A One Health real-time surveillance system for nowcasting Campylobacter gastrointestinal illness outbreaks, Norway, week 30 2010 to week 11 2022.

BackgroundCampylobacter is a leading cause of food and waterborne illness. Monitoring and modelling Campylobacter at chicken broiler farms, combined with weather pattern surveillance, can aid nowcasting of human gastrointestinal (GI) illness outbreaks. Near real-time sharing of data and model results with health authorities can help increase potential outbreak responsiveness.AimsTo leverage data on weather and Campylobacter on broiler farms to build a risk model for possible human Campylobacter outbreaks and to communicate risk assessments with health authorities.MethodsWe developed a spatio-temporal random effects model for weekly GI illness consultations in Norwegian municipalities with Campylobacter monitoring and weather data from week 30 2010 to 11 2022 to give 1-week nowcasts of GI illness outbreaks. The approach combined a municipality random effects baseline model for seasonally-adjusted GI illness with a second model for peak deviations from that baseline. Model results are communicated to national and local stakeholders through an interactive website: Sykdomspulsen One Health.ResultsLagged temperature and precipitation covariates, as well as 2-week-lagged positive Campylobacter sampling in broilers, were associated with higher levels of GI consultations. Significant inter-municipality variability in outbreak nowcasts were observed.ConclusionsCampylobacter surveillance in broilers can be useful in GI illness outbreak nowcasting. Surveillance of Campylobacter along potential pathways from the environment to illness such as via water system monitoring may improve nowcasting. A One Health system that communicates near real-time surveillance data and nowcast changes in risk to health professionals facilitates the prevention of Campylobacter outbreaks and reduces impact on human health.

Immigrant screening for latent tuberculosis infection: numbers needed to test and treat, a Norwegian population-based cohort study.

OBJECTIVES: To estimate the number needed to screen (NNS) and the number needed to treat (NNT) to prevent one tuberculosis (TB) case in the Norwegian immigrant latent tuberculosis infection (LTBI) screening programme and to explore the effect of delay of LTBI treatment initiation. DESIGN: Population-based, prospective cohort study. PARTICIPANTS: Immigrants to Norway. OUTCOME: Incident TB. METHODS: We obtained aggregated data on immigration to Norway in 2008-2011 and used data from the Norwegian Surveillance System for Infectious Diseases to assess the number of TB cases arising in this cohort within 5 years after arrival. We calculated the average NNS and NNT for immigrants from the top 10 source countries for TB in Norway and by estimated TB incidence rates in source countries. We explored the sensitivity of these estimates with regard to test performance, treatment efficacy and treatment adherence using an extreme value approach, and assessed the effects of emigration, time to TB diagnosis (to define incident TB) and intervention timing. RESULTS: NNS and NNT were overall high, with substantial variation. NNT showed numerically stronger negative correlation with TB notification rate in Norway (-0.75 [95% CI -1.00 to -0.44]) than with the WHO incidence rate (IR) (-0.32 [95% CI -0.93 to 0.29]). NNT was affected substantially by emigration and the definition of incident TB. Estimates were lowest for Somali (NNS 99 [70-150], NNT 27 [19-41]) and highest for Thai immigrants (NNS 585 [413-887], NNT 111 [79-116]). Implementing LTBI treatment in immigrants sooner after arrival may improve the effectiveness of the programme. CONCLUSION: Using TB notifications in Norway, rather than IR in source countries, would improve targeting of immigrants for LTBI management. However, the overall high NNT is a concern and challenges the scale-up of preventive LTBI treatment for significant public health impact. Better data are urgently needed to monitor and evaluate NNS and NNT in countries implementing LTBI screening.

General practice consultations and use of prescription drugs after changes to school absence policy. / Legesøkning og legemiddeluttak etter innføring av nye fraværsregler.

BACKGROUND: New rules for absence with stricter requirements for documentation were introduced in upper secondary schools in the autumn of 2016. We investigated the use of general practice services and dispensing of prescription drugs among 16 ­ 18-year-olds in the autumn of 2016 and compared this with equivalent figures for the period 2013 ­ 15. MATERIAL AND METHOD: We retrieved information on consultations in general practice (GP) and dispensing of prescription drugs to 15 ­ 18-year-olds in the period 2013 ­ 16 from the Directorate of Health's system for control and payment of health reimbursements (KUHR) and the Norwegian Prescription Database respectively. The number of consultations and dispensing of drugs were compared to previous years using Poisson regression (reference year 2015). The incidence rate ratio (IRR) was used as an outcome measure. RESULTS: The number of GP consultations for 16 ­ 18-year-olds was 30 % higher in the autumn of 2016 than in the autumn of 2015 (IRR 1.30, 95 % confidence interval (CI) 1.29 ­ 1.31). In the same period, the dispensing of drugs to this age group increased by 8 % (IRR 1.08, 95 % CI 1.08 ­ 1.09). Among the diagnosis groups, respiratory tract infections had the largest increase (IRR 2.21, 95 % CI 2.17 ­ 2.25). The largest increase in drug dispensing was found for remedies for coughs and colds (IRR 1.73, 95 % CI 1.65 ­ 1.80). INTERPRETATION: The increase in consultations in general practice and dispensing of drugs to 16 ­ 18-year-olds coincided in time with the introduction of new rules for absence from school. We hold it to be highly likely that the changes were caused by the stricter rules for documentation of absence from school.

Upper secondary school leaving celebrations and final exams - consultations in general practice and emergency care. / Russefeiring og eksamenstid ­ bruk av fastlege og legevakt.

BACKGROUND: Increased use of antibiotics and a higher rate of injury in May for 19-year-olds have been described earlier. We examined whether 19-year-olds also demonstrate greater use of general practitioner services at the time of russefeiring ­ celebrations in connection with completion of upper secondary school. MATERIAL AND METHOD: The study is based on data from the Directorate of Health's system for the control and payment of reimbursements to healthcare providers (KUHR) for all consultations in the general practitioner services for age group 18 ­ 20 years in the period 2012 ­ 15. The number of consultations per month and age group were analysed using Poisson regression, with 19-year-olds in March as a reference group. The incidence rate ratio (IRR) was the outcome measure. RESULTS: All calendar years showed a sharp increase in the number of consultations among 19-year-olds in May in all calendar years compared with other calendar months and the cohorts above and below. The incidence rate ratio for consultations with GPs and emergency departments was 1.40 (95 % confidence interval (CI) 1.38 ­ 1.41) and 2.07 (95 % CI 2.02 ­ 2.13). The increase was greatest for respiratory infections (IRR 3.64, 95 % CI 3.55 ­ 3.73). The incidence rate ratio for injuries was 1.21 (95 % CI 1.16 ­ 1.27). The increase commenced in the three weeks before 17 May (Constitution Day) and persisted in the following two weeks. INTERPRETATION: The sharp increase in the number of consultations for 19-year-olds in the general practitioner services is associated timewise with celebrations in connection with completion of upper secondary school (russefeiring). More frequent contact with these services lasts well into the ensuing examination period.