Incidence of Vaccine-Preventable Childhood Diseases in the European Union and in the European Free Trade Association Countries

Introduction: Despite the widespread availability of vaccines, the incidence of vaccine-preventable childhood diseases (VPCD) started to grow in recent years. The aim of the study was to compare the annual incidence of selected VPCDs in the EU (European Union) and EFTA (European Free Trade Association) countries in the period of the last 5 years (2014–2019 or other intervals, depending on data availability), and the country-specific vaccine schedules. Methods: VPCD incidence rates in Europe were based on “The Surveillance Atlas of Infectious Diseases” by the ECDC (European Centre for Disease Prevention and Control); vaccination schedules were based on ECDC reports. Results: The obligation to vaccinate was not universal, and it generally only applied to two preparations: the MMR (measles, mumps, rubella) vaccine and the one against polio. During the study, the situation associated with mumps did not change or improve in individual countries; the median incidence amounted to 30 cases. The median incidence associated with rubella amounted to 1 case, but in a few countries, it grew very rapidly, i.e., in Germany, Italy, and Romania; in Poland, the incidence was clearly decreasing, from 5923 to 1532 cases. The most dynamic situation concerned measles. The total median was 2.4 cases per 100,000 population; the only one country with falling incidence was Germany. The diseases associated with Streptococcus pneumoniae and Neisseria meningitidis remained at a stable level in all analyzed countries. Conclusion: Vaccine schedules differ among the countries, so does the epidemiological situation of selected diseases. Morbidity on measles was the most disturbing phenomenon: the incidence rate increased in almost 40% of all countries, regardless of the obligation to vaccinate. The increasing incidence of VPCD may be due to anti-vaccine movements, the activity of which is often caused by mistrust and spreading misinformation. In order to better prevent the increase in morbidity, standardization of vaccine schedules and documentation should be considered in the EU countries.

Incidence and clinical predictors of infections in patients treated with severe systemic ANCA-associated vasculitis

BackgroundImmunosuppressive therapy has improved the outcome of ANCA-associated vasculitis (AAV), but infectious morbidity and mortality remained high. Recognizing its risk factors seems crucial for prevention, aiming to increase survival of these patients.MethodsWe investigated the incidence and types of infections and assessed predictive factors in 132 patients with severe systemic AAV.ResultsPatients with lower than median incidence of total infections/patient-year during induction had lower baseline serum creatinine, dialysis requirement and Charlson comorbidity index (CCI), compared to those with higher than median incidence (P = 0.037; P = 0.024; P = 0.001; respectively). In subgroups with below and above than median number of severe infections/patient-year during induction, differences were found in baseline creatinine (P = 0.002) and dialysis requirement (P = 0.001); comparing the same cohorts during maintenance immunosuppression, baseline dialysis requirement, diabetes, CCI, and dose of cyclophosphamide (CYC) administered as induction therapy differed significantly (P = 0.019; P = 0.015; P = 0.001; P = 0.015, respectively). Severe infections were predicted by baseline serum creatinine (OR 1.002 [CI 1.001–1.003]) and pulmonary manifestation (OR 2.153 [CI 1.017–4.560]) during induction immunosuppression. In multivariable Cox regression model all-cause mortality was independently predicted by severe infection (HR 1.998 [CI 1.214–3.287]). Among the 168 positive cultures Gram-negative bacteria were responsible for blood stream infections in 33%, and respiratory tract infections in 72%.ConclusionsAdvanced renal failure, pulmonary involvement and high degree of comorbidities increase the risk of infection in AAV. Those who suffer infection during induction immunosuppression have worse long-term survival. Our findings indicate the need for high vigilance for infections and close follow-up of comorbidities when treating AAV.

A Qualitative Transcriptional Signature for the Risk Assessment of Precancerous Colorectal Lesions

It is meaningful to assess the risk of cancer incidence among patients with precancerous colorectal lesions. Comparing the within-sample relative expression orderings (REOs) of colorectal cancer patients measured by multiple platforms with that of normal colorectal tissues, a qualitative transcriptional signature consisting of 1,840 gene pairs was identified in the training data. Within an evaluation dataset of 16 active and 18 inactive (remissive) ulcerative colitis subjects, the median incidence risk score of colorectal carcinoma was 0.6402 in active ulcerative colitis subjects, significantly higher than that in remissive subjects (0.3114). Evaluation of two other independent datasets yielded similar results. Moreover, we found that the score significantly positively correlated with the degree of dysplasia in the case of colorectal adenomas. In the merged dataset, the median incidence risk score was 0.9027 among high-grade adenoma samples, significantly higher than that among low-grade adenomas (0.8565). In summary, the developed incidence risk score could well predict the incidence risk of precancerous colorectal lesions and has value in clinical application.

908. Evaluation of Blood Culture Submission Rates in Japan

Background Blood culture tests are useful for accurate diagnosis of bacteremia and selection of antimicrobial treatment, and they are essential for instituting antimicrobial resistance (AMR) countermeasures. This study investigated blood culture submission rates in Japan and their association with the incidence of bloodstream infections. Methods Blood culture data recorded in the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) database from January to December 2019 and data submitted for consecutive 12 months from acute care hospitals (hospitals with a mean length of patient stay of ≤19 days) were included for analysis. Samples comprised 1 set of blood culture samples (aerobic and anaerobic bottles) defined as one submission. The annual blood culture submission rate was calculated as the total number of submitted blood cultures per 1000 patients/day. The incidence of bloodstream infections was calculated as the number of positive blood cultures excluding contaminated specimens per 1000 patients/day. The blood culture submission rate was then divided into four categories, respectively: category 1: 0–15; category 2: 15–30; category 3: 30–45; and category 4: 45–80. The Kruskal-Wallis test was performed to determine overall difference among 4 submission rate categories and the Dunn test with Bonferroni correction was used to compare pairs of submission rate categories. Filtering of facilities for data analysis Results A total of 117 hospitals were included in the analysis. The median number of beds was 415.0 (interquartile ratio [IQR]: 274.5–549.5). The median incidence of bloodstream infection was 2.78 (2.17–3.87). The median blood culture submission rate was 26.18 (17.20–35.76). The median incidence of bloodstream infection by category of blood culture submission rate was 1.39, 2.53, 3.61, and 4.48, respectively; with a significant difference observed among the four categories overall (p< 0.01). Significant differences were observed between categories 1 and 2 and between categories 2 and 3 (both p< 0.01) but not between categories 3 and 4 (p=0.758). Characteristics of the acute hospitals by category of blood culture submission rate Incidence of bloodstream infections by category of blood culture submission rate Conclusion The blood culture submission rate is considered to be around 45 in the acute hospital setting in Japan. The incidence of bloodstream infections is greatly affected by submission rates. Disclosures All Authors: No reported disclosures

Geospatial clustering of meningitis: an early warning system (hotspot) for potential meningitis outbreak in upper east region of Ghana

Objective: We mapped and generated hot spots for potential meningitis outbreak from existing data in Upper East region, Ghana.Design: This was a cross-sectional study conducted in 2017Data Source: Meningitis data in the Upper East Region from January 2007, to December 2016.Main outcome measure: We used spatial tools in Quantum Geographic Information System (QGIS) and Geoda to draw choropleth map of meningitis incidence, case fatality and hotspot for potential meningitis outbreak Results: A total of 2312 meningitis cases (suspected and confirmed) were recorded from 2016-2017 with median incidence of 15.0cases/100,000 population (min 6.3, max 47.8). Median age of cases was 15 years (IQR: 6-31 years). Most (44.2%) of those affected were 10 years and below. Females (51.2%) constituted the highest proportion. Median incidence from 2007-2011 was 20cases/100,000 population (Min 11.3, Max 39.9) whilst from 2012-2016 was 11.1cases/100,000 populations (Min 6.3, Max 47.8). A total of 28 significant hotspot sub-districts clusters (p=0.024) were identified with 7 High-high risk areas as potential meningitis outbreak spots.Conclusion: The occurrence of meningitis is not random, spatial cluster with high –high-risk exist in some sub-districts. Overall meningitis incidence and fatality rate have declined in the region with district variations. Districts with high meningitis incidence and fatality rates should be targeted for intervention.Keywords: meningitis outbreak, geospatial clustering, Upper East Region, meningitis incidence, GhanaFunding: Author EA was supported by the West Africa Health Organization (Ref.: Prog/A17IEpidemSurveillN°57212014/mcrt).

Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review

ObjectiveHypocalcaemia is the most common complication after total or completion thyroidectomy. This study assesses recent evidence on predictive factors for post-thyroidectomy hypocalcaemia in order to identify the patients affected and aid prevention.MethodTwo authors independently assessed articles and extracted data to provide a narrative synthesis. This study was an updated systematic search and narrative review regarding predictors of post-thyroidectomy hypocalcaemia using the Ovid Medline, Embase, Cochrane and Cinahl databases. Results were limited to papers published from January 2012 to August 2019.ResultsSixty-three observational studies with a total of 210 401 patients met the inclusion criteria. The median incidence was 27.5 per cent for transient biochemical hypocalcaemia, 12.5 per cent for symptomatic hypocalcaemia and 2.2 per cent for permanent hypocalcaemia. The most frequent statistically significant predictor of hypocalcaemia was peri-operative parathyroid hormone level. Symptomatic hypocalcaemia and permanent hypocalcaemia were seen more frequently in patients undergoing concomitant neck dissection.ConclusionMany factors have been studied for their link to post-thyroidectomy hypocalcaemia, and this study assesses the recent evidence presented in each case.

Systematic Review of the Incidence and Characteristics of Preventable Adverse Drug Events in Ambulatory Care

Objective: To estimate the incidence and describe characteristics of preventable adverse drug events (pADEs) in ambulatory care. Data Sources: Studies were searched in PubMed (1966–March 2007), International Pharmaceutical Abstracts (1970–December 2006), the Cochrane database of systematic reviews (1993–March 2007), EMBASE (1980–February 2007), and Web of Science (1945–March 2007). Key words included medication error, adverse drug reaction, iatrogenic disease, outpatient, ambulatory care, primary health care, general practice, patient admission, hospitalization, observational study, retrospective studies, health services research, and follow-up studies. Additional articles were found in the reference sections of retrieved articles. Study Selection and Data Extraction: Peer-reviewed articles assessing pADEs in ambulatory care, with detailed descriptions/frequency distributions of (1) ADE/pADE incidence, (2) clinical outcomes, (3) associated drug groups, and/or (4) underlying medication errors were included. Study country, year and design, sample size, follow-up time, ADE/pADE identification method, proportion of ADEs/pADEs and ADEs/pADEs requiring hospital admission, and frequency distribution of adverse outcome, associated drug groups, or medication errors were extracted. Data Synthesis: Twenty-nine studies met inclusion criteria: 14 were ambulatory-based and 15 were hospital-based. Seven studies enrolled only elderly patients. The median ADE incidence was 14.9 (range 4.0–91.3) per 1000 person-months, and the pADE incidence was 5.6 per 1000 person-months (1.1–10.1). The median ADE preventability rate was 21% (11–38%). The median incidence of ADEs requiring hospital admission was 0.45 (0.10–13.1) per 1000 person-months, and the median incidence of pADEs requiring hospital admission was 4.5 per 1000 person-months. Cardiovascular drugs, analgesics, and hypoglycemic agents together accounted for 86.5% of pADEs, and 77.2% of pADEs resulted in symptoms of the central nervous system, electrolyte/renal system, and gastrointestinal tract. Medication errors resulting in pADEs occurred in the prescribing and monitoring stages. The most frequent drug therapy problem and error of commission reported in ambulatory-based studies on pADEs was the use of inappropriate drugs (42.7%; 40.4–45%). For pADEs requiring hospital admission, the most frequent drug therapy problem and error of omission reported was inadequate monitoring (45.4%; range 22.2–69.8%). Failure to prescribe prophylaxis to patients taking nonsteroidal antiinflammatory drugs or antiplatelet drugs frequently caused gastrointestinal toxicity, whereas lack of monitoring of diuretic, hypoglycemic, and anticoagulant use caused over- or under-diuresis, hyper- or hypoglycemia, and bleeding. Conclusions: ADEs in ambulatory care are common, with many being preventable and many resulting in hospitalization. Quality improvement programs should target errors in prescribing and monitoring, especially for patients using cardiovascular, analgesic, and hypoglycemic agents.

Scorpion poisoning in the Acosta and Caripe Counties of Monagas State, Venezuela. part 1: characterization of some epidemiological aspects

Scorpion poisoning was surveyed in Acosta and Caripe counties, located in the Turimiquire subregion of Monagas State, Venezuela, aiming to expand information on stings by characterizing some epidemiological aspects. From 1987 to 1993, 298 cases of scorpion stings were recorded in Acosta and Caripe counties. Acosta had 212 cases, with an annual incidence rate of 18.3‰(cases per 10,000 inhabitants) and a period median incidence rate of 128‰. The scorpion poisoning index is 4.18 times greater in Acosta than in Caripe, confirming the former as a hyperendemic zone for this type of injury, with a phenomenon of cyclical temporal fluctuations and an upward trend. This area is infested with scorpions of the genus Tityus. Our results show that the region surveyed in Monagas State is endemic for scorpion stings, posing a major public health problem.

Methicillin-ResistantStaphylococcus aureusEpidemiology and Control in Belgian Hospitals, 1991 to 1995

Objectives:To describe the Belgian methicillin-resis-tantStaphylococcus aureus(MRSA) surveillance network, the evolution of methods used in Belgian hospitals for MRSA detection and control, and MRSA incidence from 1994 to1995.Design, Setting, and Participants:Questionnaire surveys; infection control physicians from acute-care hospitals in Belgium.Intervention:Publication of national guidelines for MRSA control in 1993.Results:The participation rate in surveys ranged from 42% to 57% of hospitals. In 1995, 88% of participants detected MRSA strains by disk diffusion tests, with little improvement in standardization since 1991. More centers employed the oxacillin agar screen method (27%), automated systems (29%), or a combination of methods (29%) than in 1991 (P<.005). Between 1991 and 1995, the proportion of hospitals reporting MRSA control measures increased from 68% to 95% (P<.01). Practices that were used increasingly included patient placement in private room (from 50% to 93%,P<.01) and hand decontamination with antiseptic (from 43% to 87%,P<.01). The proportion of centers that reported screening MRSA carriers and treating them topically increased two- and threefold, respectively (P<.05). Surveillance data from 1994 to 1995 showed that MRSA represented a mean of 21.3% ofS aureusclinical isolates (range, 1.6% to 62.4%). The median incidence of nosocomial MRSA acquisition was 2.8 per 1,000 admissions, with a wide range (0 to 13.7 per 1,000 admissions) across hospitals of all sizes. The median incidence decreased over the first three semesters of surveillance in hospitals with continuous participation.Conclusion:MRSA detection and control measures have improved in Belgian hospitals after publication of national guidelines. However, MRSA incidence rates show the persistence of nosocomial transmission, with large variations between centers. The national MRSA surveillance network should indicate whether control efforts eventually will curb the problem.

Cross-Sectional TEM Sample Preparation for Multilayer Electronic Materials

ABSTRACTThe preparation of cross-sectional TEM samples from multilayer materials commonly encountered in electronic industry is difficult in general due to the large variation in chemical and physical etching rate. We have developed a technique consisting of a median incidence angle ion sputtering to perforation followed by a short time (<2 hours) low incidence angle sputtering with the glue line direction shielded from the ion beams. This technique takes advantage of the fast sputtering rate associated with the median incidence angle sputtering initially. The near normal (relative to the glue line direction) low angle sputtering in the second step smooths out any non-uniformity in thickness due to the strong dependence of sputtering rate on the sputtering angle. High quality TEM samples prepared from many different types of multilayer structures using this technique are demonstrated.