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1. Determinants of sporadic Campylobacter infections in Denmark: a nationwide case-control study among children and young adults

Author

Gaardbo Kuhn K, Nielsen EM, Mølbak K, and Ethelberg S

Subjects
Campylobacter, determinants, case-control, environment, food, Infectious and parasitic diseases, RC109-216
Abstract

Katrin Gaardbo Kuhn,1 Eva Møller Nielsen,2 Kåre Mølbak,1,3 Steen Ethelberg1 1Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark; 2Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark; 3Institute of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark Background: Each year more than 4,000 cases of campylobacteriosis are reported in Denmark, making it the most common bacterial gastrointestinal infection. Here we describe a case-control study to identify sources of infection with a focus on environmental factors.Methods: From January to December 2016, we conducted a prospective case-control study among Danish persons aged 1–30 years. Participants were invited by letter to complete an online questionnaire. Crude and adjusted ORs were calculated and final parsimonious multivariate models developed using logistic regression.Results: The study recruited 1366 cases and 4,418 controls, of whom 65% and 66%, respectively, completed the questionnaire. A multivariate model for domestically acquired cases showed, among others, increased risk of infection with bathing in fresh water (OR=5.1), contact to beach sand (OR=1.8), owning a pet dog with diarrhea (OR=4.6), and eating minced beef (OR=2.6) or chicken (OR=2.5). The model for children highlighted similar risk factors but also included bathing in a paddling pool (OR=13.6) and eating fresh strawberries (OR=5.3). A separate analysis for persons reporting foreign travel showed increased infection risk when traveling to Asia, Africa, or Turkey and that eating from street kitchens and having contact to water during traveling were also risk factors.Conclusion: Environmental factors and animal contact account for a sizeable proportion of domestic Campylobacter infections in the age group studied. The study also re-confirmed handling/consumption of chicken as an important risk factor while highlighting minced beef as a potential new risk factor. Overall, these results contribute to a better understanding of the transmission dynamics of Campylobacter and will be used to improve national guidelines for prevention of infection. Keywords: Campylobacter, determinants, case-control, environment, food

Published
2018

2. European all-cause excess and influenza-attributable mortality in the 2017/18 season: should the burden of influenza B be reconsidered?

Author

Nielsen, J., Vestergaard, L.S., Richter, L., Schmid, D., Bustos, N., Asikainen, T., Trebbien, R., Denissov, G., Innos, K., Virtanen, M.J., Fouillet, A., Lytras, T., Gkolfinopoulou, K., Heiden, M. an der, Grabenhenrich, L., Uphoff, H., Paldy, A., Bobvos, J., Domegan, L., O'Donnell, J., Scortichini, M., de Martino, A., Mossong, J., England, K., Melillo, J., van Asten, L., de Lange, M. MA, Tønnessen, R., White, R.A., da Silva, S.P., Rodrigues, A.P., Larrauri, A., Mazagatos, C., Farah, A., Carnahan, A.D., Junker, C., Sinnathamby, M., Pebody, R.G., Andrews, N., Reynolds, A., McMenamin, J., Brown, C.S., Adlhoch, C., Penttinen, P., Mølbak, K., and Krause, T.G.

Published
2019
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39. Electronic reporting of diagnostic laboratory test results from all health care sectors is a cornerstone of national preparedness and control of COVID-19 in Denmark

Author

Schønning, K, Dessau, Rbc, Jensen, T G, Thorsen, N M, Wiuff, C, Nielsen, L, Gubbels, S, Denwood, M, Thygesen, Uffe Høgsbro, Christiansen, Lasse Engbo, Møller, C H, Møller, J K, Ellermann-Eriksen, S, Østergaard, C, Lam, J, Abushalleeh, N, Meaidi, M, Olsen, S S, Mølbak, K, Voldstedlund, M, Schønning, K, Dessau, Rbc, Jensen, T G, Thorsen, N M, Wiuff, C, Nielsen, L, Gubbels, S, Denwood, M, Thygesen, Uffe Høgsbro, Christiansen, Lasse Engbo, Møller, C H, Møller, J K, Ellermann-Eriksen, S, Østergaard, C, Lam, J, Abushalleeh, N, Meaidi, M, Olsen, S S, Mølbak, K, and Voldstedlund, M

Abstract

The COVID-19 pandemic has led to an unprecedented demand for real-time surveillance data in order to inform critical decision makers regarding the management of the pandemic. The aim of this review is to describe how the Danish national microbiology database, MiBa, served as a cornerstone for providing data to the real-time survelliance system by linkage to other nationwide health registries. The surveillance system was established on an existing IT health infrastructure and a close network between clinical microbiologists, information technology experts and public health officials. In 2020, testing capacity for SARS-CoV-2 was ramped up from none to over 10,000 weekly PCR tests per 100,000 population. The crude incidence data mirrored this increase in testing. Real-time access to denominator data and patient registries enabled adjustments for fluctuations testing activity, providing robust data on crude SARS-CoV-2 incidence during the changing diagnostic and management strategies. The use of the same data for different purposes, e.g. final laboratory reports, information to the public, contact tracing, public health and science, has been a critical asset for the pandemic response.It has also raised issues concerning data protection and critical capacity of the underlying technical systems and key ressources. However, even with these limitations, the set-up has enabled decision makers to adopt timely interventions. The experiences from COVID-19 may motivate a transformation from traditional indicator based public health surveillance to an all-encompassing information system based on access to a comprehensive set of data sources, including diagnostic and reference microbiology.

Published
2021

46. Surveillance of surgical site infection in a teaching hospital in Ghana:a prospective cohort study

Author

Bediako-Bowan, A., Owusu, E., Debrah, S., Kjerulf, A., Newman, M. J., Kurtzhals, J. A.L., Mølbak, K., Bediako-Bowan, A., Owusu, E., Debrah, S., Kjerulf, A., Newman, M. J., Kurtzhals, J. A.L., and Mølbak, K.

Abstract

Background: Surveillance systems for surgical site infections (SSIs), as a measure of patient safety, help health institutions devise strategies to reduce or prevent them. No surveillance systems exist to monitor SSIs in Ghana. Aim: To establish a system for monitoring trends and detecting outbreaks in order to create awareness of and control SSIs. Methods: An active 30-day surveillance was undertaken at the general surgical unit of the Korle Bu Teaching Hospital, from July 1st, 2017 to December 31st, 2018 to identify SSI. It involved a daily inpatient surveillance of patients who had had a surgical procedure, followed by post-discharge surveillance by means of a healthcare personnel-based survey and a patient-based telephone survey. We supplied quarterly feedback of results to surgeons. Findings: Among the 3267 patients included, 331 were identified with an SSI, a 10% incidence risk. Patients who acquired an SSI experienced increased morbidity including nine extra days in hospital and an adjusted relative mortality risk of 2.3 (95% confidence interval: 1.3 - 4.1; P=0.006) compared to patients without SSI. Forty-nine per cent (161/331) of SSIs were diagnosed post discharge using the healthcare personnel-based survey. The patient-based telephone survey contributed 12 additional cases. SSI incidence risk decreased from 12.8% to 7.5% during the study period. Conclusion: Post-discharge surveillance is feasible using existing healthcare personnel, and the results highlight the high risk and burden of SSIs in Ghana. A surveillance system with feedback for monitoring SSIs may contribute to reducing SSIs; however, firm conclusions regarding the impact need longer observation time.

Published
2020

47. Risk factors for surgical site infections in abdominal surgeries in Ghana:Emphasis on the impact of operating rooms door openings

Author

Bediako-Bowan, A A A, Mølbak, K, Kurtzhals, J A L, Owusu, E, Debrah, S, Newman, M. J., Bediako-Bowan, A A A, Mølbak, K, Kurtzhals, J A L, Owusu, E, Debrah, S, and Newman, M. J.

Abstract

Major surgery carried out in low- and middle-income countries is associated with a high risk of surgical site infections (SSI), but knowledge is limited regarding contributory factors to such infections. This study explores factors related to patients developing an SSI in a teaching hospital in Ghana. A prospective cohort study of patients undergoing abdominal surgical procedures was conducted at Korle Bu Teaching Hospital. Patient characteristics, procedures and environmental characteristics were recorded. A 30-day daily surveillance was used to diagnose SSI, and Poisson regression analysis was used to test for association of SSI and risk factors; survival was determined by proportional hazard regression methods. We included 358 patients of which 58 (16.2%; 95% CI 12.7-20.4%) developed an SSI. The median number of door openings during an operation was 79, with 81% being unnecessary. Door openings greater than 100 during an operation (P = 0.028) significantly increased a patient's risk of developing an SSI. Such patients tended to have an elevated mortality risk (hazard ratio 2.67; 95% CI 0.75-9.45, P = 0.128). We conclude that changing behaviour and practices in operating rooms is a key strategy to reduce SSI risk.

Published
2020

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