scholarly journals Travel-associated hepatitis A in Europe, 2009 to 2015

2018 ◽  
Vol 23 (22) ◽  
Author(s):  
Julien Beauté ◽  
Therese Westrell ◽  
Daniela Schmid ◽  
Luise Müller ◽  
Jevgenia Epstein ◽  
...  
Keyword(s):  
European Union ◽  
Risk Factor ◽  
Hepatitis A ◽  
Hepatitis A Virus ◽  
Surveillance Systems ◽  
European Economic Area ◽  
The European Union ◽  
Younger Age ◽  
Travel Abroad ◽  
The Eu

Background Travel to countries with high or intermediate hepatitis A virus (HAV) endemicity is a risk factor for infection in residents of countries with low HAV endemicity. Aim: The objective of this study was to estimate the risk for hepatitis A among European travellers using surveillance and travel denominator data. Methods: We retrieved hepatitis A surveillance data from 13 European Union (EU)/ European Economic Area (EEA) countries with comprehensive surveillance systems and travel denominator data from the Statistical Office of the European Union. A travel-associated case of hepatitis A was defined as any case reported as imported. Results: From 2009 to 2015, the 13 countries reported 18,839 confirmed cases of hepatitis A, of which 5,233 (27.8%) were travel-associated. Of these, 39.8% were among children younger than 15 years. The overall risk associated with travel abroad decreased over the period at an annual rate of 3.7% (95% confidence interval (CI): 0.7–2.7) from 0.70 cases per million nights in 2009 to 0.51 in 2015. The highest risk was observed in travellers to Africa (2.11 cases per million nights). Cases more likely to be reported as travel-associated were male and of younger age (< 25 years). Conclusion: Travel is still a major risk factor for HAV infection in the EU/EEA, although the risk of infection may have slightly decreased in recent years. Children younger than 15 years accounted for a large proportion of cases and should be prioritised for vaccination.

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 Improving preparedness to respond to cross-border hepatitis A outbreaks in the European Union/European Economic Area: towards comparable sequencing of hepatitis A virus

2019 ◽  
Vol 24 (28) ◽  
Author(s):  
Theresa Enkirch ◽  
Ettore Severi ◽  
Harry Vennema ◽  
Lelia Thornton ◽  
Jonathan Dean ◽  
...  
Keyword(s):  
European Union ◽  
Hepatitis A ◽  
Hepatitis A Virus ◽  
Outbreak Detection ◽  
European Economic Area ◽  
The European Union ◽  
European Economic ◽  
Cross Border ◽  
Economic Area ◽  
Primary Diagnostics

Introduction Sequence-based typing of hepatitis A virus (HAV) is important for outbreak detection, investigation and surveillance. In 2013, sequencing was central to resolving a large European Union (EU)-wide outbreak related to frozen berries. However, as the sequenced HAV genome regions were only partly comparable between countries, results were not always conclusive. Aim The objective was to gather information on HAV surveillance and sequencing in EU/European Economic Area (EEA) countries to find ways to harmonise their procedures, for improvement of cross-border outbreak responses. Methods In 2014, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on HAV surveillance practices in EU/EEA countries. The survey enquired whether a referral system for confirming primary diagnostics of hepatitis A existed as well as a central collection/storage of hepatitis A cases’ samples for typing. Questions on HAV sequencing procedures were also asked. Based on the results, an expert consultation proposed harmonised procedures for cross-border outbreak response, in particular regarding sequencing. In 2016, a follow-up survey assessed uptake of suggested methods. Results Of 31 EU/EEA countries, 23 (2014) and 27 (2016) participated. Numbers of countries with central collection and storage of HAV positive samples and of those performing sequencing increased from 12 to 15 and 12 to 14 respectively in 2016, with all countries typing an overlapping fragment of 218 nt. However, variation existed in the sequenced genomic regions and their lengths. Conclusions While HAV sequences in EU/EEA countries are comparable for surveillance, collaboration in sharing and comparing these can be further strengthened.

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 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 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 FEATURES OF THE TRANSFORMATION OF AGRARIAN RELATIONS IN BULGARIA AFTER ACCESSION TO THE EUROPEAN UNION (2007–2019)

2021 ◽  
pp. 6-16
Author(s):  
Maria Georgieva
Keyword(s):  
European Union ◽  
Agricultural Production ◽  
Agricultural Sector ◽  
Industrial Relations ◽  
European Economic Area ◽  
The European Union ◽  
Wide Range ◽  
Depth Analysis ◽  
Production Relations ◽  
The Eu

The article reveals the peculiarities of the development of industrial relations in the agricultural sector of the Bulgarian economy in terms of its membership in the European Union. Thanks to the involvement of a wide range of statistical sources, it is determined that modern Bulgarian society is experiencing profound changes in socio-economic development, the response to which has brought the Bulgarian agricultural sector to a competitive level. It is determined that the agricultural sector of the Bulgarian economy had a rather difficult way of adapting production relations to European requirements. At the same time, Bulgaria’s accession to the European Union stimulated the development of agriculture, contributed to the introduction of the latest agro-technical production technologies, rational land use, improvement of agricultural products. The main trends in the development of the agricultural sector of the Bulgarian economy after the country’s accession to the EU and the transformation processes in the sector are analyzed. In addition, as a result of an in-depth analysis, it was proved that the Bulgarian agricultural sector on the verge of joining the EU had a number of problems that hindered the increase of its productivity and profitability. Following Bulgaria’s accession to the European Economic Area, the country had to take a number of measures to address the above-mentioned problem. In particular, it consisted in the adaptation of agricultural legislation, state support measures to European norms and standards of agricultural production to European norms and requirements. The deepening of European integration and the further accession of Bulgaria to the EU accelerated the transformation of agricultural production relations and the modernization of agriculture, which was accompanied by the adaptation and harmonization of the agricultural sector to increase its productivity.

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.

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