scholarly journals Widespread circulation of pertussis and poor protection against diphtheria among middle-aged adults in 18 European countries

2020 ◽  
Author(s):  
Guy Berbers ◽  
Pieter van Gageldonk ◽  
Jan van de Kassteele ◽  
Ursula Wiedermann ◽  
Isabelle Desombere ◽  
...  
Keyword(s):  
Adult Population ◽  
Age Groups ◽  
European Economic Area ◽  
The European Union ◽  
Pertussis Infection ◽  
Economic Area ◽  
Middle Aged Adults ◽  
Antibody Levels ◽  
Tetanus Antibodies ◽  
The Eu

Abstract Reported incidence of pertussis in member states of the European Union (EU) and the European Economic Area (EEA) varies and may not reflect the real situation. In the EU/EEA, vaccine-induced protection against diphtheria and tetanus seems sufficient as few cases are reported even among the adult population who was vaccinated many years ago. Aim of this study was to determine the seroprevalence of pertussis, diphtheria and tetanus antibodies in EU/EEA countries within the age groups of 40-49 and 50-59 years. Eighteen countries collected around 500 samples between 2015 and 2018 (N=10,302 in total) and they were analysed for IgG-specific antibodies against pertussis toxin (PT), diphtheria toxoid (Dt) and tetanus toxin (TT). The proportion of sera with IgG-PT antibody levels ≥100 IU/mL, indicative for recent pertussis infection was comparable for 13/18 countries ranging between 4.0-6.4%. For diphtheria the proportion of sera lacking the protective level (<0.1 IU/mL) varied between 22.8% and 82.0%. For tetanus the protection was sufficient: only very few sera showed unprotective IgG-TT antibody levels. The seroprevalence of pertussis indicates that the circulation of B. pertussis is widespread across EU/EEA. The lack of vaccine-induced seroprotection against diphtheria in EU/EEA in these age groups is of concern and deserves further attention.

scholarly journals Circulation of pertussis and poor protection against diphtheria among middle-aged adults in 18 European countries

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Guy Berbers ◽  
◽  
Pieter van Gageldonk ◽  
Jan van de Kassteele ◽  
Ursula Wiedermann ◽  
...  
Keyword(s):  
Age Groups ◽  
European Economic Area ◽  
The European Union ◽  
Protective Level ◽  
Real Situation ◽  
Specific Antibodies ◽  
Recent Exposure ◽  
Economic Area ◽  
Middle Aged Adults ◽  
Antibody Levels

AbstractReported incidence of pertussis in the European Union (EU) and the European Economic Area (EEA) varies and may not reflect the real situation, while vaccine-induced protection against diphtheria and tetanus seems sufficient. We aimed to determine the seroprevalence of DTP antibodies in EU/EEA countries within the age groups of 40–49 and 50–59 years. Eighteen countries collected around 500 samples between 2015 and 2018 (N = 10,302) which were analysed for IgG-DTP specific antibodies. The proportion of sera with pertussis toxin antibody levels ≥100 IU/mL, indicative of recent exposure to pertussis was comparable for 13/18 countries, ranging between 2.7–5.8%. For diphtheria the proportion of sera lacking the protective level (<0.1 IU/mL) varied between 22.8–82.0%. For tetanus the protection was sufficient. Here, we report that the seroprevalence of pertussis in these age groups indicates circulation of B. pertussis across EU/EEA while the lack of vaccine-induced seroprotection against diphtheria is of concern and deserves further attention.

The EU Influence on Norwegian Domestic Legislation for the Protection of the Arctic Marine Environment

2018 ◽  
Vol 33 (2) ◽  
pp. 415-435 ◽  
Author(s):  
Elise Johansen
Keyword(s):  
European Union ◽  
Marine Environment ◽  
The Arctic ◽  
European Economic Area ◽  
The European Union ◽  
Environmental Legislation ◽  
Economic Area ◽  
Domestic Legislation ◽  
Marine Areas ◽  
The Eu

Abstract In the last several decades, the European Union (EU) has demonstrated its intention to play an important role in supporting Arctic cooperation and helping to meet the challenges now facing the region. Norway, one of the five Arctic coastal states, and the EU have cooperated closely in this regard, particularly through the Agreement on the European Economic Area (EEA Agreement). This article examines how Norway’s domestic legislation applicable to its Arctic marine areas has been influenced by the development of EU environmental legislation. Specifically, this paper provides a discussion and analysis of the relevant Norwegian laws and mechanisms used to regulate how EU environmental legislation has been incorporated into Norway’s domestic legislation through the EEA Agreement.

scholarly journals Die EU und ihre Nachbarschaftsbeziehungen: etablierte Assoziierungsmodelle und neue Grundformen

IG ◽  
2019 ◽  
Vol 42 (2) ◽  
pp. 83-96 ◽  
Author(s):  
Barbara Lippert
Keyword(s):  
European Union ◽  
European Economic Area ◽  
The European Union ◽  
European Economic ◽  
Economic Area ◽  
The Creation ◽  
The Eu

In this article, the author presents established models of association of the European Union (EU) with European third countries. She shows their different strategic perspectives, outlines benefits and problems, and examines the potential for developing these relations. Basically, these can go in the direction of expanding or dismantling partial sectoral integration. In addition, new basic forms of EU neighbourhood relations are discussed: the introduction of a new status of partial membership in the EU and - inspired by the European Economic Area - the creation of a European political and economic area.

scholarly journals Surveillance perspective on Lyme borreliosis across the European Union and European Economic Area

2017 ◽  
Vol 22 (27) ◽  
Author(s):  
Cees C van den Wijngaard ◽  
Agnetha Hofhuis ◽  
Mariana Simões ◽  
Ente Rood ◽  
Wilfrid van Pelt ◽  
...  
Keyword(s):  
European Union ◽  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Case Definition ◽  
European Economic Area ◽  
The European Union ◽  
European Economic ◽  
Key Indicator ◽  
Economic Area ◽  
The Eu

Lyme borreliosis (LB) is the most prevalent tick-borne disease in Europe. Erythema migrans (EM), an early, localised skin rash, is its most common presentation. Dissemination of the bacteria can lead to more severe manifestations including skin, neurological, cardiac, musculoskeletal and ocular manifestations. Comparison of LB incidence rates in the European Union (EU)/European Economic Area (EEA) and Balkan countries are difficult in the absence of standardised surveillance and reporting procedures. We explored six surveillance scenarios for LB surveillance in the EU/EEA, based on the following key indicators: (i) erythema migrans, (ii) neuroborreliosis, (iii) all human LB manifestations, (iv) seroprevalence, (v) tick bites, and (vi) infected ticks and reservoir hosts. In our opinion, neuroborreliosis seems most feasible and useful as the standard key indicator, being one of the most frequent severe LB manifestations, with the possibility of a specific case definition. Additional surveillance with erythema migrans as key indicator would add value to the surveillance of neuroborreliosis and lead to a more complete picture of LB epidemiology in the EU/EEA. The other scenarios have less value as a basis for EU-level surveillance, but can be considered periodically and locally, as they could supply complementary insights.

scholarly journals ‘Did I pass the licensing exam?’ aspects influencing migrant physicians’ results: a mixed methods study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038670
Author(s):  
Linda Sturesson ◽  
Andreas Heiding ◽  
Daniel Olsson ◽  
Terese Stenfors
Keyword(s):  
European Union ◽  
Mixed Methods ◽  
Strong Predictor ◽  
Mixed Methods Study ◽  
Pass Rate ◽  
European Economic Area ◽  
The European Union ◽  
Web Based ◽  
Economic Area ◽  
The Eu

ObjectivesMigrant physicians (MPs) who wish to practise their profession in a new country often must undergo a recertification process, including a licensing exam. In many cases, this is the same licensing exam used for peers educated within the country; however, the pass rate of MPs is usually lower. This study aimed to explore MPs exam results, focusing on MPs that had participated in a complementary programme (CPP) for physicians with a medical degree from outside the European Union/European Economic Area (EU/EEA), and aspects that may influence these.MethodsMixed methods were applied. The data consisted of 2013 to 2019 licensing exam results of 564 physicians in Sweden that were educated outside of the EU. The data was analysed using linear and logistic regression analysis. Further, 14 interviews with MPs were conducted and thematically analysed.ResultsAn interaction between age and CPP participation was found for both the total score in per cent (p=0.01) and for the proportion failing their first attempt (p=0.04). Age was found to be a very strong predictor for failing on the first attempt, with those 45 and older failing on the first attempt in 72 and 82 per cent for CPP and non-CPP participants, respectively. Interview data was categorised into two themes: preparations and biographical aspects, and the exam and exam situation.ConclusionsAge seems to be an important predictor for failing the first attempt. MPs have had less time to familiarise themselves with the exam type and the language used on the exam. To improve exam results, MPs used different strategies and tools, that is, studying with nationally trained physicians, and using old exams and a web-based study tool consisting of common exam subjects. At the same time, these strategies and tools have also become mediators in the socialisation of MPs into the exam context.

scholarly journals Potential scenarios for the progression of a COVID-19 epidemic in the European Union and the European Economic Area, March 2020

2020 ◽  
Vol 25 (9) ◽  
Author(s):  
Helen C Johnson ◽  
Céline M Gossner ◽  
Edoardo Colzani ◽  
John Kinsman ◽  
Leonidas Alexakis ◽  
...  
Keyword(s):  
European Union ◽  
Severe Acute Respiratory Syndrome ◽  
European Economic Area ◽  
The European Union ◽  
European Economic ◽  
Economic Area ◽  
Community Transmission ◽  
Transmission Phase ◽  
The Eu

Two months after the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the possibility of established and widespread community transmission in the European Union and European Economic Area (EU/EEA) is becoming more likely. We provide scenarios for use in preparedness for a possible widespread epidemic. The EU/EEA is moving towards the ‘limited sustained transmission’ phase. We propose actions to prepare for potential mitigation phases and coordinate efforts to protect the health of citizens.

scholarly journals Lessons learnt to keep Europe polio-free: a review of outbreaks in the European Union, European Economic Area, and candidate countries, 1973 to 2013

2016 ◽  
Vol 21 (16) ◽  
Author(s):  
Tarik Derrough ◽  
Alexandra Salekeen
Keyword(s):  
European Union ◽  
Age Groups ◽  
Wild Strain ◽  
World Health ◽  
Paralytic Poliomyelitis ◽  
European Economic Area ◽  
The European Union ◽  
European Economic ◽  
Wild Poliovirus ◽  
Economic Area

Between 1973 and 2013, 12 outbreaks of paralytic poliomyelitis with a cumulative total of 660 cases were reported in the European Union, European Economic Area and candidate countries. Outbreaks lasted seven to 90 weeks (median: 24 weeks) and were identified through the diagnosis of cases of acute flaccid paralysis, for which infection with wild poliovirus was subsequently identified. In two countries, environmental surveillance was in place before the outbreaks, but did not detect any wild strain before the occurrence of clinical cases. This surveillance nonetheless provided useful information to monitor the outbreaks and their geographical spread. Outbreaks were predominantly caused by poliovirus type 1 and typically involved unvaccinated or inadequately vaccinated groups within highly immunised communities. Oral polio vaccine was primarily used to respond to the outbreaks with catch-up campaigns implemented either nationwide or in restricted geographical areas or age groups. The introduction of supplementary immunisation contained the outbreaks. In 2002, the European region of the World Health Organization was declared polio-free and it has maintained this status since. However, as long as there are non-vaccinated or under-vaccinated groups in European countries and poliomyelitis is not eradicated, countries remain continuously at risk of reintroduction and establishment of the virus. Continued efforts to reach these groups are needed in order to ensure a uniform and high vaccination coverage.

scholarly journals The (Uncertain) Impact of Brexit on the United Kingdom's Membership in the European Economic Area

2017 ◽  
Author(s):  
Ulrich G. Schroeter ◽  
Heinrich Nemeczek
Keyword(s):  
European Union ◽  
European Economic Area ◽  
Implicit Assumption ◽  
The European Union ◽  
Business Law ◽  
European Economic ◽  
Eu Membership ◽  
Economic Area ◽  
The Uk ◽  
The Eu

Until recently, the on-going legal discussions about ‘Brexit’, the United Kingdom’s upcoming withdrawal from the European Union (EU), have predominantly focused on the requirements and consequences of the withdrawal procedure set out in Article 50 of the Treaty on European Union (TEU). A hitherto neglected, though arguably no less important question concerns the effect, if any, that a withdrawal from the EU will have on the UK’s membership in the European Economic Area (EEA): Given that the EEA extends many aspects of EU membership beyond the EU’s borders, resulting in a Common Market ‘light’, a future UK membership in the EEA could – at least from a European business law point of view – effectively result in ‘business as usual’, as a significant share of EU law would continue to apply to UK companies, albeit in form of EEA law.Against this background, it is interesting to note that legal analyses of Brexit generally assume that the UK’s EEA membership will be terminated ipso iure, should the UK decide to withdraw from the EU. According to this view, the UK subsequently could (re-)apply for EEA membership should its government so choose, with such an application having to be accepted by all remaining EEA Contracting Parties – an option commonly referred to as the ‘Norway option’ in reference to Norway’s status within the EEA. The present article challenges the underlying (and often merely implicit) assumption that the UK’s withdrawal from the EU will automatically result in its withdrawal from the EEA, given that the EEA Agreement is a separate international treaty subject to separate legal rules governing withdrawals and effects of possible changes in EU membership. It argues that a withdrawal from the EU will in fact not affect the UK’s continuing EEA membership, as long as the UK does not voluntarily choose to also withdraw from the EEA. It then analyses the post-Brexit situation under the EEA Agreement by addressing its practical application to a number of different areas, as inter alia the free movement of UK companies within the EEA, the future of the ‘European passport’ for UK credit institutions and investment firms, as well as the free (but possibly restrictable) movement of workers in the EEA.

scholarly journals Improving influenza virological surveillance in Europe: strain-based reporting of antigenic and genetic characterisation data, 11 European countries, influenza season 2013/14

2016 ◽  
Vol 21 (41) ◽  
Author(s):  
Eeva Broberg ◽  
Olav Hungnes ◽  
Brunhilde Schweiger ◽  
Katarina Prosenc ◽  
Rod Daniels ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Influenza Season ◽  
Age Groups ◽  
European Economic Area ◽  
Genetic Characterisation ◽  
Economic Area ◽  
Hospitalised Patients ◽  
And Control ◽  
Virological Surveillance ◽  
The Eu

Influenza antigenic and genetic characterisation data are crucial for influenza vaccine composition decision making. Previously, aggregate data were reported to the European Centre for Disease Prevention and Control by European Union/European Economic Area (EU/EEA) countries. A system for collecting case-specific influenza antigenic and genetic characterisation data was established for the 2013/14 influenza season. In a pilot study, 11 EU/EEA countries reported through the new mechanism. We demonstrated feasibility of reporting strain-based antigenic and genetic data and ca 10% of influenza virus-positive specimens were selected for further characterisation. Proportions of characterised virus (sub)types were similar to influenza virus circulation levels. The main genetic clades were represented by A/StPetersburg/27/2011(H1N1)pdm09 and A/Texas/50/2012(H3N2). A(H1N1)pdm09 viruses were more prevalent in age groups (by years) < 1 (65%; p = 0.0111), 20–39 (50%; p = 0.0046) and 40–64 (55%; p = 0.00001) while A(H3N2) viruses were most prevalent in those ≥ 65 years (62%*; p = 0.0012). Hospitalised patients in the age groups 6–19 years (67%; p = 0.0494) and ≥ 65 years (52%; p = 0.0005) were more frequently infected by A/Texas/50/2012 A(H3N2)-like viruses compared with hospitalised cases in other age groups. Strain-based reporting enabled deeper understanding of influenza virus circulation among hospitalised patients and substantially improved the reporting of virus characterisation data. Therefore, strain-based reporting of readily available data is recommended to all reporting countries within the EU/EEA.

scholarly journals Application of a new methodology and R package reveals a high burden of healthcare-associated infections (HAI) in Germany compared to the average in the European Union/European Economic Area, 2011 to 2012

2019 ◽  
Vol 24 (46) ◽  
Author(s):  
Benedikt Zacher ◽  
Sebastian Haller ◽  
Niklas Willrich ◽  
Jan Walter ◽  
Muna Abu Sin ◽  
...  
Keyword(s):  
European Union ◽  
R Package ◽  
European Economic Area ◽  
Healthcare Associated Infections ◽  
The European Union ◽  
High Burden ◽  
European Economic ◽  
Economic Area ◽  
Healthcare Associated ◽  
The Eu

Background Healthcare-associated infections (HAIs) pose a major challenge to health systems. Burden of disease estimations in disability-adjusted life years (DALYs) are useful for comparing and ranking HAIs. Aim To estimate the number of five common HAIs, their attributable number of deaths and burden for Germany. Methods We developed a new method and R package that builds on the approach used by the Burden of Communicable Diseases in Europe (BCoDE) project to estimate the burden of HAIs for individual countries. We used data on healthcare-associated Clostridioides difficile infection, healthcare-associated pneumonia, healthcare-associated primary bloodstream infection, healthcare-associated urinary tract infection and surgical-site infection, which were collected during the point prevalence survey of HAIs in European acute-care hospitals between 2011 and 2012. Results We estimated 478,222 (95% uncertainty interval (UI): 421,350–537,787) cases for Germany, resulting in 16,245 (95% UI: 10,863–22,756) attributable deaths and 248,920 (95% UI: 178,693–336,239) DALYs. Despite the fact that Germany has a relatively low hospital prevalence of HAIs compared with the European Union/European Economic Area (EU/EEA) average, the burden of HAIs in Germany (308.2 DALYs/100,000 population; 95% UI: 221.2–416.3) was higher than the EU/EEA average (290.0 DALYs/100,000 population; 95% UI: 214.9–376.9). Our methodology is applicable to other countries in or outside of the EU/EEA. An R package is available from https://CRAN.R-project.org/package=BHAI. Conclusion This is the first study to estimate the burden of HAIs in DALYs for Germany. The large number of hospital beds may be a contributing factor for a relatively high burden of HAIs in Germany. Further focus on infection prevention control, paired with reduction of avoidable hospital stays, is needed to reduce the burden of HAIs in Germany.

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