Healthcare-Associated COVID-19 across Five Pandemic Waves: Prediction Models and Genomic Analyses.

BACKGROUND: Healthcare-associated SARS-CoV-2 infections need to be explored further. Our study is an analysis of hospital-acquired infections (HAIs) and ambulatory healthcare workers (aHCWs) with SARS-CoV-2 across the pandemic in a Belgian university hospital. METHODS: We compared HAIs with community-associated infections (CAIs) to identify the factors associated with having an HAI. We then performed a genomic cluster analysis of HAIs and aHCWs. We used this alongside the European Centre for Disease Control (ECDC) case source classifications of an HAI. RESULTS: Between March 2020 and March 2022, 269 patients had an HAI. A lower BMI, a worse frailty index, lower C-reactive protein (CRP), and a higher thrombocyte count as well as death and length of stay were significantly associated with having an HAI. Using those variables to predict HAIs versus CAIs, we obtained a positive predictive value (PPV) of 83.6% and a negative predictive value (NPV) of 82.2%; the area under the ROC was 0.89. Genomic cluster analyses and representations on epicurves and minimal spanning trees delivered further insights into HAI dynamics across different pandemic waves. The genomic data were also compared with the clinical ECDC definitions for HAIs; we found that 90.0% of the 'definite', 87.8% of the 'probable', and 70.3% of the 'indeterminate' HAIs belonged to one of the twenty-two COVID-19 genomic clusters we identified. CONCLUSIONS: We propose a novel prediction model for HAIs. In addition, we show that the management of nosocomial outbreaks will benefit from genome sequencing analyses.

A call to action to reclaim focus on testing and early treatment for HIV, viral hepatitis, sexually transmitted infections and tuberculosis.

We present the outcomes of the HepHIV 2021 Lisbon & virtual conference held on 5-7 May 2021, including a Call to Action addressing policy and practice implications in the field of earlier and integrated testing for HIV, viral hepatitis, STI and TB and in light of lessons learned from the COVID-19 pandemic. Conference presentations showed that combination prevention and integrated testing and care models for multiple infectious diseases are necessary and feasible in diverse settings. Successful examples of service and system adaptations developed to mitigate impact of the pandemic were shared. Aiming to ensure greater equity in health in current and future health policies and programmes and address the adverse effects of COVID-19, we must learn from the many innovative approaches to service delivery developed in response to the pandemic, many of which have the potential to reach people whose needs were not met by existing models.

Identification of Workers at Increased Risk of Infection During a COVID-19 Outbreak in a Meat Processing Plant, France, May 2020.

On 13 May 2020, a COVID-19 cluster was detected in a French processing plant. Infected workers were described. The associations between the SARS-CoV-2 infection and the socio-demographic and occupational characteristics were assessed in order to implement risk management measures targeting workers at increased risk of contamination. Workers were tested by RT-PCR from samples taken during screening campaigns. Workers who tested positive were isolated and their contacts were quarantined. Workers were described and associations with the SARS-CoV-2 infection were assessed through risk ratios using multivariable Poisson regression. Of the 1347 workers, 87.5% were tested: 140 cases were identified; 4 were hospitalised, including 2 admitted to intensive care. In the company, the cluster remained limited to deboning and cutting activities. The attack rate was 11.9% in the company, reaching 16.6% in the cutting department. Being an employee of a subcontractor significantly increased the risk of infection by 2.98 [1.81-4.99]. In the cutting department, an association with virus infection was found for a group of non-French speaking workers from the same Eastern European country (RR = 2.67 [1.76-4.05]). They shared accommodation or carpooled more frequently than the other cases. The outbreak investigation revealed a significantly increased risk of SARS-CoV-2 infection for workers of subcontractors and some foreign-born workers. There are many such populations in meat processing plants; the observed associations and the ways in which these workers are contaminated need to be confirmed by further work. Prevention campaigns should now target these workers. Environmental risk factors in the workplace setting remain to be clarified.

Is Europe facing an opioid epidemic: What does European monitoring data tell us?

This paper addresses the question of whether Europe is facing an opioid epidemic and utilizes data from the European monitoring system on opioid use, harms and availability, to help assess the situation. Data sources covering the last decade on overdose deaths, drug treatment entrants and drug-related emergencies suggest that the health burden associated with opioid use is mostly related to the consumption of heroin - and to a lesser extent diverted opioid substitution treatment medications - and that it is primarily affecting an ageing cohort of vulnerable users, with little evidence of an increase in initiation. While opioid-related deaths are currently at much lower levels than in the United States, they still represent a large preventable health burden with differences across EU countries. There is also increasing concern related to the high availability of heroin, illicitly produced synthetic opioids and diverted opioid pain medications on the European drugs market. Trends in the latter categories are poorly monitored and we may miss signs of emerging problems. Moreover, the economic recession following the COVID-19 pandemic has a potential to lead to resurgence in opioid use and harms. SIGNIFICANCE: This paper looks at data from the European monitoring system to address the question of whether Europe is facing an opioid epidemic. It reviews available health and supply side indicators, considering the limitations of each data source. A summary of the available evidence would suggest that while opioid-related deaths in Europe represent a large preventable health burden with differences across EU countries, Europe as a whole is not facing an opioid crisis of the size and nature seen in the US.