bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survey of nosocomial influenza in South-western Swiss hospitals during two seasonal epidemics
Authors: Hequet D , Qalla-Widmer L , Balmelli C , Clerc O , Fuehrer U , Iten A , Portillo V , Senn L , Troillet N 
Published: November 2019

Abstract

Nosocomial influenza increases morbidity and mortality in hospitalised patients. No multicentre study analysed its impact in Swiss hospitals yet. This study was conducted From November 1st to April 30th in 2016-2017 and 2017-2018 in 27 acute-care public hospitals in South-western Switzerland. It aimed at describing nosocomial cases of seasonal influenza. During these 2 time-periods, every patient hospitalized for &gt;72 hours that was positively screened by RT-PCR or antigen detection for influenza was retrospectively included in the survey. Policies to prevent influenza were collected in each participating hospital. Characteristics of patients included age, sex, and comorbidities. Included patients were followed-up until discharge or death. Complications and administration of anti-neuraminidases and/or antibiotics were registered.
The mean influenza vaccine coverage of healthcare workers (HCW) was 40%. 836 patients were included (98% with a type A influenza virus in 2016-2017; 77% with a type B virus in 2017-2018). Most patients (81%) had an unknown vaccine status. Overall, the incidence of nosocomial influenza was 0.3/100 admissions (0.35/1000 patient-days). The most frequent comorbidities were diabetes (21%), chronic respiratory diseases (18%), and malnutrition (17%). Fever (77%) and cough (66%) were the most frequent symptoms. 70% of patients received anti-neuraminidases, 28% received antibiotics. Infectious complications such as pneumonia were reported in 8%. Overall, the all-cause mortality was 6%.
The occurrence of nosocomial influenza underlines the importance of vaccinating patients and HCW, rapidly recognising community or hospital-acquired cases, and applying adequate additional measures to prevent dissemination, including the timely administration of anti-neuraminidases to avoid antibiotic use (and misuse).

Key messages
Important to encourage patients to be vaccinated against influenza. Apply additional measures in order to prevent influenza dissemination.
Laboratory based Influenza sentinel surveillance in Pakistan At NIC, Islamabad 2007-2017
Authors: Bashir F , Fawad Khan K , Zafar Qureshi S , Khaudaidad F , Sonia R 
Published: November 2019

Abstract

Background
A country-wide lab-based surveillance system for ILI and Severe Acute Respiratory Illness (SARI) with weekly sampling and reporting was established in 2008.This system was necessary for early detection of emerging novel influenza subtypes and timely response for influenza prevention and control.

Objectives
To assess the trends of Influenza-like-Illness(ILI) and to monitor the predominant circulating strains of influenza viruses through Lab based sentinel surveillance.

Methods
A cross-sectional study was conducted based on ten years (2007-2017) influenza surveillance data obtained from National Influenza Central Laboratory Pakistan (NICLP) from January to March 2018.Study was done from the data records and samples of suspected ILI patients and SARI patients received from all seven sentinel sites. An ILI case was defined as sudden onset of fever of ≥ 38 C° and cough, with onset within last 10 days, while patients with sudden onset of fever (&gt;38 °C), cough/sore throat requiring hospital admission within 7 days were termed as SARI. Samples were tested at NICLP for confirmation of virus, typing and subtyping by RT-PCR.

Results
A total of 15885 samples were analyzed during ten years period, out of which 3475(21.9%) were found positive for influenza virus. Among positive samples 26(0.75%) were Influenza-A (H1N1), 550(38%) were A/H3N1,550(15.9%) were A/H3N1,1587(45.7%) were A/H1N1 pdm09and 1312(37.8%) were influenza B. Males were predominant(54%).Influenza Maximum cases were reported from age group 01-&gt;12 years(66%).Virus circulation was detected throughout the year along with few cases of seasonal A/H1N1 virus during late winter(January February) and spring(March). Influenza A/H3N2 virus circulation was mainly observed during summer months (August-October).

Conclusions
The findings of this study emphasize the need for continuous and comprehensive influenza surveillance to predict seasonal trends for vaccine development and to further fortify pandemic preparedness.

Key messages
The need for continuous and comprehensive influenza surveillance. Public health importance by pandemic preparedness.
Evaluating latent tuberculosis testing and treatment programme for new migrants in South East England
Authors: Paudyal P , Mason A , Gedi A , Purcell B 
Published: November 2019

Abstract

Background
Tuberculosis (TB) cases in England often originate from high burden TB countries due to ’reactivation’ of the latent TB infection (LTBI), an asymptomatic and non-infectious phase lasting years. 5,137 TB cases were notified in England in 2017, and 71% of these patients were born outside the UK. This mixed-method study evaluated the implementation of the four LTBI testing and treatment programme for new migrants in South East (SE) England.

Methods
A retrospective database (May 2016-Feb 2018) review was undertaken to identify LTBI cases using multiple data sources; LTBI testing laboratories, LTBI programmes, and the national TB team at Public Health England. In addition, a survey questionnaire was emailed to 51 stakeholders (45% response rate) and five in-depth interviews were conducted with LTBI programme leads/TB nurses to explore the challenges of the programme. Quantitative data were analysed using descriptive summary statistics and qualitative interviews were analysed using thematic content analysis.

Results
Of the 5931 eligible patients, 40 % (n = 2391) accepted the LTBI test and 13.4% (n = 321) tested positive. 93.1% (n = 299) of the positive patients were referred for treatment and 63.8% (n = 191) of these accepted the treatment. The programme also picked up 18 active TB cases, an unexpected incidental finding. Results from the survey and the interviews identified laboratory arrangements, workforce, and data collection/management as the greatest challenges for the LTBI programme. Patient focused care, cultural understanding, success in testing/treating migrants, and raising awareness amongst professionals/communities were highlighted as achievements of the programme.

Conclusions
This study found that LTBI programmes in SE England are in line with national expectations and other LTBI programmes in England. The study recognises the achievements and good practice of the LTBI teams in SE England and identifies key barriers to improve the service for the future.

Key messages
Data collection and management is the biggest challenges of the LTBI programmes in SE England. The LTBI programmes in SE England are in line with national expectations.
Analysis of risk factors for occupationally acquired HBV, HCV, HIV infections in Polish paramedics
Authors: Topczewska Katarzyna , Gańczak Maria 
Published: November 2019

Abstract

Background
Paramedics constitute a group of professionals constantly exposed to potentially infectious biological material through close contacts with patients, possibly resulting in occupationally acquired infections.

Objectives
To assess the prevalence and to analyze selected risk factors for occupationally acquired HBV, HCV and HIV infections among Polish paramedics.

Methods
Between December 2018-April 2019 a cross-sectional sero-survey was conducted in 6 randomly selected ambulance stations in the West Pomeranian region of Poland with the use of an anonymous questionnaire. Serum samples were assessed for anti-HBc total, anti-HCV, anti-HIV with the use of 3rd-generation testing methods.

Results
Response rate was 83%; 141 participants (82% males, median age 33 years, median length of practice 11.9 years) agreed to participate. Anti-HBc were found in 7% participants, none of infected individuals was aware of an infection; no anti-HCV/anti-HIV positive paramedics were recognized. Risk factors for occupationally acquired infections were as follows: 5.1% paramedics were not vaccinated against HBV, 18.3% sustained ≥ 1 sharps injury in the preceding year (44.4% of incidents were not reported), 95.6% irregularly used masks/goggles, 6.2% used gloves irregularly (the lack of availability was the most commonly stated reason), 5.1% had never participated in infection control training, 61.6 % did not use safety engineered devices at work, 52.2% reported recapping a needle in the last 12 months. The risk of a single exposure to HBV was correctly defined by 40.2 % of participants, to HCV - by 33.0%, to HIV - by 28.3%.

Conclusions
Most risk factors for occupationally acquired blood-borne infections among Polish paramedics are modifiable. Unsatisfactory knowledge about the occupational exposure risks and poor compliance with infection-control procedures call for better risk recognition and assessment to reduce HBV, HCV and HIV infections in this group of health professionals.

Key messages
Paramedics showed detectable markers of HBV infection; individuals with not recognized occupationally acquired infection could be a source of infection for patients. Existing policies should be reinforced, and better surveillance for occupational risks should be instituted to minimize occupational blood borne infections among paramedics.
How to reach high behavioral riskgroups for HBV-vaccination: combining offline and online strategies
Authors: Urbanus A T , Meiberg A E 
Published: November 2019

Abstract

Issue
Since 2002, the Netherlands started a hepatitis B-vaccination program targeted at high behavioral risk groups in absence of a universal vaccination policy (implemented from 2011 onwards). The Public Health Services (PHS) offer free HBV-vaccination to sexworkers (SW) and men who have sex with men (MSM). In order to increase vaccination coverage and adherence a combination of offline and online strategies was used.

Description
In 2002 the HBV-program started to reach risk groups by offline outreach activities like visiting sauna’s, brothels, festivals etc. In addition targeted campaigns were developed: posters and incentives were used at outreach locations. Gradually, reaching the riskgroups at location became less effective and more costly, therefore online outreach became more important: targeted campaigns are conducted via social media, online dating platforms and commercial sex websites. These campaigns refer to websites with sexual health information, tailored advice and an online module to schedule vaccination appointments.

Results
In 16 years’ time, the program reached over 62,000 MSM and 23,000 SW with a combination of offline and online strategies. Nowadays, PHS nurses organize each year around 70-80 regional (online and offline) outreach actions for MSM and around 30-35 for SW. in 2017-2018 9-13% of the first vaccinations among MSM and SW was facilitated by the online appointment module. In addition, each year PHS are motivated to develop innovative plans in order to increase vaccination coverage such as informative meetings for MSM migrants with a festive touch, and in-depth research in how to reach male and female SW at home.

Lessons
Combining targeted online and offline strategies in order to reach the risk groups for vaccination has been successful over the past 16 years. Each year about 4,000 MSM and 1,000 SW receive their first HBV-vaccination thanks to constant commitment and creativity of enthusiastic health professionals for new approaches.

Key messages
Combining targeted online and offline strategies in order to reach the risk groups for vaccination has been successful. Encouraging innovative plans is succesful in reaching high behavioral risk groups for vaccinations.
Perioperative antibiotic prophylaxis: tools, results and reflections from a 6-year monitoring
Authors: d’Angelo M , Malacarne F , Perri G , Smaniotto C , Battistella C , Brunelli L , Madia A , Arnoldo L , Cocconi R , Brusaferro S 
Published: November 2019

Abstract

Background
Perioperative antimicrobial prophylaxis is a key practice to prevent surgical site infection. The Udine Healthcare and University Integrated Trust has defined its features in a specific procedure, available on the hospital Intranet. Compliance with the procedure has been monitored on a semi-annual basis.

Methods
Between July 2013 and December 2018 15 clinical records per semester for each one of the 16 surgical units were randomly extracted, including ordinary admissions with clean or clean/contaminated surgery. Compliance with the procedure was monitored for all the items considered: drug, dosage, timing of administration, redosing and duration of prophylaxis. A first comparison analysis both between semesters and for longer time frames was performed with the chi-square test; to evaluate the presence of a linear trend all over time (in semestres), the Pearson linear correlation coefficient was calculated; in case of correlation, a simple two-variable linear regression analysis was performed. Statistical significance was assessed for p &lt; 0.05.

Results
A sample of 2775 records was evaluated. Focusing on the first and last semester of monitoring, overall compliance increased in 9 of the 16 units, although there is a drop, when extending the analysis to the whole sample (72% vs 70.8%) with no statistical significance. Otherwise a statistically significant difference is recorded between the first and the last two years of analysis (p &lt;0.007), with an increase of overall compliance from 64.2% (2013-2014) to 69.7% (2017-2018). Finally a strong and significant negative correlation between time and overall compliance to redosing emerges (r = -0.79; p = 0.004).

Conclusions
Compliance with hospital procedure has substantially improved over time reaching a stable performance value. However the linear regression analysis highlights the need to implement new intervention strategies in order to increase overall compliance to redosing.

Key messages
Overall compliance with hospital procedure has improved over time. Results highlight the need to implement new intervention strategies.
Determinants of influenza vaccination uptake among Polish school teachers
Authors: Ganczak M , Biesiada D , Molas-Biesiada A , Topczewska K , Drozd-Dąbrowska M 
Published: November 2019

Abstract

Background
School settings place teachers at risk for influenza infection. Polish National Immunization Program recommends influenza vaccination (IV) for this occupational group. The study objective was to assess teachers’ knowledge and attitudes regarding IV, to determine 2018/2019 uptake and factors influencing the IV receipt; this has never been performed before in Central/Eastern Europe.

Methods
Between March-April 2019 teachers from 5 randomly selected primary schools (2 urban, 3 suburban) in West Pomerania, Poland, were surveyed with the use of the self-administered, anonymous questionnaire.

Results
Response rate was 50.1%. Among 102 respondents (68.6% females, mean age 45.7 years, mean length of practice 20.3 years), 31.4% were chronically ill. Only 4.9% reported getting the 2018/2019 IV, 8.8% were willing to be vaccinated in the next season. Of the respondents getting the 2018/2019 IV, only one also re-ported getting the 2017/2018 vaccine. The most common source of information about the IV were: family doctor (55.9%) and TV (68.6%). Beliefs that the IV was not effective (40.2%%) and concerns about the side effects (19.6%) were the most common reasons for not getting it. Only 44.1% of respondents believed teachers have heightened risk of contracting influenza. Regarding preventive methods, 83.3% teachers pointed at social distancing, 65.7% - at frequent handwash-ing, 65.7% - at vaccination; 38.2% believed that drinking tea with lemon could prevent influenza. More than a third of teachers (38.4%) thought influenza infection is always symptomatic. Older age was the only factor independently associated with IV receipt (p &lt; 0.05).

Conclusions
Influenza vaccination coverage among Polish primary school teachers is disturbingly low. Future education strategies encouraging teachers to immunize themselves against influenza should tackle misconceptions about the IV and increase awareness. Interventions related to maximizing IV uptake should focus especially on younger teachers.

Key messages
This preliminary study showed that influenza vaccination coverage among Polish primary school teachers urgently needs improvement. Teachers should better understand the importance of influenza vaccination as a significant preventive measure and realize their role in infection prevention and transmission at the school setting.
Understanding the complexities of HIV risk among sexual minority men in a global context
Authors: Stojanovski K , King E J 
Published: November 2019

Abstract

Background
Complex systems theory recognizes the intricacy of health issues and inequities, which permits the study of interrelationships across multiple levels of the socioecological model. We interrogated the research to identify upstream and downstream factors, their intersections, and recursive processes to develop a visualization of HIV risk among sexual minority men.

Methods
Using global HIV literature drawn from diverse disciplines and geographies, we elucidated HIV risk factors through a complex systems theory approach. We used thematic analysis to categorize HIV risk factors into different levels of the socioecological model, such as policies, community risk factors, individual behaviors, etc. We also identified the relationships between these risk factors to assess how they shaped HIV risk. The analyses were used to inform the connections between the various factors that lead to HIV risk in order to develop a visualization of the complex system, for which Stella Architecture was used.

Results
The thematic analysis of the literature and complex systems visualization portrays that HIV risk arises from a complex interplay of recursive and reinforcing factors ranging from policies, community factors, healthcare systems, and interpersonal relationships leading to manipulations in individual-level behaviors that put sexual minority men at risk for HIV. This visual representation indicates that HIV risk cannot simply be thought of as an individual-level factor nor simply related to sexual behaviors. Rather, HIV risk arises from upstream societal forces such as stigma, poor mental health, and health systems that relate to a multitude of downstream factors that socially pattern sexual minority men’s HIV risk.

Conclusions
The risk of HIV among sexual minority men stems from numerous intersecting factors across multiple levels of the socioecological model indicating the need to improve structural- and community-oriented approaches to address HIV.

Key messages
HIV risk arises from multiple social determinants. HIV preventions need to encompass multi-level interventions to fully address HIV risk.
Local Tuberculosis Georeference: a tool to define BCG vaccination in high-incidence area in Portugal
Authors: Freire Rodrigues E , Leite A , Cabral M , Duarte G , Marques A P , Cale E , Silva A C 
Published: November 2019

Abstract

Issue
Tuberculosis (TB) incidence in Portugal is &lt; 20/100000 people, with high-incidence municipalities in urban areas such as Amadora. In 2016, the national vaccination programme moved the BCG vaccine from universal to restricted risk groups. Amadora, due to the higher-incidence area, maintained a universal vaccination policy. Recently, it was hypothesized that vaccination could be applied to specific parishes even in high incidence counties.

Description
We aimed to identify specific geographic areas with higher risk of TB to help redefine the local BCG vaccination policy. We proposed to georeference active TB cases between 2015 and 2017, in Amadora, to then assess the incidence per parish and statistical section. We also aimed at identifying geo-clusters and density of cases.

Methods
(1) notified TB cases from 1 January of 2015 to 31 December 2017 were extracted from TB surveillance system; (2) cases of latent TB infection (LTBI), cases out of Amadora’s bounds and without national ID were excluded; (3) ArcGis®Online and associated maps were used to provide populational estimates; (4) cumulative incidence was calculated per year and averaged for the 3-year period; (5) Clusters were determined using distance and simple density of cases was calculated using Kernel algorithm.

Results
Considering the 6 parishes of Amadora, the 3-year cumulative incidence varied from 19.58 to 38.3 per 100000 hab. The highest incidence was found on the parish with the best socio-economic profile. 14 geo-clusters were mapped; 3 matched known deprived neighborhoods. Overall density was higher in these neighborhoods.

Lessons
With this approach we found that deprived neighborhoods had higher levels of case density, but 3-year cumulative incidence was higher on the parish considered to have low occurrence of TB. As such, and due to the intense population flows in Amadora, the local public health unit recommended the persistence of BCG vaccination to all residents of the municipality.

Key messages
Georeferecing supported our recommendation to mantain a universal BCG vaccination policy. Georeferencing associated to surveillance systems is highly useful to ensure evidence based public health practices, even at the local level.
Late presentation of chronic hepatitis B virus in Spain: a country with access to therapy
Authors: Picchio C , Roel E , Buti M , Lens S , Andrade R J , Crespo J , Calleja J L , Simon M A , Lazarus J V 
Published: November 2019

Abstract

Background and aims
Chronic infection with hepatitis B virus (HBV) can progress to liver cirrhosis and lead to complications such as decompensated liver disease, hepatocellular carcinoma and liver-related death. Antiviral agents against HBV are very effective in suppressing viremia and greatly reduce the risk of complications if treatment is initiated before the onset of advanced liver disease. The aim of this study is to assess the prevalence of late presentation in leading hospitals across Spain.

Methods
Retrospective cohort study of patients seeking first time care with a liver specialist at six tertiary Spanish hospitals, with 2018 data. Late presentation (LP) included advanced liver disease (ALD) defined by significant fibrosis (≥ F3 assessed by either APRI score &gt; 1.5, FIB-4 &gt; 3.2, transient elastography (FibroScan) &gt; 9.5 kPa or biopsy ≥ METAVIR stage F3) with no previous antiviral treatment and late-stage liver disease (LSLD) was defined by the presence of decompensated cirrhosis and/or hepatocellular carcinoma. Prevalence of ALD and LSLD at first consultation, demographics, and associated risk factors were analysed.

Results
203 patients chronically infected with HBV were included. Advanced liver disease was detected in 14.8% and late stage liver disease was observed in 6.1% of cases. 57.1% of the cases were male. The majority of those with HBV were non-Spanish (53.7%). The median age was 47 and the median of years from diagnosis to specialist care was 1 (IQR 7). 58.6% of patients were referred from primary care and 3.7% cases had hepatocellular carcinoma upon presentation for care.

Conclusions
Late presentation with HBV is common in Spain, particularly for the foreign-born population, despite full access to antiviral therapy for HBV in the country. In order to rectify this health systems failure, improve outcomes and reach the viral hepatitis elimination goal adopted by WHO in 2016, strategies to reduce late presentation to care are essential.

Key messages
Early diagnosis of HBV is needed in order to rectify the health systems failure of late presentation to care. Interventions targeting foreign-born populations should be implemented to reduce late presentation to HBV care and treatment.