#Drug #resistant #tuberculosis in eastern #Europe and central #Asia: a time-series analysis of routine surveillance data (Lancet Infect Dis., abstract)

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

Drug-resistant tuberculosis in eastern Europe and central Asia: a time-series analysis of routine surveillance data

Andrei Dadu, MD, Arax Hovhannesyan, MD, Sevim Ahmedov, MD, Marieke J van der Werf, PhD, Masoud Dara, MD

Published: November 26, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30568-7




Among all WHO regions, the WHO European Region has the highest proportion of drug-resistant tuberculosis among new and retreated cases. The 18 high-priority countries in eastern Europe and central Asia account for 85% of the tuberculosis incidence and more than 90% of drug-resistant tuberculosis cases emerging in the region. We aimed to analyse time-series trends in notification rates of drug-resistant tuberculosis among new tuberculosis cases in the 18 high-priority countries in the WHO European Region.


We used country data stored in WHO’s global tuberculosis database. For each country, we calculated annual notification rates per 100 000 population of new tuberculosis cases and of drug-resistant tuberculosis among new cases reported from Jan 1, 2000, to Dec 31, 2017. We computed annual percentage changes of notification rates and identified time-points of significant change in trends using the joinpoint regression method.


All 17 countries with data (no data available from Turkmenistan) showed a significant decline in new tuberculosis notification rates in the most recent years since the last joinpoint if one was identified. Notification rates of drug-resistant tuberculosis showed diverse trends, with substantial year-to-year variation. In the most recent years, notification rates of drug-resistant tuberculosis among new tuberculosis cases were decreasing in two countries (Estonia and Latvia), increasing in eight countries (Azerbaijan, Kyrgyzstan, Moldova [Republic of Moldova], Romania, Russia [Russian Federation], Tajikistan, Ukraine, and Uzbekistan), and stable in seven countries (Armenia, Belarus, Bulgaria, Georgia, Kazakhstan, Lithuania, and Turkey).


Our findings suggest that countries in the WHO European Region are more successful in controlling drug-susceptible tuberculosis than drug-resistant forms, and as a result, the proportion of drug-resistant strains among newly notified patients with tuberculosis is increasing in many settings. Two countries showed that it is possible to decrease incidence of both drug-susceptible and drug-resistant tuberculosis. If no additional efforts are made in prevention and care of patients with drug-resistant tuberculosis, further decline of the tuberculosis burden will be halted. Further studies are needed to investigate the success stories and document the most effective interventions to reach the target to end tuberculosis by 2030.


United States Agency for International Development.

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


#Zika virus #threshold determines #transmission by #European #Aedes albopictus #mosquitoes (Emerg Microbes Infect., abstract)

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

Emerg Microbes Infect. 2019;8(1):1668-1678. doi: 10.1080/22221751.2019.1689797.

Zika virus threshold determines transmission by European Aedes albopictus mosquitoes.

Vazeille M1, Madec Y2, Mousson L1, Bellone R1, Barré-Cardi H3, Sousa CA4, Jiolle D5, Yébakima A6, de Lamballerie X7, Failloux AB1.

Author information: 1 Institut Pasteur, Department of Virology, Arboviruses and Insect Vectors, Paris, France. 2 Institut Pasteur, Department of Infection and Epidemiology, Emerging Diseases Epidemiology, France. 3 Office de l’Environnement de la Corse, Observatoire Conservatoire des Insectes de Corse, Corte, France. 4 Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal. 5 UMR MIVEGEC (IRD 224-CNRS 5290-UM), Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle, Institut de Recherche pour le Développement (IRD), Montpellier, France. 6 VECCOTRA, Rivière salée, Martinique. 7 Unité des Virus Emergents (UVE), Aix Marseille Université, IHU Méditerranée Infection, Marseille, France.



Since its emergence in Yap Island in 2007, Zika virus (ZIKV) has affected all continents except Europe. Despite the hundreds of cases imported to European countries from ZIKV-infested regions, no local cases have been reported in localities where the ZIKV-competent mosquito Aedes albopictus is well established. Here we analysed the vector competence of European Aedes (aegypti and albopictus) mosquitoes to different genotypes of ZIKV. We demonstrate that Ae. albopictus from France was less susceptible to the Asian ZIKV than to the African ZIKV. Critically we show that effective crossing of anatomical barriers (midgut and salivary glands) after an infectious blood meal depends on a viral load threshold to trigger: (i) viral dissemination from the midgut to infect mosquito internal organs and (ii) viral transmission from the saliva to infect a vertebrate host. A viral load in body ≥4800 viral copies triggered dissemination and ≥12,000 viral copies set out transmission. Only 27.3% and 18.2% of Ae. albopictus Montpellier mosquitoes meet respectively these two criteria. Collectively, these compelling results stress the poor ability of Ae. albopictus to sustain a local transmission of ZIKV in Europe and provide a promising tool to evaluate the risk of ZIKV transmission in future outbreaks.

KEYWORDS: Aedes albopictus; Europe; Zika; arbovirus; epidemic potential

PMID: 31735122 DOI: 10.1080/22221751.2019.1689797

Keywords: Zika Virus; Mosquitoes; Aedes albopictus; European Region.


#TB, #HIV, and viral #hepatitis #diagnostics in eastern #Europe and central #Asia: high time for integrated and people-centred services (Lancet Infect Dis., abstract)

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

Tuberculosis, HIV, and viral hepatitis diagnostics in eastern Europe and central Asia: high time for integrated and people-centred services

Masoud Dara, MD  †, Soudeh Ehsani, MD, Antons Mozalevskis, MD, Elena Vovc, MD, Daniel Simões, MPH, Ana Avellon Calvo, PhD, Jordi Casabona i Barbarà, PhD, Otar Chokoshvili, MPH, Irina Felker, PhD, Sven Hoffner, PhD, Gulmira Kalmambetova, PhD, Ecatarina Noroc, MD, Natalia Shubladze, PhD, Alena Skrahina, MD, Rasim Tahirli, MD, Prof Tengiz Tsertsvadze, PhD,

Published: November 15, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30524-9



Globally, high rates (and in the WHO European region an increasing prevalence) of co-infection with tuberculosis and HIV and HIV and hepatitis C virus exist. In eastern European and central Asian countries, the tuberculosis, HIV, and viral hepatitis programmes, including diagnostic services, are separate vertical structures. In this Personal View, we consider underlying reasons for the poor integration for these diseases, particularly in the WHO European region, and how to address this with an initial focus on diagnostic services. In part, this low integration has reflected different diagnostic development histories, global funding sources, and sample types used for diagnosis (eg, typically sputum for tuberculosis and blood for HIV and hepatitis C). Cooperation between services improved as patients with tuberculosis needed routine testing for HIV and vice versa, but financial, infection control, and logistical barriers remain. Multidisease diagnostic platforms exist, but to be used optimally, appropriate staff training and sensible understanding of different laboratory and infection control risks needs rapid implementation. Technically these ideas are all feasible. Poor coordination between these vertical systems remains unhelpful. There is a need to increase political and operational integration of diagnostic and treatment services and bring them closer to patients.

Keywords: Public Health; European Region; TB; HIV/AIDS; Viral hepatitis.


#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



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.


#Prediction of unfavorable #outcomes in #WNV #neuroinvasive #infection – result of a multinational ID-IRI study (J Clin Virol., abstract)

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

Journal of Clinical Virology / Available online 11 November 2019, 104213 / In Press, Journal Pre-proof

Prediction of unfavorable outcomes in West Nile virus neuroinvasive infection – result of a multinational ID-IRI study

Corneliu Petru Popescu a,b,c,1, Simin Aysel Florescu a,b,1, Rodrigo Hasbun d, Arjan Harxhi e, Razi Evendar f, Hasip Kahraman g, Ami Neuberger f, Daniel Codreanu b, Mihaela Florentina Zaharia a,b,c, Selma Tosun h, Emanoil Ceausu b, Simona Maria Ruta a,i, Gorana Dragovacj, k, Natalia Pshenichnaya l,m, Galina Gopatsa n, Olga Shmaylenko o, Éva Nagy, p, Jelena Djekic Malbasaj k, Mirjana Strbac j, Nenad  Pandak q, Husnu Pullukcu g, Botond Lakatos p, Yasemin Cag r, Antonio Cascio s, Ilaria Coledan t, Serkan Oncu u, Hakan Erdemc v

{a} University of Medicine and Pharmacy Carol Davila Bucharest, Romania; {b} Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases Bucharest, Romania; {c} ESCMID Study Group for Infectious Diseases of the Brain – ESGIB, Switzerland; {d} Department of Infectious Diseases, UT Health McGovern Medical School, Houston, TX, USA; {e} Service of Infectious Disease, University Hospital Center of Tirana, Tirana, Albania; {f} Infectious Diseases Institute, Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel; {g}
Ege University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey; {h} Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey; {i} Stefan S. Nicolau Institute of Virology, Bucharest, Romania; {j} Institute of Public Health of Vojvodina, Department of Prevention and Control of Diseases, Novi Sad, Serbia; {k}
University of Novi Sad, Faculty of Medicine, Department of Epidemiology, Novi Sad, Serbia; {l} National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia; {m} Central Scientific Research Laboratory, Rostov State Medical University, Rostov-on-Don, Russia; {n} Department of Infectious Diseases, Rostov State Medical University, Rostov-on-Don, Russia; {o} Department of Infectious Diseases #5, City Hospital #1 named after N.A. Semashko, Rostov-on-Don, Russia; {p}
National Institute of Hematology and Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary; {q} General Hospital Slavonski Brod, Department for Infectious Diseases, School of Medicine, University of Split, Split, Croatia; {r} Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey; {s} Section of Infectious and Tropical Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy; {t} Department of Diagnostics and Public Health, Section of Infectious Diseases, University of Verona, Verona, Italy; {u} Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University School of Medicine, Aydin, Turkey; {v} ID-IRI, Ankara, Turkey

Received 30 August 2019, Revised 31 October 2019, Accepted 7 November 2019, Available online 11 November 2019. DOI: https://doi.org/10.1016/j.jcv.2019.104213



  • Prognosis of unfavorable outcomes in West Nile virus neuroinvasive infection.
  • The relative risk for death by age.
  • Encephalitis, meningoencephalitis, meningitis.
  • Glasgow coma score was correlated with evolution to death.
  • Risk score was calculated according to age, co-morbidities, clinical manifestations.




WNV causes 1.4% of all central nervous system infections and is the most common cause of epidemic neuro-invasive disease in humans.


Our main objective was to investigate retrospectively West Nile virus neuroinvasive disease (WNND) cases hospitalized during 2010- 2017 and identified factors that can influence prognosis.

Study design

We documented the demographic, epidemiologic, clinical and laboratory data of WNND and identified factors that can influence prognosis. The data were recruited through Infectious Diseases International Research Initiative (ID-IRI), which serves as a network for clinical researches.


We investigated 165 patients with WNND in 10 countries from three continents. 27 patients died and the mortality rate was 16.4%. In an univariate analysis age, congestive heart failure, neoplasm and ischemic heart disease (p < 0.001), neuropsychiatric disorders (p = 0.011), chronic hepatitis (p = 0.024) and hypertension (p = 0.043) were risk factors for death. Fatal evolution was also correlated with ICU addmission, disorientation, speech disorders, change in consciousnes, coma, a low Glasgow coma score, obtundation, confusion (p < 0.001), history of syncope (p = 0.002) and history of unconsciousness (p = 0.037). In a binomial logistic regresssion analysis only age and coma remained independent prediction factors for death. We created an equation that was calculated according to age, co-morbidities and clinical manifestations that may be used to establish the prognosis of WNND patients.


WNND remain an important factor for morbidity and mortality worldwide, evolution to death or survival with sequelae are not rare. Our study creates an equation that may be used in the future to establish the prognosis of WNND patients.

Keywords: West Nile virus – WNV – meningitis – encephalitis – neuroinvasive – death

{1} These authors contributed equally to this article.

© 2019 Elsevier B.V. All rights reserved.

Keywords: WNV; WNND; Neuroinvasion; Encephalitis; Meningitis; European Region.


#Antimicrobial susceptibility profiles of #anaerobic #bacteria, isolated from #human clinical specimens, within different #European and surrounding countries. A joint ESGAI study (Anaerobe, abstract)

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

Anaerobe. 2019 Oct 18:102111. doi: 10.1016/j.anaerobe.2019.102111. [Epub ahead of print]

Antimicrobial susceptibility profiles of anaerobic bacteria, isolated from human clinical specimens, within different European and surrounding countries. A joint ESGAI study.

Veloo ACM1, Tokman HB2, Jean-Pierre H3, Dumont Y3, Jeverica S4, Lienhard R5, Novak A6, Rodloff A7, Rotimi V8, Wybo I9, Nagy E10; ESGAI study group.

Author information: 1 University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, the Netherlands. Electronic address: a.c.m.veloo@umcg.nl. 2 Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Medical Microbiology, Istanbul, Turkey. 3 Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; MIVEGEC, IRD, CNRS, Université de Montpellier, Montpellier, France. 4 Institute for Microbiology and Immunology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia. 5 Analyses et Diagnostics Médicaux (ADMed) Microbiologie, La Chaux-de-Fonds, Switzerland. 6 University Hospital Center of Split, University of Split, School of Medicine, Split, Croatia. 7 Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany. 8 Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait. 9 Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium. 10 Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary.




Studies on the antimicrobial susceptibility profile of anaerobic bacteria are underrepresented in the literature. Within this study we aim to give an extensive overview of the differences in antimicrobial susceptibility profiles between different European and surrounding countries.


Minimal inhibitory concentration (MIC) data of different antibiotics were collected from 10 participating laboratories, representing an equal number of countries. All MIC’s were determined using Etest, according to the protocol used by the participating laboratory. Anaerobic genera represented by at least 10 clinical isolates were included in the study.


Each country tested different antibiotics, sometimes depending on the kind of infection and/or the anaerobic species isolated. All countries tested clindamycin and metronidazole. Resistance rates differed remarkably between the different countries. Especially in Kuwait, resistance was high for all tested antibiotics. Unexpected metronidazole resistance was observed for Finegoldia magna isolates, Peptoniphilus isolates and Eggerthella lenta isolates.


Due to the extensive differences in antimicrobial susceptibility profile of anaerobic bacteria isolated within different countries, we strongly recommend to perform this kind of study on a regular basis.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Anaerobic bacteria; Antibiotics; ESGAI study; Europe; Resistance profile

PMID: 31634565 DOI: 10.1016/j.anaerobe.2019.102111

Keywords: Antibiotics; Drugs Resistance; European Region.


#Serological #surveillance reveals patterns of #exposure to #H5 and #H7 #influenza A viruses in #European #poultry (Transbound Emerg Dis., abstract)

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

Transbound Emerg Dis. 2019 Sep 24. doi: 10.1111/tbed.13371. [Epub ahead of print]

Serological surveillance reveals patterns of exposure to H5 and H7 influenza A viruses in European poultry.

Hillman AE1,2, Smith RP3, Batey N3,4, Verheyen KL5, Pittman M6, Brown IH3, Breed AC3,7,8,9.

Author information: 1 Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK. 2 Current address: Ausvet, Fremantle, Australia. 3 Animal and Plant Health Agency Weybridge, Addlestone, UK. 4 Current address: Veterinary Medicines Directorate, New Haw, Addlestone, UK. 5 Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK. 6 European Commission, Directorate for Health and Food Safety, Brussels. 7 Current address: Department of Agriculture and Water Resources, Canberra, Australia. 8 School of Veterinary Science, University of Queensland, Brisbane, Australia. 9 Epidemiology and One Health Section, Department of Agriculture, Canberra, Australia.



Influenza A viruses of H5 and H7 subtype in poultry can circulate subclinically, and subsequently mutate from low to high pathogenicity with potentially devastating economic and welfare consequences. European Union Member States undertake surveillance of commercial and backyard poultry for early detection and control of subclinical H5 and H7 influenza A infection. This surveillance has moved towards a risk-based sampling approach in recent years; however quantitative measures of relative risk associated with risk factors utilised in this approach are necessary for optimisation. This study describes serosurveillance for H5 and H7 influenza A in domestic and commercial poultry undertaken in the European Union from 2004 to 2010, where a random sampling and thus representative approach to serosurveillance was undertaken. Using these representative data, this study measured relative risk of seropositivity across poultry categories and spatially across the EU. Data were analysed using multivariable logistic regression. Domestic waterfowl, game birds, fattening turkeys, ratites, backyard poultry and the “other” poultry category holdings had relatively increased probability of H5 and/or H7 influenza A seropositivity, compared to laying-hen holdings. Amongst laying-hen holdings, free-range rearing was associated with increased probability of H7 seropositivity. Spatial analyses detected ‘hotspots’ for H5 influenza A seropositivity in western France and England, and H7 influenza A seropositivity in Italy and Belgium, which may be explained by the demographics and distribution of poultry categories. Findings suggest certain poultry category holdings are at increased risk of subclinical H5 and/or H7 influenza A circulation, and free-range rearing increases the likelihood of exposure to H7 influenza A. These findings may be used in further refining risk-based surveillance strategies, and prioritising management strategies in influenza A outbreaks.

© 2019 Blackwell Verlag GmbH.

KEYWORDS: Avian; bird; influenza; poultry; risk; serosurveillance; virus

PMID: 31549792 DOI: 10.1111/tbed.13371

Keywords: Avian Influenza; H5; H7; Poultry; Wild Birds; European Region.