Risk reduction of severe outcomes in vaccinated COVID-19 cases: an analysis of surveillance data from Estonia, Ireland, Luxembourg and Slovakia, January to November 2021.

Despite high COVID-19 vaccine coverage in the EU/EEA, there are increasing reports of SARS-CoV-2 infections and hospitalisations in vaccinated individuals. Using surveillance data from Estonia, Ireland, Luxembourg and Slovakia (January-November 2021), we estimated risk reduction of severe outcomes in vaccinated cases. Increasing age remains the most important driver of severity, and vaccination significantly reduces risk in all ages for hospitalisation (adjusted relative risk (aRR): 0.32; 95% confidence interval (CI): 0.26-0.39) and death (aRR: 0.20; 95% CI: 0.13-0.29).

Initial assessment of the COVID-19 vaccination's impact on case numbers, hospitalisations and deaths in people aged 80 years and older, 15 EU/EEA countries, December 2020 to May 2021.

Prioritisation of elderly people in COVID-19 vaccination campaigns aimed at reducing severe outcomes in this group. Using EU/EEA surveillance and vaccination uptake, we estimated the risk ratio of case, hospitalisation and death notifications in people 80 years and older compared with 25-59-year-olds. Highest impact was observed for full vaccination uptake 80% or higher with reductions in notification rates of cases up to 65% (IRR: 0.35; 95% CI: 0.13-0.99), hospitalisations up to 78% (IRR: 0.22; 95% CI: 0.13-0.37) and deaths up to 84% (IRR: 0.16; 95% CI: 0.13-0.20).

Influenza vaccine uptake among healthcare workers and residents in public health care facilities in Ireland over nine influenza seasons (2011-2012 to 2019-2020).

The influenza vaccine is free to all healthcare workers (HCWs) working in hospitals and long-term/residential health care facilities in Ireland. To evaluate influenza vaccine uptake, the Health Service Executive-Health Protection Surveillance Centre surveyed HCWs each season between 2011-2012 and 2019-2020. The national HCW uptake target was 40% for the first six seasons and was increased to 75% for the 2019-2020 season. Data on seasonal influenza vaccine uptake among HCWs employed in these healthcare settings were obtained using web-based surveys sent to occupational or management contact points. Data on numbers of staff vaccinated by Health Service Executive (HSE) professional staff grade and numbers eligible for vaccination in each grade were provided. Since the 2017-2018 season, a point prevalence survey for residents to assess influenza vaccine uptake has also been undertaken in long-term/residential care facilities (LTCFs) and aggregate data submitted, initially using a desktop spreadsheet survey tool, but later using web-based survey tools; these surveys were undertaken to investigate how uptake differed between HCWs and residents, both long-term and short-term. Participation by healthcare facilities and influenza vaccine uptake by both HCWs and LTCF-residents in these surveys increased over the nine seasons. Uptake among HCWs employed in publicly-funded hospitals increased from 18.1% (2011-2012) to 58.9% (2019-2020). Uptake in publicly-funded LTCFs increased from 17.8% (2011-2012) to 45.5% (2019-2020). Overall, uptake among hospital nursing staff was lowest among all staff categories for most seasons, but increased from 12.4% in 2011-2012 to 58.1% in 2019-2020. In all seasons since 2011-2012, medical/dental, management/administrative or health and social care professional staff reported the highest uptake values in public LTCFs. Of the three annual point prevalence surveys between 2017-2018 and 2019-2020, all showed high overall uptake among long-term residents (between 88.9% and 89.4%), and a lower and wider uptake range among respite residents (between 57.5% and 66.5%).

cgMLST characterisation of invasive Neisseria meningitidis serogroup C and W strains associated with increasing disease incidence in the Republic of Ireland.

INTRODUCTION AND AIMS: Since 2013 MenC and MenW disease incidence and associated mortality rates have increased in the Republic of Ireland. From 2002/2003 to 2012/2013, the average annual MenC incidence was 0.08/100,000, which increased to 0.34/100,000 during 2013/2014 to 2017/18, peaking in 2016/17 (0.72/100,000) with an associated case fatality rate (CFR) of 14.7%. MenW disease incidence has increased each year from 0.02/100,000 in 2013/2014, to 0.29/100,000 in 2017/18, with an associated CFR of 28.6%. We aimed to characterise and relate recent MenC isolates to the previously prevalent MenC:cc11 ET-15 clones, and also characterise and relate recent MenW isolates to the novel 'Hajj' clones. METHODS: Using WGS we characterised invasive (n = 74, 1997/98 to 2016/17) and carried (n = 16, 2016/17) MenC isolates, and invasive (n = 18, 2010/11 to 2016/17) and carried (n = 15, 2016/17) MenW isolates. Genomes were assembled using VelvethOptimiser and stored on the PubMLST Neisseria Bacterial Isolate Genome Sequence Database. Isolates were compared using the cgMLST approach. RESULTS: Most MenC and MenW isolates identified were cc11. A single MenC:cc11 sub-lineage contained the majority (68%, n = 19/28) of recent MenC:cc11 disease isolates and all carried MenC:cc11 isolates, which were interspersed and distinct from the historically significant ET-15 clones. MenW:cc11 study isolates clustered among international examples of both the original UK 2009 MenW:cc11, and novel 2013 MenW:cc11clones. CONCLUSIONS: We have shown that the majority of recent MenC disease incidence was caused by strain types distinct from the MenC:cc11 ET-15 clone of the late 1990s, which still circulate but have caused only sporadic disease in recent years. We have identified that the same aggressive MenW clone now established in several other European countries, is endemic in the RoI and responsible for the recent MenW incidence increases. This data informed the National immunisation Advisory Committee, who are currently deliberating a vaccine policy change to protect teenagers.

Seroepidemiological and phylogenetic characterization of neurotropic enteroviruses in Ireland, 2005-2014.

Enteroviruses (EVs) are associated with a broad spectrum of clinical presentation, including aseptic meningitis (AM), encephalitis, hand, foot and mouth disease, acute flaccid paralysis, and acute flaccid myelitis. Epidemics occur sporadically and are associated with increased cases of AM in children. The present study describes the seroepidemiological analysis of circulating EVs in Ireland from 2005 to 2014 and phylogenetic characterization of echovirus 30 (E-30), enterovirus A71 (EV-A71), and enterovirus D68 (EV-D68). EV VP1 genotyping was applied to viral isolates and clinical samples, including cerebrospinal fluid (CSF), and those isolates that remained untypeable by neutralising anti-sera. An increase in AM cases from 2010 to 2014 was associated with an E-30 genogroup variant VII and sequences clustered phylogenetically with those detected in AM outbreaks in France and Italy. EV-D68 viral RNA was not detected in CSF samples and no neurological involvement was reported. Three EV-A71 positive CSF samples were identified in patients presenting with AM. A phylogenetic analysis of respiratory-associated EV-D68 and EV-A71 cases in circulation was performed to determine baseline epidemiological data. EV-D68 segregated with clades B and B(1) and EV-A71 clustered as subgenogroup C2. The EV VP1 genotyping method was more sensitive than neutralising anti-sera methods by virus culture and importantly demonstrated concordance between EV genotypes in faecal and CSF samples which should facilitate EV screening by less invasive sampling approaches in AM presentations.

The use of complementary and alternative medicine in an Irish cohort of people with an iatrogenic hepatitis C infection: results from a health and lifestyle survey.

INTRODUCTION: A cohort of people with iatrogenic HCV infection, current or resolved, in Ireland have access to primary and secondary health care services, including specified complementary and alternative medicine (CAM) services, free of charge. OBJECTIVES: Information about their pattern of CAM usage and its association with various demographic and lifestyle factors, and current HCV status, was sought as part of a health and lifestyle survey, in order to provide information for health service planning. DESIGN AND METHODS: The survey was carried out by self-administered postal questionnaire. The level of CAM usage was compared to an age- and sex-matched sample of the general population. RESULTS: The response was 48% (720/1485). Compared to the general population, the HCV population was significantly more likely to have attended a CAM practitioner (50.1% vs 23.9%, OR 3.2; 95% CI 2.7-3.9). Within the HCV population, multivariate analysis showed that females (OR 3.1; 95% CI 1.9-4.9), those who reported fibromyalgia (OR 2.7; 95% CI 1.8-3.9) and those who reported anxiety (OR 1.4; 95% CI 1.0-2.0) were significantly more likely to have used CAM, and smokers significantly less likely (OR 0.6; 95% CI 0.4-0.8). CAM attendance did not vary by current HCV status. Reflexology, acupuncture and massage were the most commonly used forms of CAM. CONCLUSIONS: This study demonstrates that CAM services are used by a high proportion of people with iatrogenic chronic HCV. A more holistic approach to health care, using a biopsychosocial model framework, may better meet the physical and psychological health needs of this group.

Underreporting of viral encephalitis and viral meningitis, Ireland, 2005-2008.

Viral encephalitis (VE) and viral meningitis (VM) have been notifiable infectious diseases under surveillance in the Republic of Ireland since 1981. Laboratories have reported confirmed cases by detection of viral nucleic acid in cerebrospinal fluid since 2004. To determine the prevalence of these diseases in Ireland during 2005-2008, we analyzed 3 data sources: Hospital In-patient Enquiry data (from hospitalized following patients discharge) accessed through Health Intelligence Ireland, laboratory confirmations from the National Virus Reference Laboratory, and events from the Computerised Infectious Disease Reporting surveillance system. We found that the national surveillance system underestimates the incidence of these diseases in Ireland with a 10-fold higher VE hospitalization rate and 3-fold higher VM hospitalization rate than the reporting rate. Herpesviruses were responsible for most specified VE and enteroviruses for most specified VM from all 3 sources. Recommendations from this study have been implemented to improve the surveillance of these diseases in Ireland.

Evaluation of screening risk and nonrisk patients for methicillin-resistant Staphylococcus aureus on admission in an acute care hospital.

BACKGROUND: Screening for methicillin-resistant Staphylocccus aureus (MRSA) is advocated as part of control measures, but screening all patients on admission to hospital may not be cost-effective. OBJECTIVE: Our objective was to evaluate the additional yield of screening all patients on admission compared with only patients with risk factors and to assess cost aspects. METHODS: A prospective, nonrandomized observational study of screening nonrisk patients ≤72 hours of admission compared with only screening patients with risk factors over 3 years in a tertiary referral hospital was conducted. We also assessed the costs of screening both groups. RESULTS: A total of 48 of 892 (5%) patients was MRSA positive; 28 of 314 (9%) during year 1, 12 of 257 (5%) during year 2, and 8 of 321 (2%) during year 3. There were significantly fewer MRSA-positive patients among nonrisk compared with MRSA-risk patients: 4 of 340 (1%) versus 44 of 552 (8%), P ≤ .0001, respectively. However, screening nonrisk patients increased the number of screening samples by 62% with a proportionate increase in the costs of screening. A backward stepwise logistic regression model identified age > 70 years, diagnosis of chronic pulmonary disease, previous MRSA infection, and admission to hospital during the previous 18 months as the most important independent predictors to discriminate between MRSA-positive and MRSA-negative patients on admission (94.3% accuracy, P < .001). CONCLUSION: Screening patients without risk factors increased the number of screenings and costs but resulted in few additional cases being detected. In a hospital where MRSA is endemic, targeted screening of at-risk patients on admission remains the most efficient strategy for the early identification of MRSA-positive patients.

Prostate cancer mortality predictions for Ireland up to 2015.

The objective of this analysis was to predict average world age-standardized mortality rates per person-years (100,000 person-years) and numbers of prostate cancer deaths in Ireland for the years 2005, 2010 and 2015. Poisson linear and log-linear regression models of Irish prostate cancer mortality data for the years 1950-2002 were used to predict trends for the whole population, for men aged 0-64 and 50-74 years. The prostate cancer world age-standardized mortality rate in 2015 is predicted to remain unchanged from the average recorded in 1998-2002, while, because of population growth, the number of deaths is predicted to increase. In persons under 65 years of age, the world age-standardized mortality rate is expected to increase, but the number of deaths in this age group is expected to nearly double between 2002 and 2015. Similarly, the world age-standardized mortality rate for men aged 50-74 years is predicted to rise with the number of deaths in this age group expected to increase sharply. The historical evidence predicts a small increase of age-adjusted prostate cancer mortality rates in Ireland and only in the age groups of 0-64 and 50-74 years in the next 10 years, along with a continuing marked increase in number of deaths due to demographic change.

Cumulative cancer mortality risk and potential years of life lost to 64 years of age in Ireland, 1953-2002.

Premature cancer mortality trends were examined by reviewing cumulative mortality risk ('cumulative risk' hereafter) and potential years of life lost (PYLL) up to and including 64 years of age between 1953 and 2002 in Ireland. Trends were assessed quantitatively by Joinpoint analysis of both measures (with PYLL expressed as an age-standardized rate). The age of 64 years was used for these summary measures to reflect the focus of the Irish Government's cancer strategy on cancer in the under-65 population. Some differences emerged when ranking the significant types of cancer using cumulative risk and PYLL values. In general, however, the two methods generated similar overall trends, although PYLL rates tended to show steeper or longer-term declines, presumably reflecting the greater weight given to deaths at younger ages. Most cancers have, in recent years, shown a downward, or levelling-off of, trend for both sexes. The only exceptions were significant increases for oesophageal cancer in men (both measures), and prostate cancer (cumulative risk), cervical cancer (PYLL rate) and lymphoma in both sexes (cumulative risk). Rankings based on both cumulative risk and PYLL showed that male lung cancer is still the leading cause of premature death from cancer in Ireland, despite recent falls in mortality rates. Breast cancer has consistently been the leading cause of premature cancer death in women since the 1950s. Stomach cancer was once the second leading cause of premature cancer death in women, but since the 1960s it has been replaced by lung cancer. Ovarian cancer, having had a middle ranking for many years has, since the early 1990s, become the third leading cause of premature cancer death for women.

Lung cancer mortality predictions for Ireland 2001-2015 and current trends in North Western Europe.

UNLABELLED: PURPOSE AND METHODOLOGY: Poisson regression models of Irish lung cancer mortality data for the years 1954-2000 were used to predict European age standardized mortality rates (EASMRs) and numbers of deaths for the period 2001-2015. Predictions for the whole population and for the age group 0-64 years were the main focus of this analysis. The models employed in this analysis were written for the STATA 6.0 STATISTICAL PACKAGE FOR WINDOWS. Linear models were applied, in general, to upward trends and log-linear models to downward trends. RESULTS: For males of all ages, EASMRs are expected to fall significantly from 59.7 per 100,000 person years (100,000 PY(-1)) in 2000 to 47.2 in the period 2011-2015. Female EASMRs are expected to fall from 28.3 100,000 PY(-1) in 2000 to 27.8 in 2011-2015. The EASMR for males under 65 years of age is predicted to continue its decline from 20.6 100,000 PY(-1) in 2000 to 11.7 in 2011-2015. The rate for females in this same age group is predicted to decline from 10.7 100,000 PY(-1) in 2000 to 7.0 in 2001-2015. Recent lung cancer trends In Ireland were also compared to other countries in North Western Europe.