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Day MJ, Jacobsson S, Spiteri G, Kulishev C, Sajedi N, Woodford N, Blumel B, van der Werf MJ, Amato-Gauci AJ, Unemo M, Cole MJ. Significant increase in azithromycin "resistance" and susceptibility to ceftriaxone and cefixime in Neisseria gonorrhoeae isolates in 26 European countries, 2019. BMC Infect Dis 2022; 22:524. [PMID: 35672671 PMCID: PMC9171984 DOI: 10.1186/s12879-022-07509-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/27/2022] [Indexed: 12/31/2022] Open
Abstract
Background The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) performs annual sentinel surveillance of Neisseria gonorrhoeae susceptibility to therapeutically relevant antimicrobials across the European Union/European Economic Area (EU/EEA). We present the Euro-GASP results from 2019 (26 countries), linked to patient epidemiological data, and compared with data from previous years. Methods Agar dilution and minimum inhibitory concentration (MIC) gradient strip methodologies were used to determine the antimicrobial susceptibility (using EUCAST clinical breakpoints, where available) of 3239 N. gonorrhoeae isolates from 26 countries across the EU/EEA. Significance of differences compared with Euro-GASP results in previous years was analysed using Z-test and the Pearson's χ2 test was used to assess significance of odds ratios for associations between patient epidemiological data and antimicrobial resistance. Results European N. gonorrhoeae isolates collected between 2016 and 2019 displayed shifting MIC distributions for; ceftriaxone, with highly susceptible isolates increasing over time and occasional resistant isolates each year; cefixime, with highly-susceptible isolates becoming increasingly common; azithromycin, with a shift away from lower MICs towards higher MICs above the EUCAST epidemiological cut-off (ECOFF); and ciprofloxacin which is displaying a similar shift in MICs as observed for azithromycin. In 2019, two isolates displayed ceftriaxone resistance, but both isolates had MICs below the azithromycin ECOFF. Cefixime resistance (0.8%) was associated with patient sex, with resistance higher in females compared with male heterosexuals and men-who-have-sex-with-men (MSM). The number of countries reporting isolates with azithromycin MICs above the ECOFF increased from 76.9% (20/26) in 2016 to 92.3% (24/26) in 2019. Isolates with azithromycin MICs above the ECOFF (9.0%) were associated with pharyngeal infection sites. Following multivariable analysis, ciprofloxacin resistance remained associated with isolates from MSM and heterosexual males compared with females, the absence of a concurrent chlamydial infection, pharyngeal infection sites and patients ≥ 25 years of age. Conclusions Resistance to ceftriaxone and cefixime remained uncommon in EU/EEA countries in 2019 with a significant decrease in cefixime resistance observed between 2016 and 2019. The significant increase in azithromycin “resistance” (azithromycin MICs above the ECOFF) threatens the effectiveness of the dual therapy (ceftriaxone + azithromycin), i.e., for ceftriaxone-resistant cases, currently recommended in many countries internationally and requires close monitoring.
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Affiliation(s)
| | - Susanne Jacobsson
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden
| | | | | | | | | | - Benjamin Blumel
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | | | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden.,University College London (UCL), London, UK
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Cole MJ, Day M, Jacobsson S, Amato-Gauci AJ, Spiteri G, Unemo M. The European response to control and manage multi- and extensively drug-resistant Neisseria gonorrhoeae. Euro Surveill 2022; 27:2100611. [PMID: 35514307 PMCID: PMC9074391 DOI: 10.2807/1560-7917.es.2022.27.18.2100611] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Because cefixime and ceftriaxone resistance in Neisseria gonorrhoeae and gonorrhoea treatment failures were increasing, a response plan to control and manage multidrug-resistant N. gonorrhoeae (MDR-NG) in Europe was published in 2012. The three main areas of the plan were to: (i) strengthen surveillance of antimicrobial resistance (AMR), (ii) implement monitoring of treatment failures and (iii) establish a communication strategy to increase awareness and disseminate AMR results. Since 2012, several additional extensively drug-resistant N. gonorrhoeae (XDR-NG) strains have emerged, and strains with high-level ceftriaxone resistance spread internationally. This prompted an evaluation and review of the 2012 European Centre for Disease Prevention and Control (ECDC) response plan, revealing an overall improvement in many aspects of monitoring AMR in N. gonorrhoeae; however, treatment failure monitoring was a weakness. Accordingly, the plan was updated in 2019 to further support European Union/European Economic Area (EU/EEA) countries in controlling and managing the threat of MDR/XDR-NG in Europe through further strengthening of AMR surveillance and clinical management including treatment failure monitoring. The plan will be assessed biennially to ensure its effectiveness and its value. Along with prevention, diagnostic, treatment and epidemiological surveillance strategies, AMR surveillance is essential for effective control of gonorrhoea.
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Affiliation(s)
| | - Michaela Day
- UK Health Security Agency, London, United Kingdom
| | - Susanne Jacobsson
- World Health Organization Collaborating Centre for Gonorrhoea and other STIs, Örebro University, Örebro, Sweden
| | | | | | - Magnus Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and other STIs, Örebro University, Örebro, Sweden,University College London (UCL), London, United Kingdom
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3
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Sperle I, Nielsen S, Bremer V, Gassowski M, Brummer-Korvenkontio H, Bruni R, Ciccaglione AR, Kaneva E, Liitsola K, Naneva Z, Perchemlieva T, Spada E, Toikkanen SE, Amato-Gauci AJ, Duffell E, Zimmermann R. Developing and Piloting a Standardized European Protocol for Hepatitis C Prevalence Surveys in the General Population (2016-2019). Front Public Health 2021; 9:568524. [PMID: 34123980 PMCID: PMC8193123 DOI: 10.3389/fpubh.2021.568524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/28/2021] [Indexed: 12/09/2022] Open
Abstract
Background: A robust estimate of the number of people with chronic hepatitis C virus (HCV) infection is essential for an appropriate public health response and for monitoring progress toward the WHO goal of eliminating viral hepatitis. Existing HCV prevalence studies in the European Union (EU)/European Economic Area (EEA) countries are heterogeneous and often of poor quality due to non-probability based sampling methods, small sample sizes and lack of standardization, leading to poor national representativeness. This project aimed to develop and pilot standardized protocols for undertaking nationally representative HCV prevalence surveys in the general adult population. Methods: From 2016 to 2019 a team from the Robert Koch-Institute contracted by the European Centre for Disease Prevention and Control synthesized evidence on existing HCV prevalence surveys and survey methodology and drafted a protocol. The methodological elements of the protocol were piloted and evaluated in Bulgaria, Finland and Italy, and lessons learnt from the pilots were integrated in the final protocol. An international multidisciplinary expert group was consulted regularly. Results: The protocol includes three alternative study approaches: a stand-alone survey; a “nested” survey within an existing health survey; and a retrospective testing survey approach. A decision algorithm advising which approach to use was developed. The protocol was piloted and finalized covering minimum and gold standards for all steps to be implemented from sampling, data protection and ethical issues, recruitment, specimen collection and laboratory testing options, staff training, data management and analysis and budget considerations. Through piloting, the survey approaches were effectively implemented to produce HCV prevalence estimates and the pilots highlighted the strengths and limitations of each approach and key lessons learnt were used to improve the protocol. Conclusions: An evidence-based protocol for undertaking HCV prevalence serosurveys in the general population reflecting the different needs, resources and epidemiological situations has been developed, effectively implemented and refined through piloting. This technical guidance supports EU/EEA countries in their efforts to estimate their national hepatitis C burden as part of monitoring progress toward the elimination targets.
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Affiliation(s)
- Ida Sperle
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Charité, Universitätsmedizin Berlin, Berlin, Germany
| | | | - Viviane Bremer
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Martyna Gassowski
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Roberto Bruni
- Department of Infectious Disease, Istituto Superiore di Sanità, Rome, Italy
| | | | - Elena Kaneva
- Regional Health Inspectorate, Stara Zagora, Bulgaria
| | - Kirsi Liitsola
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Enea Spada
- Department of Infectious Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Salla E Toikkanen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Erika Duffell
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Ruth Zimmermann
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Adlhoch C, Mook P, Lamb F, Ferland L, Melidou A, Amato-Gauci AJ, Pebody R. Very little influenza in the WHO European Region during the 2020/21 season, weeks 40 2020 to 8 2021. Euro Surveill 2021; 26:2100221. [PMID: 33739256 PMCID: PMC7976381 DOI: 10.2807/1560-7917.es.2021.26.11.2100221] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/18/2021] [Indexed: 01/22/2023] Open
Abstract
Between weeks 40 2020 and 8 2021, the World Health Organization European Region experienced a 99.8% reduction in sentinel influenza virus positive detections (33/25,606 tested; 0.1%) relative to an average of 14,966/39,407 (38.0%; p < 0.001) over the same time in the previous six seasons. COVID-19 pandemic public health and physical distancing measures may have extinguished the 2020/21 European seasonal influenza epidemic with just a few sporadic detections of all viral subtypes. This might possibly continue during the remainder of the influenza season.
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Affiliation(s)
- Cornelia Adlhoch
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Piers Mook
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Lisa Ferland
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Angeliki Melidou
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Richard Pebody
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
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5
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Mårdh O, Quinten C, Kuchukhidze G, Seguy N, Dara M, Amato-Gauci AJ, Pharris A, On Behalf Of The Ecdc/Who Hiv Surveillance Network. HIV among women in the WHO European Region - epidemiological trends and predictors of late diagnosis, 2009-2018. ACTA ACUST UNITED AC 2020; 24. [PMID: 31796153 PMCID: PMC6891943 DOI: 10.2807/1560-7917.es.2019.24.48.1900696] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Human immunodeficiency virus (HIV) transmission among women remains an issue in the WHO European Region, with nearly 50,000 women diagnosed in 2018 and over half (54%) diagnosed late. Although new HIV diagnoses declined between 2009 and 2018 in the West of the Region, they increased in the Centre and East. Understanding the characteristics of women diagnosed with HIV can inform gender-sensitive prevention services including pre-exposure prophylaxis and early testing and linkage to care.
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Affiliation(s)
- Otilia Mårdh
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Chantal Quinten
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Nicole Seguy
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - Masoud Dara
- WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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6
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van de Laar MJ, Bosman A, Pharris A, Andersson E, Assoumou L, Ay E, Bannert N, Bartmeyer B, Brady M, Chaix ML, Descamps D, Dauwe K, Fonager J, Hauser A, Lunar M, Mezei M, Neary M, Poljak M, van Sighem A, Verhofstede C, Amato-Gauci AJ, Broberg EK. Piloting a surveillance system for HIV drug resistance in the European Union. ACTA ACUST UNITED AC 2020; 24. [PMID: 31088600 PMCID: PMC6518967 DOI: 10.2807/1560-7917.es.2019.24.19.1800390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background A steady increase in HIV drug resistance (HIVDR) has been demonstrated globally in individuals initiating first-line antiretroviral therapy (ART). To support effective use of ART and prevent spread of HIVDR, monitoring is essential. Aim We piloted a surveillance system for transmitted HIVDR to assess the feasibility of implementation at the European level. Method All 31 countries in the European Union and European Economic Area were invited to retrospectively submit data on individuals newly diagnosed with HIV in 2015 who were tested for antiviral susceptibility before ART, either as case-based or as aggregate data. We used the Stanford HIV database algorithm to translate genetic sequences into levels of drug resistance. Results Nine countries participated, with six reporting case-based data on 1,680 individuals and four reporting aggregated data on 1,402 cases. Sequence data were available for 1,417 cases: 14.5% of individuals (n = 244) showed resistance to at least one antiretroviral drug. In case-based surveillance, the highest levels of transmitted HIVDR were observed for non-nucleoside reverse-transcriptase inhibitors (NNRTIs) with resistance detected in 8.6% (n = 145), followed by resistance to nucleoside reverse-transcriptase inhibitors (NRTI) (5.1%; n = 85) and protease inhibitors (2.0%; n = 34). Conclusion We conclude that standard reporting of HIVDR data was feasible in the participating countries. Legal barriers for data sharing, consensus on definitions and standardisation of interpretation algorithms should be clarified in the process of enhancing European-wide HIV surveillance with drug resistance information.
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Affiliation(s)
| | | | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Emmi Andersson
- Department of Clinical Microbiology, Karolinska University Laboratory, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lambert Assoumou
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Eva Ay
- National Public Health Institute, Department of Retroviruses, Budapest, Hungary
| | | | | | - Melissa Brady
- Health Service Executive (HSE), Health Protection Surveillance Centre, Dublin, Ireland
| | - Marie-Laure Chaix
- Paris Diderot University, Paris, France.,Laboratoire de Virologie, APHP, Saint Louis Hospital, INSERM UMR944, Paris, France
| | - Diane Descamps
- Laboratoire de Virologie, Bichat-Claude Bernard University Hospital, INSERM UMR_1137, Paris, France.,Paris Diderot University, Paris, France
| | - Kenny Dauwe
- Aids Reference Laboratory, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Jannik Fonager
- Virus and Microbiological Special Diagnostics, Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | | | - Maja Lunar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maria Mezei
- National Public Health Institute, Department of Retroviruses, Budapest, Hungary
| | - Martha Neary
- University College Dublin (UCD), National Virus Reference Laboratory, Dublin, Ireland
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Chris Verhofstede
- Aids Reference Laboratory, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | | | - Eeva K Broberg
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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7
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Mårdh O, Quinten C, Amato-Gauci AJ, Duffell E. Mortality from liver diseases attributable to hepatitis B and C in the EU/EEA - descriptive analysis and estimation of 2015 baseline. Infect Dis (Lond) 2020; 52:625-637. [PMID: 32644030 DOI: 10.1080/23744235.2020.1766104] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: WHO has set target to reduce mortality attributable to hepatitis B (HBV) and hepatitis C (HCV) by 65% by 2030, with 2015 as baseline. We aimed to describe the European Union/European Economic Area (EU/EEA) baseline mortality from liver diseases, as defined by WHO Core-10 indicator through ICD-10 codes, and estimate mortality attributable to HBV and HCV.Methods: Age-standardised mortality rates per 100,000 for hepatocellular carcinoma (HCC, ICD-10 C22.0), chronic liver disease (CLD, ICD-10 K72-K75) and chronic viral hepatitis B and C (CHB/CHC, ICD-10 B18.1-B18.3) were calculated by gender, age-group and country using 2015 Eurostat data. Because aetiology fraction (AF) estimates were lacking for HCC and CLD as defined by C10, number of deaths in EU/EEA countries in 2015 from liver cancer (ICD-10 C22) and 'cirrhosis and other chronic liver diseases' (ICD-10 B18-B18.9, I85-I85.9, I98.2, K70-K70.3, K71.7, K74-K74.9, K75.2, K75.4-K76.2, K76.4-K76.9 and K77.8) were adjusted by corresponding AF estimates from Global Burden of Disease publications.Results: In 2015, there were wide variations across countries in mortality rates from HCC, CLD and CHB/CHC. A 2015 mortality baseline of 63,927 deaths attributable to HBV and HCV is proposed, that includes 55% of liver cancer and 45% of 'cirrhosis and other chronic liver diseases' deaths.Conclusions: The HBV and HCV attributable mortality in the EU/EEA is high. Greater efforts are needed to identify HBV and HCV infections at an early stage and link cases to care to reduce mortality from liver diseases. Country-specific AF estimates are needed to accurately estimate HBV, HCV associated mortality.
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Affiliation(s)
- Otilia Mårdh
- European Centre for Diseases Prevention and Control, Solna, Sweden
| | - Chantal Quinten
- European Centre for Diseases Prevention and Control, Solna, Sweden
| | | | - Erika Duffell
- European Centre for Diseases Prevention and Control, Solna, Sweden
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8
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Cole MJ, Quinten C, Jacobsson S, Day M, Amato-Gauci AJ, Woodford N, Spiteri G, Unemo M. The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union/European Economic Area. BMC Infect Dis 2019; 19:1040. [PMID: 31822275 PMCID: PMC6902330 DOI: 10.1186/s12879-019-4631-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) antimicrobial resistance (AMR) data are used to inform gonorrhoea treatment guidelines; therefore the data need to be robust and representative. We assessed the extent to which Euro-GASP reflects national measures of the AMR situation for Neisseria gonorrhoeae across the European Union/European Economic Area (EU/EEA). Methods We compared data from Euro-GASP with published national gonococcal AMR data from 15 countries for azithromycin, cefixime and ciprofloxacin for the period 2009 to 2013 and performed Poisson regression to identify differences (p < 0.05) between the proportions of resistant isolates. The 2014 Euro-GASP AMR data for each country (n = 19) were weighted to account for differences in the distribution of patient characteristics between Euro-GASP and EU/EEA epidemiological gonorrhoea surveillance data. Data were compared to determine whether estimates of resistance levels differed with regards to the 5% threshold used to assess the clinical utility of first-line gonorrhoea treatments. We assessed the quality of decentralised testing by comparing AMR data for isolates tested both centrally and in the participating laboratories, and by evaluating external quality assessment (EQA) performance. Results There was no significant difference for azithromycin, cefixime and ciprofloxacin resistance when Euro-GASP country data were compared with data from national reports. Weighting slightly altered the Euro-GASP AMR estimates (by between − 4.7 and 4.7% from the unweighted estimates). Weighting resulted in greater changes in estimates of resistance to azithromycin (from − 9.5 to 2.7%) and ciprofloxacin (from − 14.8 to 17.9%) in countries with low isolate numbers and low completeness of reporting (n = 3). Weighting caused AMR levels to fall below or above the 5% threshold for cefixime or azithromycin, respectively in only two countries. Susceptibility category data submitted from the decentralised Euro-GASP laboratories were concordant with the Euro-GASP data (> 90%). EQA performance was also good; < 5% of the minimum inhibitory concentration (MIC) results differed by > 4-fold from the modal MIC of the EQA isolate. Conclusions The overall prevalence of AMR reported by Euro-GASP reflects closely the AMR situation for N. gonorrhoeae in the EU/EEA. Euro-GASP data can be used to provide robust AMR estimates to inform the European guideline for the management of gonorrhoea.
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Affiliation(s)
- Michelle J Cole
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, UK.
| | - Chantal Quinten
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Susanne Jacobsson
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Michaela Day
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, UK
| | | | - Neil Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, UK
| | | | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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9
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Cole MJ, Field N, Pitt R, Amato-Gauci AJ, Begovac J, French PD, Keše D, Klavs I, Zidovec Lepej S, Pöcher K, Stary A, Schalk H, Spiteri G, Hughes G. Substantial underdiagnosis of lymphogranuloma venereum in men who have sex with men in Europe: preliminary findings from a multicentre surveillance pilot. Sex Transm Infect 2019; 96:137-142. [PMID: 31235527 PMCID: PMC7035679 DOI: 10.1136/sextrans-2019-053972] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/30/2019] [Accepted: 05/19/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives Understanding the public health impact of lymphogranuloma venereum (LGV) in Europe is hampered by inadequate diagnostics and surveillance systems in many European countries. We developed and piloted LGV surveillance in three European countries without existing systems and performed a preliminary investigation of LGV epidemiology, where little evidence currently exists. Methods We recruited STI or dermatovenereology clinics and associated laboratories serving men who have sex with men (MSM) in Austria, Croatia and Slovenia, using the UK for comparison. We undertook centralised LGV testing of Chlamydia trachomatis (CT)-positive rectal swabs collected between October 2016 and May 2017 from MSM attending these clinics. Stored specimens from Austria (2015–2016) and Croatia (2014) were also tested. Clinical and sociodemographic data were collected using a standardised proforma. The ompA gene of LGV-positive specimens was sequenced. Results In total, 500 specimens from CT-positive MSM were tested, and LGV positivity was 25.6% (128/500; 95% CI 22.0% to 29.6%) overall, and 47.6% (79/166; 40.1% to 55.2%) in Austria, 20.0% (3/15; 7.1% to 45.2%) in Croatia, 16.7% (1/6; 3.0% to 56.4%) in Slovenia and 14.4% (45/313; 10.9% to 18.7 %) in the UK. Proformas were completed for cases in Croatia, Slovenia and in the UK; proformas could not be completed for Austrian cases, but limited data were available from line listings. Where recorded, 83.9% (78/93) of LGV-CT cases were HIV-positive compared with 65.4% (149/228) of non-LGV-CT cases; MSM with LGV-CT were more likely to have proctitis (Austria, 91.8% vs 40.5%, p<0.001; Croatia, 100% vs 25%, p=0.04; UK, 52.4% vs 11.7%, p<0.001) than those with non-LGV-CT. Six different ompA sequences were identified, including three new variants; the L2 ompA sequence predominated (58.6%, 51/87). Conclusions LGV is substantially underdiagnosed in MSM across Europe. Unified efforts are needed to overcome barriers to testing, establish effective surveillance, and optimise diagnosis, treatment and prevention.
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Affiliation(s)
| | - Nigel Field
- National Infection Service, Public Health England, London, UK.,Research Department of Infection and Population Health, University College London, London, UK
| | - Rachel Pitt
- National Infection Service, Public Health England, London, UK
| | - Andrew J Amato-Gauci
- Office of the Chief Scientist, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Josip Begovac
- University Hospital for Infectious Diseases 'Dr Fran Mihaljevic', Zagreb, Croatia
| | | | - Darja Keše
- Institute of Microbiology and Immunology, Ljubljana, Slovenia
| | - Irena Klavs
- Institut za varovanje zdravja Republike Slovenije, Ljubljana, Slovenia
| | | | - Katharina Pöcher
- Outpatients' Centre for Diagnosis of Infectious Venero-Dermatological Diseases, Vienna, Austria
| | - Angelika Stary
- Outpatients' Centre for Diagnosis of Infectious Venero-Dermatological Diseases, Vienna, Austria
| | | | - Gianfranco Spiteri
- Surveillance and Response Support Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Gwenda Hughes
- National Infection Service, Public Health England, London, UK
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10
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Day MJ, Spiteri G, Jacobsson S, Woodford N, Amato-Gauci AJ, Cole MJ, Unemo M. Stably high azithromycin resistance and decreasing ceftriaxone susceptibility in Neisseria gonorrhoeae in 25 European countries, 2016. BMC Infect Dis 2018; 18:609. [PMID: 30509194 PMCID: PMC6276195 DOI: 10.1186/s12879-018-3528-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/19/2018] [Indexed: 11/22/2022] Open
Abstract
Background The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) performs annual sentinel surveillance of Neisseria gonorrhoeae susceptibility to therapeutically relevant antimicrobials across the European Union/European Economic Area (EU/EEA). We present the Euro-GASP results from 2016 (25 countries), linked to patient epidemiological data, and compared with data from previous years. Methods Agar dilution and minimum inhibitory concentration (MIC) gradient strip methodologies were used to determine the antimicrobial susceptibility (using EUCAST breakpoints) of 2660 N. gonorrhoeae isolates from 25 countries across the EU/EEA. Significance of differences compared with Euro-GASP results in previous years was analysed using Z-tests. Results No isolates with resistance to ceftriaxone (MIC > 0.125 mg/L) were detected in 2016 (one in 2015). However, the proportion of isolates with decreased susceptibility to ceftriaxone (MICs from 0.03 mg/L to 0.125 mg/L) increased significantly (p = 0.01) from 2015 to 2016. There were 14 (0.5%) isolates with ceftriaxone MICs 0.125 mg/L (on the resistance breakpoint), of which one isolate was resistant to azithromycin and four showed intermediate susceptibility to azithromycin. Cefixime resistance was detected in 2.1% of isolates in 2016 compared with 1.7% in 2015 (p = 0.26) and azithromycin resistance in 7.5% in 2016 compared with 7.1% in 2015 (p = 0.74). Seven (0.3%) isolates from five countries displayed high-level azithromycin resistance (MIC≥256 mg/L) in 2016 compared with five (0.2%) isolates in 2015. Resistance rate to ciprofloxacin was 46.5% compared with 49.4% in 2015 (p = 0.06). No isolates were resistant to spectinomycin and the MICs of gentamicin remained stable compared with previous years. Conclusions Overall AMR rates in gonococci in EU/EEA remained stable from 2015 to 2016. However, the ceftriaxone MIC distribution shifted away from the most susceptible (≤0.016 mg/L) and the proportion of isolates with decreased susceptibility to ceftriaxone increased significantly. This development is of concern as current European gonorrhoea management guideline recommends ceftriaxone 500 mg plus azithromycin 2 g as first-line therapy. With azithromycin resistance at 7.5%, the increasing ceftriaxone MICs might soon threaten the effectiveness of this therapeutic regimen and requires close monitoring.
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Affiliation(s)
- Michaela J Day
- National Infection Service, Public Health England, London, UK.
| | | | - Susanne Jacobsson
- WHO Collaborating Centre for Gonorrhea and other STIs, Örebro University, Örebro, Sweden
| | - Neil Woodford
- National Infection Service, Public Health England, London, UK
| | | | - Michelle J Cole
- National Infection Service, Public Health England, London, UK
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhea and other STIs, Örebro University, Örebro, Sweden
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11
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Brown AE, Hayes R, Noori T, Azad Y, Amato-Gauci AJ, Pharris A, Delpech VC. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill 2018; 23:1800622. [PMID: 30621820 PMCID: PMC6280419 DOI: 10.2807/1560-7917.es.2018.23.48.1800622] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/29/2018] [Indexed: 12/24/2022] Open
Abstract
In 2018, 52 of 55 European and Central Asian countries reported data against the UNAIDS 90-90-90 targets. Overall, 80% of people living with HIV (PLHIV) were diagnosed, of whom 64% received treatment and 86% treated were virally suppressed. Subregional outcomes varied: West (87%-91%-93%), Centre (83%-73%-75%) and East (76%-46%-78%). Overall, 43% of all PLHIV were virally suppressed; intensive efforts are needed to meet the 2020 target of 73%.
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Affiliation(s)
- Alison E Brown
- Public Health England, London, United Kingdom
- Independent Consultant, London, United Kingdom
| | | | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Yusef Azad
- National AIDS Trust, London, United Kingdom
| | | | - Anastasia Pharris
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Valerie C Delpech
- Public Health England, London, United Kingdom
- Independent Consultant, Watipa, London, United Kingdom
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12
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Rosinska M, Pantazis N, Janiec J, Pharris A, Amato-Gauci AJ, Quinten C. Potential adjustment methodology for missing data and reporting delay in the HIV Surveillance System, European Union/European Economic Area, 2015. Euro Surveill 2018; 23:1700359. [PMID: 29897039 PMCID: PMC6152165 DOI: 10.2807/1560-7917.es.2018.23.23.1700359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Accurate case-based surveillance data remain the key data source for estimating HIV burden and monitoring prevention efforts in Europe. We carried out a literature review and exploratory analysis of surveillance data regarding two crucial issues affecting European surveillance for HIV: missing data and reporting delay. Initial screening showed substantial variability of these data issues, both in time and across countries. In terms of missing data, the CD4+ cell count is the most problematic variable because of the high proportion of missing values. In 20 of 31 countries of the European Union/European Economic Area (EU/EEA), CD4+ counts are systematically missing for all or some years. One of the key challenges related to reporting delays is that countries undertake specific one-off actions in effort to capture previously unreported cases, and that these cases are subsequently reported with excessive delays. Slightly different underlying assumptions and effectively different models may be required for individual countries to adjust for missing data and reporting delays. However, using a similar methodology is recommended to foster harmonisation and to improve the accuracy and usability of HIV surveillance data at national and EU/EEA levels.
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Affiliation(s)
- Magdalena Rosinska
- National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
| | - Nikos Pantazis
- National and Kapodistrian University of Athens, Athens, Greece
| | - Janusz Janiec
- National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Chantal Quinten
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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13
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Sullivan AK, Sperle I, Raben D, Amato-Gauci AJ, Lundgren JD, Yazdanpanah Y, Jakobsen SF, Tavoschi L. HIV testing in Europe: Evaluating the impact, added value, relevance and usability of the European Centre for Disease Prevention and Control (ECDC)'s 2010 HIV testing guidance. ACTA ACUST UNITED AC 2018; 22. [PMID: 29208158 PMCID: PMC5725791 DOI: 10.2807/1560-7917.es.2017.22.48.17-00323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: An evaluation of the 2010 ECDC guidance on HIV testing, conducted in October 2015–January 2016, assessed its impact, added value, relevance and usability and the need for updated guidance. Methods: Data sources were two surveys: one for the primary target audience (health policymakers and decision makers, national programme managers and ECDC official contact points in the European Union/European Economic Area (EU/EEA) countries and one for a broader target audience (clinicians, civil society organisations and international public health agencies); two moderated focus group discussions (17 participants each); webpage access data; a literature citation review; and an expert consultation (18 participants) to discuss the evaluation findings. Results: Twenty-three of 28 primary target audience and 31 of 51 broader target audience respondents indicated the guidance was the most relevant when compared with other international guidance. Primary target audience respondents in 11 of 23 countries reported that they had used the guidance in development, monitoring and/or evaluation of their national HIV testing policy, guidelines, programme and/or strategy, and 29 of 51 of the broader target audience respondents reported having used the guidance in their work. Both the primary and broader target audience considered it important or very important to have an EU/EEA-level HIV testing guidance (23/28 and 46/51, respectively). Conclusion: The guidance has been widely used to develop policies, guidelines, programmes and strategies in the EU/EEA and should be regularly updated due to continuous developments in the field in order to continue to serve as an important reference guidance in the region.
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Affiliation(s)
- Ann K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Ida Sperle
- CHIP, Rigshospitalet, University of Copenhagen, Denmark
| | - Dorthe Raben
- CHIP, Rigshospitalet, University of Copenhagen, Denmark
| | | | | | | | | | - Lara Tavoschi
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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14
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Abstract
It is well-documented that early HIV diagnosis and linkage to care reduces morbidity and mortality as well as HIV transmission. We estimated the median time from HIV infection to diagnosis in the European Union/European Economic Area (EU/EEA) at 2.9 years in 2016, with regional variation. Despite evidence of a decline in the number of people living with undiagnosed HIV in the EU/EEA, many remain undiagnosed, including 33% with more advanced HIV infection (CD4 < 350 cells/mm3).
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Affiliation(s)
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Chantal Quinten
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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- The members of the networks are listed at the end of the article
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15
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Abstract
IntroductionExpanding access to HIV antiretroviral treatment is expected to decrease HIV incidence and acquired immunodeficiency syndrome (AIDS) mortality. However, this may also result in increased HIV drug resistance (DR). Better monitoring and surveillance of HIV DR is required to inform treatment regimens and maintain the long term effectiveness of antiretroviral drugs. As there is currently no formal European Union (EU)-wide collection of HIV DR data, this study aimed to assess the current HIV molecular surveillance capacity in EU/European Economic Area (EEA) countries in order to inform the planning of HIV DR monitoring at EU level. Methods: Thirty EU/EEA countries were invited to participate in a survey on HIV molecular surveillance capacity, which also included laboratory aspects. Results: Among 21 responding countries, 13 reported using HIV sequence data (subtype and/or DR) for surveillance purposes at national level. Of those, nine stated that clinical, epidemiological and sequence data were routinely linked for analysis. Discussion/conclusion: We identified similarities between existing HIV molecular surveillance systems, but also found important challenges including human resources, data ownership and legal issues that would need to be addressed.Information on capacities should allow better planning of the phased introduction of HIV DR surveillance at EU/EEA level.
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Affiliation(s)
- Patrick Keating
- Österreichische Agentur für Gesundheit und Ernährungssicherheit (AGES), Vienna, Austria,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Katrin Leitmeyer
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Stefania De Angelis
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | | | - Eeva Broberg
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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16
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Pharris A, Quinten C, Noori T, Amato-Gauci AJ, van Sighem A. Estimating HIV incidence and number of undiagnosed individuals living with HIV in the European Union/European Economic Area, 2015. ACTA ACUST UNITED AC 2017; 21:30417. [PMID: 27934585 PMCID: PMC5388115 DOI: 10.2807/1560-7917.es.2016.21.48.30417] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/01/2016] [Indexed: 11/23/2022]
Abstract
Since 2011, human immunodeficiency virus (HIV) incidence appears unchanged in the European Union/European Economic Area with between 29,000 and 33,000 new cases reported annually up to 2015. Despite evidence that HIV diagnosis is occurring earlier post-infection, the estimated number of people living with HIV (PLHIV) who were unaware of being infected in 2015 was 122,000, or 15% of all PLHIV (n=810,000). This is concerning as such individuals cannot benefit from highly effective treatment and may unknowingly sustain transmission.
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Affiliation(s)
- Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Chantal Quinten
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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- Members are listed at the end of the article
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17
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Pharris A, Quinten C, Noori T, Amato-Gauci AJ, van Sighem A. Authors' reply: New metrics to monitor progress towards global HIV targets: using the estimated number of undiagnosed HIV-infected individuals as denominator. Euro Surveill 2016; 21:30428. [PMID: 28006654 PMCID: PMC5291137 DOI: 10.2807/1560-7917.es.2016.21.50.30428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 12/03/2022] Open
Affiliation(s)
- Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Chantal Quinten
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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18
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Pharris A, Quinten C, Tavoschi L, Spiteri G, Amato-Gauci AJ. Trends in HIV surveillance data in the EU/EEA, 2005 to 2014: new HIV diagnoses still increasing in men who have sex with men. ACTA ACUST UNITED AC 2016; 20:30071. [PMID: 26625124 DOI: 10.2807/1560-7917.es.2015.20.47.30071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/24/2015] [Indexed: 11/20/2022]
Abstract
Human immunodeficiency virus (HIV) transmission remains significant in Europe. Rates of acquired immunodeficiency syndrome (AIDS) have declined, but not in all countries. New HIV diagnoses have increased among native and foreign-born men who have sex with men. Median CD4(+) T-cell count at diagnosis has increased, but not in all groups, and late diagnosis remains common. HIV infection and AIDS can be eliminated in Europe with resolute prevention measures, early diagnosis and access to effective treatment.
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Affiliation(s)
- Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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19
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Mardh O, Amato-Gauci AJ. ECDC publishes updated evidence-based guidance for chlamydia prevention and control and makes latest chlamydia figures available online through interactive Surveillance Atlas. Euro Surveill 2016; 21:30157. [DOI: 10.2807/1560-7917.es.2016.21.10.30157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 03/10/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
- O Mardh
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - AJ Amato-Gauci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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20
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van den Broek IV, Sfetcu O, van der Sande MA, Andersen B, Herrmann B, Ward H, Götz HM, Uusküla A, Woodhall SC, Redmond SM, Amato-Gauci AJ, Low N, van Bergen JE. Changes in chlamydia control activities in Europe between 2007 and 2012: a cross-national survey. Eur J Public Health 2015; 26:382-8. [PMID: 26498953 PMCID: PMC4884327 DOI: 10.1093/eurpub/ckv196] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2012, the levels of chlamydia control activities including primary prevention, effective case management with partner management and surveillance were assessed in 2012 across countries in the European Union and European Economic Area (EU/EEA), on initiative of the European Centre for Disease Control (ECDC) survey, and the findings were compared with those from a similar survey in 2007. METHODS Experts in the 30 EU/EEA countries were invited to respond to an online questionnaire; 28 countries responded, of which 25 participated in both the 2007 and 2012 surveys. Analyses focused on 13 indicators of chlamydia prevention and control activities; countries were assigned to one of five categories of chlamydia control. RESULTS In 2012, more countries than in 2007 reported availability of national chlamydia case management guidelines (80% vs. 68%), opportunistic chlamydia testing (68% vs. 44%) and consistent use of nucleic acid amplification tests (64% vs. 36%). The number of countries reporting having a national sexually transmitted infection control strategy or a surveillance system for chlamydia did not change notably. In 2012, most countries (18/25, 72%) had implemented primary prevention activities and case management guidelines addressing partner management, compared with 44% (11/25) of countries in 2007. CONCLUSION Overall, chlamydia control activities in EU/EEA countries strengthened between 2007 and 2012. Several countries still need to develop essential chlamydia control activities, whereas others may strengthen implementation and monitoring of existing activities.
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Affiliation(s)
- Ingrid V van den Broek
- Unit of Epidemiology and Surveillance, RIVM/Centre for Infectious Disease Control Netherlands, Bilthoven, The Netherlands
| | - Otilia Sfetcu
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Marianne A van der Sande
- Unit of Epidemiology and Surveillance, RIVM/Centre for Infectious Disease Control Netherlands, Bilthoven, The Netherlands Julius Centre, UMC Utrecht, Utrecht, The Netherlands
| | - Berit Andersen
- Department of Public Health, Randers Hospital, Skovlyvej, Randers, Denmark
| | - Björn Herrmann
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Helen Ward
- Infectious Diseases Epidemiology, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, UK
| | - Hannelore M Götz
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Anneli Uusküla
- Department of Public Health, University of Tartu, Tartu, Estonia
| | - Sarah C Woodhall
- HIV & STI Department, National Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Shelagh M Redmond
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jan E van Bergen
- Unit of Epidemiology and Surveillance, RIVM/Centre for Infectious Disease Control Netherlands, Bilthoven, The Netherlands Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands STI AIDS Netherlands, Amsterdam, The Netherlands
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21
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Abstract
Hepatitis C is a major public health issue across Europe, and with rapidly evolving developments in the therapeutic field, it is essential that countries have access to epidemiological information. In 2011, The European Centre for Disease Prevention and Control (ECDC) introduced enhanced surveillance of hepatitis C across EU/EEA countries collecting routine data from national notification systems using standardized case definitions. Data collected from 2006 to 2012 indicate a high burden of disease with great variation in reported cases between countries. Most cases occurred among young adult males, and although injecting drug use dominated across all cases, there were increasing numbers of acute cases reported among men who have sex with men. Geographically, the reported data were the inverse of what may be expected based on findings from recent prevalence surveys in a number of EU/EEA countries. Unexpectedly, low figures were reported through notification systems in some southern and eastern European countries where prevalence is known from surveys to be high. This discrepancy highlights the limitation of surveillance data for a disease such as hepatitis C which is largely asymptomatic until a late stage, so that notifications reflect testing practices rather than real occurrence of disease. Further improvements to the quality of the data are important to increase data utility. Improved understanding of national testing practices is necessary to allow a better interpretation of surveillance results. Additional epidemiological studies alongside routine case-based reporting in notification systems should also be considered to better estimate the true disease burden across Europe.
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Affiliation(s)
- E F Duffell
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - M J W van de Laar
- Formerly of European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - A J Amato-Gauci
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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22
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Abstract
Robust epidemiological information on hepatitis B is important to help countries plan prevention and control programmes and evaluate public health responses to control transmission. European Centre Disease Prevention and Control (ECDC) introduced enhanced surveillance of hepatitis B at EU/EEA level in 2011 to collate routine surveillance data from national notification systems. Analysis of the data collected for the years 2006-2012 shows a high burden of hepatitis B across Europe with 110 005 cases reported over the period with the majority of these cases being chronic infections. The most commonly reported routes of transmission in acute cases included heterosexual transmission, nosocomial transmission, injecting drug use and transmission among men who have sex with men. Mother-to-child transmission was the most common route reported for chronic cases. Trends over time were difficult to analyse as national reporting practices changed, but data suggest a downward trend in acute cases, which probably reflects the impact of the widespread implementation of vaccination programmes. Notifications of chronic infection varied across countries and showed discrepancy with the expected results based on findings from recent prevalence surveys. This indicated that notifications mirror local testing practices rather than real occurrence of disease. Improving the quality of the data and considering reported notifications alongside other data sources, such as local screening practices and vaccination policies, will improve the utility of the data.
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Affiliation(s)
- E F Duffell
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - M J W van de Laar
- Formerly of European Centre for Disease Prevention and Control (ECDC), Stockholm, 171 83, Sweden
| | - A J Amato-Gauci
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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23
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Fakoya I, Álvarez-del Arco D, Woode-Owusu M, Monge S, Rivero-Montesdeoca Y, Delpech V, Rice B, Noori T, Pharris A, Amato-Gauci AJ, del Amo J, Burns FM. A systematic review of post-migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: mplications for effectively managing HIV prevention programmes and policy. BMC Public Health 2015; 15:561. [PMID: 26085030 PMCID: PMC4472169 DOI: 10.1186/s12889-015-1852-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 05/19/2015] [Indexed: 12/02/2022] Open
Abstract
Background Migrant populations from countries with generalised HIV epidemics make up a significant proportion of all HIV/AIDS cases in many European Union and European Economic Area (EU/EEA) countries, with heterosexual transmission the predominant mode of HIV acquisition. While most of these infections are diagnosed for the first time in Europe, acquisition is believed to have predominantly occurred in the home country. A proportion of HIV transmission is believed to be occurring post-migration, and many countries may underestimate the degree to which this is occurring. Our objectives were to review the literature estimating the proportion of migrants believed to have acquired their HIV post-migration and examine which EU member states are able to provide estimates of probable country of HIV acquisition through current surveillance systems. Methods A systematic review was undertaken to gather evidence of sexual transmission of HIV within Europe among populations from countries with a generalised epidemic. In addition, national surveillance focal points from 30 EU/EEA Member States were asked to complete a questionnaire about surveillance methods and monitoring of the likely place of HIV acquisition among migrants. Results & discussion Twenty-seven papers from seven countries were included in the review and 24 countries responded to the survey. Estimates of HIV acquisition post-migration ranged from as low as 2 % among sub Saharan Africans in Switzerland, to 62 % among black Caribbean men who have sex with men (MSM) in the UK. Surveillance methods for monitoring post-migration acquisition varied across the region; a range of methods are used to estimate country or region of HIV acquisition, including behavioural and clinical markers. There is little published evidence addressing this issue, although Member States highlight the importance of migrant populations in their epidemics. Conclusions There is post-migration HIV acquisition among migrants in European countries but this is difficult to quantify accurately with current data. Migrant MSM appear at particular risk of HIV acquisition post-migration. Countries that identify migrants as an important part of their HIV epidemic should focus on using an objective method for assigning probable country of HIV acquisition. Robust methods to measure HIV incidence should be considered in order to inform national prevention programming and resource allocation.
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Affiliation(s)
- Ibidun Fakoya
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK.
| | - Débora Álvarez-del Arco
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. .,Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain.
| | - Melvina Woode-Owusu
- HIV & STI Department, Health Protection, Public Health England, England, UK.
| | - Susana Monge
- Department of Health and Socio-medical Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain. .,Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain.
| | - Yaiza Rivero-Montesdeoca
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. .,Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain.
| | - Valerie Delpech
- HIV & STI Department, Health Protection, Public Health England, England, UK.
| | - Brian Rice
- HIV & STI Department, Health Protection, Public Health England, England, UK.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden.
| | | | | | - Julia del Amo
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. .,Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain.
| | - Fiona M Burns
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK. .,Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
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24
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Affiliation(s)
- K Haar
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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25
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Abstract
In 2004, the 31 countries of the European Union and European Economic Area (EU/EEA) adopted the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia. In 2013, 29,157 persons were diagnosed with HIV in 30 EU/EEA countries (adjusted rate: 6.2/100,000); new diagnoses have increased by 33% since 2004 among men who have sex with men and late diagnosis remains common. Evidence-based prevention measures and efforts towards earlier testing need to be expanded.
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Affiliation(s)
- A Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Janiec J, Haar K, Spiteri G, Likatavicius G, Van de Laar M, Amato-Gauci AJ. Surveillance of human immunodeficiency virus suggests that younger men who have sex with men are at higher risk of infection, European Union, 2003 to 2012. ACTA ACUST UNITED AC 2013; 18:20644. [PMID: 24308979 DOI: 10.2807/1560-7917.es2013.18.48.20644] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In 2012, newly reported human immunodeficiency virus diagnoses in the European Union /European Economic Area remained stable at around 30,000 cases. Since 2003, cases in men who have sex with men (MSM) aged 20 to 29 years-old doubled, while the proportion of late presenters in this group remained stable. Persistent declines occurred among older MSM age groups, particularly that between 30 and 39 years-old. Interventions targeting younger MSM are needed to prevent a resurgence of the epidemic in Europe.
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Affiliation(s)
- J Janiec
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Penttinen PM, Kaasik-Aaslav K, Friaux A, Donachie A, Sudre B, Amato-Gauci AJ, Memish ZA, Coulombier D. Taking stock of the first 133 MERS coronavirus cases globally--Is the epidemic changing? ACTA ACUST UNITED AC 2013; 18. [PMID: 24094061 DOI: 10.2807/1560-7917.es2013.18.39.20596] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since June 2012, 133 Middle East respiratory syndrome coronavirus (MERS-CoV) cases have been identified in nine countries. Two time periods in 2013 were compared to identify changes in the epidemiology. The case-fatality risk (CFR) is 45% and is decreasing. Men have a higher CFR (52%) and are over-represented among cases. Thirteen out of 14 known primary cases died. The sex-ratio is more balanced in the latter period. Nosocomial transmission was implied in 26% of the cases.
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Affiliation(s)
- P M Penttinen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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28
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Affiliation(s)
- A J Amato-Gauci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - H Zeller
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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