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PURPOSE: Digital methods to augment traditional contact tracing approaches were developed and deployed globally during the COVID-19 pandemic. These Exposure Notification (EN) systems present new opportunities to support public health interventions. To date, there have been attempts to model the impact of such systems, yet no reports have explored the value of real-time system data for predictive epidemiological modeling. METHODS: We investigated the potential to short-term forecast COVID-19 caseloads using data from Californias implementation of the Google Apple Exposure Notification (GAEN) platform, branded as CA Notify. CA Notify is a digital public health intervention leveraging residents smartphones for anonymous EN. We extended a published statistical model that uses prior case counts to investigate the possibility of predicting short-term future case counts and then added EN activity to test for improved forecast performance. Additional predictive value was assessed by comparing the pandemic forecasting models with and without EN activity to the actual reported caseloads from 1-7 days in the future. RESULTS: Observation of time series presents noticeable evidence for temporal association of system activity and caseloads. Incorporating earlier ENs in our model improved prediction of the caseload counts. Using Bayesian inference, we found nonzero influence of EN terms with probability one. Furthermore, we found a reduction in both the mean absolute percentage error and the mean squared prediction error, the latter of at least 5% and up to 32% when using ENs over the model without. CONCLUSIONS: This preliminary investigation suggests smartphone based ENs can significantly improve the accuracy of short-term forecasting. These predictive models can be readily deployed as local early warning systems to triage resources and interventions.

BACKGROUND: To analyze the influence of the COVID-19 pandemic on the process of diagnosis and monitoring of drug-resistant pulmonary tuberculosis (TB) cases reported in the state of Paraná, Brazil, from 2015 to 2020. METHODS: Ecological study with quantitative approach. This study was based on diagnosed cases of pulmonary TB reported in the Notifiable Disease Information System in residents of Paraná; as well as through the number of confirmed cases of COVID-19 in the state epidemiological bulletin for the year 2020. The study data were analyzed using descriptive statistics. RESULTS: It was found that, although the number of reported pulmonary TB cases (drug-resistant and general) increased between 2015 and 2019, there was a drop in notification in 2020, the first year of the COVID-19 pandemic. The notification of TB cases was also influenced monthly during the year according to the increase in the number of COVID-19 cases. For cases of drug-resistant pulmonary TB, the provision of diagnostic tests and Directly Observed Treatment decreased by more than half in 2020, especially when compared to 2019. CONCLUSIONS: In view of these findings, the influence of COVID-19 on the diagnosis and monitoring of drug-resistant and general pulmonary TB cases is evident, showing that the pandemic has compromised the advances of recent decades in achieving the goals established for its eradication by 2035.

Background: Public health surveillance data do not always capture all cases, due in part to test availability and health care seeking behaviour. Our study aimed to estimate under-ascertainment multipliers for each step in the reporting chain for COVID-19 in Toronto, Canada. Design and methods: We applied stochastic modeling to estimate these proportions for the period from March 2020 (the beginning of the pandemic) through to May 23, 2020, and for three distinct windows with different laboratory testing criteria within this period. Results: For each laboratory-confirmed symptomatic case reported to Toronto Public Health during the entire period, the estimated number of COVID-19 infections in the community was 18 (5th and 95th percentile: 12, 29). The factor most associated with under-reporting was the proportion of those who sought care that received a test. Conclusions: Public health officials should use improved estimates to better understand the burden of COVID-19 and other similar infections.

Dengue is a public health issue in tropical south-eastern Asia responsible for significant morbidity and mortality. Informationon dengue epidemiology is necessary for developing strategies to control infections effectively. In the Lao People’s DemocraticRepublic (Lao PDR), Champasak and Savannakhet provinces account for around 30% of the national dengue burden. Inthis study, the dengue epidemiological profile in these two southern provinces of Lao PDR was described by analysingseasonal and spatial dengue notification data from 2003–2020 using the long-term mean (LTM) method. Savannakhet hada higher LTM (132.0 cases/month, 95% confidence interval [Cl]: 92.2–171.7) than Champasak (113.3 cases/month, 95%CI: 86.0–140.5), with peaks in dengue notifications following the rainy season in both provinces. The highest notificationrates were observed in July to September; these months were also when the LTM was most frequently exceeded. Previously,dengue notifications were largely confined to the western districts of Savannakhet and the northern districts of Champasak,but more recently, notifications have increased in the eastern districts of Savannakhet and southern districts of Champasak.While the notification rate remained high in children and young adults (5–30 years), especially among students and farmers,a shift in the age structure of dengue cases was observed, with a greater proportion of notifications now occurring in thoseaged over 30 years. Community-based vector control and prevention programmes are needed to restrict the spread of dengueinto new geographical areas in the southern provinces of Lao PDR.

Dengue is a public health issue in tropical south-eastern Asia responsible for significant morbidity and mortality. Informationon dengue epidemiology is necessary for developing strategies to control infections effectively. In the Lao People’s DemocraticRepublic (Lao PDR), Champasak and Savannakhet provinces account for around 30% of the national dengue burden. Inthis study, the dengue epidemiological profile in these two southern provinces of Lao PDR was described by analysingseasonal and spatial dengue notification data from 2003–2020 using the long-term mean (LTM) method. Savannakhet hada higher LTM (132.0 cases/month, 95% confidence interval [Cl]: 92.2–171.7) than Champasak (113.3 cases/month, 95%CI: 86.0–140.5), with peaks in dengue notifications following the rainy season in both provinces. The highest notificationrates were observed in July to September; these months were also when the LTM was most frequently exceeded. Previously,dengue notifications were largely confined to the western districts of Savannakhet and the northern districts of Champasak,but more recently, notifications have increased in the eastern districts of Savannakhet and southern districts of Champasak.While the notification rate remained high in children and young adults (5–30 years), especially among students and farmers,a shift in the age structure of dengue cases was observed, with a greater proportion of notifications now occurring in thoseaged over 30 years. Community-based vector control and prevention programmes are needed to restrict the spread of dengueinto new geographical areas in the southern provinces of Lao PDR.

Dengue is a public health issue in tropical south-eastern Asia responsible for significant morbidity and mortality. Informationon dengue epidemiology is necessary for developing strategies to control infections effectively. In the Lao People’s DemocraticRepublic (Lao PDR), Champasak and Savannakhet provinces account for around 30% of the national dengue burden. Inthis study, the dengue epidemiological profile in these two southern provinces of Lao PDR was described by analysingseasonal and spatial dengue notification data from 2003–2020 using the long-term mean (LTM) method. Savannakhet hada higher LTM (132.0 cases/month, 95% confidence interval [Cl]: 92.2–171.7) than Champasak (113.3 cases/month, 95%CI: 86.0–140.5), with peaks in dengue notifications following the rainy season in both provinces. The highest notificationrates were observed in July to September; these months were also when the LTM was most frequently exceeded. Previously,dengue notifications were largely confined to the western districts of Savannakhet and the northern districts of Champasak,but more recently, notifications have increased in the eastern districts of Savannakhet and southern districts of Champasak.While the notification rate remained high in children and young adults (5–30 years), especially among students and farmers,a shift in the age structure of dengue cases was observed, with a greater proportion of notifications now occurring in thoseaged over 30 years. Community-based vector control and prevention programmes are needed to restrict the spread of dengueinto new geographical areas in the southern provinces of Lao PDR.

ObjectivesToward common methods for system monitoring and evaluation, we proposed a key performance indicator framework and discussed lessons learned while implementing a statewide exposure notification (EN) system in California during the COVID-19 epidemic.Materials and methodsCalifornia deployed the Google Apple Exposure Notification framework, branded CA Notify, on December 10, 2020, to supplement traditional COVID-19 contact tracing programs. For system evaluation, we defined 6 key performance indicators: adoption, retention, sharing of unique codes, identification of potential contacts, behavior change, and impact. We aggregated and analyzed data from December 10, 2020, to July 1, 2021, in compliance with the CA Notify privacy policy.ResultsWe estimated CA Notify adoption at nearly 11 million smartphone activations during the study period. Among 1 654 201 CA Notify users who received a positive test result for SARS-CoV-2, 446 634 (27%) shared their unique code, leading to ENs for other CA Notify users who were in close proximity to the SARS-CoV-2-positive individual. We identified at least 122 970 CA Notify users as contacts through this process. Contact identification occurred a median of 4 days after symptom onset or specimen collection date of the user who received a positive test result for SARS-CoV-2.Practice implicationsSmartphone-based EN systems are promising new tools to supplement traditional contact tracing and public health interventions, particularly when efficient scaling is not feasible for other approaches. Methods to collect and interpret appropriate measures of system performance must be refined while maintaining trust and privacy.

Dengue is a public health issue in tropical south-eastern Asia responsible for significant morbidity and mortality. Informationon dengue epidemiology is necessary for developing strategies to control infections effectively. In the Lao People’s DemocraticRepublic (Lao PDR), Champasak and Savannakhet provinces account for around 30% of the national dengue burden. Inthis study, the dengue epidemiological profile in these two southern provinces of Lao PDR was described by analysingseasonal and spatial dengue notification data from 2003–2020 using the long-term mean (LTM) method. Savannakhet hada higher LTM (132.0 cases/month, 95% confidence interval [Cl]: 92.2–171.7) than Champasak (113.3 cases/month, 95%CI: 86.0–140.5), with peaks in dengue notifications following the rainy season in both provinces. The highest notificationrates were observed in July to September; these months were also when the LTM was most frequently exceeded. Previously,dengue notifications were largely confined to the western districts of Savannakhet and the northern districts of Champasak,but more recently, notifications have increased in the eastern districts of Savannakhet and southern districts of Champasak.While the notification rate remained high in children and young adults (5–30 years), especially among students and farmers,a shift in the age structure of dengue cases was observed, with a greater proportion of notifications now occurring in thoseaged over 30 years. Community-based vector control and prevention programmes are needed to restrict the spread of dengueinto new geographical areas in the southern provinces of Lao PDR.

Dengue is a public health issue in tropical south-eastern Asia responsible for significant morbidity and mortality. Informationon dengue epidemiology is necessary for developing strategies to control infections effectively. In the Lao People’s DemocraticRepublic (Lao PDR), Champasak and Savannakhet provinces account for around 30% of the national dengue burden. Inthis study, the dengue epidemiological profile in these two southern provinces of Lao PDR was described by analysingseasonal and spatial dengue notification data from 2003–2020 using the long-term mean (LTM) method. Savannakhet hada higher LTM (132.0 cases/month, 95% confidence interval [Cl]: 92.2–171.7) than Champasak (113.3 cases/month, 95%CI: 86.0–140.5), with peaks in dengue notifications following the rainy season in both provinces. The highest notificationrates were observed in July to September; these months were also when the LTM was most frequently exceeded. Previously,dengue notifications were largely confined to the western districts of Savannakhet and the northern districts of Champasak,but more recently, notifications have increased in the eastern districts of Savannakhet and southern districts of Champasak.While the notification rate remained high in children and young adults (5–30 years), especially among students and farmers,a shift in the age structure of dengue cases was observed, with a greater proportion of notifications now occurring in thoseaged over 30 years. Community-based vector control and prevention programmes are needed to restrict the spread of dengueinto new geographical areas in the southern provinces of Lao PDR.

BackgroundLeishmaniasis is a neglected tropical vector-borne disease, which is on the rise in Sri Lanka. Spatiotemporal and risk factor analyses are useful for understanding transmission dynamics, spatial clustering and predicting future disease distribution and trends to facilitate effective infection control.MethodsThe nationwide clinically confirmed cutaneous leishmaniasis and climatic data were collected from 2001 to 2019. Hierarchical clustering and spatiotemporal cross-correlation analysis were used to measure the region-wide and local (between neighboring districts) synchrony of transmission. A mixed spatiotemporal regression-autoregression model was built to study the effects of climatic, neighboring-district dispersal, and infection carryover variables on leishmaniasis dynamics and spatial distribution. Same model without climatic variables was used to predict the future distribution and trends of leishmaniasis cases in Sri Lanka.ResultsA total of 19,361 clinically confirmed leishmaniasis cases have been reported in Sri Lanka from 2001-2019. There were three phases identified: low-transmission phase (2001-2010), parasite population buildup phase (2011-2017), and outbreak phase (2018-2019). Spatially, the districts were divided into three groups based on similarity in temporal dynamics. The global mean correlation among district incidence dynamics was 0.30 (95% CI 0.25-0.35), and the localized mean correlation between neighboring districts was 0.58 (95% CI 0.42-0.73). Risk analysis for the seven districts with the highest incidence rates indicated that precipitation, neighboring-district effect, and infection carryover effect exhibited significant correlation with district-level incidence dynamics. Model-predicted incidence dynamics and case distribution matched well with observed results, except for the outbreak in 2018. The model-predicted 2020 case number is about 5,400 cases, with intensified transmission and expansion of high-transmission area. The pred

BackgroundWith its epicenter in Wuhan, China, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO). While many countries have implemented flight restrictions to China, an increasing number of cases with or without travel background to China are confirmed daily. These developments support concerns on possible unidentified and unreported international COVID-19 cases, which could lead to new local disease epicenters.MethodsWe have analyzed all available data on the development of international COVID-19 cases from January 20th, 2020 until February 18th, 2020. COVID-19 cases with and without travel history to China were divided into cohorts according to the Healthcare Access and Quality Index (HAQ-Index) of each country. Chi-square and Post-hoc testing were performed.ResultsWhile COVID-19 cases with travel history to China seem to peak for each HAQ-cohort, the number of non-travel related COVID-19 cases seem to continuously increase in the HAQ-cohort of countries with higher medical standards. Further analyses demonstrate a significantly lower proportion of reported COVID-19 cases without travel history to China in countries with lower HAQ (HAQ I vs. HAQ II, posthoc p < 0.01).ConclusionsOur data indicate that countries with lower HAQ-index may either underreport COVID-19 cases or are unable to adequately detect them. Although our data may be incomplete and must be interpreted with caution, inconsistencies in reporting COVID-19 cases is a serious problem which might sabotage efforts to contain the virus.

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

Burkina Faso has recently implemented an additional strategy, the free healthcare policy, to further improve maternal and child health. This policy targets children under five who bear the brunt of the malaria scourge. The effects of the free-of-charge healthcare were previously assessed in women but not in children. The present study aims at filling this gap by assessing the effect of this policy in children under five with a focus on the induced spatial and temporal changes in malaria morbidity. We used a Bayesian spatiotemporal negative binomial model to investigate the space-time variation in malaria incidence in relation to the implementation of the policy. The analysis relied on malaria routine surveillance data extracted from the national health data repository and spanning the period from January 2013 to December 2018. The model was adjusted for meteorological and contextual confounders. We found that the number of presumed and confirmed malaria cases per 1000 children per month increased between 2013 and 2018. We further found that the implementation of the free healthcare policy was significantly associated with a two-fold increase in the number of tested and confirmed malaria cases compared with the period before the policy rollout. This effect was, however, heterogeneous across the health districts. We attributed the rise in malaria incidence following the policy rollout to an increased use of health services combined with an increased availability of rapid tests and a higher compliance to the "test and treat" policy. The observed heterogeneity in the policy effect was attributed to parallel control interventions, some of which were rolled out at different paces and scales. Our findings call for a sustained and reinforced effort to test all suspected cases so that, alongside an improved case treatment, the true picture of the malaria scourge in children under five emerges clearly (see the hippopotamus almost entirely).

BackgroundWith its epicenter in Wuhan, China, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO). While many countries have implemented flight restrictions to China, an increasing number of cases with or without travel background to China are confirmed daily. These developments support concerns on possible unidentified and unreported international COVID-19 cases, which could lead to new local disease epicenters.MethodsWe have analyzed all available data on the development of international COVID-19 cases from January 20th, 2020 until February 18th, 2020. COVID-19 cases with and without travel history to China were divided into cohorts according to the Healthcare Access and Quality Index (HAQ-Index) of each country. Chi-square and Post-hoc testing were performed.ResultsWhile COVID-19 cases with travel history to China seem to peak for each HAQ-cohort, the number of non-travel related COVID-19 cases seem to continuously increase in the HAQ-cohort of countries with higher medical standards. Further analyses demonstrate a significantly lower proportion of reported COVID-19 cases without travel history to China in countries with lower HAQ (HAQ I vs. HAQ II, posthoc p < 0.01).ConclusionsOur data indicate that countries with lower HAQ-index may either underreport COVID-19 cases or are unable to adequately detect them. Although our data may be incomplete and must be interpreted with caution, inconsistencies in reporting COVID-19 cases is a serious problem which might sabotage efforts to contain the virus.

Introduction: the COVID-19 pandemic reached Santander on March 17, 2020. The first cases were imported and related, keeping a low occurrence in general, until the end of May. Since then the cases increased rapidly, consequence of the occupational flexibilization of mid-May and the lack of confinement since June 1. The objective of the study is to provide supplies to decision-makers to improve the response to the pandemic. Materials and methods: An analysis of the behavior of the COVID-19 pandemic in Santander was carried out, using data from official records and analysis of side effects from the public health perspective and a One Health approach. Results: the side effects of the pandemic that do not only affect the health sector are beginning to be evident. The consequences of the day without VAT (June 19) on the occurrence of infected people are still unknown. A preliminary evaluation of the government response in Santander suggests lack of preparation; It is evident the diminished capacity for surveillance in public health, field epidemiology and diagnostic capacity, inability to increase the number of intensive care units, inadequate communication with community, limited capacity for community action, and lack of clarity in intersectoral management of the various manifestations and side effects of the pandemic. Discussion: based on the analysis, in July 2020 the panorama of response to the pandemic is discouraging in Santander., Introducción: la pandemia de COVID-19 llegó al departamento de Santander el 17 de marzo de 2020; los primeros casos fueron importados y relacionados, manteniendo una baja ocurrencia generalizada hasta finales de mayo. Desde ese momento empiezan a aumentar los casos de manera rápida, consecuencia de la flexibilización laboral de mitad de mayo y el desconfinamiento desde el 1 de junio. Se tiene como objetivo generar un insumo a los tomadores de decisiones en el mejoramiento de la respuesta a la pandemia Materiales y métodos: se realizó un análisis del comportamiento de la pandemia por COVID-19 en Santander, a partir de datos de registros oficiales y análisis de efectos colaterales desde la visión de la salud pública y un enfoque de Una Salud. Resultados: Se comienzan a evidenciar los efectos colaterales de la pandemia que no afectan únicamente al sector salud. Aún no se conocen las consecuencias del día sin IVA (19 de junio) en la ocurrencia de infectados. Una evaluación preliminar de la respuesta gubernamental en Santander sugiere falta de preparación; es notoria la disminuida capacidad de vigilancia en salud pública, en epidemiología de campo y capacidad diagnóstica, incapacidad de aumentar el número de unidades de cuidado intensivo, inadecuada comunicación con la sociedad, limitada capacidad de acción de las comunidades y falta de claridad en el manejo intersectorial de las diversas manifestaciones y efectos colaterales de la pandemia. Discusión: con base en el análisis, a comienzos de julio 2020 el panorama de respuesta a la pandemia es desalentador en Santander.

The coronavirus disease pandemic was declared in March 2020, as the southern hemispheres winter approached. Australia expected co-circulation of severe acute respiratory syndrome coronavirus 2, influenza and other seasonal respiratory viruses. However, influenza notifications were 7,029 (March-September) compared with an average 149,832 for the same period in 2015-2019 [corrected], despite substantial testing. Restrictions on movement within and into Australia may have temporarily eliminated influenza. Other respiratory pathogens also showed remarkably changed activity in 2020.

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

Introduction: Public health surveillance together with good sanitary decisions is essential for the proper management of the SARS-CoV-2 pandemic.Objective: To compare the performance of Colombian departments based on the quality of the data and to build the national ranking.Materials and methods: We analyzed the accumulated cases published between March 6 and September 1, 2020, by the Instituto Nacional de Salud. To achieve comparability, the analyses considered the day the first case was diagnosed as the first analysis date for each department. The fulfillment of Benford’s law was assessed with p-values in the log-likelihood ratio or chi-square tests. The analysis was completed with the lethality observed in each department and then the performance ranking was established.Results: Bogotá and Valle del Cauca had optimal public health surveillance performance all along. The data suggest that Antioquia, Nariño, and Tolima had good containment and adequate public health surveillance after the economic opening beginning on June 1, 2020.Conclusion: We obtained the ranking of the departments regarding the quality of public health surveillance data. The best five departments can be case studies to identify the elements associated with good performance., Introducción. La vigilancia en salud pública y las decisiones sanitarias recomendadas son fundamentales para el manejo adecuado de la pandemia de SARS-CoV-2.Objetivo. Hacer una evaluación comparativa del desempeño de los departamentos colombianos de este atributo del sistema de vigilancia con base en la calidad de los datos y construir la clasificación nacional según el desempeño.Materiales y métodos. Se analizaron los casos acumulados publicados por el Instituto Nacional de Salud entre el 6 de marzo y el 1° de septiembre de 2020. Para la comparación, los análisis consideraron el día en que se diagnosticó el primer caso como la primera fecha de análisis de cada departamento. El cumplimiento de la ley de Benford se evaluó con los valores de p en las pruebas de razón del logaritmo de la verosimilitud o ji al cuadrado. Se completó el análisis del atributo de calidad del dato con la letalidad observada en cada departamento, y se estableció la clasificación según el desempeño.Resultados. La ciudad de Bogotá y el departamento del Valle del Cauca tuvieron un desempeño óptimo en la vigilancia en salud pública durante todo el periodo observado. Los datos sugieren que los departamentos de Antioquia, Nariño y Tolima tuvieron una buena contención y una adecuada vigilancia en salud pública después de la apertura económica iniciada el 1° de junio de 2020.Conclusión. Se obtuvo una clasificación de los departamentos y de Bogotá según la calidad de los datos de vigilancia en salud pública. Los mejores cinco entes territoriales pueden ser casos de estudio para determinar los elementos asociados con el buen desempeño.

Introduction: The COVID pandemic is a challenge for public health surveillance and an opportunity to assess its strengths and weaknesses to improve the response.Objective: To evaluate the performance of the Colombian public health surveillance system during the first 50 days of the COVID-19 pandemic in the country.Materials and methods: We analyzed the data published between March 6 and April 24, 2020, by the Instituto Nacional de Salud and the World Health Organization (WHO).We evaluated: i) the quality of the data according to the fulfillment of Benford’s law, and ii) the timeliness of the information measured as the difference in dates between the data generated by the Instituto Nacional de Salud and WHO’s situational reports. We assessed the fulfillment of Benford’s law using the p values of the log-likelihood ratio, the chi square or Moreno’s exact tests.Results: Until April 24 there were 4,881 cases of COVID-19 in Colombia. During most of the first 50 days of the pandemic, Benford’s law was fulfilled except the first days of the epidemic. The difference between Instituto Nacional de Salud and WHO reports largely depends on the different reporting times.Conclusion: In general, the Colombian public health surveillance system fulfilled Benford’s law suggesting that there was quality in the data. Future studies comparing the performance of the departments and districts will improve the diagnosis of the Colombian surveillance system., Introducción. La pandemia de COVID es un desafío para la vigilancia en salud pública y una oportunidad para evaluar sus fortalezas y debilidades en aras de mejorar la respuesta.Objetivo. Evaluar el desempeño del sistema de vigilancia en salud pública colombiano durante los primeros 50 días de la pandemia de COVID-19 en el país.Materiales y métodos. Se analizaron los datos publicados entre el 6 de marzo y el 24 de abril de 2020 por el Instituto Nacional de Salud y la Organización Mundial de Salud (OMS). Se consideraron en la evaluación: i) la calidad de los datos según la ley de Benford y ii) la oportunidad de la información, medida como la diferencia en fechas entre los datos generados en el Instituto Nacional de Salud y los recogidos en el informe situacional de la OMS. La variabilidad en el cumplimiento de la ley de Benford se evaluó con los valores de p en las pruebas de razón del logaritmo de la verosimilitud, ji al cuadrado o exacta de Moreno.Resultados. Hasta el 24 de abril hubo 4.881 casos de COVID-19 en Colombia. En la mayoría de los primeros 50 días se cumplió la ley de Benford, excepto en los primeros días de la epidemia. La diferencia entre los informes del Instituto Nacional de Salud y la OMS ha dependido, en gran medida, de la diferencia en los horarios de cierre de la información.Conclusión. En general, el sistema de vigilancia en salud pública colombiano cumplió con la ley de Benford, lo cual sugiere que hubo calidad en los datos. En futuros estudios que comparen el desempeño de los departamentos y distritos se podrá mejorar el diagnóstico de la vigilancia en salud pública del país.

BACKGROUND:Dengue is the most prevalent mosquito-borne disease in the world, with China affected seriously in recent years. 65.8% of dengue cases identified in mainland China since 2005 were reported from the city of Guangzhou. METHODS:In this study, we described the incidence rate and distribution of dengue cases using data collected form National Notifiable Infectious Disease Reporting Information System data in Guangzhou for 2001 to 2016. All dengue cases were investigated using standardized questionnaire. RESULTS:A total of 42,469 dengue cases were reported, with an average annual incidence rate of 20.99 per 100,000 resident population. Over this time period, the incidence rate of indigenous cases increased. Dengue affected areas also expanded sharply geographically from 58.1% of communities affected during 2001-2005 to 96.4% of communities affected in 2011-2016. Overall 95.30% of the overseas imported cases were reported during March and December, while 99.79% of indigenous cases were reported during July and November. All four dengue virus serotypes were identified both in imported cases and indigenous cases. The Aedes albopictus mosquito was the only vector for dengue transmission in the area. CONCLUSIONS:Guangzhou has become the dengue epicenter in mainland China. Control strategies for dengue should be adjusted to the epidemiological characteristics above and intensive study need to be conducted to explore the factors that driving the rapid increase of dengue.

Background: Gonorrhoea is usually managed in community sexual health or general practice, but a proportion of cases present to hospital settings. In this study, we examined how gonorrhoea was managed through a large hospital network and what the implications may be for public health management. Method(s): A retrospective chart review was performed of the management of patients with Neisseria gonorrhoeae infection diagnosed at a large Australian healthcare network from January 2015 to May 2018. Documentation rates of five parameters of care were assessed: (1) the presence (or absence) of previous sexually transmissible infections (STIs); (2) recent travel; (3) discussion of HIV testing; (4) contact tracing; and (5) public health notification. Result(s): In all, 110 cases (48 male, 62 female) were analysed. Most cases were in the 15-39 years age group; 98 cases (89%) were symptomatic, and 12 (11%) were screening tests. The most common presenting syndromes were pelvic inflammatory disease (32%; 31/98 symptomatic cases), urethritis (26%; 25/98) and epididymo-orchitis (13%; 13/98). None of the five parameters assessed were documented in most cases. Documentation was most likely to occur in patients admitted to hospital. When HIV testing was performed, no new cases of HIV were identified. Conclusion(s): Infections with gonorrhoea present on a regular basis to hospital practice, but overall management is suboptimal. Automated prompts for other recommended tests, including HIV testing when testing for other sexually transmissible diseases is ordered, may improve management. Better awareness of best practice is needed, which can be facilitated with ongoing education. However, the greatest benefit is likely achieved by linking patients back to community-based services, which are best placed to provide ongoing long-term care.Copyright © CSIRO 2019 Open Access.

Background: Gonorrhoea is usually managed in community sexual health or general practice, but a proportion of cases present to hospital settings. In this study, we examined how gonorrhoea was managed through a large hospital network and what the implications may be for public health management. Method(s): A retrospective chart review was performed of the management of patients with Neisseria gonorrhoeae infection diagnosed at a large Australian healthcare network from January 2015 to May 2018. Documentation rates of five parameters of care were assessed: (1) the presence (or absence) of previous sexually transmissible infections (STIs); (2) recent travel; (3) discussion of HIV testing; (4) contact tracing; and (5) public health notification. Result(s): In all, 110 cases (48 male, 62 female) were analysed. Most cases were in the 15-39 years age group; 98 cases (89%) were symptomatic, and 12 (11%) were screening tests. The most common presenting syndromes were pelvic inflammatory disease (32%; 31/98 symptomatic cases), urethritis (26%; 25/98) and epididymo-orchitis (13%; 13/98). None of the five parameters assessed were documented in most cases. Documentation was most likely to occur in patients admitted to hospital. When HIV testing was performed, no new cases of HIV were identified. Conclusion(s): Infections with gonorrhoea present on a regular basis to hospital practice, but overall management is suboptimal. Automated prompts for other recommended tests, including HIV testing when testing for other sexually transmissible diseases is ordered, may improve management. Better awareness of best practice is needed, which can be facilitated with ongoing education. However, the greatest benefit is likely achieved by linking patients back to community-based services, which are best placed to provide ongoing long-term care.Copyright © CSIRO 2019 Open Access.

An HIV diagnosis may be associated with severe emotional and psychological distress, which can contribute to delays in care or poor self-management. Few studies have explored the emotional, psychological, and psychosocial impacts of an HIV diagnosis on women in low-resource settings. We conducted in-depth interviews with 30 women living with HIV in the Dominican Republic. Interviews were audio-recorded, transcribed, and analyzed using the biographical disruption framework. Three disruption phases emerged (impacts of a diagnosis, postdiagnosis turning points, and integration). Nearly all respondents described the news as deeply distressful and feelings of depression and loss of self-worth were common. Several reported struggling with the decision to disclose-worrying about stigma. Postdiagnosis turning points consisted of a focus on survival and motherhood; social support (family members, friends, HIV community) promoted integration. The findings suggest a need for psychological resources and social support interventions to mitigate the negative impacts of an HIV diagnosis.

BACKGROUND:Dengue is the most prevalent mosquito-borne disease in the world, with China affected seriously in recent years. 65.8% of dengue cases identified in mainland China since 2005 were reported from the city of Guangzhou. METHODS:In this study, we described the incidence rate and distribution of dengue cases using data collected form National Notifiable Infectious Disease Reporting Information System data in Guangzhou for 2001 to 2016. All dengue cases were investigated using standardized questionnaire. RESULTS:A total of 42,469 dengue cases were reported, with an average annual incidence rate of 20.99 per 100,000 resident population. Over this time period, the incidence rate of indigenous cases increased. Dengue affected areas also expanded sharply geographically from 58.1% of communities affected during 2001-2005 to 96.4% of communities affected in 2011-2016. Overall 95.30% of the overseas imported cases were reported during March and December, while 99.79% of indigenous cases were reported during July and November. All four dengue virus serotypes were identified both in imported cases and indigenous cases. The Aedes albopictus mosquito was the only vector for dengue transmission in the area. CONCLUSIONS:Guangzhou has become the dengue epicenter in mainland China. Control strategies for dengue should be adjusted to the epidemiological characteristics above and intensive study need to be conducted to explore the factors that driving the rapid increase of dengue.

An HIV diagnosis may be associated with severe emotional and psychological distress, which can contribute to delays in care or poor self-management. Few studies have explored the emotional, psychological, and psychosocial impacts of an HIV diagnosis on women in low-resource settings. We conducted in-depth interviews with 30 women living with HIV in the Dominican Republic. Interviews were audio-recorded, transcribed, and analyzed using the biographical disruption framework. Three disruption phases emerged (impacts of a diagnosis, postdiagnosis turning points, and integration). Nearly all respondents described the news as deeply distressful and feelings of depression and loss of self-worth were common. Several reported struggling with the decision to disclose-worrying about stigma. Postdiagnosis turning points consisted of a focus on survival and motherhood; social support (family members, friends, HIV community) promoted integration. The findings suggest a need for psychological resources and social support interventions to mitigate the negative impacts of an HIV diagnosis.

Background: The partner notification is one of the main activities of epidemiological surveillance in Public Health. The primary objective was to estimate the compliance of the partner notification by health professionals who reported sexually transmitted diseases (HIV, Gonorrhoea, Syphilis and Chlamydia) during 2017 in Lleida’s regions. Methods: We carried out a descriptive epidemiological study of prevalence about the compliance of partner notification. Data collection was done by epidemiological surveys of these notifiable diseases and additional information was recovered through medical record and interview with professionals. The factors associated with the lack of partner notification were studied through the odds ratio (OR) and its 95% confidence interval (CI). ORs were adjusted (ORa) with multivariate logistic regression models. Results: We studied 203 STD cases with an average age of 30.6 years (SD=11.1); 32.5% were women. There was 46.3% without partner notification. The main cause of this absence was the lack of patient cooperation (23.4%). The variables associated with the lack of partner notification were the male sex (aOR-3.5; CI95%=1.6–7.5), gonococcal infection (aOR-4.9; CI95%=1.2- 19.8), chlamydia infection (aOR-3.9; CI95%=0.9- 16.1) and homosexual/bisexual sexual orientation (aOR-2.2; CI95%=0.9-5.4). Conclusions: Compliance of partner notification is low and it is related to male sex, sexual orientation (homosexual/bisexual/transsexual) and type of infection (Gonorrhoea and Chlamydia). Reducing the social stigma associated with sexual orientation and improving the information of health professionals could favour the contact studies., Fundamentos: El estudio de contactos constituye una de las principales actividades de vigilancia epidemiológica en salud pública. El objetivo principal de este estudio fue estimar el grado de su cumplimiento por parte de los profesionales que informaron sobre las infecciones de transmisión sexual (VIH/gonococia/sífilis/clamidia) en el año 2017 en las comarcas de Lleida. Métodos: Se realizó un estudio descriptivo de prevalencia sobre el cumplimiento del estudio de contactos. Se recogió la información de las encuestas epidemiológicas de las enfermedades citadas y se recuperó información de la realización del estudio de contactos mediante las historias clínicas y el contacto con los profesionales. Se estudiaron los factores asociados a la falta de estudio de contactos mediante un modelo multivariado de regresión logística y el cálculo de la odds ratio ajustada (ORa), con sus intervalos de confianza (IC) del 95%. Resultados: Se estudiaron 203 casos de ITS, con una edad media de 30,6 años (±11,1). El 32,5% eran mujeres. El porcentaje de casos diagnosticados sin estudio de contactos fue del 46,3%, causado principalmente por la falta de colaboración del paciente (23,4%). Las variables asociadas a la falta de estudio de contactos fueron el sexo masculino (ORa=3,5; IC95%=1,6–7,5), la infección gonocócica (ORa=4,9; IC95%=1,2-19,8), la infección por clamidia (ORa=3,9; IC95%=0,9-16,1) y la orientación sexual homosexual/bisexual (ORa=2,2; IC 95%=0,9-5,4). Conclusiones: El cumplimiento de los estudios de contactos es bajo y se relaciona con el sexo masculino, la orientación sexual (homosexual/bisexual) y el tipo de infección (gonococia/clamidia). Reducir el estigma asociado a la orientación sexual y mejorar la información de los profesionales podría favorecer su correcto cumplimiento.

BACKGROUND: Dengue is the most prevalent mosquito-borne disease in the world, with China affected seriously in recent years. 65.8% of dengue cases identified in mainland China since 2005 were reported from the city of Guangzhou. METHODS: In this study, we described the incidence rate and distribution of dengue cases using data collected form National Notifiable Infectious Disease Reporting Information System data in Guangzhou for 2001 to 2016. All dengue cases were investigated using standardized questionnaire. RESULTS: A total of 42,469 dengue cases were reported, with an average annual incidence rate of 20.99 per 100,000 resident population. Over this time period, the incidence rate of indigenous cases increased. Dengue affected areas also expanded sharply geographically from 58.1% of communities affected during 2001-2005 to 96.4% of communities affected in 2011-2016. Overall 95.30% of the overseas imported cases were reported during March and December, while 99.79% of indigenous cases were reported during July and November. All four dengue virus serotypes were identified both in imported cases and indigenous cases. The Aedes albopictus mosquito was the only vector for dengue transmission in the area. CONCLUSIONS: Guangzhou has become the dengue epicenter in mainland China. Control strategies for dengue should be adjusted to the epidemiological characteristics above and intensive study need to be conducted to explore the factors that driving the rapid increase of dengue.

BackgroundInterseasonal influenza outbreaks are not unusual in countries with temperate climates and well-defined influenza seasons. Usually, these are small and diminish before the main influenza season begins. However, the 2018/19 summer-autumn interseasonal influenza period in Australia saw unprecedented large and widespread influenza outbreaks.AimOur objective was to determine the extent of the intense 2018/19 interseasonal influenza outbreaks in Australia epidemiologically and examine the genetic, antigenic and structural properties of the viruses responsible for these outbreaks.MethodsThis observational study combined the epidemiological and virological surveillance data obtained from the Australian Government Department of Health, the New South Wales Ministry of Health, sentinel outpatient surveillance, public health laboratories and data generated by the World Health Organization Collaborating Centre for Reference and Research on Influenza in Melbourne and the Singapore Agency for Science, Technology and Research.ResultsThere was a record number of laboratory-confirmed influenza cases during the interseasonal period November 2018 to May 2019 (n= 85,286; 5 times the previous 3-year average) and also more institutional outbreaks, hospitalisations and deaths, than what is normally seen.ConclusionsThe unusually large interseasonal influenza outbreaks in 2018/19 followed a mild 2018 influenza season and resulted in a very early start to the 2019 influenza season across Australia. The reasons for this unusual event have yet to be fully elucidated but are likely to be a complex mix of climatic, virological and host immunity-related factors. These outbreaks reinforce the need for year-round surveillance of influenza, even in temperate climates with strong seasonality patterns.

Introduction: Infectious disease (ID) is an ongoing problem worldwide. In order to manage this problem, it is important to have an integrated and effective surveillance system that can be used to estimate the burden of ID. There is a scarcity of studies published on the prevalence of IDs in the United Arab Emirates (UAE), both in hospital settings and in the community. Infectious Intestinal Disease (IIDs) have been one of the most commonest IDs that have been studied in the community around the world, there are no studies on the prevalence of IIDs in Ras Al Khaimah (RAK). Furthermore, while the UAE is a member state of the World Health Organization (WHO) Eastern Mediterranean Region that is working toward a plan to fulfil the implementation of the International Health Regulations, and has in recent years started developing surveillance systems for several IDs, there are no publications describing or assessing these systems. Aims: The aim of this study is to estimate the burden of IIDs in the community and to describe the surveillance system in the emirate of RAK. Method: In the first part of this research, a population-based cross-sectional study design using a telephone-based questionnaire was used to estimate IIDs in a representative sample of the RAK population (N= 1254; 57.3% males; 25.2 % below 18 years) from all age groups. Participants completed the questionnaire collecting the sociodemographic characteristics and information about IIDs during the four-week period prior to the telephone interview. The second part of this study was a descriptive scoping assessment of the core activities and supportive functions of the ID surveillance system in government health institutions in RAK based on the WHO guidelines.\ Results: Overall prevalence of IIDs was 4.2% in the four weeks prior to the interview. Multivariate logistic regression analysis identified that being female (odds ratio (OR) 2.43, 95% confidence interval (CI) 1.16-5.07) an

Gonorrhoea, a condition on the rise, is associated with high morbidity, and the possibility of reproductive sequelae has become a public health problem in Denmark. It is important to perform swabs for gonorrhoea from all relevant anatomical locations, whether or not there are symptoms. Through complete microbiological diagnostics, treatment with recommended antibiotics and partner detection, infection chains can be broken. Whole-genome sequencing in real time will identify outbreaks in high-risk populations.

BackgroundTB patients co-infected with HIV have worse treatment outcomes than non-coinfected patients. How clinical characteristics of TB and socioeconomic characteristics influence these outcomes is poorly understood. Here, we use polytomous regression analysis to identify clinical and epidemiological characteristics associated with unfavorable treatment outcomes among TB-HIV co-infected patients in Brazil.MethodsTB-HIV cases reported in the Brazilian information system (SINAN) between January 1, 2001 and December 31, 2011 were identified and categorized by TB treatment outcome (cure, default, death, and development of MDR TB). We modeled treatment outcome as a function of clinical characteristics of TB and patient socioeconomic characteristics by polytomous regression analysis. For each treatment outcome, we used cure as the reference outcome.ResultsBetween 2001 and 2011, 990,017 cases of TB were reported in SINAN, of which 93,147 (9.4%) were HIV co-infected. Patients aged 15-19 (OR=2.86; 95% CI: 2.09-3.91) and 20-39 years old (OR=2.30; 95% CI: 1.81-2.92) were more likely to default on TB treatment than those aged 0-14 years old. In contrast, patients aged ≥60 years were more likely to die from TB (OR=2.22; 95% CI: 1.43-3.44) or other causes (OR=2.86; 95% CI: 2.14-3.83). Black patients were more likely to default on TB treatment (OR=1.33; 95% CI: 1.22-1.44) and die from TB (OR=1.50; 95% CI: 1.29-1.74). Finally, alcoholism was associated with all unfavorable outcomes: default (OR=1.94; 95% CI: 1.73-2.17), death due to TB (OR=1.46; 95% CI: 1.25-1.71), death due to other causes (OR=1.38; 95% CI: 1.21-1.57) and MDR-TB (OR=2.29; 95% CI: 1.46-3.58).ConclusionsSocio-economic vulnerability has a significant effect on treatment outcomes among TB-HIV co-infected patients in Brazil. Enhancing social support, incorporation of alcohol abuse screening and counseling into current TB surveillance programs and targeting interventions to specific age groups are interventions that c

The primary aim of the Danish enterovirus (EV) surveillance system is to document absence of poliovirus infection. The conflict in Syria has left many children unvaccinated and movement from areas with polio cases to Europe calls for increased awareness to detect and respond to virus-transmission in a timely manner. We evaluate the national EV laboratory surveillance, to generate recommendations for system strengthening. The system was analysed for completeness of viral typing analysis and clinical information and timeliness of specimen collection, laboratory results and reporting of clinical information. Of 23,720 specimens screened, 2,202 (9.3%) were EV-positive. Submission of cerebrospinal fluid and faecal specimens from primary diagnostic laboratories was 79.5% complete (845/1,063), and varied by laboratory and patient age. EV genotypes were determined in 68.5% (979/1,430) of laboratory-confirmed cases, clinical information was available for 63.1% (903/1,430). Primary diagnostic results were available after a median of 1.4 days, typing results after 17 days, detailed clinical information after 33 days. The large number of samples typed demonstrated continued monitoring of EV-circulation in Denmark. The system could be strengthened by increasing the collection of supplementary faecal specimens, improving communication with primary diagnostic laboratories, adapting the laboratory typing methodology and collecting clinical information with electronic forms.

Introduction: Dengue is the most widespread arbovirus worldwide. In Paraguay, it reappeared in 1988-1989, with one of the largest epidemic outbreaks occurring in 2011.Objective: To evaluate the performance of the dengue epidemiological surveillance system in Paraguay between 2009 and 2011.Materials and methods: We conducted an ecological study with secondary epidemiological surveillance data. We analyzed notified cases of the disease based on the distribution expected by Benford’s law. To this end, we used the first and second digits from the global records stratified by region, season, population density, indicators of housing conditions and heads of cattle.Results: The epidemiological surveillance system performed better during non-epidemic periods and in the states with better housing conditions and fewer heads of cattle.Conclusion: Given that a difference in the performance existed, we recommended that the system remains operating at the same high alert level even during periods when fewer cases are expected. The technology used by the method proposed to monitor the notification of cases is easy to transfer to operational staff., Introducción. El dengue es la principal arbovirosis en el mundo. En Paraguay reapareció en 1988-1989, y en el 2011 se produjo uno de los mayores brotes epidémicos.Objetivo. Evaluar el desempeño del sistema de vigilancia epidemiológica del dengue en Paraguay entre 2009 y 2011.Materiales y métodos. Se hizo un estudio ecológico basado en datos secundarios de la vigilancia epidemiológica. Con base en la distribución esperada según la ley de Benford, se analizaron los casos notificados de la enfermedad; para tal fin, se usaron los primeros y segundos dígitos de los registros globales y estratificados por regiones, estaciones, densidad poblacional, indicadores de las condiciones de la vivienda y número de cabezas de ganado bovino.Resultados. El sistema de vigilancia epidemiológica se desempeñó mejor durante los periodos no epidémicos, y en los departamentos donde existen mejores condiciones de vivienda y pocas cabezas de ganado bovino.Conclusión. Dadas las diferencias de desempeño, se recomendó que el sistema mantenga la alerta incluso cuando no se espere un mayor número de casos. El método propuesto para evaluar la notificación de casos es fácil de transferir al personal operativo.

Introduction: The data regarding birth defects at local levels in developing countries like Colombia are scarce.Objective: To describe the profile of congenital abnormalities in the province of Risaralda, Colombia.Materials and methods: We included the information on infants with structural and functional abnormalities at birth between June, 2010, and December, 2013, from records of the Instituto Nacional de Salud, and compared it with those of children born in the same period in a local clinic participating in the Collaborative Study of Congenital Malformations. We analyzed the data using Stata 10®.Results: We found a prevalence of nine defects per 1,000 newborns from the total live births in Risaralda. The local clinic registered in the Collaborative Study of Congenital Malformations registered a prevalence of 34 defects per 1,000 births. Most frequent defects were heart defects, followed by cleft lip and palate, abdominal wall defects, skeletal dysplasia, hydrocephalus, polydactyly and Down syndrome.Conclusions: Having a baseline on the prevalence of congenital defects in Risaralda is very useful in the design of prevention policies oriented to decrease congenital defects incidence and severity. Inclusion of maternity hospitals in the Collaborative Study of Congenital Malformations strengthens national recording and reporting of birth defects., Introducción. Los datos sobre defectos congénitos en el ámbito regional de los países en desarrollo como Colombia son escasos.Objetivo. Describir la prevalencia de anomalías congénitas en el departamento de Risaralda, Colombia.Materiales y métodos. Se incluyeron los neonatos con defectos estructurales y funcionales entre junio de 2010 y diciembre de 2013, cuyos casos fueron notificados al Instituto Nacional de Salud por ser de interés en salud pública. Se compararon con los nacidos en el mismo periodo en una clínica de la región inscrita en el Estudio Colaborativo de Malformaciones Congénitas. Los datos se analizaron con el programa Stata 10®.Resultados. La prevalencia entre los nacidos vivos en el periodo de estudio fue de nueve casos por cada 1.000 recién nacidos en el departamento. En la clínica inscrita en el Estudio Colaborativo de Malformaciones Congénitas, se encontró una prevalencia de 34 casos por cada 1.000 nacimientos; el primer lugar lo ocuparon las cardiopatías, seguidas por el labio y paladar hendido, los defectos de la pared abdominal (no especificados), la displasia esquelética, la hidrocefalia, la polidactilia y el síndrome de Down.Conclusión. El establecimiento de una línea de base sobre la prevalencia de los defectos congénitos en Risaralda es de gran utilidad para la adopción de políticas preventivas que lleven a la disminución de la incidencia y de la gravedad de las discapacidades; la inclusión de los hospitales materno-infantiles en la red del Estudio Colaborativo de Malformaciones Congénitas mejora el registro nacional y la notificación de los defectos congénitos.

The growing field of digital disease detection, or epidemic intelligence, attempts to improve timely detection and awareness of infectious disease (ID) events. Early detection remains an important priority; thus, the next frontier for ID surveillance is to improve the recognition and monitoring of drivers (antecedent conditions) of ID emergence for signals that precede disease events. These data could help alert public health officials to indicators of elevated ID risk, thereby triggering targeted active surveillance and interventions. We believe that ID emergence risks can be anticipated through surveillance of their drivers, just as successful warning systems of climate-based, meteorologically sensitive diseases are supported by improved temperature and precipitation data. We present approaches to driver surveillance, gaps in the current literature, and a scientific framework for the creation of a digital warning system. Fulfilling the promise of driver surveillance will require concerted action to expand the collection of appropriate digital driver data.

Objectives Directly measuring disease incidence in a population is difficult and not feasible to do routinely. We describe the development and application of a new method of estimating at a population level the number of incident genital chlamydia infections, and the corresponding incidence rates, by age and sex using routine surveillance data. Methods A Bayesian statistical approach was developed to calibrate the parameters of a decision-pathway tree against national data on numbers of notifications and tests conducted (2001-2013). Independent beta probability density functions were adopted for priors on the time-independent parameters; the shape parameters of these beta distributions were chosen to match prior estimates sourced from peer-reviewed literature or expert opinion. To best facilitate the calibration, multivariate Gaussian priors on (the logistic transforms of) the time-dependent parameters were adopted, using the Matérn covariance function to favour changes over consecutive years and across adjacent age cohorts. The model outcomes were validated by comparing them with other independent empirical epidemiological measures i.e. prevalence and incidence as reported by other studies. Results Model-based estimates suggest that the total number of people acquiring chlamydia per year in Australia has increased by ~120% over 12 years. Nationally, an estimated 356,000 people acquired chlamydia in 2013, which is 4.3 times the number of reported diagnoses. This corresponded to a chlamydia annual incidence estimate of 1.54% in 2013, increased from 0.81% in 2001 (~90% increase). Conclusions We developed a statistical method which uses routine surveillance (notifications and testing) data to produce estimates of the extent and trends in chlamydia incidence.

The growing field of digital disease detection, or epidemic intelligence, attempts to improve timely detection and awareness of infectious disease (ID) events. Early detection remains an important priority; thus, the next frontier for ID surveillance is to improve the recognition and monitoring of drivers (antecedent conditions) of ID emergence for signals that precede disease events. These data could help alert public health officials to indicators of elevated ID risk, thereby triggering targeted active surveillance and interventions. We believe that ID emergence risks can be anticipated through surveillance of their drivers, just as successful warning systems of climate-based, meteorologically sensitive diseases are supported by improved temperature and precipitation data. We present approaches to driver surveillance, gaps in the current literature, and a scientific framework for the creation of a digital warning system. Fulfilling the promise of driver surveillance will require concerted action to expand the collection of appropriate digital driver data.

Periodic assessment of surveillance systems is recommended to verify whether they are appropriately monitoring the public health problem under surveillance. The aim of this study was to evaluate timeliness, data quality and representativeness of data reported to the Italian Integrated Epidemiological System for Acute Viral Hepatitis (SEIEVA).

US state and territorial laws were reviewed to identify Clostridium difficile infection reporting mandates. Twenty states require reporting either under state law or by incorporating federal Centers for Medicare & Medicaid Services' reporting requirements. Although state law mandates are more common, the incorporation of federal reporting requirements has been increasing.

Background: Laboratory- confirmed norovirus illness is reportable in Germany since 2001. Reported case numbers are known to be undercounts, and a valid estimate of the actual incidence in Germany does not exist. An increase of reported norovirus illness was observed simultaneously to a large outbreak of Shiga toxin-producing E. coli O104: H4 in Germany in 2011 - likely due to enhanced (but not complete) awareness of diarrhoea at that time. We aimed at estimating age- and sex-specific factors of that excess, which should be interpretable as (minimal) under-reporting factors of norovirus illness in Germany. Methods: We used national reporting data on laboratory-confirmed norovirus illness in Germany from calendar week 31 in 2003 through calendar week 30 in 2012. A negative binomial time series regression model was used to describe the weekly counts in 8.2 age- sex strata while adjusting for secular trend and seasonality. Overall as well as age- and sex- specific factors for the excess were estimated by including additional terms (either an O104: H4 outbreak period indicator or a triple interaction term between outbreak period, age and sex) in the model. Results: We estimated the overall under- reporting factor to be 1.76 (95% Cl 1.28- 2.41) for the first three weeks of the outbreak before the outbreak vehicle was publicly communicated. Highest under-reporting factors were here estimated for 20- 29 year-old males (2.88, 95% Cl 2.01- 4.11) and females (2.67, 95% Cl 1.87- 3.79). Under-reporting was substantially lower in persons aged < 10 years and 70 years or older. Conclusions: These are the first estimates of (minimal) under- reporting factors for norovirus illness in Germany. They provide a starting point for a more detailed investigation of the relationship between actual incidence and reporting incidence of norovirus illness in Germany., AuthorCount:3

Background: Laboratory- confirmed norovirus illness is reportable in Germany since 2001. Reported case numbers are known to be undercounts, and a valid estimate of the actual incidence in Germany does not exist. An increase of reported norovirus illness was observed simultaneously to a large outbreak of Shiga toxin-producing E. coli O104: H4 in Germany in 2011 - likely due to enhanced (but not complete) awareness of diarrhoea at that time. We aimed at estimating age- and sex-specific factors of that excess, which should be interpretable as (minimal) under-reporting factors of norovirus illness in Germany. Methods: We used national reporting data on laboratory-confirmed norovirus illness in Germany from calendar week 31 in 2003 through calendar week 30 in 2012. A negative binomial time series regression model was used to describe the weekly counts in 8.2 age- sex strata while adjusting for secular trend and seasonality. Overall as well as age- and sex- specific factors for the excess were estimated by including additional terms (either an O104: H4 outbreak period indicator or a triple interaction term between outbreak period, age and sex) in the model. Results: We estimated the overall under- reporting factor to be 1.76 (95% Cl 1.28- 2.41) for the first three weeks of the outbreak before the outbreak vehicle was publicly communicated. Highest under-reporting factors were here estimated for 20- 29 year-old males (2.88, 95% Cl 2.01- 4.11) and females (2.67, 95% Cl 1.87- 3.79). Under-reporting was substantially lower in persons aged < 10 years and 70 years or older. Conclusions: These are the first estimates of (minimal) under- reporting factors for norovirus illness in Germany. They provide a starting point for a more detailed investigation of the relationship between actual incidence and reporting incidence of norovirus illness in Germany., AuthorCount:3

Background: Laboratory- confirmed norovirus illness is reportable in Germany since 2001. Reported case numbers are known to be undercounts, and a valid estimate of the actual incidence in Germany does not exist. An increase of reported norovirus illness was observed simultaneously to a large outbreak of Shiga toxin-producing E. coli O104: H4 in Germany in 2011 - likely due to enhanced (but not complete) awareness of diarrhoea at that time. We aimed at estimating age- and sex-specific factors of that excess, which should be interpretable as (minimal) under-reporting factors of norovirus illness in Germany. Methods: We used national reporting data on laboratory-confirmed norovirus illness in Germany from calendar week 31 in 2003 through calendar week 30 in 2012. A negative binomial time series regression model was used to describe the weekly counts in 8.2 age- sex strata while adjusting for secular trend and seasonality. Overall as well as age- and sex- specific factors for the excess were estimated by including additional terms (either an O104: H4 outbreak period indicator or a triple interaction term between outbreak period, age and sex) in the model. Results: We estimated the overall under- reporting factor to be 1.76 (95% Cl 1.28- 2.41) for the first three weeks of the outbreak before the outbreak vehicle was publicly communicated. Highest under-reporting factors were here estimated for 20- 29 year-old males (2.88, 95% Cl 2.01- 4.11) and females (2.67, 95% Cl 1.87- 3.79). Under-reporting was substantially lower in persons aged < 10 years and 70 years or older. Conclusions: These are the first estimates of (minimal) under- reporting factors for norovirus illness in Germany. They provide a starting point for a more detailed investigation of the relationship between actual incidence and reporting incidence of norovirus illness in Germany., AuthorCount:3

Background: Laboratory- confirmed norovirus illness is reportable in Germany since 2001. Reported case numbers are known to be undercounts, and a valid estimate of the actual incidence in Germany does not exist. An increase of reported norovirus illness was observed simultaneously to a large outbreak of Shiga toxin-producing E. coli O104: H4 in Germany in 2011 - likely due to enhanced (but not complete) awareness of diarrhoea at that time. We aimed at estimating age- and sex-specific factors of that excess, which should be interpretable as (minimal) under-reporting factors of norovirus illness in Germany. Methods: We used national reporting data on laboratory-confirmed norovirus illness in Germany from calendar week 31 in 2003 through calendar week 30 in 2012. A negative binomial time series regression model was used to describe the weekly counts in 8.2 age- sex strata while adjusting for secular trend and seasonality. Overall as well as age- and sex- specific factors for the excess were estimated by including additional terms (either an O104: H4 outbreak period indicator or a triple interaction term between outbreak period, age and sex) in the model. Results: We estimated the overall under- reporting factor to be 1.76 (95% Cl 1.28- 2.41) for the first three weeks of the outbreak before the outbreak vehicle was publicly communicated. Highest under-reporting factors were here estimated for 20- 29 year-old males (2.88, 95% Cl 2.01- 4.11) and females (2.67, 95% Cl 1.87- 3.79). Under-reporting was substantially lower in persons aged < 10 years and 70 years or older. Conclusions: These are the first estimates of (minimal) under- reporting factors for norovirus illness in Germany. They provide a starting point for a more detailed investigation of the relationship between actual incidence and reporting incidence of norovirus illness in Germany., AuthorCount:3

Background: Laboratory- confirmed norovirus illness is reportable in Germany since 2001. Reported case numbers are known to be undercounts, and a valid estimate of the actual incidence in Germany does not exist. An increase of reported norovirus illness was observed simultaneously to a large outbreak of Shiga toxin-producing E. coli O104: H4 in Germany in 2011 - likely due to enhanced (but not complete) awareness of diarrhoea at that time. We aimed at estimating age- and sex-specific factors of that excess, which should be interpretable as (minimal) under-reporting factors of norovirus illness in Germany. Methods: We used national reporting data on laboratory-confirmed norovirus illness in Germany from calendar week 31 in 2003 through calendar week 30 in 2012. A negative binomial time series regression model was used to describe the weekly counts in 8.2 age- sex strata while adjusting for secular trend and seasonality. Overall as well as age- and sex- specific factors for the excess were estimated by including additional terms (either an O104: H4 outbreak period indicator or a triple interaction term between outbreak period, age and sex) in the model. Results: We estimated the overall under- reporting factor to be 1.76 (95% Cl 1.28- 2.41) for the first three weeks of the outbreak before the outbreak vehicle was publicly communicated. Highest under-reporting factors were here estimated for 20- 29 year-old males (2.88, 95% Cl 2.01- 4.11) and females (2.67, 95% Cl 1.87- 3.79). Under-reporting was substantially lower in persons aged < 10 years and 70 years or older. Conclusions: These are the first estimates of (minimal) under- reporting factors for norovirus illness in Germany. They provide a starting point for a more detailed investigation of the relationship between actual incidence and reporting incidence of norovirus illness in Germany., AuthorCount:3

BackgroundPublic reporting of surgical site infections (SSIs) by hospitals is largely limited to infections detected during surgical hospitalizations or readmissions to the same facility. SSI rates may be underestimated if patients with SSIs are readmitted to other hospitals. We assessed the impact of readmissions to other facilities on hospitals' SSI rates following primary total hip arthroplasty (THA) or total knee arthroplasty (TKA).MethodsThis was a retrospective cohort study of all patients who underwent primary THA or TKA at California hospitals between 1 January 2006 and 31 December 2009. SSIs were identified using ICD-9-CM diagnosis codes predictive of SSI assigned at any California hospital within 365 days of surgery using a statewide repository of hospital data that allowed tracking of patients between facilities. We used statewide data to estimate the fraction of each hospital's THA and TKA SSIs identified at the operative hospital versus other hospitals.ResultsA total of 91 121 THA and 121 640 TKA procedures were identified. Based on diagnosis codes, SSIs developed following 2214 (2.3%) THAs and 2465 (2.0%) TKAs. Seventeen percent of SSIs would have been missed by operative hospital surveillance alone. The proportion of hospitals' SSIs detected at nonoperative hospitals ranged from 0% to 100%. Including SSIs detected at nonoperative hospitals resulted in better relative ranking for 61% of THA hospitals and 61% of TKA hospitals.ConclusionsLimiting SSI surveillance to the operative hospital caused varying degrees of SSI underestimation and substantially impacted hospitals' relative rankings, suggesting that alternative methods for comprehensive postdischarge surveillance are needed for accurate benchmarking.