysis, European Union/European Economic Area, 2001 to 2018. Euro Surveill. 2019;24(46):pii=1900656. https://doi.org/10.2807/1560-7917.ES.2019.24.46.1900656

Received: 29 Oct 2019;   Accepted: 13 Nov 2019

 

Abstract

Investments to reduce the spread of antimicrobial resistance (AMR) in the European Union have been made, including efforts to strengthen prudent antimicrobial use. Using segmented regression, we report decreasing and stabilising trends in data reported to the European Surveillance of Antimicrobial Consumption Network and stabilising trends in data reported to the European Antimicrobial Resistance Surveillance Network. Our results could be an early indication of the effect of prioritising AMR on the public health agenda.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Antibiotics; Drugs Resistance; EU; European Region.

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Application of national #pollutant #inventories for #monitoring trends on #dioxin #emissions from stationary #industrial sources in #Australia, #Canada and #EU (PLOS One, abstract)

[Source: PLOS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Application of national pollutant inventories for monitoring trends on dioxin emissions from stationary industrial sources in Australia, Canada and European Union

Khushbu Salian , Vladimir Strezov, Tim J. Evans, Mark Taylor, Peter F. Nelson

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Published: October 25, 2019 / DOI: https://doi.org/10.1371/journal.pone.0224328

 

Abstract

Industrial sources, including iron ore sintering, municipal waste incineration and non-ferrous metal processing have been prominent emitters of dioxins to the environment. With the expanding industrial sectors, many international conventions were established in order to reduce the emission of dioxins in the past two decades. The Stockholm convention, a global monitoring treaty, entered into force in 2004 with the aim to promote development of strategies to reduce or eliminate dioxin emissions. According to the convention, parties are required to develop national inventory databases to report emission levels and develop a national implementation plan (NIP) to reduce further dioxin emissions. In order to understand the trend of dioxin emissions since 1990s this study provides a comparative assessment of dioxin emissions from different industrial sources by deriving emission data from the national inventory databases of Australia, Canada and the 28 European countries (EU-28). According to the data collected, iron and steel production and electricity generation were the highest emitters of dioxins in 2017 for Europe, Canada and Australia, when compared to other stationary industrial sources. The change in the trend of dioxin emissions from the iron and steel industry and the public electricity sector was also assessed. The emission of dioxins during 1990–2017 from both iron and steel production and electricity generation revealed a relative decreasing trend, except for Spain and Italy who showed higher level of emissions from iron and steel production in 2017. Furthermore, comparing emission data for metal production revealed that the blast furnace process was the prominent emitter of dioxins comparing to electric arc furnace process. Further investigation was performed to compare the amount of dioxin emitted from three different fuel types, black coal, brown coal and natural gas, used for electricity generation in Australia. The study showed that dioxin emissions from brown coal were higher than black coal for the last two years, while power production from natural gas emits the lowest amounts of dioxins to the environment.

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Citation: Salian K, Strezov V, Evans TJ, Taylor M, Nelson PF (2019) Application of national pollutant inventories for monitoring trends on dioxin emissions from stationary industrial sources in Australia, Canada and European Union. PLoS ONE 14(10): e0224328. https://doi.org/10.1371/journal.pone.0224328

Editor: Bing Xue, Institute for Advanced Sustainability Studies, GERMANY

Received: May 21, 2019; Accepted: October 10, 2019; Published: October 25, 2019

Copyright: © 2019 Salian et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Sources are referenced.

Funding: This research was funded by the Australian Government through the Australian Research Council Linkage Projects funding scheme, project number LP160101600 (https://www.arc.gov.au/) to VS, TE, MT and PF. ARC played no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Environmental pollution; Toxic chemicals; Dioxins; EU; Australia; Canada.

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Standardising #surveillance of #hepatitis E virus #infection in the #EU/EEA: a review of national practices and suggestions for the way forward (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 19 September 2019 / In Press, Journal Pre-proof

Standardising surveillance of hepatitis E virus infection in the EU/EEA: a review of national practices and suggestions for the way forward

Cornelia Adlhoch a, Zdenka Manďáková b, Steen Ethelberg c, Jevgenia Epštein d, Ruska Rimhanen-Finne e, Julie Figoni f, Sally A. Baylis g, Mirko Faber h, Kassiani Mellou i, Niamh Murphy j, Joanne O’Gorman j, Maria Elena Tosti k, Anna Rita Ciccaglione k, Agnetha Hofhuis l, Hans Zaaijer m, Heidi Lange n, Rita de Sousa o, Ana Avellón p, Lena Sundqvist q, Bengü Said r, Samreen Ijaz r

{a} European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73, Solna, Sweden; {b} National Institute of Public Health, Prague, Czech Republic; {c} Statens Serum Institut, Copenhagen, Denmark; {d} Health Board, Tallinn, Estonia; {e}
National Institute for Health and Welfare (THL), Helsinki, Finland; {f} Santé Publique France, Saint-Maurice, France; {g} Paul-Ehrlich-Institut (PEI), Langen, Germany; {h} Robert Koch-Institut, Berlin, Germany; {i} Hellenic Public Health Organization, Athens, Greece; {j} Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland; {k} Istituto Superiore di Sanità, Rome, Italy; {l} National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; {m}
Sanquin Blood Supply Foundation, Amsterdam, the Netherlands; {n} Norwegian Institute of Public Health, Oslo, Norway; {o} Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal; {p} Viral Hepatitis Reference and Research Laboratory National Center of Microbiology Carlos III Health Institute, Madrid, Spain; {q} The Public Health Agency of Sweden (Folkhalsomyndigheten), Stockholm, Sweden; {r} Public Health England, London, United Kingdom

Received 3 July 2019, Revised 5 September 2019, Accepted 11 September 2019, Available online 19 September 2019.

DOI: https://doi.org/10.1016/j.jcv.2019.09.005

 

Highlights

  • Experts suggest primary objectives for national HEV surveillance in EU/EEA countries:
    • to monitor the incidence of acute HEV cases
    • to monitor chronic HEV infections
    • to describe the epidemiology of acute and chronic HEV infections
  • Suggested secondary objectives for national HEV surveillance in EU/EEA countries:
    • to monitor HEV phylotypes/subtypes
    • to identify potential clusters/outbreaks
    • to collect information on possible routes of transmission
  • Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.

 

Abstract

Background

Hepatitis E virus (HEV) infection is not notifiable at EU/EEA level, therefore surveillance relies on national policies only. Between 2005 and 2015, more than 20,000 cases were reported in EU/EEA countries. HEV testing is established in 26 countries and 19 countries sequence HEV viruses.

Objective and study design

WHO’s European Action plan for viral hepatitis recommends harmonised surveillance objectives and case definitions. ECDC’s HEV expert group developed minimal and optimal criteria for national hepatitis E surveillance to support EU/EEA countries in enhancing their capacity and to harmonise methods.

Results

The experts agreed that the primary objectives of national surveillance for HEV infections should focus on the basic epidemiology of the disease: to monitor the incidence of acute cases and chronic infections. The secondary objectives should be to describe viral phylotypes or subtypes and to identify potential clusters/outbreaks and possible routes of transmission. Seventeen of 20 countries with existing surveillance systems collect the minimal data set required to describe the epidemiology of acute cases. Eleven countries test for chronic infections. Twelve countries collect data to identify potential clusters/outbreaks and information on possible routes of transmission.

Discussion

Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.

Keywords: Hepatitis E virus – EU/EEA – surveillance – testing

© 2019 Published by Elsevier B.V.

Keywords: Hepatitis E; EU.

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Strong #correlation between the rates of intrinsically #antibiotic #resistant species and the rates of acquired resistance in Gram-negative species causing #bacteraemia, #EU/EEA, 2016 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Strong correlation between the rates of intrinsically antibiotic-resistant species and the rates of acquired resistance in Gram-negative species causing bacteraemia, EU/EEA, 2016

Vincent Jarlier 1,2, Liselotte Diaz Högberg 3, Ole E Heuer 3, José Campos 4, Tim Eckmanns 5, Christian G Giske 6,7, Hajo Grundmann 8,Alan P Johnson 9, Gunnar Kahlmeter 10, Jos Monen 11, Annalisa Pantosti 12, Gian Maria Rossolini 13,14, Nienke van de Sande-Bruinsma 15,Alkiviadis Vatopoulos 16, Dorota Żabicka 17, Helena Žemličková 18,19, Dominique L Monnet 3, Gunnar Skov Simonsen 20,21, EARS-Net participants 22

Affiliations: 1 Sorbonne Universités (Paris 06) Inserm Centre d’Immunologie et des Maladies Infectieuses (CIMI), UMR 1135, Paris, France; 2 Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière hospital, Laboratoire de Bactériologie-Hygiène, Paris, France; 3 European Centre for Disease Prevention and Control, Solna, Sweden; 4 Reference and Research Laboratory on Antimicrobial Resistance, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain; 5 Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany; 6 Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; 7 Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; 8 Medical Center – University of Freiburg, Department for Infection Prevention and Hospital Epidemiology, Freiburg, Germany; 9 National Infection Service, Public Health England, London, United Kingdom; 10 Clinical Microbiology, Central Hospital, Växjö, Sweden; 11 National Institute for Public Health and the Environment, Bilthoven, the Netherlands; 12 Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; 13 Department of Experimental and Clinical Medicine, University of Florence, Italy; 14 Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy; 15 Pan American Health Organization/World Health Organization (PAHO/ WHO), Washington DC, United States; 16 Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece; 17 Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland; 18 National Institute of Public Health, National Reference Laboratory for Antibiotics, Prague, Czech Republic; 19 Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czech Republic; 20 Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway; 21 Research Group for Host-Microbe Interaction, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway; 22 The members of the group are listed at the end of the article

Correspondence:  Liselotte Diaz Högberg

Citation style for this article: Jarlier Vincent, Diaz Högberg Liselotte, Heuer Ole E, Campos José, Eckmanns Tim, Giske Christian G, Grundmann Hajo, Johnson Alan P,Kahlmeter Gunnar, Monen Jos, Pantosti Annalisa, Rossolini Gian Maria, van de Sande-Bruinsma Nienke, Vatopoulos Alkiviadis, Żabicka Dorota, Žemličková Helena,Monnet Dominique L, Simonsen Gunnar Skov, EARS-Net participants. Strong correlation between the rates of intrinsically antibiotic-resistant species and the rates of acquired resistance in Gram-negative species causing bacteraemia, EU/EEA, 2016. Euro Surveill. 2019;24(33):pii=1800538. https://doi.org/10.2807/1560-7917.ES.2019.24.33.1800538

Received: 03 Oct 2018;   Accepted: 01 Apr 2019

 

Abstract

Background

Antibiotic resistance, either intrinsic or acquired, is a major obstacle for treating bacterial infections.

Aim

Our objective was to compare the country-specific species distribution of the four Gram-negative species Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter species and the proportions of selected acquired resistance traits within these species.

Method

We used data reported for 2016 to the European Antimicrobial Resistance Surveillance Network (EARS-Net) by 30 countries in the European Union and European Economic Area.

Results

The country-specific species distribution varied considerably. While E. coli accounted for 31.9% to 81.0% (median: 69.0%) of all reported isolates, the two most common intrinsically resistant species P. aeruginosa and Acinetobacterspp. combined (PSEACI) accounted for 5.5% to 39.2% of isolates (median: 10.1%). Similarly, large national differences were noted for the percentages of acquired non-susceptibility to third-generation cephalosporins, carbapenems and fluoroquinolones. There was a strong positive rank correlation between the country-specific percentages of PSEACI and the percentages of non-susceptibility to the above antibiotics in all four species (rho > 0.75 for 10 of the 11 pairs of variables tested).

Conclusion

Countries with the highest proportion of P. aeruginosa and Acinetobacter spp. were also those where the rates of acquired non-susceptibility in all four studied species were highest. The differences are probably related to national differences in antibiotic consumption and infection prevention and control routines.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Antibiotics; Drugs Resistance; Bacteremia; EU.

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An #international #outbreak of #Salmonella enterica serotype Enteritidis linked to #eggs from #Poland: a microbiological and epidemiological study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

An international outbreak of Salmonella enterica serotype Enteritidis linked to eggs from Poland: a microbiological and epidemiological study

Roan Pijnacker, MSc  *, Timothy J Dallman, PhD *, Aloys S L Tijsma, PhD, Gillian Hawkins, MBChB, Lesley Larkin, BVSc, Saara M Kotila, MSc, Giusi Amore, PhD, Ettore Amato, PhD, Pamina M Suzuki, MSc, Sarah Denayer, PhD, Sofieke Klamer, MSc, Judit Pászti, Jacquelyn McCormick, MPH, Hassan Hartman, PhD, Gareth J Hughes, PhD, Lin C T Brandal, PhD, Derek Brown, MSc, Joël Mossong, PhD, Cecilia Jernberg, PhD, Luise Müller, MSc, Daniel Palm, PhD, Ettore Severi, MSc, Joannna Gołębiowska, DVM, Blaženka Hunjak, PhD, Slawomir Owczarek, MSc, Simon Le Hello, PhD, Patricia Garvey, PhD, Kirsten Mooijman, MSc, Ingrid H M Friesema, PhD, Coen van der Weijden, BSc, Menno van der Voort, PhD, Valentina Rizzi, PhD, Eelco Franz, PhD on behalf of theInternational Outbreak Investigation Team †

Published: May 24, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30047-7

 

Summary

Background

Salmonella spp are a major cause of food-borne outbreaks in Europe. We investigated a large multi-country outbreak ofSalmonella enterica serotype Enteritidis in the EU and European Economic Area (EEA).

Methods

A confirmed case was defined as a laboratory-confirmed infection with the outbreak strains of S Enteritidis based on whole-genome sequencing (WGS), occurring between May 1, 2015, and Oct 31, 2018. A probable case was defined as laboratory-confirmed infection withS Enteritidis with the multiple-locus variable-number tandem repeat analysis outbreak profile. Multi-country epidemiological, trace-back, trace-forward, and environmental investigations were done. We did a case-control study including confirmed and probable cases and controls randomly sampled from the population registry (frequency matched by age, sex, and postal code). Odds ratios (ORs) for exposure rates between cases and controls were calculated with unmatched univariable and multivariable logistic regression.

Findings

18 EU and EEA countries reported 838 confirmed and 371 probable cases. 509 (42%) cases were reported in 2016, after which the number of cases steadily increased. The case-control study results showed that cases more often ate in food establishments than did controls (OR 3·4 [95% CI 1·6–7·3]), but no specific food item was identified. Recipe-based food trace-back investigations among cases who ate in food establishments identified eggs from Poland as the vehicle of infection in October, 2016. Phylogenetic analysis identified two strains of S Enteritidis in human cases that were subsequently identified in salmonella-positive eggs and primary production premises in Poland, confirming the source of the outbreak. After control measures were implemented, the number of cases decreased, but increased again in March, 2017, and the increase continued into 2018.

Interpretation

This outbreak highlights the public health value of multi-country sharing of epidemiological, trace-back, and microbiological data. The re-emergence of cases suggests that outbreak strains have continued to enter the food chain, although changes in strain population dynamics and fewer cases indicate that control measures had some effect. Routine use of WGS in salmonella surveillance and outbreak response promises to identify and stop outbreaks in the future.

Funding

European Centre for Disease Prevention and Control; Directorate General for Health and Food Safety, European Commission; and National Public Health and Food Safety Institutes of the authors’ countries (see Acknowledgments for full list).

Keywords: Food Safety; EU; European Region; Samonella spp.

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