Mortality among people with HIV in the UK in 2021: findings from the National HIV Mortality Review

Background: The National HIV Mortality Review (NHMR) was launched by UK Health Security Agency (UKHSA) and British HIV Association to better recognise causes of death and preventable death, and to describe end-of-life care, among people with HIV. Method(s): UK HIV services submitted data on all known deaths among people with HIV under their care in 2021 through a secure online form. Cause of death was categorised by an epidemiologist and four clinicians using the Coding Causes of Death in HIV protocol. Result(s): In 2021, 101 services reported 606 deaths among people with HIV to NHMR. In 2019, 74 services reported to the NHMR while 121 reported in 2020. Median age at death was 58 [interquartile range (IQR): 56-59] and most (76%) were male. Death cause was ascertainable for 78% (n=475), with the most common being non-AIDS-related cancers (26%), followed by non-AIDS-defining infections (19%), cardiovascular disease (16%), AIDS (9%), substance misuse (8%), respiratory disease (4%), accident/suicide (3%), liver disease (2%) and other causes (11%). COVID- 19 caused or contributed to 11% of all deaths. Thirtythree people (5%) died within a year of HIV diagnosis, 90% of these were diagnosed late (CD4<350 cells/mm3), 80% very late (CD4<200 cells/mm3), 54% diagnosed with AIDS and 33% had documented missed opportunities for earlier diagnosis. Viral suppression (<200 copies/mL) (87%) and treatment coverage (98%) was high with the median time on treatment 13 years [IQR: 8-20]. Common lifestyle risk factors in the preceding year included smoking (33%;n=179), excessive alcohol use (20%;n=103). Other factors included drug use (non-injecting and injecting) and opioid substitution therapy. Death had been expected for 298 (49%) individuals, of whom 230 had discussed end-of-life care and 108 had a documented advanced end-of-life care plan in place. Conclusion(s): Over half of people living with diagnosed HIV are aged over 50. Most deaths were not AIDS related however, one in eleven people with diagnosed HIV in the UK died from AIDS. Of people that died within a year of diagnosis, one in three had documented missed opportunities for earlier HIV diagnosis.

IDWeek 2022

IDWeek is the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS) and the Society of Infectious Diseases Pharmacists (SIDP). For the first time since the COVID-19 public health emergency began, IDWeek 2022 returned to in-person attendance. It was held in Washington, D.C., and the meeting comprised 5 days of live sessions and on-demand content that included posters and oral presentations.Copyright © 2023 Clarivate.

Retrospective Assessment of the Accuracy of Mpox Case Projections in New York City

Background: In mid-2022, New York City (NYC) became the epicenter of the US mpox epidemic. Health authorities were in need of forecasts to anticipate the timing and magnitude of the outbreak. We provided mathematical modelbased projections with methodologies that evolved alongside the epidemic. Here, we retrospectively evaluate our mpox case projections and reflect on potential reasons for accuracies and inaccuracies. Method(s): Early in the outbreak (July 1 - 15, 2022), when the size of the at-risk population was unknown, we performed short-term (2-week) forecasting using exponential regression. Once epidemic growth was no longer exponential (July 15 - Aug. 9), we consulted with the NYC Department of Health and Mental Hygiene regarding populations most-at-risk of mpox based on available epidemiological data. Modelers and epidemiologists collaboratively developed an estimate of 70,180 people at risk, informed by estimates of LGBTQ adults with male sex at birth who had 2+ partners in the last 3 months. We combined this with NYC case count data, NYC vaccination data, and global mpox natural history data to develop a Susceptible-Exposed-Infected-Recovered (SEIR) model, taking into account immunity accrued through vaccination and prior exposure, for longer-term forecasting. Result(s): Initial exponential forecasts of the NYC mpox outbreak were only accurate for very short-term predictions (< 2 weeks) (Figure, top panel). Forecasts were more accurate after 1 week (mean absolute error: 83.0 cases/ wk) than after 2 weeks (mean absolute error: 351.4 cases/wk). In contrast, the SEIR model accurately predicted the decline in cases through the end of Sept. 2022, when cases fell to < 70/wk. Over the period from Aug. 10 to Sept. 24 2022, the mean absolute error of the SEIR-based projection was 8.2 cases per week (Figure, bottom panel). Conclusion(s): Model-based NYC mpox projections provided only short-term accuracy in the early epidemic, but long-term accuracy once the epidemic exited exponential growth and an SEIR model was developed. Cumulative cases and vaccinations when exiting exponential growth, and the epidemiology of those most-at-risk, provided evidence for the likely size of the most-at-risk population - a crucial input for an accurate SEIR model. The ability of the SEIR model to accurately forecast mpox cases was in part attributable to lack of vaccine or immune escape by mpox, in contrast to more rapidly-evolving viruses such as SARS-CoV-2.

Counterpoint: Epidemiology's Dual Social Commitment-Science and Health.

Matching epidemiology's aspirations to actual delivery of goods valuable for population health depends both on the scientific and operational capabilities of epidemiology and on the degree to which the goods meet its contract with society. Epidemiology's capabilities have advanced remarkably in recent decades, although research gaps have appeared during the current coronavirus disease 2019 (COVID-19) pandemic. Epidemiology's social contract reflecting a dual commitment to science and health could arguably be entirely met by producing research results under conditions variously described as objective, impartial, neutral, or independent and handing such results to decision makers and the public at large. However, a closer examination shows that those four terms address sharply distinct issues, with distinct practical implications, and that the epidemiologist responsibility is de facto involved beyond providing research results. Hence the epidemiologist's engagement should encompass arguing from a science-for-health viewpoint and proactively driving the results into decision processes on public health issues.

Three Nordic countries responding to COVID-19 - Eldercare perspectives.

Comparative international studies show that about half of the deceased in the COVID-19 pandemic were persons living in institutional and residential eldercare. As seniors are the most affected age group, we aim to study if and to what extent the eldercare services were included in the National Pandemic Plans, and how they were included in the response during the first phase of the pandemic in Finland, Iceland, and Sweden. We use the CRISMART approach to crisis documentation and analysis in comparing national response to the pandemic for the eldercare sector. The method enables comparison of extraordinary crisis situations from the decision-making and policy-making perspective. We found that there were both similarities and differences in the preparedness of the three Nordic countries, as well as in how they responded to the pandemic. In all three countries the focus of the national responses framed the problem as a health and healthcare services' problem. We also found value conflicts in the response between the value of protection versus social contact and self-determination and hence relating to the quality of eldercare. Keeping in mind the proportional increase of elderly people, care challenges, and future crises, we must strengthen the position of local social services within the emergency management systems to enhance disaster resilience and sustainability of our societies.

Brazilian Collaborative Network For COVID-19 Modeling: Successful Experience Of Using Real-Time Science To Support Evidence-Based Decision-Making

Introduction. Modeling is important for guiding policy during epidemics. The objective of this work was to describe the experience of structuring a multidisciplinary collaborative network in Brazil for modeling coronavirus disease 2019 (COVID-19) to support decisionmaking throughout the pandemic. Methods. Responding to a national call in June 2020 for proposals on COVID-19 mitigation projects, we established a team of investigators from public universities located in various regions throughout Brazil. The team's main objective was to model severe acute respiratory syndrome coronavirus 2 transmission dynamics in various demographic and epidemiologic settings in Brazil using different types of models and mitigation interventions. The modeling results aimed to provide information to support policy making. This descriptive study outlines the processes, products, challenges, and lessons learned from this innovative experience. Results. The network included 18 researchers (epidemiologists, infectious diseases experts, statisticians, and modelers) from various backgrounds, including ecology, geography, physics, and mathematics. The criteria for joining the network were having a communication channel with public health decision-makers and being involved in generating evidence for public policy. During a 24-month period, the following sub-projects were established: (i) development of a susceptible-exposed-infected-recovered-like, individual-based metapopulation and Markov chain model;(ii) projection of COVID-19 transmission and impact over time with respect to cases, hospitalizations, and deaths;(iii) assessment of the impact of non-pharmacological interventions for COVID-19;(iv) evaluation of the impact of reopening schools;and (v) determining optimal strategies for COVID-19 vaccination. In addition, we mapped existing COVID-19 modeling groups nationwide and conducted a systematic review of relevant published research literature from Brazil. Conclusions. Infectious disease modeling for guiding public health policy requires interaction between epidemiologists, public health specialists, and modelers. Communicating modeling results in a nonacademic format is an additional challenge, so close interaction with policy makers is essential to ensure that the information is useful. Establishing a network of modeling groups will be useful for future disease outbreaks.

Tunisian first COVID-19 Intra-Action Review, March-July 2021

Introduction/ Background: The objective of the Intra-Action Review (IAR) was to review the Tunisian COVID-19 national preparedness and response best practices and challenges to adjust the response to the crisis and impact of COVID-19 pandemic on health systems. Methods: RIA is an interactive and structured methodology, developed by WHO to identify best practices and challenges in a response to an ongoing crisis. The first RIA on COVID-19 response in Tunisia was carried out, under the Tunisian Ministry of Health in cooperation with the German Biological Safety Program and the Biosecurity Cooperation Project in Tunisia, from March 30 to July 1, 2021. Four pillars of the Covid-19 response were selected for review: coordination, laboratory, points of entry, and logistic support. Results: The RIA identified 24 best practices, 23 challenges and 23 recommendations to improve the current response by adopting appropriate actions for immediate, mid and long-term implementation. The best practices include: availability of a prevention, preparedness, response and resilience plan (2P2R), an Early Warning, Alert and Response System (EWARS);regular weekly teleconference “EPICOV”;trained Rapid Response Teams (RRTs), Field epidemiologist and laboratory staff, decentralization of SARS-CoV-2 testing;and an efficient stock management system. The most important challenges were leadership and coordination mechanism, legal framework, human resources, and genomic-sequencing surveillance capacity. Impact: The RIA was an opportunity to analyze the operational capacity of the Tunisian health system to respond to the pandemic in collaboration with other relevant sectors. The results of the RIA will serve to adjust the national response to Covid-19. Conclusion: The recommendations target a legal framework, a quality assurance management system and an Integrated Disease Surveillance and Response (IDRS) system. The RIA recommended also to enhance coordination within and between pillars;and mobilize funds to support 2P2R, EWARS, IDRS and human resources and provide a basis for future joint activities.

Public Health Emergency Operation Centres (PHEOCs): key ingredient to improve public health response in Nigeria, 2020

Introduction/ Background: A Public Health Emergency Operations Centre (PHEOC) is a physical location for the coordination of information and resources to support incident management activities. Nigeria had its first confirmed case of COVID-19 on 27th February 2020. The Incident Management System (IMS) was activated in the PHEOCs across the country for response. Methods: Secondary data analysis was done using data from an adapted World Health Organisation (WHO) checklist on state preparedness for COVID-19. Response was received from State Epidemiologists from 17th March to 31st March, 2010. Thirty-one (31) states and the Federal Capital Territory (FCT) returned the checklist out of 36 states and the FCT. Questions covered five key areas on coordination which include availability of preparedness and response plan, functional multisectoral coordination mechanism, functional PHEOC organizational structure which can be activated in 120 minutes, funds for response activities, established PHEOC in the state. Data was analysed for means and proportions. Results: A total of 32 (86.5%) states and Federal Capital Territory (FCT) responded out of the 36 states and the FCT. Ten (31.3%) states had all five key areas for effective coordination of the response. Four (12.5%) states had less than three of the key areas ready for response. Twenty-seven (84.4%) states had a PHEOC established, a functional organization structure and multi-sectoral coordination. However, 20 (62.5%) states did not have readily accessible funds for response. Impact: The PHEOC emergency management model has been shown to be effective especially at the subnational level. Despite the paucity of funds and resources, it was used as a platform to mobilise resources across the states of the federation. Conclusion: There is a need to strengthen the existing PHEOCs at the state level and establish more at the local government levels for prompt efficient and effective public health response. The high level of preparedness helped Nigeria to respond effectively to the COVID-19 outbreak.

Innovative linkage model to re-engage loss-to-follow-up individuals in the national hepatitis C elimination program of Georgia

Background and aims: The National Hepatitis C Elimination Program has made notable progress in Georgia. However, in the setting of COVID-19 related limitations, the number of individuals registering in the treatment program has declined over time, from an average of 996 per month in 2019 to 339 per month in 2021. As of September 30, 2021, 75% (n = 2, 081, 548) of the adult population of Georgia has been screened for hepatitis C virus (HCV), but among antibody positive adults, 20, 913 (15%) had not completed a viremia test. In 2019, the National Center for Disease Control and Public Health Georgia piloted a project to link to care those individuals who screened positive for anti-HCV but had not completed a viremia test. After success of the initial pilot, the model will be scaled up across Georgia. Method: All anti-HCV positive adults (aged ≥18 years) who did not have record of viremia testing in the national HCV electronic database 3 months from the date of a positive result, and who were not registered in the HIV/AIDS program or with a correctional facility, were eligible for follow-up. Using the phone number listed in the database, individuals were contacted by phone or home visit by patient navigators (trained epidemiologists and primary healthcare physicians) and referred to HCV care and treatment. If the first attempt was unsuccessful, one repeat attempt was made to contact the individual. Incentives were provided to regional health personnel for each patient that was successfully linked to care, defined as presenting for viremia testing. Results: As of October 1, 2020, 18, 030 persons were not linked to care;patient navigators attempted to reach 8, 907 (49%) with phone numbers in the database;6, 718 (75%)were reached. The remaining 2, 189 could not be reached, had moved, or emigrated. Of those contacted, 1, 546 (23%) presented for viremia testing, and 811 (52%) were positive for HCV RNA or core antigen. Overall, 419 (52%) persons with chronic HCV infection were enrolled in the HCV treatment program as a result of this effort. Conclusion: Program-wide implementation of the piloted model showed that this can be scaled up and is effective for re-engaging people in care. The main challenge in Georgia remains linkage-tocare, which is essential to meet elimination goals. Innovative approaches are necessary to reinforce linkage to care. This is especially important during the COVID-19 pandemic when there is an increased need for programs that can re-engage people in HCV care.

Experiences in the health services of epidemiologists in training during the COVID-19 pandemic

Introduction: Although there is ample scientific evidence on the pandemic, the impact of COVID-19 on health services from the perspective of healthcare personnel has been little explored. Objective: To explore the experiences in health services of epidemiologists in training during the COVID-19 pandemic. Methods: Exploratory, qualitative-descriptive study, with ethnographic research tools for data collection such as observation, field diary and group interview;as well as grounded theory for the construction of categories that allowed to understand the studied phenomenon. For the formation of the focus group, seven epidemiologists in training from a Colombian university participated, with prior informed consent. The topic was introduced, with the subsequent application of the focus group guide tools, consensus posters, response sheets and an observation guide. Results: Hospital collapse and emerging restructuring of health services were generated, promoting other care strategies such as telemedicine. Study participants experienced fear attending patients on stressful days, with shortages of supplies and medicines;they were stigmatized, which generated "anxiety and work stress." However, they learned "to better classify cases" and with the increase in patients they were able to perceive inequities that represented a professional and human challenge. Conclusions: The COVID-19 pandemic has been valid as a learning process with new training perspectives to be able to act in the face of health events of global interest, with the necessary application and management of protocols, which can change the focus of health care and allow epidemiology to move towards education, promotion and prevention.

Assessing Past vs Present COVID-19 Infection: A Survey of Criteria for Discontinuing Precautions in Asymptomatic Patients

Background. COVID-19 patients can remain positive by PCR-testing for several months. Pre-admission or pre-procedure testing can identify recovered asymptomatic patients who may no longer be contagious but would require precautions according to current CDC recommendations (10 days). This can result in unintended consequences, including procedure delays or transfer to appropriate care (e.g., psychiatric or post-trauma patients requiring admission to COVID-19 units instead of psychiatric or rehabilitation facilities, respectively). Methods. We conducted a structured survey of healthcare epidemiologists and infection prevention experts from the SHEA Research Network between March-April, 2021. The 14-question survey, presented a series of COVID-19 PCR+ asymptomatic patient case scenarios and asked respondents if (1) they would consider the case recovered and not infectious, (2) if they have cleared precautions in such cases, and if so, (3) how many transmission events occurred after discontinuing precautions. The survey used one or a combination of 5 criteria: history of COVID-19 symptoms, history of exposure to a household member with COVID-19, COVID-19 PCR cycle threshold (CT), and IgG serology. Percentages were calculated among respondents for each question. Results. Among 60 respondents, 56 (93%) were physicians, 51 (86%) were hospital epidemiologists, and 46 (77%) had >10y infection prevention experience. They represented facilities that cumulatively cared for >29,000 COVID-19 cases;46 (77%) were academic, and 42 (69%) were large ( >400 beds). One-third to one-half would consider an incidentally found PCR+ case as recovered based on solo criteria, particularly those with two consecutive high CTs or COVID IgG positivity recovered (53-55%) (Table 1). When combining two criteria, half to four-fifths of respondents deemed PCR+ cases to be recovered (Table 2). Half of those had used those criteria to clear precautions (45-64%) and few to none experienced a subsequent transmission event resulting from clearance. Conclusion. The majority of healthcare epidemiologists consider a combination of clinical and diagnostic criteria as recovered and many have used these to clear precautions without high numbers of transmission.

West Nile fever in the background of the COVID-19 pandemic

Due to climate change, tropical pathogens are spreading throughout Europe, posing a risk to the safety of haemotherapy in the Czech Republic. The first occurrence of the West Nile virus (WNV) in the Czech Republic was documented as early as 1985 and it has been demonstrated that WNV has been circulating in the Czech Republic for a long time. Transmission of WNV infection by blood transfusion has been known known since 2002. In 2018, five locally acquired (autochthonous) WNV human infections were confirmed in the South Moravian Region, and the transfusion service facility was faced with the question of how to adequately ensure transfusion product in the region in accordance with mandatory legislation. The readiness of Czech transfusion services to deal with similar situations must be ensured every WNV season. This is not possible without close cooperation with infectologists and epidemiologists. This article summarizes basic data on the occurrence of WNV in the Czech Republic and on the procedures to ensure safety of haemotherapy in relation to WNV.

Problems of the sanitary and epidemiological service in the fight against COVID-19

Introduction The State Sanitary and Epidemiological Surveillance in the Republic of Kazakhstan is carried out by the Committee for Sanitary and Epidemiological Control, which is a unified centralized system for the prevention, detection, suppression of violations in the field of ensuring the sanitary and epidemiological well-being of the population in order to protect the health of the population and the human environment. The pandemic of a novel Coronavirus Disease 2019 (COVID-19) caused by the severe acute respiratory syndrome SARS-CoV2 has posed a severe global crisis. During the COVID-19 pandemic, this service took full control, monitoring and analysis of work to combat coronavirus infection. The purpose of infection control is to prevent and combat the emergence of acute infectious diseases among the population. The activities of the committee are aimed at: 1. Protection of public health. 2. Sanitary and epidemiological welfare of the population. 3. Anti-corruption activities. 4. Control and supervision over compliance with the requirements established by technical regulations in the country. Methods An analysis was made of the structure of this state body, its activities, the number of employees and the results of their work. Results and Conclusion There was a high shortage of specialist epidemiologists in this industry during the pandemic. After analyzing the activities of the sanitary and epidemiological service, we came to the conclusion that these problems arose in connection with the constant reorganization of this service. Over the period of 10 years (2010-2020), there have been transformations and changes in the committee for sanitary and epidemiological control more than 6 times, which significantly influenced the work of the sanitary and epidemiological service and its weakening. It should be noted that over the years of its existence, the service has been one of the main ones in protecting the health of the population of Kazakhstan.