The burden of low back pain in Malta at a population level

Background

Low back pain (LBP) is a leading global cause of all-age years lived with disability (YLD). Studies conducted in Malta reported that musculoskeletal complaints were the commonest in primary care. The aim was to estimate for the first time the burden of LBP at population level in Malta in terms of disability-adjusted life years (DALYs) and compare to estimates obtained by the Global Burden of Disease (GBD) study.

Methods

LBP prevalence data were obtained from the Maltese European Health Interview Survey dataset for 2015 through representative self-reported history of chronic LBP for 12 months in combination to the extent of daily activities limitation. Proportions of LBP severity (with and without leg pain -mild, moderate, severe and most severe) and their corresponding disability weights followed values reported in GBD study. YLDs for LBP were estimated for the whole population by sex. Since LBP does not carry any mortality, YLDs reflected DALYs. The estimated local DALYs per100,000 were compared to the GBD study for Malta for the same year.

Results

Point prevalence of LBP causing a limitation was of 6.3% (5.6% males; 7.0% females), contributing to a total of 27,006 Maltese suffering from LBP. Global LBP DALYs were of 783 per100,000. Females experienced higher LBP burden per100,000 (876 DALYs) than males (689 DALYs). On comparing these DALYs to those reported by GBD study, a discrepancy was observed per 100,000 (Global LBP 1,828 DALYs; Males 1,657 DALYs; Females 1,999 DALYs).

Conclusions

LBP imposes substantial burden in Malta, which is expected to increase with the ageing population. Since etiology of LBP is multifactorial, it is suggested that a multi-disciplinary targeted preventive and management approach is considered. Differences observed between local estimates and those of the GBD study suggest the integration of locally sourced data into the model in order to improve the DALYs estimates of each country.

Key messages

Low back pain is a public health burden. Locally sourced data is suggested to be integrated with the GBD study to improve the DALYs estimation for each country.

Use of general health care by people with substance use disorders in Belgium (2008-2017)

Background

Substance use disorders (SUD) are associated with an increased use of general health care services (e.g. use of emergency departments (ED), visits to GP or use of inpatient services). However, little is known about the extent to which people with SUD are using these services compared to people without SUD.

Methods

Data from the national register of people who were in specialized treatment for SUD between 2011 and 2014 (N = 30,905) was linked to health insurance data. Four comparators were matched on sex, age and region to each subject in treatment for SUD (N = 123,620). For people with alcohol (AUD), opiate (OUD), cocaine (CoUD) and cannabis (CaUD) use disorders and their respective comparators we analyzed the contacts with GP, psychiatrist, ED and days in hospital between 2008 and 2017. Negative binomial regression was used to obtain incidence rate ratios (IRRs) in the four different settings both for all drugs combined and for each drug separately.

Preliminary results

People with SUD were significantly more likely to contact a GP (IRR 1.9 95%CI 1.9-2.0, p < 0.0001), a psychiatrist (IRR 7.4 95%CI 7.0-7.7, p < 0.0001), an ED (IRR 4.2 95%CI 4.2-4.3, p < 0.0001) or to be hospitalized (IRR 6.4 95%CI 6.3-6.5, p < 0.0001), compared to people who were not in specialized treatment for SUD. Differences were stable over time and always highest for people with AUD and lowest for people with CaUD, except for visits to the GP where the differences were highest for people with OUD (IRR 2.6 95%CI 2.5-2.7, p < 0.0001).

Conclusions

People with SUD have between 2 and 7 times more contacts with general health services than people without SUD. SUD is not a specialty health issue but affects all health service settings.

Key messages

People with SUD have a 2-7 times higher use of general health care services than people without SUD. All health professionals should have the competencies to support people with SUD adequately.

Validity of air pollution annoyance to assess long-term exposure to air pollution in Belgium

Background

In environmental epidemiology, air pollution exposure is often estimated at the population level. To avoid the risk of exposure misclassification, one possibility is to interpolate air pollution measures at the residence through Geographical Information Systems. However, this might imply cumbersome administrative procedures. Data on air pollution annoyance from surveys can be an alternative to assess individual exposure to air pollution. This study investigates the association between air pollution annoyance and individual air pollution exposure.

Methods

Analyses were carried out based on a linkage of data from the Belgian Health Interview Survey (HIS 2008 and 2013; >15 years; n = 9347) and annual means of air pollution concentration at the residence. Self-reported air pollution annoyance was assessed through a five-point Likert scale. Statistical analyses included Spearman correlation coefficient, analysis of variance and multivariable ordinal logistic regressions (OLR).

Results

A significant exposure-response relationship was observed between long-term air pollution exposure and self-reported air pollution annoyance. However, Spearman coefficients were low (0.18-0.24), meaning a high heterogeneity of annoyance levels for a given exposure. In multivariable OLR, the odds of being annoyed by air pollution was 2.10 (95% CI: 1.86-2.67) times higher for each Interquartile range (IQR) increase in NO2 concentration (PM2.5: 1.77 [95% CI: 1.53-2.07], PM10: 1.61 [95% CI: 1.33-1.67], black carbon: 1.45 [95% CI: 1.27-1.67]). Air pollution annoyance depended largely on individual factors especially health status.

Conclusions

Air pollution exposure has a significant influence on self-reported air pollution annoyance. However, many other factors were found to influence annoyance, independently of the exposure. We found a limited validity of self-reported air pollution annoyance to assess individual long-term exposure to air pollution.

Key messages

Significant exposure-response relationship between individual long-term air pollution exposure and self-reported air pollution annoyance. Limited validity of self-reported air pollution annoyance for assessing individual long term exposure to air pollution.

The burden of cancer in Belgium, 2004-2017

Background

Monitoring the health status of a population requires consistent and comparable data on the morbidity and mortality impacts of a disease. The Disability-Adjusted Life Year (DALY) is an increasingly used disease burden indicator, combining healthy life years lost due to living with disease (Years Lived with Disability; YLDs) and due to dying prematurely (Years of Life Lost; YLLs). In Belgium, as in many other developed countries, cancer is a major contributor to the overall burden of disease. To date, however, local estimates of the burden of cancer are lacking.

Methods

We estimated the burden of 48 cancers in Belgium from 2004 to 2017 in terms of DALYs, using national population-based cancer registry data and international disease models. We developed a microsimulation model to translate incidence- into prevalence-based estimates, and used expert elicitation to integrate the long-term impact of surgical treatment.

Results

In 2017, in Belgium, breast cancer was the cancer with the highest disease burden among women, followed by lung cancer and colorectal cancer. Among men, lung cancer had the highest disease burden, followed by colorectal cancer and prostate cancer. Between 2004 and 2017, the burden of lung cancer increased by more than 50% in women, while in both sexes, significant increases were observed in melanoma and skin cancer burden. The majority of the cancer burden remained linked to premature mortality.

Conclusions

Cancer maintains a major impact on the health of the Belgian population. Current resources allocated for their prevention and treatment will need to be maintained to further reduce the cancer burden. Lung cancer remains a crucial challenge, among both men and women, calling for strengthened tobacco control policies. Integrating the current study in the Belgian national burden of disease study (BeBOD) will allow monitoring the burden of cancer over time, highlighting new trends and assessing the impact of public health policies.

Key messages

Burden of disease studies allow assessing and monitoring the impact of diseases and risk factors in a comparable way. Cancer maintains a major impact on the health of the Belgian population; lung cancer in particular remains a crucial challenge.

Data inputs and assumptions in calculating the fatal burden in burden of disease studies

Years of Life Lost (YLL) is a measure of premature mortality used in the calculation of the Disability-Adjusted Life Year (DALY), as well as stand-alone measure in itself. The concept of years of life lost is to estimate the length of time a person is expected to have lived had they not died prematurely. The YLL is based on comparing the age of death to an external standard life expectancy curve, and can incorporate time discounting and age weighting. Furthermore, YLL can be calculated for specific causes of death. In this way the indicator can be used to compare the relative importance of different causes of premature death within a particular population. Thus, it can be used by health planners to define priorities for the prevention interventions.

The process of calculating a YLL involves several components and this presentation will provide a sequential walk through each step in the YLL calculation, including causes of death statisticsdefinition of ill-defined deathsmethods of redistribution of ill-defined deathsthe use of life tablessocial weighting

The aim of this presentation is to outline a simple step by step guide on the key components in the YLL calculation. Using the real-life example of cerebrovascular disease, the presentation will outline the key choices and assumptions that underline each data inputs in the YLL calculation. Participants in this session will also be provided with links to resources to help facilitate this decision making process. The workshop will end with an interactive session where the presenters will discuss the implications of the different methodological choices with the audience.

Impact of overweight on the burden of non-communicable diseases in Belgium: the WaIST project

Issue

Excess weight status is one of the main metabolic risk factors for non-communicable diseases. According to the Belgian health interview survey of 2018, 49.3% of the adult population suffered from overweight. Despite the great national burden, and apart from isolated actions, there is not anymore a comprehensive nutritional and physical activity health plan in Belgium. Consequentially, Belgium requires action-oriented research to support the implementation of evidence-based policies for the prevention of excessive weight gain.

Description of the Problem

The WaIST project aims to assess the contribution of excess weight status to the societal impact of non-communicable diseases, disability and multi-morbidity, and to model and compare the potential impact of internationally recommended health policies. The project also aims to support knowledge translation and policy transfer through a close interaction with national decision makers and stakeholders.

Results

The disease burden of diabetes, cardiovascular diseases, cancer and musculoskeletal disorders will be estimated in terms of disability-adjusted life years (DALYs) and healthcare expenses from a societal perspective. For this purpose, survey, registry, health insurance, and hospital discharge data will be used. Subsequently, health interventions tackling overweight will be selected considering scientific evidence and stakeholder priorities. Health impact assessments will then be conducted projecting the future impact of the interventions on health outcomes and costs related to excess weight status.

Lessons

The use of national data for the computation of the burden of disease provides better estimates for DALYs and costs compared to European or global study results. Moreover, the results of the project will allow to explore the impact of health intervention specific for the Belgian case.

Key messages

Considering the burden associated with overweight-related diseases, preventing obesity is important from a public health and financial perspective. Integrating these results into evidence-based policies could provide governments and partners with a key tool for effective health interventions.

Perceived utility and feasibility of pathogen genomics for public health practice: a survey among public health professionals working in the field of infectious diseases, Belgium, 2019

BACKGROUND

Pathogen genomics is increasingly being translated from the research setting into the activities of public health professionals operating at different levels. This survey aims to appraise the literacy level and gather the opinions of public health experts and allied professionals working in the field of infectious diseases in Belgium concerning the implementation of next-generation sequencing (NGS) in public health practice.

METHODS

In May 2019, Belgian public health and healthcare professionals were invited to complete an online survey containing eight main topics including background questions, general attitude towards pathogen genomics for public health practice and main concerns, genomic literacy, current and planned NGS activities, place of NGS in diagnostic microbiology pathways, data sharing obstacles, end-user requirements, and key drivers for the implementation of NGS. Descriptive statistics were used to report on the frequency distribution of multiple choice responses whereas thematic analysis was used to analyze free text responses. A multivariable logistic regression model was constructed to identify important predictors for a positive attitude towards the implementation of pathogen genomics in public health practice.

RESULTS

146 out of the 753 invited public health professionals completed the survey. 63% of respondents indicated that public health agencies should be using genomics to understand and control infectious diseases. Having a high level of expertise in the field of pathogen genomics was the strongest predictor of a positive attitude (OR = 4.04, 95% CI = 1.11 - 17.23). A significantly higher proportion of data providers indicated to have followed training in the field of pathogen genomics compared to data end-users (p < 0.001). Overall, 79% of participants expressed interest in receiving further training. Main concerns were related to the cost of sequencing technologies, data sharing, data integration, interdisciplinary working, and bioinformatics expertise.

CONCLUSIONS

Belgian health professionals expressed favorable views about implementation of pathogen genomics in their work activities related to infectious disease surveillance and control. They expressed the need for suitable training initiatives to strengthen their competences in the field. Their perception of the utility and feasibility of pathogen genomics for public health purposes will be a key driver for its further implementation.

Slowing improvements in life expectancy across European Economic Area countries

Background

Life expectancy improvements have slowed down in several European countries since around 2011. The relative contributions from changes in specific conditions (e.g. cancers) and broader risk factors (e.g. smoking or austerity) remain unclear. We aimed to explore the different potential causes in 17 European Economic Area (EEA) countries.

Methods

We compared Global Burden of Disease (GBD) study estimates for life expectancy, years of life lost (YLLs) and population attributable fractions (PAFs) for risk factors, for 2005-2011 and 2011-2017 for 17 EEA countries. Three countries with the largest absolute improvements and three with the smallest were selected for analysis by gender, age, condition and risk factors.

Results

Norway, France and Belgium had the largest improvement in life expectancy (+1.5, +1.2 and +1.2 years respectively) from 2011 to 2017, and Germany, Iceland and the UK the smallest (+0.1, +0.2 and +0.2 years). Life expectancy reduced slightly for women aged over 80 in Germany and UK, men aged over 50 in Germany, and for men in all age groups up to 90 years in Iceland. Norway, France and Belgium saw faster improvements in YLLs from lung cancer and Norway and France for COPD in both men and women, and from self-harm in men, after 2011 than before. PAF for tobacco declined faster after 2011. Germany, Iceland and the UK saw slower improvements in cardiovascular disease and in Germany and the UK lung cancer. In Iceland, YLLs for cancers, self harm, respiratory disease, cirrhosis and dementia all worsened after 2011. PAF for tobacco remained high or declined less after 2011 in all 3 countries. PAFs for alcohol and drug use remained high in Iceland and UK.

Conclusions

Differential changes in major fatal diseases and risk factors help explain national changes in life expectancies, but national differences in data availability may affect results. Further research is needed into the ‘causes of the causes’, such as the 2008 economic crash in Iceland.

Key messages

Differential changes in major fatal diseases and risk factors help explain national changes in life expectancies. Norway, France and Belgium had the largest improvement in life expectancy from 2011 to 2017, and Germany, Iceland and the UK the smallest.

Health impact of substituting red meat by fish: addressing variability in risk-benefit assessments

Background

Sufficient intake of fish and limited red meat intake is commonly encouraged by national dietary guidelines to prevent various lifestyle diseases. One way to fulfill these guidelines would be to substitute red meat by fish. However, quantitative evidence of the public health gain of such substitution is lacking. Moreover, contaminants in these foods may compromise nutritional benefits. We aimed to estimate the health impact of substituting red meat by fish in the Danish diet in a risk-benefit assessment (RBA). Our study can support policy makers in defining evidence-based public health strategies.

Methods

We quantified the health impact of substituting red meat by fish among Danish adults in terms of Disability-Adjusted Life Years (DALY) using data from a national dietary survey and food monitoring. We investigated the use of probabilistic methods to model variability in individual substitution behaviors and to assess health impact distributions in RBA of food.

Results

Health impact of the substitution varied largely by the type of fish consumed and by age and sex of the consumer. We estimated that 134 (95% uncertainty interval: 102; 169) DALYs/100,000 could be averted per year if a mix of lean and fatty fish is consumed in the Danish recommended amounts and intake of red meat decreased among Danish adults. The highest benefit was estimated for women in the childbearing age and for men above 50 years of age. However, a small fraction of women were assigned an overall health loss due to methylmercury exposure during pregnancy and the associated adverse effects in unborn children.

Conclusions

Our study estimated an overall health gain of substituting red meat by fish in the general Danish adult population, while providing insight in the variability in health impact at the level of individual consumers. Our approach can be applied in other RBAs and the results support the need for targeted public health strategies to ensure consumer health and safety.

Key messages

The health impact of substituting red meat by fish in Danish adults was quantified in terms of disability-adjusted life years (DALYs), while accounting for variability between individuals. We estimated that young women and men above 50 years of age will experience the largest health gain while a small fraction of the women were assigned a health loss due to chemical exposure.

Development of composite indicators to monitor burden of disease across Member States

Background

The burden of disease (BoD) methods are not part of routine public health activities and policy development process across all Member States (MSs). The main reasons for this are varying levels of knowledge, experience, and capability to apply and use BoD methods. Therefore, MSs need support, guidance and training to adopt and integrate BoD approaches in their public health systems. In this context, two workshops have been organised by InfAct. The main objectives of the workshops are to raise awareness, share knowledge and experience, and to provide mutual support to to integrate BoD indicators in the public health policies across Europe.

Methods

The workshops were about the BoD concept and methodologies, and the use of BoD data in public health policy. These workshops were supported by technical presentations describing methods and the use of BoD data in health policy with various case studies, followed by expert exchange with facilitated discussions and group work. The case studies included national BoD studies from Belgium, Germany, Netherland, and Scotland.

Results

Two workshops were held at Santé Publique France, and attended by 16 BoD experts and 40 participants from 25 MSs. The workshops were well received by the participants particularly with regards to the diversity of the group and the possibility to share knowledge and experience from various perspectives. Three areas of action were highlighted: 1. the need for methodological trainings to strengthen skills in interpreting and calculating BoD estimates; 2. the encouragement of more collaborations across MSs to share or exchange good practices on BoD; and 3. the importance of the implications of BoD data to guide policies across MSs.

Conclusions

The workshops highlighted the need for capacity building activities to implement BoD approaches across MSs in routine public health activities and to use BoD data to guide health policy. More collaborations among MSs on BoD activities are needed in the future.

An online health status report to support public health in Belgium

Issue

Monitoring population health is crucial for policymakers. In Belgium, health monitoring only existed at regional level, with no integrated view at country level.

Policy/tool

The Health Status Report (HSR) project developed a tool for centralizing key health indicators. The HSR aims to support policymakers in multiple ways: as a ’warning signal’, by contributing to the planning of health policies, and as an assessment tool for those policies. Rather than being exhaustive, the HSR selects key indicators to highlight important needs. These indicators have been identified through literature and consultations with experts and stakeholders. Topics include life and health expectancies, mortality, morbidity, and lifestyles, with an important focus on socioeconomic inequalities. Good results and health gaps are underlined with international comparisons, trend analyses, and comparisons with reference values. By disaggregating the data by sex, age, geographic level or socio-economic level, specific health needs are identified.

Results

The main outcome of the project is a continuously updated website: www.healthybelgium.be. The report highlighted that, although the Belgian health status is rather good, there is room for improvement: for some indicators Belgium lags behind other European countries; regional disparities remain important, with most indicators revealing a better health status in Flanders than in Brussels and Wallonia. Socioeconomic disparities also remain very important, and for some indicators even tend to worsen. Comparing the Belgian health status to that of the EU-15 results in more severe conclusions than in international reports.

Conclusions

We developed a new tool to support public health policy in Belgium through benchmarking and trend and disparity analyses of several health indicators. The tool will be expanded in the next years, integrating for instance the results of the Belgian national burden of disease study.

Key messages

We developed an online health status monitoring tool to inform policymakers. The rather good health status hides important regional and socioeconomic disparities in Belgium.

Monitoring of non-communicable diseases in Belgium

Key messages

There is currently no national plan to prevent and monitor the health impact of non-communicable diseases in Belgium. The Belgian Health Status Report and the Belgian National Burden of Disease Study provide new opportunities for monitoring non-communicable diseases in an integrated and comparable way.

Taenia solium control in Zambia: The potholed road to success

The taeniosis/cysticercosis neglected zoonotic disease complex is caused by Taenia solium, and is associated with significant economic and public health impacts. This paper reviews the current knowledge on T. solium in Zambia and the control strategies already studied, covering almost 20 years of research, and explores the way forward. Studies on occurrence of porcine cysticercosis indicated very high prevalences, ranging from 15 to 34% based on detection of circulating antigens, and of 46% to 68% based on full carcass dissection in slaughter age pigs. Taeniosis prevalences have been reported to range from 6.3% to 12% based on copro-Ag-ELISA. Human cysticercosis prevalence results ranged from 5.8% to 13% based on serum Ag-ELISA, and from 34% to 39% based on sero-antibody detection. Later on, a study in people with epilepsy suggested neurocysticercosis to be the single most important cause of epilepsy in this T. solium endemic area, with 57% of the people with active epilepsy diagnosed with probable or definite neurocysticercosis. While the need to reduce the disease burden of T. solium in Zambia is obvious, the exact short and long term goals, and the strategies to achieve these goals, are not clear. We have selected the most promising control/elimination strategies from reviews and assessed these for feasibility via discussions with local stakeholders from both medical and veterinary sectors. The proposed measures were evaluated using the newly developed agent-based disease transmission model, cystiSim and optimised using Zambian demographic and disease data. As a control option, yearly porcine treatments were selected as best option, while the preferred strategy for elimination was determined to be the combination of human and porcine mass drug administration combined with porcine vaccination of all eligible people and pigs, in a schedule of six iterations of four monthly interventions. These interventions are currently being field tested, combined with education. Several other hurdles to control, such as cost and socio-political factors and the need for an improved advocacy and awareness creation are discussed.

Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India

Children in slums are at high risk of acute malnutrition and death. Cost-effectiveness of community-based management of severe acute malnutrition programmes has been demonstrated previously, but there is limited evidence in the context of urban slums where programme cost structure is likely to vary tremendously.

This study assessed the cost-utility of adding a community based prevention and treatment for acute malnutrition intervention to Government of India Integrated Child Development Services (ICDS) standard care for children in Mumbai slums. The intervention is delivered by community health workers in collaboration with ICDS Anganwadi community health workers. The analysis used a decision tree model to compare the costs and effects of the two options: standard ICDS services with the intervention and prevention versus standard ICDS services alone. The model used outcome and cost data from the Society for Nutrition, Education & Health Action’s Child Health and Nutrition programme in Mumbai slums, which delivered services to 12,362 children over one year from 2013 to 2014. An activity-based cost model was used, with calculated costs based on programme financial records and key informant interviews. Cost data were coupled with programme effectiveness data to estimate disability adjusted life years (DALYs) averted.

The community based prevention and treatment programme averted 15,016 DALYs (95% Uncertainty Interval [UI]: 12,246–17,843) at an estimated cost of $23 per DALY averted (95%UI:19–28) and was thus highly cost-effective. This study shows that ICDS Anganwadi community health workers can work efficiently with community health workers to increase the prevention and treatment coverage in slums in India and can lead to policy recommendations at the state, and potentially the national level, to promote such programmes in Indian slums as a cost-effective approach to tackling moderate and severe acute malnutrition.

Changes in health in Belgium, 1990-2016: a benchmarking analysis based on the global burden of disease 2016 study

BACKGROUND

Despite increasing of the Belgian health expenditures, several indicators related to population health showed poor results. The objectives of this study were to perform an in-depth analysis of the secular trend of Belgian health status using the Global Burden of Disease (GBD) 2016 study results for Belgium, and to compare these results with other European countries.

METHODS

We collected results of the Global Burden of Disease 2016 study through the GBD results and visualization tools. We benchmarked Belgian GBD results with the other initial members of the European Union (EU15).

RESULTS

Belgium performed significantly better in 2016 than in 1990 in terms of age-standardized (AS) Year of Life Lost (YLL) rates but not significantly different in terms of AS Year Lived with Disability (YLD) and Disability-Adjusted Life Year (DALY) rates. The contribution of AS YLDs to total of AS DALYs increased from 1990 (42%) to 2016 (54%). Although AS YLD and DALY rates did not seem to differ between Belgium and the EU15 from 1990 to 2016, the ranking of Belgium among the EU15 in terms of AS DALY and YLL rates was worse in 2016 than in 1990. Belgium had significantly higher AS YLL rates for lower respiratory infections (B: 264 AS YLLs [95% uncertainty interval [UI] 231-301] per 100,000; EU15: 188 AS YLLs [95%UI 168-212] per 100,000), chronic obstructive pulmonary disease (B: 368 AS YLLs [95%UI 331-407] per 100,000; EU15: 285 AS YLLs [95%UI 258-316] per 100,000) and tracheal, bronchus, and lung cancer (B: 785 AS YLLs [95%UI 699-879] per 100,000; EU15: 613 AS YLLs [95%UI 556-674] per 100,000).

CONCLUSION

Belgium's ranking among the EU15 in terms of AS YLL and DALY rates decreased from 1990 to 2016. Significant health gains appear possible by acting on risk factors directly linked to a significant part of the Belgian burden of diseases, i.e., alcohol and tobacco consumption, and high body mass index. National burden of disease estimates can help defining Belgian health targets and are necessary as external validity of GBD results is not always guaranteed.

Re-visiting the detection of porcine cysticercosis based on full carcass dissections of naturally Taenia solium infected pigs

Background

Taenia solium is a neglected zoonotic parasite. The performances of existing tools for the diagnosis of porcine cysticercosis need further assessment, and their shortcomings call for alternatives. The objective of this study was to evaluate the performance of tongue palpation and circulating antigen detection for the detection of porcine cysticercosis in naturally infected pigs of slaughter age compared to full carcass dissections (considered the gold standard). Additionally, alternative postmortem dissection procedures were investigated. A total of 68 rural pigs of slaughter age randomly selected in the Eastern Province of Zambia were dissected. Dissections were conducted on full carcasses (or half carcass in case cysticerci were already detected in the first half), including all the organs. Total cysticercus counts, location and stages were recorded and collected cysticerci were identified morphologically and molecularly. All sera were analysed with the B158/B60 antigen detecting ELISA (Ag-ELISA).

Results

Key findings were the high occurrence of T. solium infected pigs (56%) and the presence of T. solium cysticerci in the livers of 26% of infected animals. More than half of the infected carcasses contained viable cysticerci. Seven carcasses had T. hydatigena cysticerci (10%), out of which five carcasses were co-infected with T. hydatigena and T. solium; two carcasses (3%) had only T. hydatigena cysticerci. Compared to full carcass dissection, the specificity of the Ag-ELISA to detect infected carcasses was estimated at 67%, the sensitivity at 68%, increasing to 90% and 100% for the detection of carcasses with one or more viable cysticerci, and more than 10 viable cysts, respectively. Tongue palpation only detected 10% of the cases, half carcass dissection 84%.

Selective dissection of the diaphragm, tongue and heart or masseters can be considered, with an estimated sensitivity of 71%, increasing to 86% in carcasses with more than 10 cysticerci.

Conclusions

Depending on the aim of the diagnosis, a combination of Ag-ELISA and selective dissection, including investigating the presence of T. hydatigena, can be considered. Full carcass dissection should include the dissection of the liver, kidneys, spleen and lungs, and results should be interpreted carefully, as small cysticerci can easily be overlooked.

Present status of laboratory diagnosis of human taeniosis/cysticercosis in Europe

Human cysticercosis (CC) is a parasitic zoonosis caused by the larval stage (cyst) of the Taenia solium. Cysts can establish in the human central nervous system (neurocysticercosis, NCC) and other organs and tissues; they also develop in pigs, the natural intermediate host. Human taeniosis may be caused by T. solium, Taenia saginata and Taenia asiatica tapeworms; these infections are usually asymptomatic, but show a significant relevance as they perpetuate the parasites’ life cycle, and, in the case of T. solium, they are the origin of (N)CC. In European Union (EU) member states and associated countries, the occurrence of autochthonous T. solium cases is debated, and imported cases have significantly increased lately; the status of T. asiatica has been never reported, whereas T. saginata is prevalent and causes an economic impact due to condemned carcasses. Based on their effects on the EU society, the specific diagnosis of these pathologies is relevant for their prevention and control. The aims of this study were to know the diagnostic tests used in European laboratories for human taeniosis/cysticercosis by means of a questionnaire, to determine potential gaps in their detection, and to obtain preliminary data on the number of diagnosed taeniosis/CC cases.

Mapping EQ-5D utilities to GBD 2010 and GBD 2013 disability weights: results of two pilot studies in Belgium

Background

Utilities and disability weights (DWs) are metrics used for calculating Quality-Adjusted Life Years and Disability-Adjusted Life Years (DALYs), respectively. Utilities can be obtained with multi-attribute instruments such as the EuroQol 5 dimensions questionnaire (EQ-5D). In 2010 and 2013, Salomon et al. proposed a set of DWs for 220 and 183 health states, respectively. The objective of this study is to develop an approach for mapping EQ-5D utilities to existing GBD 2010 and GBD 2013 DWs, allowing to predict new GBD 2010/2013 DWs based on EQ-5D utilities.

Methods

We conducted two pilot studies including respectively four and twenty-seven health states selected from the 220 DWs of the GBD 2010 study. In the first study, each participant evaluated four health conditions using the standard written EQ-5D-5 L questionnaire. In the second study, each participant evaluated four health conditions randomly selected among the twenty-seven health states using a previously developed web-based EQ-5D-5 L questionnaire. The EQ-5D responses were translated into utilities using the model developed by Cleemput et al. A loess regression allowed to map EQ-5D utilities to logit transformed DWs.

Results

Overall, 81 and 393 respondents completed the first and the second survey, respectively. In the first study, a monotonic relationship between derived utilities and predicted GBD 2010/2013 DWs was observed, but not in the second study. There were some important differences in ranking of health states based on utilities versus GBD 2010/2013 DWs. The participants of the current study attributed a relatively higher severity level to musculoskeletal disorders such as ‘Amputation of both legs’ and a relatively lower severity level to non-functional disorders such as ‘Headache migraine’ compared to the participants of the GBD 2010/2013 studies.

Conclusion

This study suggests the possibility to translate any utility derived from EQ-5D scores into a DW, but also highlights important caveats. We observed a satisfactory result of this methodology when utilities were derived from a population of public health students, a written questionnaire and a small number of health states in the presence of a study leader. However the results were unsatisfactory when utilities were derived from a sample of the general population, using a web-based questionnaire. We recommend to repeat the study in a larger and more diverse sample to obtain a more representative distribution of educational level and age.

Electronic supplementary material

The online version of this article (doi:10.1186/s13690-017-0174-z) contains supplementary material, which is available to authorized users.

Comorbidities and factors associated with central nervous system infections and death in non-perinatal listeriosis: a clinical case series

Background

Listeriosis is a rare disease caused by the bacterium Listeria monocytogenes and mainly affects at risk people. Listeriosis can lead to sepsis, central nervous system (CNS) infections and death. The objectives of this study were to describe and quantify comorbidities and neurological sequelae underlying non-perinatal listeriosis cases and to describe the factors associated with death and CNS infections in non-perinatal listeriosis.

Methods

We retrospectively collected clinical data through computerized, paper or microfilmed medical records in two Belgian university hospitals. Logistic regression models and likelihood ratio tests allowed identifying factors associated with death and CNS infections.

Results

Sixty-four cases of non-perinatal listeriosis were included in the clinical case series and 84 % were affected by at least one comorbid condition. The main comorbidities were cancer, renal and severe cardio-vascular diseases. Twenty-nine patients (45 %) suffered from a CNS infection and 14 patients (22 %) died during hospitalization, among whom six (43 %) had a CNS involvement. Among surviving patients, eleven suffered from neurological sequelae (22 %) at hospital discharge; all had CNS infection. Five of these patients (45 %) still suffered of their neurological sequelae after a median follow-up of one year (range: 0.08–19). The factor associated with death during the hospitalization was the presence of a severe cardiovascular disease (OR = 4.72, p = 0.015). Two factors inversely related with CNS infections were antibiotic monotherapy (OR = 0.28, p = 0.04) and the presence of renal disease (OR = 0.18, p = 0.02).

Conclusions

In a public health context these results could be a starting point for future burden of listeriosis studies taking into account comorbidity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1602-3) contains supplementary material, which is available to authorized users.

Human migration and pig/pork import in the European Union: What are the implications for Taenia solium infections?

Taenia solium taeniasis/cysticercosis is a neglected zoonotic disease complex occurring primarily in developing countries. Though claimed eradicated from the European Union (EU), an increasing number of human neurocysticercosis cases is being detected. Risk factors such as human migration and movement of pigs/pork, as well as the increasing trend in pig rearing with outside access are discussed in this review. The entry of a tapeworm carrier into the EU seems a lot more plausible than the import of infected pork. The establishment of local transmission in the EU is presently very unlikely. However, considering the potential changes in risk factors, such as the increasing trend in pig farming with outdoor access, the increasing human migration from endemic areas into the EU, this situation might change, warranting the establishment of an early warning system, which should include disease notification of taeniasis/cysticercosis both in human and animal hosts. As currently human-to-human transmission is the highest risk, prevention strategies should focus on the early detection and treatment of tapeworm carriers, and should be designed in a concerted way, across the EU and across the different sectors.