The use of geospatial tools to study the evolution of TB incidence in North Portugal between 2008-18

Background Tuberculosis continues to be a significant global health problem. Portugal isn't an exception to this health problem, being considered by the ECDC a high incidence country. According to the SDG target 3.3, the world must end the epidemics of tuberculosis by 2030. However, several parishes in Portugal continue to observe extremely high values of TB, taking into account the WHO goal for pre-elimination of 10 TB cases per million people. Methods A cross-sectional study was conducted with data from the Surveillance System of the National Program against Tuberculosis. Descriptive and regression analyses were carried out using R 3.6.1 and Rstudio 1.2.5033. The geospatial analysis was carried out with ArcMap 10.7.1 using a five-year average of TB incidence. Animations and videos were made with Microsoft Office365 PowerPoint v2002. Results In the period 2008-2012, 55,7% of parishes had registered cases of tuberculosis. That value decreased to 50,6% parishes in the period 2014-2018. For the period of 2014-18, 30,3% of parishes had a five-year average incidence above 20/100.000 people (value defined as high-incidence by the ECDC) and 45,0% parishes an incidence above 10/100.000 people. With ArcMap HotSpot analysis was possible to observe the existence of a significant cluster of TB in the southwest of North Portugal. With animation analysis, it was also possible to see the global spatial reduction of TB cases between 2008 and 2018, and the ongoing problem of a high incidence of TB in specific regions of North Portugal. Conclusions TB continues to be a significant health problem in North Portugal. The spatial analysis pointed to a specific area of North Portugal that needs priority action. Videos produced by the Department of Public Health may guide health professionals and policymakers for future strategies to be implemented to reach SDG3. Key messages The importance of desegregated spatial data for TB elimination. The elimination efforts must be scaled up in specific areas to achieve SDG3.

An outbreak of hepatitis A among children and adults in Denmark, August 2002 to February 2003

From August 2002 to February 2003 25 cases of hepatitis A were notified from one town in Jutland. The first cases were children of three families who returned from an endemic country. The infection spread subsequently in the local community and within households. A case-control study among household index cases showed that hepatitis A was associated with contact to a case in an after-school group (OR 29·6) and with contact to a case household member in a school class or day-care centre group (OR 9·5). From a serosurvey it was estimated that for each notified patient approximately one additional infection has occurred in the households. The infection was imported by children of immigrants, born in Denmark, returning from a visit to friends and relatives in the high-incidence country of origin of their parents and was then propagated through contact between children in after-school groups, schools and their families. Immunoprophylaxis should be given to children prior to visits to friends and relatives in endemic countries and to case contacts.

Epidemiological Trends of Colorectal Cancer in the Nordic Countries

Cancer of the colorectum is the second most common cancer in the Nordic countries, after breast cancer. In this report, following Møller et al. (Eur J Cancer Prev 2002; 11 Suppl: S1–96), trends in incidence of colon and rectum cancers in the five Nordic countries are presented from 1958–1962 to 1993–1997, with future predictions for 2003–2007. The data originate from population-based cancer registries in each of the Nordic countries. Two thirds of the cases are colon cancers and one-third rectum cancers. From 1958–1962 to 1993–1997, the incidence of colon cancer has increased in all Nordic countries and the rates are predicted to increase further in Finland, Iceland, and Norway. The incidence rate of rectum cancer has increased slightly in Finland, Iceland, and Sweden, whereas the rate has decreased steadily in Denmark, originally a high-incidence country. In Norway the rates have increased substantially in both genders. Marked differences exist between individual Nordic countries in colorectal cancer incidence trends and known dietary or other life style associated factors cannot fully explain them.

Transmission Dynamics of Tuberculosis in a High-Incidence Country: Prospective Analysis by PCR DNA Fingerprinting

We have prospectively analyzed the DNA fingerprints ofMycobacterium tuberculosis strains from a random sample of patients with newly diagnosed tuberculosis in Windhoek, Namibia. Strains from 263 smear-positive patients in whom tuberculosis was diagnosed during 1 year were evaluated, and the results were correlated with selected epidemiological and clinical data. A total of 163 different IS6110 fingerprint patterns were observed among the 263 isolates. Isolates from a high percentage of patients (47%) were found in 29 separate clusters, with a cluster defined as isolates with 100% matching patterns. The largest cluster included isolates from 39 patients. One predominant strain of M. tuberculosiscaused 15% of cases of smear-positive pulmonary tuberculosis in Windhoek. That strain was also prevalent in the north of the country, suggesting that in contrast to other African countries with isolates with high levels of diversity in their DNA fingerprint patterns, only a restricted number of different strains significantly contribute to the tuberculosis problem in Namibia.