Denmark is one of the leading countries in establishing digital solutions in the health sector. When SARS-CoV-2 arrived in February 2020, a real-time surveillance system could be rapidly built on existing infrastructure, This rapid data integration for COVID-19 surveillance enabled a data-driven response. Here we describe (a) the setup of the automated, real-time surveillance and vaccination monitoring system for COVID-19 in Denmark, including primary stakeholders, data sources, and algorithms, (b) describe outputs for various stakeholders, (c) how outputs were used for action and (d) reflect on challenges and lessons learnt. Outputs were tailored to four main stakeholder groups: four outputs provided direct information to individual citizens, four to complementary systems and researchers, 25 to decision-makers, and 15 informed the public, aiding transparency. Core elements in infrastructure needed for automated surveillance had been in place for more than a decade. The COVID-19 epidemic was a pressure test that allowed us to explore the system’s potential and identify challenges for future pandemic preparedness. The system described here constitutes a model for the future infectious disease surveillance in Denmark. With the current pandemic threat posed by avian influenza viruses, lessons learnt from the COVID-19 pandemic remain topical and relevant.

The efficacy of COVID-19 vaccines against the Delta variant has been observed to be high, both against severe disease and infection. The full population level vaccine effectiveness, however, also contains the indirect effects of vaccination, which require analysis of transmission dynamics to uncover. Finland was close to naïve to SARS-CoV-2 infections before the Delta dominant era, and non-pharmaceutical interventions (NPIs) were at an internationally low level. We utilize Finnish register data and a mathematical model for transmission and COVID-19 disease burden to construct a completely unvaccinated control population and estimate the different components of the vaccine effectiveness. The estimated direct effectiveness was 72% against COVID-19 cases and 87–96% against severe disease outcomes, but the estimated indirect effectiveness was even better, 93% against cases and 94–97% against severe disease. The total and overall effectiveness, including both direct and indirect effects of vaccination, were thus excellent. Our results show how well the population was protected by vaccination during the Delta era, especially by the indirect effectiveness, providing protection also to the unvaccinated part of the population. The estimated averted numbers of hospitalizations, ICU admissions, and deaths in Finland during the Delta era under the implemented NPIs were about 100 times the observed numbers.

In 2022, an increase in invasive group A streptococcal (iGAS) infections was observed in the Netherlands. A particular increase was seen among children; therefore, we aimed to assess risk factors for iGAS infection in children aged 6 months to 5 years. A prospective case–control study was conducted between February and May 2023. We approached parents of notified iGAS cases to complete a questionnaire on exposures during 4 weeks prior to disease onset. Controls were recruited via social media and matched to cases on sex and birthyear. Conditional logistic regression was performed to estimate odds ratios (OR) of exposures. For the analysis, we included 18 cases and 103 controls. Varicella prior to onset of iGAS disease was reported in two (11%) cases and one (1%) control (OR: 12.0, 95% CI: 1.1–139.0). Exposure to group A streptococcal (GAS)-like illnesses such as impetigo, pharyngitis, and scarlet fever was reported in 8 (44%) cases and 15 (15%) controls (OR: 7.1, 95% CI: 1.8–29.0). Our findings are in line with previous studies by identifying varicella as a risk factor for iGAS among young children and highlight the association with non-invasive GAS infections in the community as a possible source of transmission.

Invasive group A Streptococcal (iGAS) outbreaks have been linked to Community Healthcare Services Delivered at Home (CHSDH). There is, however, very limited evidence describing the epidemiology and mortality of iGAS cases associated with CHSDH. We used routine data to describe iGAS cases in adults who had received CHSDH prior to onset and compare characteristics between CHSDH-outbreak and non-outbreak CHSDH cases, in South East England between December 2021 and December 2023. There were 80/898 (8.9%) iGAS case episodes with CHSDH prior to onset; cases were in elderly people (50% aged 85 and over), and had primarily received wound or ulcer care (93.8%), with almost all care delivered by community nurses (98.8%). The 30-day all-cause case fatality was 26.3%. Emm 1.0 was the most common type (17.5%). In this period, 5/11 iGAS outbreaks (45.4%) were CHSDH-associated, and 25 cases with receipt of CHSDH prior to onset (31.3%, Confidence Interval [CI] 21.3–42.6%) were linked to these outbreaks. On univariate analysis, CHSDH-outbreak case episodes were more likely to be associated with emm pattern genotype E (OR 6.1 95% CI 1.8–20.9), and skin or soft tissue infection clinical presentation (OR 3.6, 95% CI 1.1–12.0) than non-outbreak CHSDH cases. There may be an increased risk of propagation of iGAS outbreaks in patients receiving CHSDH, emphasizing the need for rigorous early infection prevention and control, and outbreak surveillance.

New-generation pneumococcal conjugate vaccines (PCVs) are available to replace PCV-13 for childhood and adult immunization. Besides cost-effectiveness evaluations which have highly variable results, the comparative immunogenicity of these new vaccines (PCV15, PCV20, PCV21) and their coverage of invasive pneumococcal disease (IPD) and carriage strains in different age-groups should be regarded as well as the antibody susceptibility, antibiotic resistance, invasiveness and virulence of serotypes included in each vaccine. Based on the Canadian experience, these topics are discussed. The optimal strategy would be a 2+1 PCV20 schedule for children, PCV21 for elderly adults and a dual PCV20+PCV21 schedule for adults at very high IPD risk. Shifting from PCV-13 to PCV-15 for children entails a risk of increased IPD incidence in adults because additional serotypes are of low virulence and could be replaced by more invasive and virulent serotypes. This risk can be reasonably excluded if PCV-20 replaces PCV-13 as the former covers additional serotypes being highly invasive and virulent. It is recognized that off-label use of PCV-20 according to a 2+1 schedule could be problematic for some jurisdictions as this is not authorized in all countries. In Canada, however, the 2+1 PCV20 schedule was authorized based on the same dataset submitted elsewhere.

Within an infrastructure to monitor vaccine effectiveness (VE) against hospitalization due to COVID-19 and COVID-19 related deaths from November 2022 to July 2023 in seven countries in real-world conditions (VEBIS network), we compared two approaches: (a) estimating VE of the first, second or third COVID-19 booster doses administered during the autumn of 2022, and (b) estimating VE of the autumn vaccination dose regardless of the number of prior doses (autumnal booster approach). Retrospective cohorts were constructed using Electronic Health Records at each participating site. Cox regressions with time-changing vaccination status were fit and site-specific estimates were combined using random-effects meta-analysis. VE estimates with both approaches were mostly similar, particularly shortly after the start of the vaccination campaign, and showed a similar timing of VE waning. However, autumnal booster estimates were more precise and showed a clearer trend, particularly compared to third booster estimates, as calendar time increased after the vaccination campaign and during periods of lower SARS-CoV-2 activity. Moreover, the decrease in protection by increasing calendar time was more clear and precise than when comparing protection by number of doses. Therefore, estimating VE under an autumnal booster framework emerges as a preferred method for future monitoring of COVID-19 vaccination campaigns.

Methicillin-resistant Staphylococcus aureus (MRSA) spa type t4549 is increasingly prevalent in Denmark, yet its epidemiological sources remain unclear. This study aimed to generate hypotheses about possible risk factors that may be associated with MRSA t4549 infections. We conducted a nationwide case – case questionnaire study comparing MRSA t4549 cases to other MRSA types (t002, t008, t127, t304, and t223) reported between January 2022 and November 2023. The analysis, which included descriptive statistics and logistic regression, found that 75% of MRSA t4549 cases were male. Infections were significantly more frequent in the foot (28%) and toe (54%) compared to other MRSA types. Key risk factors identified were contact with pheasants (OR = 8.70; 95%CI 1.25–174.29), participation in indoor team sports (OR = 7.54, 95%CI: 1.58–54.82) and swimming (OR = 4.15, 95%CI: 1.97–9.03). Although the limited number of cases warrants cautious interpretation, it is crucial to emphasize the need for preventive measures at both the individual and sports facility levels. Further environmental studies are needed to clarify the role of the environment and wildlife in MRSA t4549 transmission. The increasing prevalence of this spa type in Denmark underlines the importance of implementing effective public health strategies to reduce the risk of MRSA transmission.

The study aimed to delve into the incidence and risk factors associated with myocarditis and pericarditis following SARS-COV-2-19 vaccination, addressing a notable gap in understanding the safety profile of vaccinations. Through meticulous data selection from the National Health Insurance System (NHIS) database of Korea, the researchers employed both a case-crossover study and a nested case-control design to analyze temporal patterns and risk factors related to carditis occurrences post-immunization. Key findings revealed a significant association between SARS-COV-2-19 vaccination and the occurrence of carditis, with a strong temporal correlation observed within 10 days post-vaccination. Noteworthy factors contributing to carditis risk included the duration between vaccination and carditis, specific comorbidities and medication use. The study concluded by recommending an extended post-vaccination surveillance duration of at least 10 days and underscored the importance of considering individual medical histories and concurrent medication use in assessing vaccine-induced carditis risk. This study might contribute to understanding vaccine safety profiles and emphasizes the significance of comprehensive post-vaccination monitoring protocols.

Leptospira are bacteria that cause leptospirosis in both humans and animals. Human Leptospira infections in Uganda are suspected to arise from animal–human interactions. From a nationwide survey to determine Leptospira prevalence and circulating sequence types in Uganda, we tested 2030 livestock kidney samples, and 117 small mammals (rodents and shrews) using real-time PCR targeting the lipL32 gene. Pathogenic Leptospira species were detected in 45 livestock samples but not in the small mammals. The prevalence was 6.12% in sheep, 4.25% in cattle, 2.08% in goats, and 0.46% in pigs. Sequence typing revealed that Leptospira borgpetersenii, Leptospira kirschneri, and Leptospira interrogans are widespread across Uganda, with 13 novel sequence types identified. These findings enhance the East African MLST database and support the hypothesis that domesticated animals may be a source of human leptospirosis in Uganda, highlighting the need for increased awareness among those in close contact with livestock.

This study examined global trends in influenza-associated lower respiratory infections (LRIs) deaths from 1990 to 2019 using data from the GBD 2019. The annual percentage change (APC) and average annual percentage change (AAPC) were used to analyze age-standardized death rates (ASDR). Globally, the ASDR of influenza-associated LRIs was 3.29/100,000 in 2019, which was higher in the African region (6.57/100,000) and among adults aged 70 years and older (29.88/100,000). The ASDR of influenza-associated LRIs decreased significantly from 1990 to 2019 (AAPC = −1.88%, P < 0.05). However, it was significantly increased among adults aged 70 years and older during 2017–2019 (APC = 2.31%, P < 0.05), especially in Western Pacific Region and South-East Asia Regions. The ratio of death rates between adults aged 70 years and older and children aged under 5 years increased globally from 1.63 in 1990 to 5.34 in 2019, and the Western Pacific Region experienced the most substantial increase, with the ratio soaring from 1.83 in 1990 to 12.98 in 2019. Despite a decline in the global ASDR of influenza-associated LRIs, it continues to impose a significant burden, particularly in the African, Western Pacific regions and among the elderly population.

The study aims were to present in vitro susceptibilities of clinical isolates from Gram-negative bacteria bloodstream infections (GNBSI) collected in China. GNBSI isolates were collected from 18 tertiary hospitals in 7 regions of China from 2018 to 2020. Minimum inhibitory concentrations were assessed using a Trek Diagnostic System. Susceptibility was determined using CLSI broth microdilution, and breakpoints were interpreted using CLSI M100 (2021). A total of 1,815 GNBSI strains were collected, with E. coli (42.4%) and Klebsiella pneumoniae (28.6%) being the most prevalent species, followed by P. aeruginosa (6.7%). Susceptibility analyses revealed low susceptibilities (<40%) of ESBL-producing E. coli and K. pneumonia to third-/fourth-generation cephalosporins, monobactamases, and fluoroquinolones. High susceptibilities to colistin (95.0%) and amikacin (81.3%) were found for K. pneumoniae, while Acinetobacter baumannii exhibited a high susceptibility (99.2%) to colistin but a low susceptibility to other antimicrobials (<27.5%). Isolates from ICUs displayed lower drug susceptibility rates of K. pneumoniae and A. baumannii than isolates from non-ICUs (all P < 0.05). Carbapenem-resistant and ESBL-producing K. pneumoniae detection was different across regions (both P < 0.05). E. coli and K. pneumoniae were major contributors to GNBSI, while A. baumannii exhibited severe drug resistance in isolates obtained from ICU departments.

The H3N2 canine influenza virus (CIV) emerged from an avian reservoir in Asia to circulate entirely among dogs for the last 20 years. The virus was first seen circulating outside Asian dog populations in 2015, in North America. Utilizing viral genomic data in addition to clinical reports and diagnostic testing data, we provide an updated analysis of the evolution and epidemiology of the virus in its canine host. CIV in dogs in North America is marked by a complex life history – including local outbreaks, regional lineage die-outs, and repeated reintroductions of the virus (with diverse genotypes) from different regions of Asia. Phylogenetic and Bayesian analysis reveal multiple CIV clades, and viruses from China have seeded recent North American outbreaks, with 2 or 3 introductions in the past 3 years. Genomic epidemiology confirms that within North America the virus spreads very rapidly among dogs in kennels and shelters in different regions – but then dies out locally. The overall epidemic therefore requires longer-distance dispersal of virus to maintain outbreaks over the long term. With a constant evolutionary rate over 20 years, CIV still appears best adapted to transmission in dense populations and has not gained properties for prolonged circulation among dogs.

Clostridiodes difficile’s epidemiology has evolved over the past decades, being recognized as an important cause of disease in the community setting. Even so, there has been heterogeneity in the reports of CA-CDI. Therefore, the aim of this study was to assess the epidemiologic profile of CA-CDI.

This systematic review and meta-analysis were conducted according to PRISMA checklist and Cochrane guidelines (CRD42023451134). Literature search was performed by an experienced librarian from inception to April 2023, searching in databases like MEDLINE, Scopus, Web of Science, EMBASE, CCRCC, CDSR, and ClinicalTrials. Observational studies that reported prevalence, incidence of CA-CDI, or indicators to calculate them were included. Pool analysis was performed using a binomial-normal model via the generalized linear mixed model. Subgroup analysis and publication bias were also explored. A total of 49 articles were included, obtaining a prevalence of 5% (95% CI 3–8) and an incidence of 7.53 patients (95% CI 4.45–12.74) per 100,000 person-years.

In conclusion, this meta-analysis underscores that among the included studies, the prevalence of CA-CDI stands at 5%, with an incidence rate of 7.3 cases per 100,000 person-years. Noteworthy risk factors identified include prior antibiotic exposure and age.

Due to the risk of Shiga-toxin producing Escherichia coli (STEC) transmission, current guidance advises excluding young children from childcare settings until microbiologically clear. Children can shed STEC for a prolonged period, and the cost-effectiveness of exclusion has not been evaluated. Our decision tree analysis, including probabilistic sensitivity analysis, estimated comparative health system costs and effects of exclusion until microbiological clearance versus return to childcare setting before this. Due to the risk of secondary cases, return before microbiological clearance resulted in the incremental loss of 0.019 QALYs, but savings of £156. Using the willingness-to-pay threshold of £20000 per QALY, the incremental net monetary benefit of exclusion until microbiological clearance was £215. Exclusion until microbiological clearance remained cost-effective if the total costs for managing the exclusion were below £576. Return before microbiological clearance may, therefore, become cost-effective in cases where the costs of managing exclusion until microbiological clearance are high and/or the risk of secondary cases is very low. Broadening the decision perspective, including the costs of exclusion to the families, may also impact the recommendation. Further research is needed to assess the risk of STEC transmission from children who have clinically recovered and the impact of STEC and exclusion on families of the affected children.

Children, adolescents, and young people living with HIV (CALWHIV), including those in resource-limited settings, may be at increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, poorer coronavirus disease 2019 (COVID-19) outcomes, and multisystem inflammatory syndrome (MIS). We conducted a repeat SARS-CoV-2 seroprevalence survey among CALWHIV in Europe (n = 493) and South Africa (SA, n = 307), and HIV-negative adolescents in SA (n = 100), in 2020–2022. Blood samples were tested for SARS-CoV-2 antibody, questionnaires collected data on SARS-CoV-2 risk factors and vaccination status, and clinical data were extracted from health records. SARS-CoV-2 seroprevalence (95% CI) was 55% (50%–59%) in CALWHIV in Europe, 67% (61%–72%) in CALWHIV in SA, and 85% (77%–92%) among HIV-negative participants in SA. Among those unvaccinated at time of sampling (n = 769, 85%), seroprevalence was 40% (35%–45%), 64% (58%–70%), and 81% (71%–89%), respectively. Few participants (11% overall) had a known history of SARS-CoV-2-positive PCR or self-reported COVID-19. Three CALWHIV were hospitalized, two with COVID-19 (nonsevere disease) and one young adult with MIS. Although SARS-CoV-2 seroprevalence was high across all settings, even in unvaccinated participants, it was broadly comparable to general population estimates, and most infections were mild/asymptomatic. Results support policy decisions excluding CALWHIV without severe immunosuppression from high-risk groups for COVID-19.

Our study aimed to describe the transmission dynamics and genotypic diversity of Mycobacterium tuberculosis in people deprived of liberty (PDL) in four Colombian prisons. Our cohort study included 64 PDL with bacteriologically confirmed pulmonary tuberculosis diagnosed in four Colombian prisons. The 132 isolates were genotyped using 24-mycobacterial interspersed repeated units-variable number tandem repeats (MIRUs-VNTR). A cluster was defined when ≥2 isolates from different PDL had the same genotype. Tuberculosis acquired in prison was considered when ≥2 persons were within the same cluster and had an epidemiological link. We mapped the place of residence before incarceration and within prisons. We assessed overcrowding and ventilation conditions in the prison that had clusters. We found that the most frequent genotypes were LAM (56.8%) and Haarlem (36.4%), and 45.3% of the PDL diagnosed with tuberculosis were clustered. Most PDL diagnosed in prison came from neighborhoods in Medellin with a high TB incidence. M. tuberculosis infection acquired in prison was detected in 19% of PDL, 9.4% had mixed infection, 3.1% reinfection, and 1.6% relapse. Clusters only appeared in one prison, in cell blocks with overcrowding >100%, and inadequate ventilation conditions. Prisons require the implementation of effective respiratory infection control measures to prevent M. tuberculosis transmission.

Bartonella is a widely distributed Gram-negative bacterium that includes species that are capable of causing illness in humans. Rodents represent one of the main reservoirs of zoonotic pathogens, and monitoring their populations can provide valuable insights into human health. We conducted a surveillance study of rodents from two north-western states of Mexico (Baja California and Chihuahua) to investigate the prevalence and genetic diversity of Bartonella by polymerase chain reaction (PCR) amplification and sequencing of the citrate synthase (gltA) gene. A total of 586 rodents belonging to 28 species were captured, and 408 were tested for Bartonella spp. The overall Bartonella spp. prevalence was 39.71%. The prevalence found in Chihuahua was higher (42.80%) than in Baja California (32.52%), and rodents such as Neotoma albigula, Neotoma mexicana, Peromyscus boylii, and Chaetodipus baileyi had the highest prevalence. The gltA sequences revealed seven genetic variants, some of which were obtained from Peromyscus and Dipodomys rodents and were associated with Bartonella species of human health concern, such as B. grahamii and B. vinsonii subsp. arupensis. In addition, a sequence obtained from a Peromyscus maniculatus was clustered with Candidatus Bartonella rudakovii, a previously unreported association. This study provides valuable data and new insight into the Bartonella-hosts interactions in rodent species in north-western Mexico.

Although SARS-CoV-2 vaccination reduces hospitalization and mortality, its long-term impact on Long-COVID remains to be elucidated. The aim of the study was to evaluate the different development of Long-COVID clinical phenotypes according to the vaccination status of patients. Clinical and demographic characteristics were assessed for each patient, while Long-COVID symptoms were self-reported and later stratified into distinct clinical phenotypes. Vaccination was significantly associated with the avoidance of hospitalization, less invasive respiratory support, and less alterations of cardiopulmonary functions, as well as reduced lasting lung parenchymal damage. However, no association between vaccination status and the development of at least one Long-COVID symptom was found. Nevertheless, clinical phenotypes were differently associated with vaccination status, as neuropsychiatric were more frequent in unvaccinated patients and cardiorespiratory symptoms were reported mostly in vaccinated patients. Different progression of disease could be at play in the different development of specific Long-COVID clinical phenotypes, as shown by the different serological responses between unvaccinated and vaccinated patients. A higher anti-Spike (S) antibody titre was protective for vaccinated patients, while it was detrimental for unvaccinated patients. A better understanding of the mechanism underlying the development of Long-COVID symptoms might be reached by standardized methodologies and symptom classification.

In 2015, the WHO African Region was responding to the largest Ebola virus disease outbreak in history while at the same time working to contain a wild poliovirus outbreak [1]. The 2030 Agenda for Sustainable Development had recently been endorsed, reflecting new global development priorities. By 2016, the Ebola outbreak was under control, and a new approach to reform and priority setting was in place in the region; the Transformation Agenda [2]. This agenda, introduced by the new Regional Director for Africa, Dr Matshidiso Moeti, set up a robust system for improving the efficiency and accountability of the WHO Secretariat for the African Region, which has been instrumental in the transformative changes that have been seen across the region in the past 10 years. This commentary discusses significant contributions to public health in the WHO African Region in the past decade, in the context of the Transformation Agenda, and the contributions of major investment in health security in the region. It is important to understand the need to sustain particular initiatives and elements of the transformative change that has taken place in the region.