scholarly journals Hepatitis E virus infection in Europe: surveillance and descriptive epidemiology of confirmed cases, 2005 to 2015

2017 ◽  
Vol 22 (26) ◽  
Author(s):  
Esther J Aspinall ◽  
Elisabeth Couturier ◽  
Mirko Faber ◽  
Bengü Said ◽  
Samreen Ijaz ◽  
...  
Keyword(s):  
Hepatitis E Virus ◽  
Hepatitis E ◽  
Case Definition ◽  
Surveillance Systems ◽  
European Economic Area ◽  
The European Union ◽  
Descriptive Epidemiology ◽  
Case Definitions ◽  
Economic Area ◽  
Testing Policies

Hepatitis E virus (HEV) is an under-recognised cause of acute hepatitis in high-income countries. The purpose of this study was to provide an overview of testing, diagnosis, surveillance activities, and data on confirmed cases in the European Union/European Economic Area (EU/EEA). A semi-structured survey was developed and sent to 31 EU/EEA countries in February 2016, 30 responded. Twenty of these countries reported that they have specific surveillance systems for HEV infection. Applied specific case definition for HEV infection varied widely across countries. The number of reported cases has increased from 514 cases per year in 2005 to 5,617 in 2015, with most infections being locally acquired. This increase could not be explained by additional countries implementing surveillance for HEV infections over time. Hospitalisations increased from less than 100 in 2005 to more than 1,100 in 2015 and 28 fatal cases were reported over the study period. EU/EEA countries are at different stages in their surveillance, testing schemes and policy response to the emergence of HEV infection in humans. The available data demonstrated a Europe-wide increase in cases. Standardised case definitions and testing policies would allow a better understanding of the epidemiology of HEV as an emerging cause of liver-related morbidity.

scholarly journals Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017

2018 ◽  
Vol 23 (33) ◽  
Author(s):  
Patricia Ndumbi ◽  
Gudrun S Freidl ◽  
Christopher J Williams ◽  
Otilia Mårdh ◽  
Carmen Varela ◽  
...  
Keyword(s):  
European Union ◽  
Sexual Behaviour ◽  
Hepatitis A ◽  
Hepatitis A Virus ◽  
European Economic Area ◽  
The European Union ◽  
Case Definitions ◽  
European Economic ◽  
Economic Area ◽  
Sex With Men

Between 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16–25801 and RIVM-HAV16–090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16–090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour.

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 Performance of surveillance case definitions for respiratory syncytial virus infections through the sentinel influenza surveillance system, Portugal, 2010 to 2018

2019 ◽  
Vol 24 (45) ◽  
Author(s):  
Emma Sáez-López ◽  
Pedro Pechirra ◽  
Inês Costa ◽  
Paula Cristóvão ◽  
Patrícia Conde ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Characteristic Curve ◽  
Age Groups ◽  
Case Definition ◽  
Influenza Surveillance ◽  
Surveillance Systems ◽  
The European Union ◽  
Case Definitions ◽  
Rsv Infection ◽  
Syncytial Virus

Background Well-established influenza surveillance systems (ISS) can be used for respiratory syncytial virus (RSV) surveillance. In Portugal, RSV cases are detected through the ISS using the European Union (EU) influenza-like illness (ILI) case definition. Aim To investigate clinical predictors for RSV infection and how three case definitions (EU ILI, a modified EU acute respiratory infection, and one respiratory symptom) performed in detecting RSV infections in Portugal. Methods This observational retrospective study used epidemiological and laboratory surveillance data (October 2010–May 2018). Associations between clinical characteristics and RSV detection were analysed using logistic regression. Accuracy of case definitions was assessed through sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). A 0.05 significance level was accepted. Results The study involved 6,523 persons, including 190 (2.9%) RSV cases. Among 183 cases with age information, RSV infection was significantly more frequent among individuals < 5 years (n = 23; 12.6%) and ≥ 65 years (n = 45; 24.6%) compared with other age groups (p < 0.0001). Cough (odds ratio (OR): 2.4; 95% confidence interval (CI): 1.2–6.5) was the best RSV-infection predictor considering all age groups, while shortness of breath was particularly associated with RSV-positivity among ≤ 14 year olds (OR: 6.7; 95% CI: 2.6–17.4 for 0–4 year olds and OR: 6.7; 95% CI: 1.5–28.8 for 5–14 year olds). Systemic symptoms were significantly associated with RSV-negative and influenza-positive cases. None of the case definitions were suitable to detect RSV infections (AUC = 0.51). Conclusion To avoid underestimating the RSV disease burden, RSV surveillance within the Portuguese sentinel ISS would require a more sensitive case definition than ILI and, even a different case definition according to age.

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 DEFINITION OF NEW SPATIAL REGIONS IN SOUTH-EAST EUROPE

2020 ◽  
Vol 8 (11) ◽  
pp. 449-454
Author(s):  
Kamen Petrov ◽  
Keyword(s):  
European Union ◽  
Regional Development ◽  
European Economic Area ◽  
The European Union ◽  
East Europe ◽  
Cross Border ◽  
South East Europe ◽  
Economic Area ◽  
Definition Of ◽  
Cross Border Cooperation

The exhibition presents the problems of cross-border cooperation and opportunities for partnership. Within the European Union, conditions are created for regional development on the national territory, as well as for border and cross-border cooperation. In this direction, the article outlines the processes of building a number of Euroregions, which are designed to promote regional development. This report will clarify some of the reasons for their construction, their role and what model of cooperation is available within the European Economic Area.

scholarly journals Assessment of HIV molecular surveillance capacity in the European Union, 2016

2017 ◽  
Vol 22 (49) ◽  
Author(s):  
Patrick Keating ◽  
Anastasia Pharris ◽  
Katrin Leitmeyer ◽  
Stefania De Angelis ◽  
Annemarie Wensing ◽  
...  
Keyword(s):  
European Union ◽  
Sequence Data ◽  
National Level ◽  
Antiretroviral Drugs ◽  
Surveillance Systems ◽  
European Economic Area ◽  
The European Union ◽  
Molecular Surveillance ◽  
Treatment Regimens ◽  
Immunodeficiency Syndrome

Introduction Expanding access to HIV antiretroviral treatment is expected to decrease HIV incidence and acquired immunodeficiency syndrome (AIDS) mortality. However, this may also result in increased HIV drug resistance (DR). Better monitoring and surveillance of HIV DR is required to inform treatment regimens and maintain the long term effectiveness of antiretroviral drugs. As there is currently no formal European Union (EU)-wide collection of HIV DR data, this study aimed to assess the current HIV molecular surveillance capacity in EU/European Economic Area (EEA) countries in order to inform the planning of HIV DR monitoring at EU level. Methods: Thirty EU/EEA countries were invited to participate in a survey on HIV molecular surveillance capacity, which also included laboratory aspects. Results: Among 21 responding countries, 13 reported using HIV sequence data (subtype and/or DR) for surveillance purposes at national level. Of those, nine stated that clinical, epidemiological and sequence data were routinely linked for analysis. Discussion/conclusion: We identified similarities between existing HIV molecular surveillance systems, but also found important challenges including human resources, data ownership and legal issues that would need to be addressed. Information on capacities should allow better planning of the phased introduction of HIV DR surveillance at EU/EEA level.

scholarly journals HIV and AIDS in the European Union, 2011

2012 ◽  
Vol 17 (48) ◽  
Author(s):  
G Likatavicius ◽  
M Van de Laar
Keyword(s):  
European Union ◽  
Drug Users ◽  
Antiretroviral Treatment ◽  
Hiv And Aids ◽  
European Economic Area ◽  
The European Union ◽  
Late Presenters ◽  
European Economic ◽  
Economic Area ◽  
Sex With Men

In 2011, a total of 28,038 new HIV diagnoses were reported by European Union and European Economic Area countries. The annual rate of HIV diagnoses does not show clear signs of decrease and HIV continues to be concentrated in selected populations such as men who have sex with men and injecting drug users, and a high proportion reported as late presenters. Despite effective and available antiretroviral treatment, the number of AIDS cases increased in a few countries.

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