Healthcare-associated hepatitis B and C transmission to patients in the EU/EEA and UK: a systematic review of reported outbreaks between 2006 and 2021.

Healthcare-associated transmission was the second most common hepatitis B (HBV) and hepatitis C (HCV) transmission route according to 2006-2012 European surveillance data, but data quality and completeness issues hinder comprehensive characterisation of this important issue. We carried out a systematic review of published literature on healthcare-associated transmission of HBV or HCV in European Union (EU) and European Economic Area (EEA) countries and the United Kingdom to complement surveillance data and identify higher-risk settings. We searched the PubMed and Embase databases and grey literature over the period January 2006 to September 2021, for publications reporting transmission events after 2000 in the EU/EEA and UK related to a healthcare setting or procedure. We collected data on the country, number of patients, setting type and route of transmission. In 65 publications from 16 countries, 43 HBV and 48 HCV events were identified resulting in 442 newly infected patients. Most events were reported from Italy (7 HBV and 12 HCV), Germany (8 HBV and 5 HCV) and the United Kingdom (8 HBV and 5 HCV). The number of patients infected from a single source within an event ranged from 1 to 53. Five large outbreaks of over 20 cases were identified, including two in Poland and one each in Belgium, Hungary and Slovakia. The majority of transmission events occurred through blood transfusions or in dialysis units. However, there were a number of outbreaks in seemingly low risk settings such as CT/MRI scanning units. A failure to adequately follow infection prevention control (IPC) precautions was reported in 30% of included studies. Healthcare-associated transmission of hepatitis B and C continues to occur in a range of community and hospital settings across EU/EEA countries and often results in large outbreaks, although the true extent of the situation cannot be fully determined due to under-reporting. Strict IPC precautions should be implemented across all healthcare settings and regularly audited, and surveillance systems strengthened and standardised to allow for comprehensive and consistent reporting of nosocomial transmission of hepatitis across the EU.

Social and behavioural determinants of syphilis: Modelling based on repeated cross-sectional surveys from 2010 and 2017 among 278,256 men who have sex with men in 31 European countries.

Background: Syphilis case notifications among men-who-have-sex-with-men (MSM) have increased markedly over the past two decades in Europe. We tested several potential factors for this resurgence. Methods: Self-reported data from two cross-sectional waves of the European MSM Internet Survey (EMIS-2010 and EMIS-2017, N = 278,256 participants living in 31 European countries) were used to fit multivariable hierarchical logistic regression models designed to evaluate potential social, behavioural, and interventional determinants of syphilis diagnosis. Additional multivariable hierarchical negative binomial models investigated determinants of the number of non-steady male condomless anal intercourse (CAI) partners. We tested the hypothesis that more CAI and syphilis-screening are associated with syphilis resurgence, both linked to use of pre-exposure prophylaxis (PrEP). Findings: Between 2010 and 2017, incidence of syphilis diagnosis in the previous 12 months rose from 2.33% (95%CI: 2.26-2.40) of respondents reporting a syphilis diagnosis in 2010 compared with 4.54% (95%CI: 4.42-4.66) in 2017. Major factors contributing to syphilis diagnosis were living with diagnosed HIV (adjusted odds ratio (aOR) 2.67, 95%CI: 2.32-3.07), each additional non-steady male CAI partner (aOR 1.01, 95%CI: 1.01-1.01), recency of STI-screening (previous month vs no screening, aOR 25.76, 95%CI: 18.23-36.41), selling sex (aOR 1.45, 95%CI: 1.27-1.65), and PrEP use (aOR 3.02, 95%CI: 2.30-3.96). Living with diagnosed HIV (adjusted incidence rate ratio (aIRR) 3.91, 95%CI: 3.77-4.05), selling sex (aIRR 4.39, 95%CI: 4.19-4.59), and PrEP use (aIRR 5.82, 95%CI: 5.29-6.41) were associated with a higher number of non-steady male CAI partners. The association between PrEP use and increased chance of syphilis diagnosis was mediated by STI-screening recency and number of non-steady male CAI partners, both substantially higher in 2017 compared to 2010. Interpretation: Syphilis cases are concentrated in three MSM population groups: HIV-diagnosed, PrEP users, and sex workers. Behavioural and interventional changes, particularly more non-steady male CAI partners and recency of STI-screening, are major contributing factors for increasing syphilis diagnoses among MSM in Europe. Funding: European Centre for Disease Prevention and Control.

Vaccination Status and Attitude among Measles Cluster Cases in Austria, 2019.

On 21 January 2019, public health authorities of two neighboring Austrian provinces reported an increase in measles cases. We investigated this occurrence to identify clusters of epidemiologically linked cases and the associated vaccination status in order to generate hypotheses on those factors explaining the size of the measles clusters. Probable cases were residents of the provinces of Styria or Salzburg with clinical presentation of measles after 1 January 2019 who were linked to a confirmed case using RNA virus detection. We collected data on age, rash onset, certificate-based vaccination status and reasons for being unvaccinated. Contact history was used to identify chains of transmission. By 11 March, we identified 47 cases, with 40 (85.1%) in unvaccinated patients. A cluster of 35 cases with a median age of seven years (IQR: 1-11) occurred between 9 January and 20 February in the province of Styria due to one transmission chain with four case generations. Of 31 vaccine-eligible cases, 25 (80.6%) were unvaccinated, of which 13 refused vaccination. Between 10 January and 1 March, we identified 12 cases as part of five unlinked clusters in the province of Salzburg. Each of these five clusters consisted of two generations: the primary case and the successive cases (median age: 22 years, IQR: 11-35). Eleven of 12 cases occurred in unvaccinated patients, with none of the 11 having a vaccination-refusing attitude. An extended measles cluster in a vaccination-refusing community, compared to five short-lived clusters concurrently occurring in the neighboring province, illustrates how vaccine refusal may hamper control of transmission.

Review of measles-related events recorded by the National IHR Focal Point in Poland in the years 2016-2018

Member States of the World Health Organization (WHO), in accordance with the requirements of the International Health Regulations (2005), were obliged to establish National Focal Points for International Health Regulations (IHR NFP), whose task is, among others, consolidating information on public health events of international importance that occur abroad or in the country. The aim of this article is to review information on measles-related events posted on the Event Information Site for IHR National Focal Points, in the Early Warning and Response System (EWRS), received by email directly from other IHR National Focal Points located in WHO member states, and from all organs of the State Sanitary Inspectorate in Poland in the years 2016-2018. In this time period, the IHR NFP recorded 92 measles-related events of which 38 related to individual cases, 37 to outbreaks of the disease, and 17 involved exposure to a measles case. 36% of reported events were aviationrelated. The number of events in 2018 has tripled compared to 2017 and increased eightfold in comparison to 2016. The current situation indicates the need to take appropriate actions, including implementation of the National Vaccination Program as well as introducing vaccination interventions.

Measles elimination ­ review of event notifications sent to National IHR Focal Point between 2010 and 2016

The Member States of the World Health Organization (WHO) in accordance with International Health Regulations (2005) were obliged to appoint National IHR Focal Points (N IHR FP), of which tasks include obtaining information concerning public health emergencies of international concern which occurred abroad or within the country. The aim of this work is the review of WHO, ECDC, National IHR Focal Points from the WHO Member States and The State Sanitary Inspection notifications related to measles received by National IHR Focal Point in Poland in the period from 2010 to 2016. During this period N IHR FP was informed about 79 events related to measles. These events include: 36 related to the outbreaks in different countries, 27 concerning individual cases, 14 related to the exposure in contact with a measles case during air travel and two concerning the implementation of the MMR vaccination programs. Despite the progress in implementing the measures included in the elimination of measles programs in Europe, there was a significant increase in the number of measles cases and outbreaks particularly in years 2010-2011.

Poliomyelitis eradication ­ the review of notifications from the years 2010-2016 sent to National IHR Focal Point

Polio eradication programme was launched after World Health Assembly in 1988. Despite considerable decrease in reported cases it still constitutes a significant public health threat. All WHO member state is bound to appoint National IHR Focal Point, which operates based on International Health Regulations (2005), which were enacted during the World Health Assembly in 2005. In Poland National IHR Focal Point (IHR NFP in Poland) operates since 2007, and is located in the Department of Epidemiology, in National Institute of Public Health - National Institute of Hygiene. Its aim is to acquire, assess and to transfer information on events which may constitute an international threat for the public health. IHR NFP in Poland has an access to WHO's Event Information Site (EIS) as well as Early Warning and Response System (EWRS) with reading-only credentials. Both platforms are of limited access (1). Among recipients of IHR NFP notifications and information are experts from many fields such as epidemiology, virology, bacteriology and others- related to specific type of notification, as well as specific and appointed members of state's administration and authorities in the field of public health. In this paper a review of notifications on the subject of poliomyelitis, sent to IHR NFP in Poland in the years 2010-2016 is presented, as well as references to poliomyelitis epidemiological situation were made based on the date from Global Polio Eradication Initiative.

Knowledge and beliefs in a selected group of parents of children aged 2 and less concerning preventive vaccination

OBJECTIVE: The objective of this research was to get to know the level of knowledge and beliefs concerning preventive vaccination among parents of children up to 2 years of age MATERIAL AND METHODS: The survey was carried out in 2015 in a group of 120 parents of children aged 2 or less in the capital city of Warsaw and its vicinity. An original survey questionnaire was applied. Descriptive statistics methods were applied RESULTS: The most numerous researched group were people aged 20-40 (79.2%) with higher education (76.8%). The majority of respondents declared their positive attitude to rationality of vaccination (76.7%). Only 1.7% of respondents declared that they remained unconvinced as to giving their children preventive vaccination. Women were convinced about the usefulness and preventive effectiveness of preventive vaccination. Among all the respondents 11.7% claimed they did not get enough information on preventive vaccination from medical staff. According to 7.5% of the respondents, the information provided by medical personnel is incomprehensible and insufficient. According to 50.8% of the respondents the effectiveness of parents' education in the scope of preventive vaccination administered to children should be improved CONCLUSIONS: The parents of children aged 2 or less point out to lack of sufficient information on preventive vaccination. It is therefore necessary to involve medical personnel more in order to increase the effectiveness of education of small children's parents in the discussed field

Emerging infectious diseases not covered by routine vaccination in Europe in 2010-2015--the review of WHO and ECDC notifications for the National IHR Focal Point in Poland.

The National IHR Focal Point is a center set up by each Member State of the World Health Organization (WHO) in accordance with the International Health Regulations (2005). The International Health Regulations (IHR) were adopted on 23 May 2005 at the World Health Assembly and entered into force since 15 June 2007 as the legal instrument designed to help protect all countries from uncontrolled international spread of diseases and other urgent public health threats. According to Article 2 of IHR the purpose and scope of these Regulations are to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade. Primarily, the scope of IHR is to establish a system of early warning (in accordance with Article 6 and 7) with the functioning in each country National IHR Focal Point which is available at any time to communicate with WHO IHR Contact Points and other entities. The tasks of the National IHR Fo- cal Point in Poland which was appointed by the Minister of Health and runs in the Department of Epidemiology, National Institute of Public Health--National Institute of Hygiene from 1 September 2007 are the notification of events that may constitute a public health emergency of international concern occurring in Poland or abroad and the dissemination of this information to the WHO, other National IHR Focal Points or competent authorities responsible for public health. The task of the National IHR Focal Point in Poland is also the dissemination of WHO and ECDC notifications, including recommendation and risk assessment documents. The aim of this work is the review of WHO and ECDC notifications received by National IHR Focal Point in Poland in the period from 2010 to 2015 which were related to emerging infectious diseases not covered by routine vaccination programs or for which there are no effective vaccines that have occurred in the WHO European Region. The review includes verotoxin-producing Escherichia coli O104: H4 infections, MERS-CoV infections, Ebola virus disease, malaria, dengue fever, West Nile fever, chikungunya and cholera.

Hepatitis C in Poland in 2012.

INTRODUCTION: In Poland, an estimated 2 000 HCV infections are reported annually, of which chronic stage of infections predominates (>95%). It is estimated that seroprevalence of anti-HCV and prevalence of active infections in the general population amount to ca 0.95% (more than 320 000 persons) and 0.6% (230 000 persons), respectively. The alarming finding is that approximately 90% of persons diagnosed with HCV infection are unaware of the condition and consequently hepatitis C virus may be transmitted to their contacts. OBJECTIVE: The objective of the present article is to determine the epidemiology of HCV infections in Poland in 2012 comparing to the preceding years. MATERIAL AND METHODS: The assessment of epidemiological situation of HCV infections in Poland was based on the analysis of aggregated data from the State Sanitary Inspection, published in "Infectious diseases and poisonings in Poland in 2012" (Czarkowski MP et al. "Infectious diseases and poisonings in Poland in 2012" Warsaw, NIPH-NIH and CSI). The data on mortality due to hepatitis C, which was obtained from the Demographic Surveys and Labour Market Department of Central Statistical Office, were also employed. RESULTS: In 2012, Poland reported 2 292 HCV infections, meeting 2005 definition (incidence 5.95), of which 1.4% were co-infections with HCV and HBV (33 cases). Compared to the data of 2011, the incidence was slightly lower (2 338; 6.07). Given 2009 definition, a total of 2 265 cases were reported (5.88), which constituted an increase of 3.5% compared to the data from the previous year (2 241; 5.82). Overall, 217 fatal cases due to hepatitis C were reported in 2012, of whom only 9 (4%) were due to acute stage of infection. CONCLUSIONS: Compared to the data from 2011, the epidemiological situation of hepatitis C in Poland has not changed significantly. The alarming fact is the increasing number of deaths due to hepatitis C. Probably, it suggests delayed diagnosis of HCV infections. Thus, it is a necessity to promote early diagnosis of HCV infections which can prevent life and health-threatening sequelae of hepatitis C.

[Acarological faunistic and statistical analysis of dust from various compartments of human dwellings in north-western Poland]. / Akarologiczna analiza faunistyczna i statystyczna kurzu pochodzacego z róznych pomieszczen mieszkan pólnocno- zachodniej Polski.

The aim of this paper was to compare the species composition of mites in dust samples collected at different compartments of human dwellings of north-western (NW) Poland. In 30 urban apartments (Szczecin, Police, Pyrzyce and Lobez) and rural quarters (Przelewice, Brzesko Szczecinskie, Bylice, Krasne, Kakolewice, Wierzchowo, Przeradz, Klodzino) from NW Poland, 150 samples of dust were collected at 5 locations: bed area, bedroom carpet, sitting area in the living room, hall carpet, and kitchen floor. Mites were isolated using Berlese-Tüllgren extractors. The isolated dust mites belonged to the order Astigmata, families Pyroglyphidae: Dermatophagoides farinae Hughes, 1961, Dermatophagoides pteronyssinus (Trouessart, 1987), Euroglyphus maynei (Cooreman, 1950) and Hirstia Hull, 1931; Chortoglyphidae: Chortoglyphus arcuatus (Troupeau, 1879) and Glycyphagidae: Gohieria fusca (Oudemans, 1902), Lepidoglyphus destructor (Schrank, 1781), and the order Prostigmata, family Cheyletidae: Cheyletus (Latreille, 1796). The most frequently observed were the species D. farinae (58.9%) and the representatives of the genus Cheyletus (30.6%). Statistically significant differences were found between: the number and concentration of D. farinae in the dust collected from beds in the bedroom and dust from the carpet in the bedroom, living room, hall and kitchen; the number of D. farinae in samples from the carpet in the bedroom and from the kitchen floor; the number and concentration of D. farinae in the dust from the living room and the dust in the hall and kitchen; the number of Cheyletus sp. in samples of dust from bed areas in the bedroom and the samples from the carpet in the bedroom, hall and kitchen; the number and concentration of Cheyletus sp. in dust samples collected from the carpet in the bedroom and samples from the kitchen; the concentration of Cheyletus sp. in dust collected from bed areas and samples from the floor in the hall and kitchen; the number of D. pteronyssinus in dust samples collected from bed areas in the bedroom and samples from the carpet in the bedroom. In conclusion, the number of mites D. farinae, D. pteronyssinus and Cheyletus sp. depended on the place where the mites were sampled. The greatest numbers of these species were observed in the bed areas in bedrooms. The tests confirmed the high occurrence of house dust mites in the apartments in north-western Poland, especially in the bed areas in the bedroom.

[House dust mites in the etiology of allergic diseases]. / Roztocze kurzu domowego w etiologii reakcji alergicznych.

One of the more important etiological factors of allergies are mites occuring in the closest vicinity of humans, i.e. in the house dust and in the stored foodstuffs. The most important are the species representing the families: Pyroglyphidae (mainly Dermatophagoides pteronyssinus, D. farinae, and Euroglyphus maynei), Glycyphagidae (e.g. Lepidoglyphus destructor, Blomia sp.), and Acaridae (e.g. Tyrophagus putrescentiae, Acarus siro). Mites shed an abundance of allergenic proteins. Particularly abundant in allergens are the extracts of mite faeces as well as the extracts of their purified bodies or culture substrate. In humans the may inflict atopic allergies (respiratory and dermal), such as bronchial asthma, rhinitis, or atopic eczema. It has been estimated that some 5% of the human population is sensitive to dust mites allergens.