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In 2020, the Namibian Ministry of Health and Social Services (MoHSS) and the Robert Koch Institute (RKI) started a twinning project with the long-term goal of establishing a Namibia Institute of Public Health (NIPH). A fundamental pillar of an NIPH is a fully operational Public Health laboratory system. Due to the COVID-19 pandemic, the need for strengthening the existing Namibian Laboratory system became eminent. Following the Intra-Action Review (IAR) of the COVID-19 response in Namibia in 2020, three regional diagnostic laboratories, at points of entry, were assessed. The major issues identified were long delays between sampling of both suspected cases and COVID-19 patients and receiving test results due to extended sample transport times to the central laboratory in Windhoek and the overload of the central capacities due to overwhelming numbers of samples during peak times. This led to the establishment of three SARS-CoV-2 PCR diagnostic laboratories through procurement and installation of equipment, provision of consumables/reagents, and on-site training of laboratory technicians with continued virtual technical support. Consequently, an important reduction of the diagnosis turnaround time was achieved. Of great value was the technical support given by the staff at the central laboratory during the trainings allowing for immediate validation of the newly established laboratories and to strengthen the communication between regional laboratories and the central laboratory. The Namibian molecular diagnostic capacities have increased in important regions in Namibia and will provide data to support the health policies of the future NIPH. New diagnostic protocols will be developed to foster the sustainability of the established laboratories and could support the implementation of genomic surveillance capacities. Finally, stronger relationships were built through these joint activities, which will support and the next steps of the establishment of the NIPH. Key messages • Supporting and Strengthening the Namibian Public Health Laboratory system. • Long-term goal of establishing a Namibia Institute of Public Health (NIPH).

To prevent maternal phenylketonuria (PKU) syndrome low phenylalanine concentrations (target range, 120-360 μmol/L) during pregnancy are recommended for women with PKU. We evaluated the feasibility and effectiveness of current recommendations and identified factors influencing maternal metabolic control and children's outcome. Retrospective study of first successfully completed pregnancies of 85 women with PKU from 12 German centers using historical data and interviews with the women. Children's outcome was evaluated by standardized IQ tests and parental rating of child behavior. Seventy-four percent (63/85) of women started treatment before conception, 64% (54/85) reached the phenylalanine target range before conception. Pregnancy planning resulted in earlier achievement of the phenylalanine target (18 weeks before conception planned vs. 11 weeks of gestation unplanned, p 0.001) and lower plasma phenylalanine concentrations during pregnancy, particularly in the first trimester (0-7 weeks of gestation: 247 μmol/L planned vs. 467 μmol/L unplanned, p 0.0001; 8-12 weeks of gestation: 235 μmol/L planned vs. 414 μmol/L unplanned, p 0.001). Preconceptual dietary training increased the success rate of achieving the phenylalanine target before conception compared to women without training (19 weeks before conception vs. 9 weeks of gestation, p 0.001). The majority (93%) of children had normal IQ (mean 103, median age 7.3 years); however, IQ decreased with increasing phenylalanine concentration during pregnancy. Good metabolic control during pregnancy is the prerequisite to prevent maternal PKU syndrome in the offspring. This can be achieved by timely provision of detailed information, preconceptual dietary training, and careful planning of pregnancy.

Worldwide, wind turbines are increasingly being built at forest sites to meet the goals of national climate strategies. Yet, the impact on biodiversity is barely understood. Bats may be heavily affected by wind turbines in forests, because many species depend on forest ecosystems for roosting and hunting and can experience high fatality rates at wind turbines. We performed acoustic surveys in 24 temperate forests in the low mountain ranges of Central Germany to monitor changes in the acoustic activity of bats in relation to wind turbine proximity, rotor size, vegetation structure and season. Call sequences were identified and assigned to one of three functional guilds: open-space, edge-space and narrow-space foragers, the latter being mainly forest specialists. Based on the response behaviour of bats towards wind turbines in open landscapes, we predicted decreasing bat activity towards wind turbines at forest sites, especially for narrow-space foragers. Vertical vegetation heterogeneity had a strong positive effect on all bats, yet responses to wind turbines in forests varied across foraging guilds. Activity of narrow-space foragers decreased towards turbines over distances of several hundred metres, especially towards turbines with large rotors and during mid-summer months. The activity of edge-space foragers did not change with distance to turbines or season, whereas the activity of open-space foragers increased close to turbines in late summer. Synthesis and applications. Forest specialist bats avoid wind turbines in forests over distances of several hundred metres. This avoidance was most apparent towards turbines with large rotors. Since forests are an important habitat for these bats, we advise to exclude forests with diverse vegetation structure as potential wind turbine sites and to consider compensation measures to account for habitat degradation associated with the operation of wind turbines in forests.

Laurie Bernstein,1,2 Joyanna Hansen,3 Christian Kogelmann,4 Margret Ellerbrok,4 Maria Gizewska,5 Sommer Gaughan,6 Julio Cesar Rocha,7– 9 Amaya Belanger,10 Fran Rohr2 1Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA; 2Met Ed Co, Boulder, CO, USA; 3Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA; 4University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 5Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland; 6Inherited Metabolic Diseases Clinic, Children’s Hospital Colorado, Aurora, CO, USA; 7Nutrition and Metabolism, NOVA Medical School | Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, 1169-056, Portugal; 8CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; 9Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Lisboa, 1169-045, Portugal; 10Hospital Universitario Ramon y Cajal, Madrid, SpainCorrespondence: Fran Rohr Email fran.rohr@met-ed.netAbstract: Phenylketonuria (PKU) is one of the most common inherited metabolic disorders, and historically has required affected individuals to follow a severely protein-restricted diet with medical food for life. A novel enzyme substitution therapy, pegvaliase, allows many adults with PKU on therapy to have a reduction in blood phenylalanine (Phe) while on an unrestricted diet. However, there is limited information on optimal nutrition management of individuals with PKU on pegvaliase therapy. This manuscript summarizes a virtual European meeting focused on nutrition management of individuals on pegvaliase therapy, including three case studies and a patient perspective that together provide clinical insights into the real-world management of individuals with PKU on pegvaliase.Keywords: PKU, phenylketonuria, pegvaliase, medical nutrition therapy