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6. Management of influenza : updated Swedish guidelines for antiviral treatment

Author

Westin, Johan, Andersson, Emmi, Bengner, Malin, Berggren, Anna, Brytting, Mia, Ernstad, Erica Ginstrom, Nilsson, Anna C., Wahlloef, Martina, Westman, Gabriel, Furberg, Maria, Westin, Johan, Andersson, Emmi, Bengner, Malin, Berggren, Anna, Brytting, Mia, Ernstad, Erica Ginstrom, Nilsson, Anna C., Wahlloef, Martina, Westman, Gabriel, and Furberg, Maria

Abstract

Influenza causes seasonal epidemics of respiratory infection in all parts of the world. Manifestations of influenza range from mild upper to severe lower respiratory tract infection. Medical risk groups are defined by factors predisposing for development of severe disease and are recommended annual vaccination as a protective measure. The previous Swedish treatment guidelines for influenza were issued in 2011, and a review of current evidence was deemed relevant. An important reason to revisit the guidelines is the recent approval of a novel drug for influenza treatment, baloxavir. Updated Swedish evidence-based guidelines created by a group of experts from various research areas, for the management of influenza are presented here. The work has been made in collaboration with the Public Health Agency of Sweden and the Swedish Reference Group for AntiViral therapy (RAV). The updated guidelines include guidelines for diagnostics, treatment and prophylaxis in special groups, including management of pregnant women and children with influenza. A new section about infection control has been added. Pharmacological treatment is covered in detail with regards to indication and dosage. Additionally, drug resistance and environmental aspects are discussed.

Published
2023
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8. Hepatitis of unknown aetiology in children – epidemiological overview of cases reported in Europe, 1 January to 16 June 2022

Author

Romaní Vidal, Adriana, primary, Vaughan, Aisling, additional, Innocenti, Francesco, additional, Colombe, Soledad, additional, Nerlander, Lina, additional, Rachwal, Natalia, additional, Ciancio, Bruno Christian, additional, Mougkou, Aikaterini, additional, Carvalho, Carlos, additional, Delgado, Enrique, additional, Mook, Piers, additional, de Muylder, Géraldine, additional, Peeters, Michael, additional, Tenev, Tencho, additional, Golkocheva-Markova, Elitsa, additional, Vorobieva Solholm Jensen, Veronika, additional, Koch, Anders, additional, Figoni, Julie, additional, Brouard, Cécile, additional, Nikolopoulou, Georgia, additional, Zisouli, Anastasia, additional, Murphy, Niamh, additional, Broderick, Annemarie, additional, Goldberg, Lital, additional, Rich, Rivka, additional, Hecht Sagie, Lior, additional, Tosti, Maria Elena, additional, Suligoi, Barbara, additional, Joosten, Rosa, additional, Pijnacker, Roan, additional, Fjeldheim, Ingvild, additional, Heen, Eli, additional, Stępień, Małgorzata, additional, Polański, Piotr, additional, Tato Marinho, Rui, additional, Vieira Martins, João, additional, Varela, Carmen, additional, Avellón, Ana, additional, Andersson, Emmi, additional, Jansson Mörk, Marie, additional, Mandal, Sema, additional, Watson, Conall, additional, Coughlan, Laura, additional, Chand, Meera, additional, Neill, Claire, additional, Bradley, Declan T, additional, Li, Kathy, additional, O’Leary, Maureen, additional, McInnes, Neil, additional, Williams, Christopher J, additional, Moore, Catherine, additional, Gjini, Ardiana, additional, Duffell, Erika, additional, and Pebody, Richard, additional

Published
2022
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12. Piloting a surveillance system for HIV drug resistance in the European Union

Author

van de Laar, Marita JW, primary, Bosman, Arnold, additional, Pharris, Anastasia, additional, Andersson, Emmi, additional, Assoumou, Lambert, additional, Ay, Eva, additional, Bannert, Norbert, additional, Bartmeyer, Barbara, additional, Brady, Melissa, additional, Chaix, Marie-Laure, additional, Descamps, Diane, additional, Dauwe, Kenny, additional, Fonager, Jannik, additional, Hauser, Andrea, additional, Lunar, Maja, additional, Mezei, Maria, additional, Neary, Martha, additional, Poljak, Mario, additional, van Sighem, Ard, additional, Verhofstede, Chris, additional, Amato-Gauci, Andrew J, additional, and Broberg, Eeva K, additional

Published
2019
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14. Mutations and migration : molecular and epidemiological aspects of HIV-1 in Sweden

Author

Andersson, Emmi and Andersson, Emmi

Abstract

The Swedish HIV-1 epidemic is characterized by a wide variation in subtypes due to migration and travel. The aims of this thesis were to investigate molecular methods for estimating time to diagnosis and epidemiological tools for estimating the proportion of undiagnosed individuals with HIV-1 in Sweden, as well as to update the knowledge on transmitted and pre-treatment drug resistance (TDR and PDR) among persons living with HIV-1 in Sweden. In Paper I we found that viral diversity estimated by the proportion of mixed base calls in pol gene sequences is an indicator of whether a HIV-1 infection is recent (≤1 year) or chronic. A cutoff of 0.47% mixed base calls identified recent infections with a sensitivity of 89% and a specificity of 75%. In Paper II we studied TDR in newly diagnosed individuals (n=1,713, 71% coverage) in 2010-2016 in Sweden. The prevalence of TDR was 7.1% (95% CI 5.8-8.3%) and resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) increased significantly from 1.5% in 2010 to 6.2% in 2016 and was related to infection/origin in sub-Saharan Africa. A transmission cluster in men having sex with men with the M41L mutation was traced back to the 1990´s. In Paper III we evaluated two mathematical models for estimation of the proportion of undiagnosed individuals with HIV-1 in Sweden, SSOPHIE and the ECDC Modelling tool. The model estimates for 2013 were 26% (n=2,100; 90% plausibility range 900-5,000) and 21% (n=2,013; 95% CI 1,831-2,189), respectively. The wide confidence bounds and problems to account for migration limited the value of the results. We concluded that improvements of models and better data on migration are needed. In Paper IV we investigated PDR in individuals diagnosed in Sweden 2017-2019 (n=224) using an in-house high-throughput sequencing (HTS) assay with a detection limit of 1% for minority viral variants. HTS was successful in 87% of samples and failure was associated with low viral loads. Drug resistance mutations (DR

Published
2019

15. Increase in transmitted drug resistance in migrants from sub-Saharan Africa diagnosed with HIV-1 in Sweden

Author

Andersson, Emmi, primary, Nordquist, Agnes, additional, Esbjörnsson, Joakim, additional, Flamholc, Leo, additional, Gisslén, Magnus, additional, Hejdeman, Bo, additional, Marrone, Gaetano, additional, Norrgren, Hans, additional, Svedhem, Veronica, additional, Wendahl, Suzanne, additional, Albert, Jan, additional, and Sönnerborg, Anders, additional

Published
2018
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17. Sweden surpasses the UNAIDS 95-95-95 target: estimating HIV-1 incidence, 2003 to 2022.

Author

Lundgren E, Locke M, Romero-Severson E, Dimitrijevic M, Axelsson M, Andersson E, Carlander C, Brännström J, Norrgren H, Mansson F, Elvstam O, Gisslén M, Fohlin L, Sönnerborg A, Albert J, and Leitner T

Subjects
Humans, Sweden epidemiology, Incidence, Male, Female, Adult, SARS-CoV-2, Middle Aged, Homosexuality, Male statistics & numerical data, Pandemics, Registries, Anti-HIV Agents therapeutic use, Young Adult, HIV Infections epidemiology, HIV Infections drug therapy, HIV Infections diagnosis, HIV-1 drug effects, COVID-19 epidemiology
Abstract

BackgroundSweden reached the UNAIDS 90-90-90 target in 2015. It is important to reassess the HIV epidemiological situation due to ever-changing migration patterns, the roll-out of PrEP and the impact of the COVID-19 pandemic.AimWe aimed to assess the progress towards the UNAIDS 95-95-95 targets in Sweden by estimating the proportion of undiagnosed people with HIV (PWHIV) and HIV incidence trends.MethodsWe used routine laboratory data to inform a biomarker model of time since infection. When available, we used previous negative test dates, arrival dates for PWHIV from abroad and transmission modes to inform our incidence model. We also used data collected from the Swedish InfCareHIV register on antiretroviral therapy (ART).ResultsThe yearly incidence of HIV in Sweden decreased after 2014. In part, this was because the fraction of undiagnosed PWHIV had decreased almost twofold since 2006. After 2015, three of four PWHIV in Sweden were diagnosed within 1.9 and 3.2 years after infection among men who have sex with men and in heterosexual groups, respectively. While 80% of new PWHIV in Sweden acquired HIV before immigration, they make up 50% of the current PWHIV in Sweden. By 2022, 96% of all PWHIV in Sweden had been diagnosed, and 99% of them were on ART, with 98% virally suppressed.ConclusionsBy 2022, about half of all PWHIV in Sweden acquired HIV abroad. Using our new biomarker model, we assess that Sweden has reached the UNAIDS goal at 96-99-98.

Published
2024
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18. [Future testing for SARS-CoV-2: not only more but smarter].

Author

Andersson E and Sönnerborg A

Subjects
Clinical Laboratory Techniques, Humans, Reproducibility of Results, Betacoronavirus, COVID-19, Pandemics
Abstract

Sars-cov-2 PCR is a cornerstone of COVID-19 clinical diagnostics and epidemiological surveillance. Viral shedding in COVID-19, as measured by isolation of infectious virus, is most prominent around symptom onset. Sars-cov-2 PCR, however, may stay positive for months and thereby does not reflect infectiousness. PCR tests are both specific and sensitive but the performance in clinical diagnostics depends on sampling technique, sample material and disease stage. Self-sampling in individuals with mild symptoms aims rather to assess infectiousness and a lower sensitivity of the test can be accepted. False positive tests are a global problem and may have serious consequences for both the tested individuals and society. Awareness of contamination risks and continuous quality assurance is vital in all laboratories to ensure test reliability. Rapid, less sensitive sars-cov-2 antigen tests are potential new tools in infection control.

Published
2020

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