Non-pharmaceutical interventions in response to the COVID-19 pandemic in 30 European countries: the ECDC-JRC Response Measures Database.

In response to the COVID-19 pandemic, the European Union/European Economic Area (EU/EEA) countries implemented a wide set of non-pharmaceutical interventions (NPIs), sometimes with limited knowledge on their effect and impact on population. The European Centre for Disease Prevention and Control (ECDC) and the European Commission's Joint Research Centre (JRC) developed a Response Measures Database (ECDC-JRC RMD) to archive NPIs in 30 EU/EEA countries from 1 January 2020 to 30 September 2022. We aimed to introduce a tool for the wider scientific community to assess COVID-19 NPIs effect and impact in the EU/EEA. We give an overview of the ECDC-JRC RMD rationale and structure, including a brief analysis of the main NPIs applied in 2020, before the roll-out of the COVID-19 vaccination campaigns. The ECDC-JRC RMD organises NPIs through a three-level hierarchical structure and uses four additional parameters ('status', 'implementation', 'target group' and 'geographical representation') to provide further information on the implementation of each measure. Features including the ready-for-analysis, downloadable format and its agile taxonomy and structure highlight the potential of the ECDC-JRC RMD to facilitate further NPI analysis and optimise decision making on public health response policies.

Upsurge in echovirus 30 detections in five EU/EEA countries, April to September, 2018.

An upsurge in Echovirus 30 (E30) infections, associated with meningitis/meningoencephalitis, has been observed in Denmark, Germany, the Netherlands, Norway and Sweden in the period April to September 2018, compared with 2015-2017. In total, 658 E30 infections among 4,537 enterovirus infections were detected in 15 countries between January and September 2018 and affected mainly newborns and 26-45 year-olds. National public health institutes are reminded to remain vigilant and inform clinicians of the ongoing epidemic.

Field investigation with real-time virus genetic characterisation support of a cluster of Ebola virus disease cases in Dubréka, Guinea, April to June 2015.

On 11 May 2015, the Dubréka prefecture, Guinea, reported nine laboratory-confirmed cases of Ebola virus disease (EVD). None could be epidemiologically linked to cases previously reported in the prefecture. We describe the epidemiological and molecular investigations of this event. We used the Dubréka EVD registers and the Ebola treatment centre's (ETC) records to characterise chains of transmission. Real-time field Ebola virus sequencing was employed to support epidemiological results. An epidemiological cluster of 32 cases was found, of which 27 were laboratory confirmed, 24 were isolated and 20 died. Real-time viral sequencing on 12 cases demonstrated SL3 lineage viruses with sequences differing by one to three nt inside a single phylogenetic cluster. For isolated cases, the average time between symptom onset and ETC referral was 2.8 days (interquartile range (IQR): 1-4). The average time between sample collection and molecular results' availability was 3 days (IQR: 2-5). In an area with scarce resources, the genetic characterisation supported the outbreak investigations in real time, linking cases where epidemiological investigation was limited and reassuring that the responsible strain was already circulating in Guinea. We recommend coupling thorough epidemiological and genomic investigations to control EVD clusters.

Sex practices and awareness of Ebola virus disease among male survivors and their partners in Guinea.

INTRODUCTION: Towards the end of the 2013-2016 West African outbreak, sexually-transmitted Ebola virus re-emerged from Ebola virus disease (EVD) survivors in all three hardest hit countries. We explore sex practices and awareness of the risk of Ebola virus transmission among EVD survivors and their partners. METHODS: In this cross-sectional study, we recruited a convenience sample of study participants aged >15 years who were male EVD survivors, their sexual partners and a comparison group. We administered a questionnaire to all respondents, estimated self-reported sexual practices and risk awareness and conducted in-depth interviews. RESULTS: We recruited 234 EVD survivors, 256 sexual partners of survivors and 65 individuals in the comparison group from five prefectures in Guinea. The prevalence of safe sexual behaviour (regular condom use or sexual abstinence >12 months) and regular condom use in EVD survivors was 38% (95% CI 31% to 44%) and 21% (95% CI 16% to 27%), respectively. Among partners, these prevalences were lower (11%, 95% CI 7% to 15% and 9%, 95% CI 5% to 12%, respectively). EVD survivors were more than five times as likely to engage in safe sexual behaviour compared with the comparison group (aOR 5.59, 95% CI 2.36 to 13.2). One-hundred and thirty one EVD survivors (57%) and 94 partners (37%) were aware of the risk of Ebola virus re-emergence associated with having unsafe sex. Partners who reported not being informed by their husband/boyfriend (EVD survivor) were more likely to be unaware of this risk (aOR 20.5, 95% CI 8.92 to 47.4). CONCLUSIONS: We disclose here a need to improve knowledge of the disease and close the gap between knowledge and practice found in EVD survivors and their partners. Current and future survivors' follow-up programmes should include partners and be more effective at communicating sex-related risks. Community-level fears and attitudes that enable stigmatisation should be addressed. Safe sex interventions targeting EVD survivors and their partners should be prioritised.

The European Medical Corps: first Public Health Team mission and future perspectives.

The 2013-2016 Ebola epidemic in West Africa challenged traditional international mechanisms for public health team mobilisation to control outbreaks. Consequently, in February 2016, the European Union (EU) launched the European Medical Corps (EMC), a mechanism developed in collaboration with the World Health Organization (WHO) to rapidly deploy teams and equipment in response to public health emergencies inside and outside the EU. Public Health Teams (PHTs), a component of the EMC, consist of experts in communicable disease prevention and control from participating countries and the European Centre for Disease Prevention and Control (ECDC), to support affected countries and WHO in risk assessment and outbreak response. The European Commission's Directorate-General European Civil Protection and Humanitarian Aid Operations and Directorate-General Health and Food Safety, and ECDC, plan and support deployments. The first EMC-PHT deployment took place in May 2016, with a team sent to Angola for a yellow fever outbreak. The aims were to evaluate transmission risks to local populations and EU citizens in Angola, the risk of regional spread and importation into the EU, and to advise Angolan and EU authorities on control measures. International actors should gain awareness of the EMC, its response capacities and the means for requesting assistance.

Early findings in outbreak of haemolytic uraemic syndrome among young children caused by Shiga toxin-producing Escherichia coli, Romania, January to February 2016.

As at 29 February 2016, 15 cases of haemolytic uraemic syndrome with onset between 25 January and 22 February were reported among children between five and 38 months in Romania, and three of them died. Cases were mostly from southern Romania. Six cases tested positive for Escherichia coli O26 by serology. Fruits, vegetables, meat and dairy products were among the possible common food exposures. Investigations are ongoing in Romania to control the outbreak.

Epidemiological investigation of a foodborne outbreak in Spain associated with U.S. West Coast genotypes of Vibrio parahaemolyticus.

We describe an outbreak of seafood-associated Vibrio parahaemolyticus in Galicia, Spain in on 18th of August 2012 affecting 100 of the 114 passengers travelling on a food banquet cruise boat. Epidemiological information from 65 people was available from follow-on interviews, of which 51 cases showed symptoms of illness. The food items identified through the questionnaires as the most probable source of the infections was shrimp. This product was unique in showing a statistically significant and the highest OR with a value of 7.59 (1.52-37.71). All the nine strains isolated from stool samples were identified as V. parahaemolyticus, seven were positive for both virulence markers tdh and trh, a single strain was positive for trh only and the remaining strain tested negative for both trh and tdh. This is the largest foodborne Vibrio outbreak reported in Europe linked to domestically processed seafood. Moreover, this is the first instance of strains possessing both tdh+ and trh+ being implicated in an outbreak in Europe and that a combination of strains represent several pathogenicity groups and belonging to different genetic variants were isolated from a single outbreak. Clinical isolates were associated with a novel genetic variant of V. parahaemolyticus never detected before in Europe. Further analyses demonstrated that the outbreak isolates showed indistinguishable genetic profiles with hyper-virulent strains from the Pacific Northwest, USA, suggesting a recent transcontinental spread of these strains.

Results from screening immigrants of low-income countries: data from a public primary health care.

BACKGROUND: A total of 3,132 immigrants from low- and middle-income countries were involved in a cross-sectional observational study to screen for infectious diseases among immigrants attending public primary health care (PHC) centers. The study was conducted to clarify the degree of demographic differences and risk predictors of these diseases. METHODS: Demographic and clinical variables, screening for infectious diseases [hepatitis B and C, human immunodeficiency virus infection, syphilis, and tuberculosis (TB)], and analytical data (anemia, hematuria, and liver function) were recorded from immigrants attending a public PHC unit in Barcelona. RESULTS: Global hepatitis B, including chronic and previous, reached 18.1%; Morocco as the country of origin [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.07-4.14] and gastrointestinal symptoms (OR 1.9, CI 1.18-3.02) were risk factors. Hepatitis C prevalence was 3.3% with elevated hepatic transaminase levels as a risk factor (OR 26.1, CI 8.68-78.37). Positive syphilis was 3.1%; latent and active TB rates were 28.1 and 5.8%, respectively. Concerning TB, we found remarkable differences both among WHO regions of origin (the Eastern Mediterranean region showed the highest rate of active TB, 8%) and the three categories of years of residence in Spain (6.5% for <1 year, 12.8% for 1-5 years, and 10% for >5 years). CONCLUSIONS: The data allowed recommendation of a minimal screening of TB in immigrants from low-income countries regardless of the years of residence in Spain, hepatitis C in patients with altered transaminase levels, and hepatitis B in patients with gastrointestinal symptoms and/or from Morocco.

Mumps vaccine effectiveness in highly immunized populations.

The aim of the study was to investigate effectiveness of mumps MMR component in communities with high MMR coverage. Outbreak-related cases of mumps born between 1995 and 2005 notified to Navarre and Catalonia public health services during the period 2005-2007 were studied. Vaccine effectiveness (VE) and their 95%CI were calculated using the screening method. Of 47 confirmed, 85.1% immunized with at least one dose (1MMR) and 44.9% with two (2MMR). Estimated VE was 85.4% (95%CI: 67.3-93.4) for 1MMR and 88.5% (95%CI: 78.1-93.9) for 2MMR. High 2MMR coverage, improved confirmation techniques and further VE studies with all confirmed cases are needed to prevent further outbreaks.

Evaluación del impacto de los programas de vacunación masiva: la experiencia de la hepatitis A en Cataluña / Evaluation of mass vaccination programmes: the experience of hepatitis A in Catalonia

Fundamento: El programa de vacunación de la hepatitisA + B en preadolescentes se introdujo en 1998 en Cataluña.Durante los siguientes años uno de los objetivos principales hasido cuantificar la reducción en la incidencia de hepatitis Aproducida por el programa de vacunación.Métodos:Se realizó un análisis retrospectivo mediante elestadístico scan espacio-temporal para la tasa de incidencianotificada por hepatitis A en las comarcas de Cataluña desde1992 hasta 2007. Se calcularon los riesgos relativos (RR) y laautocorrelación espacial se estimó mediante el estadístico I deMoran.Resultados:Seis de los 7 clústers espacio-temporalesidentificados por la metodología scan se produjeron en el períodoprevacunal (1992-1998) y sólo uno en el periodo postvacunal(1999-2007). En las 10 primeras cuadrisemanas delperiodo postvacunal (1999-2005) hubo un descenso significativoen de incidencia de hepatitis A en Cataluña respecto alperiodo prevacunal (1992-1998) (p<0,01).Conclusiones. El estadístico I de Moran no mostró ningúnpatrón de dependencia espacial global, y sí fue útil para detectarlos clústers a nivel local. Estos resultados corroboran resultadosprevios que atribuían la mayor parte del descenso en laincidencia de hepatitis A en Cataluña debido al efecto de lavacunación(AU)

Background: The hepatitis A + B vaccination programmeof preadolescents was introduced in 1998 in Catalonia. Duringthe following years, one of the main objectives has been toquantify the reduction in the incidence of hepatitis A caused bythe vaccination programme.Methods:A retrospective analysis applying the space-timescan statistic to reported incidence rates of hepatitis A wascarried out in the counties of Catalonia from 1992 to 2007. Therelative risk (RR) was calculated and the spatial autocorrelationwas estimated using Moran’s I statistic.Results: Six of the 7 space-time clusters identified by thescan statistic occurred in the pre-vaccine era (1992-1998) andonly one in the post-vaccine era (1992-2007). In the first 10four-weekly periods of the post-vaccine era (1999-2005) therewas a significant reduction in the incidence of hepatitis A inCatalonia with respect to the pre-vaccine era (1992-1998)(p<0,01).Conclusions. Moran’s I statistic showed no pattern ofglobal spatial dependence and was useful in detecting localclusters. These results corroborate previous studies thatattributed most of the reduction in the incidence of hepatitis Ain Catalonia to the effect of vaccination(AU)

Mumps: a year of enhanced surveillance in Catalonia, Spain.

Mumps is a vaccine-preventable disease candidate for elimination. Positive predictive value (PPV) of clinical case definition was assessed. During 2007, 410 suspected cases were reported in Catalonia: 348 fulfilled clinical case definition and 159 were laboratory confirmed. Incidence rate was 4.8 per 100,000 for cases that fulfilled the clinical definition, and 2.2 for laboratory confirmed cases. Global PPV was 44.5%; 38.5% in <15 years and 50% in > or =15 years (p=0.04). Most laboratory confirmed cases (72.3%) received at least one MMR dose. With sustained high MMR coverage, laboratory confirmation is necessary to control the disease and assess vaccine failure.

Changes in the evolution of meningococcal disease, 2001-2008, Catalonia (Spain).

Reported cases of meningococcal disease between 1997 and 2008 were analyzed to determine the evolution after the introduction of a conjugated vaccine. In <6 years, the incidence rate of serogroup C fell from 7.6 to 0.6 per 100,000 persons/year in the periods before (1997-2000) and after (2001-2007) the introduction of the conjugate vaccine. In serogroup B, the reduction was from 15.4 to 11.1. In <20 years case-fatality-rate increased only in serogroup B (3% and 7.4%, p=0.026). Serosubtype P1.15 was the most frequent in serogroup B (31%), mainly associated with serotype 4 (80%), and in serogroup C subtype P1.5 (36%), with serosubtype 2a (86%). Exhaustive surveillance of circulating meningococcal strains is essential.

Is the vaccination coverage established enough to control pertussis, or it is a re-emerging disease?

Although vaccination coverage is high in Catalonia, Spain, pertussis is still a significant cause of morbidity and mortality among infants, overall due to adolescent and adult contacts. An epidemiological study from voluntary health care centres to detect confirmed pertussis cases was carried out in Catalonia. From 465 pertussis-suspect-cases, we identified 126 confirmed events, 73 of them confirmed by laboratory tests. Most of cases were infants less than 4 months old 23 (18.3%), adolescents 22 (17.4%) and adults 46 (36.5%). Sixty-one cases (49.6%) presented paroxysmal cough, 33 (26.8%) post-tussive vomiting and inspiratory whoop, and 27 (22%) apnoea. The vaccination status was not known for 46 (36.5%) patients. Of the total vaccine status documented, 59 (73.8%) patients had received at least one dose. Sixty patients (47.6%) were considered index cases, 32 of them (53.3%) were children under 1-year old. Among contacts identified as pertussis cases, 63.6% (42/66) were older than 14 years of age. These contacts were parents (30), siblings (19), grandmother (4), and others (13). These results confirm protective efficacy of pertussis vaccine only during few time. Regular pertussis boosters in teenagers, and/or in adults who take care of young children, could decrease the incidence of the infection.

Factors associated with differences between conventional contact tracing and molecular epidemiology in study of tuberculosis transmission and analysis in the city of Barcelona, Spain.

The aim of this study was to analyze the factors associated with conventional contact tracing (CCT) and molecular epidemiology (ME) methods in assessing tuberculosis (TB) transmission, comparing the populations studied and the epidemiological links established by both methods. Data were obtained from TB case and CCT registries, and ME was performed using IS6110-based restriction fragment length polymorphism (RFLP) analysis and mycobacterial interspersed repetitive unit 12 (MIRU12) typing as a secondary typing method. During two years (2003 and 2004), 892 cases of TB were reported, of which 687 (77%) were confirmed by culture. RFLP analysis was performed with 463 (67.4%) of the 687 isolated strains, and MIRU12 types in 75 strains were evaluated; 280 strains (60.5%) had a unique RFLP pattern, and 183 (39.5%) shared patterns, grouping into 65 clusters. CCT of 613 (68.7%) of 892 cases detected 44 clusters involving 101 patients. The results of both CCT and ME methods yielded 96 clusters involving 255 patients. The household link was the one most frequently identified by CCT (corresponding to 80.7% of the cases clustered by this method), whereas nonhousehold and unknown links were associated with 94.1% of the strains clustered by ME. When both methods were used in 351 cases (39.3%), they showed the same results in 214 cases (61%). Of the remainder, 106 (30.2%) were clustered only by ME, 19 (5.5%) were clustered only by CCT, and 12 (3.4%) were clustered by both methods but into different clusters. Patients with factors potentially associated with social problems were less frequently studied by CCT (P = 0.002), whereas patients of <15 years of age, most with negative cultures, were less frequently studied by ME (P = 0.005). Significant differences in the populations studied by ME versus CCT were observed, possibly explaining the scarce correlation found between the results of these methods. Moreover, ME allowed the detection of nonhousehold contact relationships, whereas CCT was more useful for tracing transmission chains involving patients of <15 years of age. In conclusion, the two methods are complementary, suggesting the need to improve the methodology of contact study protocols.

[Evaluation of mass vaccination programmes: the experience of Hepatitis A in Catalonia]. / Evaluación del impacto de los programas de vacunación masiva: la experiencia de la hepatitis A en Cataluña.

BACKGROUND: The hepatitis A + B vaccination programme of preadolescents was introduced in 1998 in Catalonia. During the following years, one of the main objectives has been to quantify the reduction in the incidence of hepatitis A caused by the vaccination programme. METHODS: A retrospective analysis applying the space-time scan statistic to reported incidence rates of hepatitis A was carried out in the counties of Catalonia from 1992 to 2007. The relative risk (RR) was calculated and the spatial autocorrelation was estimated using Moran's I statistic. RESULTS: Six of the 7 space-time clusters identified by the scan statistic occurred in the pre-vaccine era (1992-1998) and only one in the post-vaccine era (1992-2007). In the first 10 four-weekly periods of the post-vaccine era (1999-2005) there was a significant reduction in the incidence of hepatitis A in Catalonia with respect to the pre-vaccine era (1992-1998) (p<0,01). CONCLUSIONS: Moran's I statistic showed no pattern of global spatial dependence and was useful in detecting local clusters. These results corroborate previous studies that attributed most of the reduction in the incidence of hepatitis A in Catalonia to the effect of vaccination.

[Epidemiology of the meningococcal disease in Catalonia before and after vaccination against serogroup C]. / Epidemiología de la enfermedad meningocócica en Cataluña antes y después de la vacunación frente al serogrupo C.

BACKGROUNDS: Meningococcal disease remains a serious public health problem worldwide. In Catalonia, after implementing the vaccination program, there has been a significant decrease in cases caused by meningococcus C. METHODS: Reported cases of meningococcal disease between 1997 and 2008 were analyzed to determine the evolution after the introduction of a conjugated vaccine in Catalonia. RESULTS: In < 6 years, the incidence rate of serogroup C fell from 7.6 to 0.6 per 100,000 persons/year in the periods before (1997-2000) and after (2001-2007) the introduction of the conjugate vaccine. In serogroup B, the reduction was from 15.4 to 11.1. In < 20 years case-fatality-rate increased only in serogroup B (3% and 7.4%). Serosubtype P1.15was the most frequent in serogroup B (31%), mainly associated with serotype 4 (80%), and in serogroup C subtype P1.5 (36%), with serotype 2a (86%). During 2008, 5 apparently unrelated cases of B:2a:P1.5 were identified in the same geographic area, with a case-fatality-rate of 80%. CONCLUSIONS: Exhaustive surveillance of circulating meningococcal strains is essential.

Prevalence of pertussis antibodies in umbilical cord blood samples in Catalonia, Spain.

The objective of the study was to determine the prevalence of detectable antipertussis antibodies (anti-PT) and recent pertussis infection in a representative sample (n=508) of pregnant women in Catalonia (Spain). Antipertussis (PT) antibodies were determined in cord blood samples using an in-house enzyme-linked immunosorbent assay test. The prevalence of detectable anti-PT levels was 72.8% and the prevalence of recent pertussis infection in mothers (cord blood anti-PT level of > or = 195 EU/mL was 1.8%. The (P<0.05) and the prevalence of recent pertussis infection decreased with maternal age (P< 0.01). Results obtained in this study show that it might be necessary to develop a pertussis vaccination program using acellular pertussis vaccines aimed at pregnant women to reduce the risk of pertussis infection during pregnancy and in neonates.

[Recommendations for health research and information on definitions and variables for the study of the foreign-born immigrant population]. / Recomendaciones para la investigación e información en salud sobre definiciones y variables para el estudio de la población inmigrante de origen extranjero.

BACKGROUND: The growth of the foreign population residing in Spain makes it necessary to avail of better information on the level of health. In the health information and research systems, no uniform criteria currently exist for the nomenclature of origin-related variables. This study poses a consensus on the definitions of immigrant and foreigner. METHODS: Employing the Delphi methodology, 66 experts in immigration from different disciplines were invited to take part in the study using a two-round questionnaire with suggested definitions, terms and variables, including in the second round the percentages of responses and the comments made by the participants in the first. The suggestions regarding which an 80% consensus was reached were put into a final document which was approved in the third round. RESULTS: A total of 57 people accepted the invitation, 44 having completed at least one round and 33 having completed all three. Some of the most important aspects regarding which a consensus was reached were: the term "immigrant" denotes the individual who comes to a country where he/she was not born to take up residency, one not being an immigrant on a lifelong basis. Those individuals born in another country who have arrived in Spain less than 5-10 years ago can be considered immigrants; and immigrated people are all those individuals born in another country. Socioeconomic variables, gender, administrative status and country of origin should also be taken into consideration. The children of immigrated individuals who are born in Spain must not be considered individuals who are born in Spain must not be considered. CONCLUSIONS: To properly define the inmigrating and immigrated population categories, the health studies and information systems must include country of birth, year of arrival and nationality.

Políticas para reducir el daño causado por el consumo de alcohol: una aproximación desde la salud pública / Policies to reduce harm caused by alcohol use: a public health perspective

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