1
|
Päll T, Abroi A, Avi R, Niglas H, Shablinskaja A, Pauskar M, Jõgeda EL, Soeorg H, Kallas E, Lahesaare A, Truusalu K, Hoidmets D, Sadikova O, Ratnik K, Sepp H, Dotsenko L, Epštein J, Suija H, Kaarna K, Smit S, Milani L, Metspalu M, Oopkaup OE, Koppel I, Jaaniso E, Kuzmin I, Inno H, Raudvere U, Härma MA, Naaber P, Reisberg T, Peterson H, Talas UG, Lutsar I, Huik K. SARS-CoV-2 clade dynamics and their associations with hospitalisations during the first two years of the COVID-19 pandemic. PLoS One 2024; 19:e0303176. [PMID: 38728305 PMCID: PMC11086870 DOI: 10.1371/journal.pone.0303176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/20/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic was characterised by rapid waves of disease, carried by the emergence of new and more infectious SARS-CoV-2 virus variants. How the pandemic unfolded in various locations during its first two years has yet to be sufficiently covered. To this end, here we are looking at the circulating SARS-CoV-2 variants, their diversity, and hospitalisation rates in Estonia in the period from March 2000 to March 2022. METHODS We sequenced a total of 27,550 SARS-CoV-2 samples in Estonia between March 2020 and March 2022. High-quality sequences were genotyped and assigned to Nextstrain clades and Pango lineages. We used regression analysis to determine the dynamics of lineage diversity and the probability of clade-specific hospitalisation stratified by age and sex. RESULTS We successfully sequenced a total of 25,375 SARS-CoV-2 genomes (or 92%), identifying 19 Nextstrain clades and 199 Pango lineages. In 2020 the most prevalent clades were 20B and 20A. The various subsequent waves of infection were driven by 20I (Alpha), 21J (Delta) and Omicron clades 21K and 21L. Lineage diversity via the Shannon index was at its highest during the Delta wave. About 3% of sequenced SARS-CoV-2 samples came from hospitalised individuals. Hospitalisation increased markedly with age in the over-forties, and was negligible in the under-forties. Vaccination decreased the odds of hospitalisation in over-forties. The effect of vaccination on hospitalisation rates was strongly dependent upon age but was clade-independent. People who were infected with Omicron clades had a lower hospitalisation likelihood in age groups of forty and over than was the case with pre-Omicron clades regardless of vaccination status. CONCLUSIONS COVID-19 disease waves in Estonia were driven by the Alpha, Delta, and Omicron clades. Omicron clades were associated with a substantially lower hospitalisation probability than pre-Omicron clades. The protective effect of vaccination in reducing hospitalisation likelihood was independent of the involved clade.
Collapse
Affiliation(s)
- Taavi Päll
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Aare Abroi
- Faculty of Science and Technology, Institute of Technology, University of Tartu, Tartu, Estonia
| | - Radko Avi
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Heiki Niglas
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | - Arina Shablinskaja
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Merit Pauskar
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Ene-Ly Jõgeda
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Hiie Soeorg
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Eveli Kallas
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | | | - Kai Truusalu
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Dagmar Hoidmets
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Olga Sadikova
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | | | - Hanna Sepp
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | - Liidia Dotsenko
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | - Jevgenia Epštein
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | - Heleene Suija
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | - Katrin Kaarna
- Clinical Research Centre, Faculty of Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Tartu University Hospital, Tartu, Estonia
| | - Steven Smit
- Institute of Genomics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Lili Milani
- Institute of Genomics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Mait Metspalu
- Institute of Genomics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Ott Eric Oopkaup
- High Performance Computing Centre, Faculty of Science and Technology, Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Ivar Koppel
- High Performance Computing Centre, Faculty of Science and Technology, Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Erik Jaaniso
- Institute of Computer Science, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Ivan Kuzmin
- High Performance Computing Centre, Faculty of Science and Technology, Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Heleri Inno
- High Performance Computing Centre, Faculty of Science and Technology, Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Uku Raudvere
- High Performance Computing Centre, Faculty of Science and Technology, Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Mari-Anne Härma
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | - Paul Naaber
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
- SYNLAB Eesti OÜ, Tallinn, Estonia
| | - Tuuli Reisberg
- Institute of Genomics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Hedi Peterson
- Institute of Computer Science, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Ulvi Gerst Talas
- High Performance Computing Centre, Faculty of Science and Technology, Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Irja Lutsar
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Kristi Huik
- Department of Microbiology, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| |
Collapse
|
2
|
Nerlander L, Champezou L, Gomes Dias J, Aspelund G, Berlot L, Constantinou E, Díaz A, Epštein J, Fogarassy E, Hernando V, Hoffmann P, Igoe D, Klavs I, Pinto Leite P, Liitsola K, McIntyre A, Molnár Z, Olsen AO, Pires-Afonso Y, Putniņa R, Rudaitis K, Siakallis G, de Stoppelaar S, Suligoi B, Hannila-Handelberg T, Velicko I, Cabral Veríssimo V, Visser M, Wessman M, Mårdh O. Sharp increase in gonorrhoea notifications among young people, EU/EEA, July 2022 to June 2023. Euro Surveill 2024; 29:2400113. [PMID: 38456219 PMCID: PMC10986672 DOI: 10.2807/1560-7917.es.2024.29.10.2400113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 03/09/2024] Open
Abstract
Gonorrhoea cases increased steeply in women aged 20 to 24 years across 15 EU/EEA countries in July to December 2022 and January to June 2023 with, respectively, 73% and 89% more cases reported than expected, based on historical data from 2015 to 2019. Smaller increases among men due to heterosexual transmission were observed in nine EU/EEA countries. Interventions to raise awareness among young people about sexually transmitted infection risks are needed, emphasising the benefit of safe sexual practices and testing.
Collapse
Affiliation(s)
- Lina Nerlander
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Lydia Champezou
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Joana Gomes Dias
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Gudrun Aspelund
- Centre for Health Security and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland
| | - Lina Berlot
- Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia
| | | | - Asunción Díaz
- National Centre of Epidemiology, CIBER in Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - Jevgenia Epštein
- Department of Communicable Diseases Epidemiology Health Board, Tallinn, Estonia
| | - Erika Fogarassy
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Victoria Hernando
- National Centre of Epidemiology, CIBER in Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - Patrick Hoffmann
- Health Directorate Luxembourg, Division de l'inspection sanitaire, Luxembourg, Luxembourg
| | - Derval Igoe
- HSE Public Health: National Health Protection Office, Dublin, Ireland
| | - Irena Klavs
- Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Pedro Pinto Leite
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Kirsi Liitsola
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Angeline McIntyre
- HSE Public Health: National Health Protection Office, Dublin, Ireland
| | - Zsuzsanna Molnár
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Anne Olaug Olsen
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway
| | - Yolanda Pires-Afonso
- Health Directorate Luxembourg, Division de l'inspection sanitaire, Luxembourg, Luxembourg
| | - Renāte Putniņa
- The Centre for Disease Prevention and Control, Riga, Latvia
| | | | | | | | - Barbara Suligoi
- National AIDS Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Inga Velicko
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Vítor Cabral Veríssimo
- Public Health Unit Cascais, Western Lisbon Local Health Unit, Lisbon, Portugal
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Maartje Visser
- Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, the Netherlands
| | - Maria Wessman
- Department of Infectious Disease Epidemiology and Prevention Statens Serum Institut, Copenhagen, Denmark
| | - Otilia Mårdh
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| |
Collapse
|
3
|
Enkirch T, Severi E, Vennema H, Thornton L, Dean J, Borg ML, Ciccaglione AR, Bruni R, Christova I, Ngui SL, Balogun K, Němeček V, Kontio M, Takács M, Hettmann A, Korotinska R, Löve A, Avellón A, Muñoz-Chimeno M, de Sousa R, Janta D, Epštein J, Klamer S, Suin V, Aberle SW, Holzmann H, Mellou K, Ederth JL, Sundqvist L, Roque-Afonso AM, Filipović SK, Poljak M, Vold L, Stene-Johansen K, Midgley S, Fischer TK, Faber M, Wenzel JJ, Takkinen J, Leitmeyer K. Improving preparedness to respond to cross-border hepatitis A outbreaks in the European Union/European Economic Area: towards comparable sequencing of hepatitis A virus. ACTA ACUST UNITED AC 2020; 24. [PMID: 31311618 PMCID: PMC6636214 DOI: 10.2807/1560-7917.es.2019.24.28.1800397] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction Sequence-based typing of hepatitis A virus (HAV) is important for outbreak detection, investigation and surveillance. In 2013, sequencing was central to resolving a large European Union (EU)-wide outbreak related to frozen berries. However, as the sequenced HAV genome regions were only partly comparable between countries, results were not always conclusive. Aim The objective was to gather information on HAV surveillance and sequencing in EU/European Economic Area (EEA) countries to find ways to harmonise their procedures, for improvement of cross-border outbreak responses. Methods In 2014, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on HAV surveillance practices in EU/EEA countries. The survey enquired whether a referral system for confirming primary diagnostics of hepatitis A existed as well as a central collection/storage of hepatitis A cases’ samples for typing. Questions on HAV sequencing procedures were also asked. Based on the results, an expert consultation proposed harmonised procedures for cross-border outbreak response, in particular regarding sequencing. In 2016, a follow-up survey assessed uptake of suggested methods. Results Of 31 EU/EEA countries, 23 (2014) and 27 (2016) participated. Numbers of countries with central collection and storage of HAV positive samples and of those performing sequencing increased from 12 to 15 and 12 to 14 respectively in 2016, with all countries typing an overlapping fragment of 218 nt. However, variation existed in the sequenced genomic regions and their lengths. Conclusions While HAV sequences in EU/EEA countries are comparable for surveillance, collaboration in sharing and comparing these can be further strengthened.
Collapse
Affiliation(s)
- Theresa Enkirch
- European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.,Public Health Agency of Sweden, Solna, Sweden
| | - Ettore Severi
- Karolinska Institutet, Stockholm, Sweden.,European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Harry Vennema
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Lelia Thornton
- HSE - Health Protection Surveillance Centre, Dublin, Ireland
| | - Jonathan Dean
- National Virus Reference Laboratory, Dublin, Ireland
| | | | | | | | - Iva Christova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Koye Balogun
- Public Health England (PHE), London, United Kingdom
| | | | - Mia Kontio
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mária Takács
- National Public Health Institute, Budapest, Hungary
| | | | | | - Arthur Löve
- Landspitali- National University Hospital, Reykjavik, Iceland
| | - Ana Avellón
- Carlos III Institute of Health, Madrid, Spain
| | | | - Rita de Sousa
- National Institute of Health Dr. Ricardo Jorge (INSA), Lisbon, Portugal
| | - Denisa Janta
- National Institute of Public Health, Bucharest, Romania
| | | | - Sofieke Klamer
- Scientific Institute of Public Health, Brussels, Belgium
| | - Vanessa Suin
- Sciensano, Directorate Infectious diseases in humans, Brussels, Belgium
| | - Stephan W Aberle
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | | | - Kassiani Mellou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | | | | | | | | | - Mario Poljak
- Institute of Microbiology and Immunology, Ljubljana, Slovenia
| | - Line Vold
- Norwegian institute of Public Health, Oslo, Norway
| | | | | | - Thea Kølsen Fischer
- Department of Infectious Diseases and Global Health, University of Southern Denmark, Odense, Denmark.,Statens Serum Institut (SSI), Copenhagen, Denmark
| | - Mirko Faber
- Robert Koch Institute (RKI), Berlin, Germany
| | - Jürgen J Wenzel
- National Reference Laboratory for HAV, Regensburg University Medical Center, Regensburg, Germany
| | - Johanna Takkinen
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Katrin Leitmeyer
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| |
Collapse
|
4
|
Abstract
Background Studies of missed opportunities for earlier diagnosis of HIV have shown that patients with undiagnosed HIV often present to healthcare settings numerous times before eventually receiving their diagnosis. Aim The aim of the study was to assess missed opportunities for HIV testing among people newly diagnosed with HIV. Methods In this observational retrospective study, we collected data from the Estonian Health Board on new HIV cases in people aged 16–49 years diagnosed in 2014–15 and from the Estonian Health Insurance Fund database for treatment invoices on their contacts with healthcare services in the 2 years preceding diagnosis. Diagnoses on treatment invoices were categorised as HIV indicator conditions using ICD-10 codes. Results Of 538 newly diagnosed HIV cases (62.5%; 336 men), 82% had visited healthcare services at least once during the 2 years before HIV diagnosis; the mean number of visits was 9.1. Of these, 16% had been tested for HIV and 31% had at least one ICD-10 code for an HIV indicator condition on at least one of their treatment invoices. In 390 cases of HIV indicator conditions, only 5% were tested for HIV. Of all new HIV cases aged 20–49 years from high-incidence regions (defined as priority groups in national testing guidance), 18% had been tested. Conclusions The HIV testing rate in the 2 years before an HIV diagnosis was very low, even in the presence of an HIV indicator condition. This emphasises the importance of implementing the Estonian HIV testing guidelines.
Collapse
Affiliation(s)
- Kristi Rüütel
- National Institute for Health Development, Tallinn, Estonia
| | - Liis Lemsalu
- National Institute for Health Development, Tallinn, Estonia
| | - Sirly Lätt
- Estonian Health Insurance Fund, Tallinn, Estonia
| | | | | |
Collapse
|
5
|
Adlhoch C, Manďáková Z, Ethelberg S, Epštein J, Rimhanen-Finne R, Figoni J, Baylis SA, Faber M, Mellou K, Murphy N, O'Gorman J, Tosti ME, Ciccaglione AR, Hofhuis A, Zaaijer H, Lange H, de Sousa R, Avellón A, Sundqvist L, Said B, Ijaz S. Standardising surveillance of hepatitis E virus infection in the EU/EEA: A review of national practices and suggestions for the way forward. J Clin Virol 2019; 120:63-67. [PMID: 31590112 PMCID: PMC6899520 DOI: 10.1016/j.jcv.2019.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hepatitis E virus (HEV) infection is not notifiable at EU/EEA level, therefore surveillance relies on national policies only. Between 2005 and 2015, more than 20,000 cases were reported in EU/EEA countries. HEV testing is established in 26 countries and 19 countries sequence HEV viruses. OBJECTIVE AND STUDY DESIGN WHO's European Action plan for viral hepatitis recommends harmonised surveillance objectives and case definitions. ECDC's HEV expert group developed minimal and optimal criteria for national hepatitis E surveillance to support EU/EEA countries in enhancing their capacity and to harmonise methods. RESULTS The experts agreed that the primary objectives of national surveillance for HEV infections should focus on the basic epidemiology of the disease: to monitor the incidence of acute cases and chronic infections. The secondary objectives should be to describe viral phylotypes or subtypes and to identify potential clusters/outbreaks and possible routes of transmission. Seventeen of 20 countries with existing surveillance systems collect the minimal data set required to describe the epidemiology of acute cases. Eleven countries test for chronic infections. Twelve countries collect data to identify potential clusters/outbreaks and information on possible routes of transmission. DISCUSSION Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.
Collapse
Affiliation(s)
- Cornelia Adlhoch
- European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73, Solna, Sweden.
| | | | | | | | | | | | | | | | | | - Niamh Murphy
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland.
| | - Joanne O'Gorman
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland.
| | | | | | - Agnetha Hofhuis
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Hans Zaaijer
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands.
| | - Heidi Lange
- Norwegian Institute of Public Health, Oslo, Norway.
| | - Rita de Sousa
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.
| | - Ana Avellón
- Viral Hepatitis Reference and Research Laboratory National Center of Microbiology Carlos III Health Institute, Madrid, Spain.
| | - Lena Sundqvist
- The Public Health Agency of Sweden (Folkhälsomyndigheten), Stockholm, Sweden.
| | - Bengü Said
- Public Health England, London, United Kingdom.
| | | |
Collapse
|
6
|
Adlhoch C, Avellon A, Baylis SA, Ciccaglione AR, Couturier E, de Sousa R, Epštein J, Ethelberg S, Faber M, Fehér Á, Ijaz S, Lange H, Manďáková Z, Mellou K, Mozalevskis A, Rimhanen-Finne R, Rizzi V, Said B, Sundqvist L, Thornton L, Tosti ME, van Pelt W, Aspinall E, Domanovic D, Severi E, Takkinen J, Dalton HR. Hepatitis E virus: Assessment of the epidemiological situation in humans in Europe, 2014/15. J Clin Virol 2016; 82:9-16. [DOI: 10.1016/j.jcv.2016.06.010] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/19/2016] [Indexed: 01/10/2023]
|