Lung function in Lolland-Falster Health Study (LOFUS).

BACKGROUND: COPD prevalence in Denmark is estimated at 18% based on data from urban populations. However, studies suggest that using the clinical cut-off for airway obstruction in population studies may overestimate prevalence. The present study aims to compare estimated prevalence of airway obstruction using different cut-offs and to present lung function data from the Lolland-Falster Health Study, set in a rural-provincial area. METHODS: Descriptive analysis of participant characteristics and self-reported respiratory disease and of spirometry results in the total population and in subgroups defined by these characteristics. Airway obstruction was assessed using previously published Danish reference values and defined according to either FEV1 /FVC below lower limit of normal (LLN) 5% (as in clinical diagnosis) or 2.5% (suggested for population studies), or as FEV1 /FVC < 70%. RESULTS: Using either FEV1 /FVC < 70% or LLN 5% cut-off, 19.0% of LOFUS participants aged 35 years or older had spirometry, suggesting airway obstruction. By the LLN 2.5% criterion, the proportion was considerably lower, 12.2%. The prevalence of airway obstruction was higher among current smokers, in participants with short education or reporting low leisure-time physical activity and in those with known respiratory disease. Approximately 40% of participants reporting known respiratory disease had normal spirometry, and 8.7% without known respiratory disease had airway obstruction. CONCLUSION: Prevalence of airway obstruction in this rural population was comparable to previous estimates from urban Danish population studies. The choice of cut-off impacts the estimated prevalence, and using the FEV1 /FVC cut-off may overestimate prevalence. However, many participants with known respiratory disease had normal spirometry in this health study.

Prevalence and duration of anti-SARS-CoV-2 antibodies in healthcare workers.

INTRODUCTION: Knowledge of the seroprevalence and duration of antibodies against SARS-CoV-2 was needed in the early phases of the COVID-19 pandemic and is still necessary for policy makers and healthcare professionals. This information allows us to better understand the risk of reinfection in previously infected individuals. METHODS: We investigated the prevalence and duration of detectable antibodies against SARS-CoV-2 in sequentially collected samples from 379 healthcare professionals. RESULTS: SARS-CoV-2 seroprevalence at inclusion was 5.3% (95% confidence interval (CI): 3.3-8.0%) and 25% of seropositive participants reverted during follow-up. At the end of follow-up, the calculated probability of having detectable antibodies among former seropositive participants was 72.2% (95% CI: 54.2-96.2%). CONCLUSION: Antibodies against SARS-CoV-2 were detectable in a subset of infected individuals for a minimum of 39 weeks. FUNDING: The assays performed at Rigshospitalet were developed with financial support from the Carlsberg Foundation (CF20-0045) and the Novo Nordisk Foundation (NFF205A0063505 and NNF20SA0064201). TRIAL REGISTRATION: The study was registered with the Danish National Committee on Health Research Ethics (H-20022312).

Histological outcomes in HPV-screened elderly women in Denmark.

INTRODUCTION: Danish women exit cervical cancer screening at age 65 years, but 23% of cervical cancer cases occur beyond this age. In addition, due to gradual implementation of cervical cancer screening, older women are underscreened by today´s standards. A one-time screening with HPV test was therefore offered to Danish women born before 1948. METHODS: Register based study reporting histology diagnoses and conizations in women found HPV positive in the one-time screening. Number and proportion of women with severe or non-severe histology results were calculated for screened and HPV-positive women by age group or region of residence. Number of women with biopsy and/or conization per case of cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) or CIN3+ were also calculated by age groups and region. RESULTS: 4,479 (4.1% of screened women) had positive HPV test. 94% of these had one or more additional tests. 2,785 (62%) of HPV-positive women had histology results, and conization was performed in 1,076 (24% of HPV-positive and 1% of all screened women). HPV positivity and CIN3+ detection varied little between regions, but the proportions of HPV positive women undergoing histology varied between regions from 40% to 86% and the proportion with conization from 13% to 36%. Correspondingly, the number of histologies and conizations per CIN3+ detected varied from 5.9 to 11.2 and 1.8 to 4.7, respectively. In total, 514 CIN2+ (0.47% of screened women, 11% of HPV-positive) and 337 CIN3+ (0.31% of screened women, 7.5% of HPV-positive) were diagnosed, including 37 cervical cancer cases. DISCUSSION: HPV screening of insufficiently screened birth cohorts can potentially prevent morbidity and mortality from cervical cancer but longer follow-up is needed to see if cancer incidence declines in the screened women in the coming years. Management strategies differed among regions which influenced the proportions undergoing biopsy/conization.

Management of low-grade cervical cytology in young women. Cohort study from Denmark.

OBJECTIVE: Cytology findings of atypical squamous cells of unknown significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) are common among women under 30, but evidence on best management strategy is insufficient. We therefore investigated how different management strategies used in Denmark influenced biopsy rates and detection of cervical intraepithelial neoplasia (CIN). METHODS: Register-based cohort study including Danish women aged less than 30 years and born 1980-95, with ASCUS/LSIL as their first abnormal cervical cytology in 2008-16. Rates and relative risks (RR) of biopsy and detection of CIN3+, CIN2 and < CIN2 during two years follow-up were compared between women referred directly to colposcopy after ASCUS/LSIL or undergoing additional testing, including mRNA or DNA test for high risk HPV or repeat cytology. RESULTS: 19,946 women with ASCUS and 19,825 with LSIL were included in the study of whom 92% had adequate information about follow-up. Among women referred directly to biopsy, CIN3+ was detected among 21%, CIN2 in 17%, while 62% had < CIN2. Repeating cytology after 6 months reduced the biopsy rate to 44% of which 53% had < CIN2. Biopsy rates with HPV test were 67% for DNA test, 77% with 14-type mRNA test and 58% with 5-type mRNA test. The detection of CIN3+ was somewhat higher, between 13% and 14% for the three HPV tests vs. 11% with repeat cytology. However, the detection of < CIN2 (not indicating treatment) also increased with RR 2.11 (95% CI 2.01-2.21) for 14-type mRNA test, 1.35 (95% CI 1.29-1.41) for 5-type mRNA test, and 1.86 (95% CI 1.76-1.97) with HPV DNA test. CONCLUSIONS: The choice of management strategy influences both the detection rate for severe lesions (CIN3+) and the proportion of women followed up for potentially insignificant findings.

Geography of COVID-19 in Denmark.

Aim: To investigate the COVID-19 situation across geographical areas of Denmark over time. Methods: We used COVID-19 data from the Danish State Serum Institute on national, regional and municipality level. Cumulative number of tests, incidence, hospitalizations and deaths per 100,000 inhabitants were analysed for the five Danish regions and for all of Denmark. The cumulative number of tested and incidence of COVID-19 per 100,000 was compared for the two municipalities, Lolland and Gentofte. A sensitivity analysis of the COVID-19 indicators on a regional level was performed using number of tested as the denominator. Results: The Capital Region ranked highest on all analysed COVID-19 indicators with 10,849 tested, 365 cases, 63 hospitalized and 18 deaths per 100,000 by 2 June 2020. The three regions in western Denmark all had low levels, while Region Zealand ranked second highest. Despite general low health status in Lolland municipality, the cumulative incidence of COVID-19 was consistently below that of Gentofte. Sensitivity analysis showed that the Capital Region had the highest number of COVID-19 cases per 100,000 tested, but Region Zealand had a higher number of hospitalized and similar number of deaths per 100,000 tested as the Capital Region over time. Conclusion: COVID-19 had affected eastern Denmark, especially the Capital Region, considerably more than western Denmark. The difference may relate to population density and housing conditions.

Selection and Interpretation of Scientific Evidence in Preparation for Policy Decisions: A Case Study Regarding Introduction of Rotavirus Vaccine Into National Immunization Programs in Sweden, Norway, Finland, and Denmark.

The World Health Organization recommends inclusion of rotavirus vaccines in national immunization programs (NIPs) worldwide. Nordic countries are usually considered comparable in terms of demographics and health-care services and have comparable rotavirus disease burden. Nevertheless, the countries have reached different decisions regarding rotavirus vaccine: Norway and Finland have already introduced rotavirus vaccines into their NIPs and Sweden is currently changing its recommendation and vaccines will now be introduced on a national scale while Denmark has decided against it. This study focuses on the selection and interpretation of medical and epidemiological evidence used during the decision-making processes in Sweden, Norway, Finland, and Denmark. The so-called "severity criteria" is identified as one of the main reasons for the different policy decisions reached across the Nordic countries.

Mumps resurgence in Denmark.

BACKGROUND: The past decade has witnessed a resurgence of parotitisvirus (mumps) in several countries where seemingly good mumps control otherwise had been achieved through vaccination. Recently detection of mumps has increased in Denmark. OBJECTIVES: To describe the age-specific changes and time trends of parotitisvirus detection in Denmark over a 10 year period. STUDY DESIGN: Retrospective cohort study based on national laboratory data for parotitisvirus typing surveillance and national epidemiology data for mumps reporting. RESULTS: The parotitisvirus detection rate has increased almost 10 times during the past 10 years from an incidence <0.1 per 100,000 in 2003 to 0.96 per 100,000 in 2013. The age distribution has shifted from children to young adults, and most cases are unvaccinated (54%) or vaccinated once (41%). The increase is due mainly to the existence of cohorts with low MMR vaccine coverage. CONCLUSION: Analysis of mumps surveillance data from Denmark documents that the incidence of mumps is increasing, and that the resurgence of parotitisvirus is primarily occurring among young Danish adults. Almost half of the infected clinical mumps cases had received the first dose of MMR.

[Listerial meningitis at the Department of Infectious Diseases, Copenhagen University Hospital 1983-2006]. / Listeriameningitis på Epidemiklinikken, Rigshospitalet 1983-2006.

INTRODUCTION: Listeria monocytogenes rarely causes meningitis, but when it does the course can be severe and case fatality rates high. The article describes clinical and laboratory findings as well as treatment and outcome among patients treated for listerial meningitis at the Department of Infectious diseases, Rigshospitalet from 1983-2006. MATERIAL AND METHODS: Patient records were reviewed for all adults with a diagnosis of listerial meningitis. RESULTS: A total of 40 patients with a discharge diagnosis of listerial meningitis were identified; records for 36 of these were available. 61% were men and 72% were older than 50 years. 64% had underlying, predisposing illnesses or took immunosuppressant medication. At presentation, patients had fever, neck stiffness, headache and/or change in mental status. The cerebrospinal fluid (CSF) cell count was raised in all patients, but the number and differential count of leukocytes in the CSF varied. L monocytogenes was present in blood and/or CSF from all patients. Treatment records were available for 35 patients, all of whom received ampicillin. Four patients died; they all had underlying diseases and three were older than 50 years. CONCLUSION: The present study confirms the findings of other studies showing that listerial meningitis is more common in patients with underlying conditions, immunosuppression or age above 50. The case fatality rate is lower than that found in other reports, which could be due to the selection of patients. Listeriosis is an important differential diagnosis in predisposed individuals.

[Gastrointestinal symptoms predominant in refugee children with malaria]. / Primaert gastrointestinale symptomer ved malaria hos flygtningebørn.

We present three cases of malaria in refugee children newly arrived from Sub-saharan Africa. Only one of the three children had fever and all had high parasite loads (2,5-14% parasitemia). Malaria is an important differential diagnosis in refugees from endemic areas, regardless of whether they present with fever.