Background infection (CDI) is a severe infection that needs to be monitored. This infection predominantly occurs in hospitalised patients after antimicrobial treatment, with high mortality in elderly patients.AimWe aimed at estimating the incidence of CDI in Italian hospitals over 4 months in 2022.MethodsWe estimated incidences of hospital-acquired CDI (HA-CDI), community or unknown CDI (CA/UA-CDI), recurrent CDI and overall CDI in 25 Italian hospitals, characterised isolates using PCR ribotyping, analysed them for toxin genes and susceptibility to antimicrobials.Results was detected in 9.7% (655/6,722) of samples from 550 patients, 18 patients died of CDI. The mean overall CDI incidence was 5.0 cases per 10,000 patient days (range: 0.7-11.9). For HA-CDI, mean incidence was 3.7 (range: 0.7-9.2), for CA/UA-CDI 0.8 (range: 0.0-3.2) and for recurrent CDI 0.5 (range: 0.0-3.4). Most patients were female (n = 295; 53.6%), aged ≥ 65 years (n = 422; 76.7%) and previously hospitalised (n = 275; 50.0%). Of the 270 culturable isolates, 267 (98.9%) had toxin A and B genes and 51 (18.9%) the binary toxin genes. Of the 55 PCR ribotypes (RTs) identified, RT 018 (n = 56; 20.7%) and RT 607 (n = 23; 8.5%) were the most common, RT 607 in the northern (p < 0.0001) and RT 018 in the central (p < 0.0001) regions of Italy. Most isolates (n = 158; 58.5%) were antimicrobial-resistant and 119 (44.1%) were multidrug-resistant (MDR).ConclusionHighly virulent and MDR types are circulating in Italian hospitals which highlights the need of robust surveillance and stringent prevention and control measures.

In 2022-23, several European countries reported paediatric acute liver failure (ALF) with enterovirus infection. In August-November 2024, three neonatal cases of ALF with echovirus 11 (E11) were reported in Tokyo, Japan. All neonates developed irreversible multiple-organ failure and died. The E11 strain belonged to the new lineage 1, which was the same as strains isolated from neonatal ALF cases in Europe in 2022-23.

In October and December 2024, circulating vaccine-derived poliovirus type 2 (cVDPV2) was detected from two wastewater samples in Poland during routine environmental surveillance. The first isolate was characterised and matched previous cVDPV2 isolates detected in Spain in September, as well as in Germany, Finland, and the United Kingdom in November and December 2024. In response to the event, active surveillance for acute flaccid paralysis (AFP) has been strengthened, and the frequency of environmental sample collection has been increased.

We isolated three genotypes of highly pathogenic avian influenza virus (HPAIV) clade 2.3.4.4b from wild birds infected with H5N1 (n = 12) and H5N8 (n = 1) in Hong Kong SAR 2021-2024. Viruses from two spoonbills from late 2022 were genetically related to a virus from a human in China. Four tested viruses exhibited variable virulence in mice but were susceptible to approved antivirals. No neutralising antibody was detected in 63 age-stratified human sera, suggesting potential risk should the virus adapt to humans.

BackgroundHuman parainfluenza viruses (HPIV) commonly cause upper respiratory tract infections, with potential for severe lower respiratory complications. Understanding seasonal increases informs strategies to prevent HPIV spreading.AimWe examined the impact of COVID-19 on HPIV epidemiological and clinical patterns in Scotland using non-sentinel and sentinel surveillance data.MethodsInformation on HPIV swab positivity (January 2017-October 2023) and demographic data was obtained from the Electronic Communication of Surveillance in Scotland (ECOSS) non-sentinel surveillance sources (laboratory-based data from hospital and community) and the Community Acute Respiratory Infection (CARI) sentinel surveillance programme (enhanced surveillance and symptom data).ResultsIn 2020 during early COVID-19 waves, HPIV detection decreased aligning with lockdowns and preventive measures. In summer 2021, HPIV positivity increased, with HPIV-3 possibly reverting to pre-pandemic seasonality, but HPIV-1 not yet re-establishing alternate-year peaks. Most positive results from non-sentinel sources came from hospital tests. Sentinel surveillance (CARI) complemented non-sentinel data, offering community-level insights. There was no significant difference in CARI swab positivity by sex in any age group. Consistent with historical trends, children under five years exhibited highest test positivity: 9.3% (95% CI: 7.6-11.2) in females and 8.5% (95% CI 7.0-10.2) in males.ConclusionThe COVID-19 pandemic impacted HPIV detection in Scotland. The decline during the pandemic peak and subsequent partial resurgence underscores the complex interplay between viral epidemiology and public health measures. Combining diverse surveillance systems provides a comprehensive understanding of HPIV dynamics. Insights into age-specific and symptom-associated patterns contribute to understanding HPIV epidemiology and refining public health strategies.

In 2021, a large outbreak of hantavirus disease (HAVID) in Croatia with 334 notified cases coincided with a COVID-19 wave and included patients from areas previously not considered endemic, challenging HAVID recognition and patient management. We analysed clinical and epidemiological data on all 254 patients with HAVID treated in the Clinical Hospital Center Rijeka (CHC Rijeka) between February and November 2021. Most patients (n = 246; 96.9%) had antibodies against Puumala virus, 212 (83.5%) were residents of endemic areas for HAVID, 93 (36.6%) reported occupational exposure and 86 (33.9%) had observed rodents or rodent excreta. Thirty-seven (14.6%) patients were not notified to the public health authorities. Most patients (n = 177; 69.7%) were male. The median age of the patients was 43 years (range: 17-79 years) in males and 54 years (range: 14-77 years) in females. More severe courses of disease were observed in males aged < 45 years than in older males and females of any age (OR = 2.27; 95% CI: 1.21-4.24; p < 0.005). Measures to prevent exposure, early detection and notification of cases and close collaboration between primary and secondary healthcare teams with public health personnel are essential to improve surveillance and prevent hantavirus outbreaks.

BackgroundToscana virus (TOSV) is transmitted to humans through bites of infected sand flies. Neuroinvasive TOSV infections are leading causes of meningitis/encephalitis in southern Europe and notifiable in Italy since 2016. In 2022-23, Italy experienced extreme climate anomalies and a concomitant increase in mosquito and tick-borne disease transmission.AimTo identify the spatiotemporal distribution and risk groups of neuroinvasive TOSV infections in Italy in 2022-23 vs 2016-21.MethodsWe retrospectively described all autochthonous, laboratory-confirmed neuroinvasive TOSV cases notified to the national surveillance system in 2016-23 using frequencies, proportions, incidences and incidence risk ratios (IRRs) with 95% CIs, stratified by year, sex, age, region/autonomous province (AP) of infection/exposure and infection/exposure municipality by urbanisation level.ResultsIn 2022-23, 276 cases were notified (average annual incidence: 2.34/1,000,000 population) vs 331 cases in 2016-21 (0.92/1,000,000), with increased incidence extending into September. In 2022-23, infections were acquired in 12/21 regions/APs, predominantly in Emilia Romagna (57.6%; 159/276) as in 2016-21, including four regions/APs with no local infections in 2016-21. Similar to 2016-21, during 2022-23 residence in rural municipalities (vs urban), male sex, working age (19-67 years) and age > 67 years (vs ≤ 18 years) were identified as risk factors with IRRs of 2.89 (95% CI: 2.01-4.17), 2.17 (95% CI: 1.66-2.84), 5.31 (95% CI: 2.81-10.0) and 5.06 (95% CI: 2.59-9.86), respectively.ConclusionItaly experienced a nearly 2.6-fold increase in neuroinvasive TOSV incidence in 2022-23 vs 2016-21. Raising public awareness on risk factors and personal protection measures may enhance prevention efforts.

This case report details the public health response to a multibacillary leprosy case in Ireland. The case presented with hypopigmented skin lesions and neurological symptoms. Challenges included delayed recognition in the clinical setting, contact tracing within a congregate setting and lack of specific Irish guidelines. Comprehensive contact tracing, chemoprophylaxis and follow-up care were implemented, guided by international protocols. This case underscores the need for tailored guidelines and stigma mitigation strategies for this neglected tropical disease in non-endemic regions.

BackgroundThe potential impact of urban structure, as population density and proximity to essential facilities, on spatial variability of infectious disease cases remains underexplored.AimTo analyse the spatial variation of COVID-19 case intensity in relation to population density and distance from urban facilities (as potential contagion hubs), by comparing Alpha and Omicron wave data representing periods of both enacted and lifted non-pharmaceutical interventions (NPIs) in Málaga.MethodsUsing spatial point pattern analysis, we examined COVID-19 cases in relation to population density, distance from hospitals, health centres, schools, markets, shopping malls, sports centres and nursing homes by non-parametric estimation of relative intensity dependence on these covariates. For statistical significance and effect size, we performed Berman 1 tests and Areas Under Curves (AUC) for Receiver Operating Characteristic (ROC) curves.ResultsAfter accounting for population density, relative intensity of COVID-19 remained consistent in relation to distance from urban facilities across waves. Although non-parametric estimations of the relative intensity of cases showed fluctuations with distance from facilities, Berman's Z1 tests were significant for health centres only (p < 0.032) when compared with complete spatial randomness. The AUC of ROC curves for population density was above 0.75 and ca 0.6 for all urban facilities.ConclusionResults reflect the difficulty in assessing facilities' effect in propagating infectious disease, particularly in compact cities. Lack of evidence directly linking higher case intensity to proximity to urban facilities shows the need to clarify the role of urban structure and planning in shaping the spatial distribution of epidemics within cities.

In 2024, circulating vaccine-derived poliovirus type 2 (cVDPV2) was detected in wastewater samples in Finland, Germany, Poland, Spain and the United Kingdom (UK). All strains were genetically linked, but sequence analysis showed high genetic diversity among the strains identified within individual wastewater sites and countries and an unexpected high genetic proximity among isolates from different countries. Taken together these results, with sequential samples having tested positive in various sites, a broader geographic distribution beyond positive sampling sites must be considered.

BackgroundTick-borne encephalitis (TBE) can be a severe neurological disease. Identifying ecological factors that may facilitate tick-borne encephalitis virus (TBEV) circulation in the Netherlands could improve awareness and detection.AimWe aimed to identify ecological factors affecting TBEV circulation in the Netherlands and to determine if there is sustained circulation and spread of the virus.MethodsBetween June and September 2021, rodents and ticks from three previously TBEV-positive locations were tested for TBEV by PCR. We sequenced TBEV and compared the sequences with previous and subsequent sequences from the Netherlands and other countries to investigate the spread of TBEV-variants.ResultsWe captured 383 rodents, 928 feeding ticks and 1,571 questing ticks and detected TBEV from six (three and three ) (2.9%) of 206 tested rodents and two (0.9%) of 215 questing tick pools. Detection of TBEV was associated with questing tick density (Mann-Whitney U test  = 81.5; 95% confidence interval (CI): - 3.7-6.3 × 10-5; p = 0.05). Tick larvae (odds ratio (OR) = 9.0; 95% CI: 2.8-38.2; p < 0.01) and nymphs (OR = 3.8; 95% CI: 1.3-13.6; p < 0.01) were more frequent on than on Sequence comparisons suggest multiple introductions and local circulation of TBEV but no spread among locations.ConclusionTick-borne encephalitis virus occurs in diverse woodlands in the Netherlands, posing a risk to those frequenting these areas. Surveillance for the early detection and monitoring of TBEV spread, along with public awareness campaigns on preventive measures, should continue. Recognition of TBE symptoms and supportive diagnostics should be made available nationwide.

BackgroundCrimean-Congo haemorrhagic fever (CCHF) is a severe illness characterised by fever, bleeding and high case-fatality rates. The disease is caused by CCHF virus (CCHFV), transmitted by ticks and infectious body fluids and tissues.AimAfter CCHF was diagnosed in three persons in 2023, we aimed to investigate the presence of antibodies against CCHFV in healthcare workers (HCW), sheep and goats, and of CCHFV in ticks, in an area in North Macedonia and characterise virus strains.MethodsIn 2023, we collected blood samples from HCWs involved in treating CCHF patients and sera and ticks from sheep and goats in the village in North Macedonia where the index case resided. The blood samples were analysed by ELISA. Ticks were tested for presence of CCHFV, and the virus from a CCHF case was sequenced.ResultsSamples from four of 52 HCWs and 10 of 17 small ruminants had antibodies against CCHFV. The virus was not detected from any of the 24 ticks. The virus strain from the index case clustered with regional strains within the Europe-1 lineage (genotype V) group and was closest to strains from Kosovo‡.ConclusionThis report shows CCHFV is endemic in North Macedonia. Raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus is important. Healthcare workers need to be aware of the disease. Early detection, robust diagnostic methods, surveillance and collaborative efforts are necessary to prevent and control CCHF in the affected regions.

BackgroundThe first Corona Monitoring Nationwide (RKI-SOEP) study (October 2020-February 2021) found a low pre-vaccine SARS-CoV-2 antibody seroprevalence (2.1%) in the German adult population (≥ 18 years).AimThe objective of this second RKI-SOEP (RKI-SOEP-2) study in November 2021-March 2022 was to estimate the prevalence of SARS-CoV-2-specific anti-spike and/or anti-nucleocapsid (anti-N) IgG antibodies (combined seroprevalence), past infection based on infection-induced seroprevalence (anti-N), and basic immunisation (at least two antigen contacts through vaccination or infection) in individuals aged ≥ 14 years. We also aimed to estimate under-reporting of infections.MethodsDried blood-spot specimens from a population-based sample embedded in a dynamic cohort, the Socio-Economic Panel (SOEP), were serologically analysed. Resulting serological data and self-reports via a questionnaire from the same individuals were used to estimate prevalences.ResultsCombined seroprevalence was 90.7% (95% CI: 89.7%-91.6%) without correction and 94.6% (95% CI: 93.6%-95.7%) with correction for sensitivity/specificity and antibody waning. While one in nine individuals had been infected (11.3%; 95% CI: 9.1%-13.5%), nine in 10 had a basic immunisation (90%; 95% CI: 88.9-90.9%), primarily due to vaccination. Population-weighted estimates differed by age, region, and socioeconomic deprivation. The under-reporting factor was estimated as 1.55 (95% CI: 1.3-1.8).ConclusionsWhen the SARS-CoV-2-Omicron wave was beginning, most people had been vaccinated, infected, or both. Large-scale vaccination, but not a high infection rate, was able to fill the immunity gap, especially in ≥ 65 year-olds who are known to be at higher risk of severe COVID-19. Our data point towards the need for targeted socioeconomically, demographically and regionally stratified mitigation strategies, including measures to enhance vaccine uptake.

BackgroundEarly detection and characterisation of SARS-CoV-2 variants have been and continue to be essential for assessing their public health impact. In August 2023, Santé publique France implemented enhanced surveillance for BA.2.86 and sub-lineage JN.1 because of their genetic divergence from other variants and increased prevalence.AimTo detail how combining epidemiological and laboratory data sources, targeted investigations and modelling enabled comprehensive characterisation of sub-lineage JN.1.MethodsData were collected from epidemiological investigations using a standardised questionnaire and from routine and novel (RELAB network) surveillance systems. JN.1 cases were compared with cases infected with previously circulating variants, such as EG.5, BA.4/BA.5 and other BA.2.86 sub-lineages. The growth rate and doubling time of JN.1 were estimated.ResultsJN.1 was first detected in September 2023 in the Île-de-France region, France, and spread widely across the country. By late November, doubling time was estimated to be 8.6 to 26.4 days depending on the region. For all data sources, cases infected by JN.1 showed similar demographics, rates of hospitalisation and RT-PCR cycle threshold values compared with those infected by previous variants. JN.1 cases also had older median age (54 years; 40-71 vs 47 years; 30-59), more frequent reports of feverish feeling and less frequent cough or nausea compared with BA.4/BA.5 cases. JN.1 cases had significantly higher frequency of anosmia compared with other BA.2.86 cases.ConclusionCombining different data sources played a key role in detecting emerging variant JN.1, for which no evidence of increased public health impact was found despite its genetic divergence.

The Canadian Sentinel Practitioner Surveillance Network (SPSN) reports interim 2024/25 vaccine effectiveness (VE) against acute respiratory illness due to laboratory-confirmed influenza during a delayed season of predominant A(H1N1)pdm09 and lower A(H3N2) co-circulation. Through mid-January, the risk of outpatient illness due to influenza A is reduced by about half among vaccinated vs unvaccinated individuals. Adjusted VE is 53% (95% CI: 36-65) against A(H1N1)pdm09, comprised of clades 5a.2a and 5a.2a.1, and 54% (95% CI: 29-70) against A(H3N2), virtually all clade 2a.3a.1.

BackgroundThe COVID-19 pandemic resulted in increased mortality directly and indirectly associated with COVID-19.AimTo assess the impact of the COVID-19 pandemic on all-cause and disease-specific mortality and explore potential health inequalities associated with area-level deprivation in Wales.MethodsTwo population-based cohort studies were derived from multi-sourced, linked demographic, administrative and electronic health record data from 2016 to 2019 (n = 3,113,319) and 2020 to 2022 (n = 3,571,471). Data were analysed using generalised linear models adjusting for age, sex, area-level deprivation and time at risk.ResultsCOVID-19 deaths peaked in January 2021 (54.9/100,000 person-months, 95% confidence interval (CI): 52.4-57.5). The pandemic indirectly affected deaths, with higher than expected maximum relative mortality rates (RR) related to cancer (RR: 1.24, 95% CI: 1.13-1.36), infectious diseases (excluding respiratory infections) (RR: 2.09, 95% CI: 1.27- 3.43), circulatory system (RR: 1.41, 95% CI: 1.28-1.56), trauma (RR: 2.04, 95% CI: 1.57- 2.65), digestive system (RR: 1.54, 95% CI: 1.25-1.91), nervous system (RR: 1.63; 95% CI: 1.34-2.00) and mental and behavioural disorders (RR: 1.85, 95% CI: 1.58-2.16). Mortality associated with respiratory diseases (unrelated to COVID-19) were lower than expected (minimum RR: 0.52, 95% CI: 0.45-0.60). All-cause mortality was lower in least deprived communities compared with most deprived (RR: 0.61, 95% CI: 0.60-0.62), and the magnitude of this effect increased during the pandemic.ConclusionsAll-cause and disease-specific mortality directly and indirectly associated with COVID-19 increased during the COVID-19 pandemic. Socioeconomic disparities were exacerbated during this time.

IntroductionNuvaxovid became available in Australia from February 2022, a year after the first COVID-19 vaccines. This protein-based vaccine was an alternative for people who had had an adverse event to and/or were hesitant to receive an mRNA or adenovirus-based COVID-19 vaccine. Although safety from clinical trials was reassuring, small trial populations, low administration rates and limited post-licensure intelligence meant potential rare adverse events were underinformed.AimWe aimed to describe Nuvaxovid's safety profile in a real-world setting.MethodsWe conducted a retrospective observational analysis of adverse events following immunisation (AEFI) spontaneously reported to SAFEVAC, the integrated vaccine safety surveillance system in Victoria and Western Australia. Reports from 14 February 2022 to 30 June 2023 were analysed by vaccinee demographics, reported reactions and COVID-19 vaccine dose, and compared as reporting rates (RR) per 100,000 doses administered.ResultsWe received 356 AEFI reports, following 102,946 Nuvaxovid doses administered. Rates were higher after dose 1 than dose 2 (rate ratio: 1.5, p = 0.0008), primary series than booster (rate ratio: 2.4, p < 0.0001), and in females vs males (rate ratio: 1.4, p = 0.004). Clinically confirmed serious AEFI included 94 cases of chest pain (RR = 91.3), two myocarditis (RR = 1.9) and 20 pericarditis (RR = 19.4). Guillain-Barré syndrome or thrombosis with thrombocytopaenia syndromes were not reported, nor deaths attributable to vaccination.ConclusionSAFEVAC's collaborative data model enabled pooling of clinically reviewed data across jurisdictions, increasing the safety profile evidence for Nuvaxovid and improving the odds for identification and description of rare events. This analysis affirmed the safety profile of Nuvaxovid.

BackgroundWithin the International Health Regulations framework, the French High Council for Public Health was mandated in 2022 by health authorities to establish a list of priority infectious diseases for public health, surveillance and research in mainland and overseas France.AimOur objective was to establish this list.MethodsA multi-criteria decision analysis was used, as recommended by the European Centre for Disease Prevention and Control. A list of 95 entities (infectious diseases or groups of these, including the World Health Organization (WHO)-labelled 'Disease X') was established by 17 infectious disease experts. Ten criteria were defined to score entities: incidence rate, case fatality rate, potential for emergence and spread, impact on the individual, on society, on socially vulnerable groups, on the healthcare system, and need for new preventive tools, new curative therapies, and surveillance. Each criterion was assigned a relative weight by 77 multidisciplinary experts. For each entity, 98 physicians from various specialties rated each criterion against the entity, using a four-class Likert-type scale; the ratings were converted into numeric values with a nonlinear scale and respectively weighted to calculate the entity score.ResultsFifteen entities were ranked as high-priorities, including Disease X and 14 known pathologies (e.g. haemorrhagic fevers, various respiratory viral infections, arboviral infections, multidrug-resistant bacterial infections, invasive meningococcal and pneumococcal diseases, prion diseases, rabies, and tuberculosis).ConclusionThe priority entities agreed with those of the WHO in 2023; almost all were currently covered by the French surveillance and alert system. Repeating this analysis periodically would keep the list updated.

BackgroundDuring the 2023/24 influenza season in the European Union/European Economic Area (EU/EEA), influenza viruses A(H1N1)pdm09, A(H3N2) and B/Victoria viruses were co-circulating.AimWe aimed to describe the circulating influenza viruses by (sub)type, genetic clade, antigenic group and antiviral susceptibility in that season in the EU/EEA.MethodsWe collected surveillance data from EU/EEA countries through weekly submissions to The European Surveillance System (TESSy). Data were submitted in strain-based format for weeks 40/2023 to 9/2024.ResultsTwenty-nine EU/EEA countries reported 154,718 influenza virus detections (primary care sentinel and non-sentinel combined), of which 97% (150,692) were type A and 3% (4,026) were type B. Of the subtyped influenza A viruses, 30,463 (75%) were influenza A(H1)pdm09 and 10,174 (25%) were influenza A(H3). For 809 (20%) of the type B viruses, the lineage was determined; all were B/Victoria/2/87 lineage, and none were B/Yamagata/16/88 lineage. Genetic diversification of seasonal influenza viruses continued, and clade 5a.2a of A(H1N1)pdm09, 2a.3a.1 of A(H3N2) and V1A.3a.2 of B/Victoria-lineage viruses dominated. Of the A(H3N2) 2a.3a.1 viruses, 23% were antigenically distinct from the 2023/24 vaccine virus.ConclusionThe 2023/24 influenza season was characterised by co-circulation of different influenza (sub)types, antigenically similar to the components recommended for the 2023/24 northern hemisphere vaccine, A/Victoria/4897/2022 (egg-based) and A/Wisconsin/67/2022 (cell culture- or recombinant-based). However, genetic diversification of the viruses continued. The World Health Organization's vaccine recommendations for the northern hemisphere 2024/25 season were updated to include a new A(H3N2) component, while maintaining the current A(H1N1)pdm09 and B/Victoria components.