ETIDIOH - NEW

Summary Background The number of older people in need of long-term care is increasing, and health-care-associated infections (HAIs) are a major cause of morbidity and mortality for residents of long-term care facilities (LTCFs). This study, organised by the European Centre for Disease Prevention and Control (ECDC), provided data on the incidence of HAIs and related adverse outcomes in LTCFs in European countries, supplementing the available estimates from repeated point prevalence surveys conducted by the ECDC. Methods In this longitudinal, prospective cohort study, we analysed all HAIs collected in a convenience sample of residents from 65 LTCFs (including general nursing homes, residential homes, and mixed facilities) in nine EU or European Economic Area (EEA) countries ( Belgium, Finland, France, Italy, Lithuania, Luxembourg, the Netherlands, Poland , and Spain ) over 12 months. Eligible residents were those expected to stay in the LTCF for at least the entire study period. Data wer...

Abstract Influenza A viruses (IAVs) are prime examples of emerging viruses in humans and animals. IAV circulation in domestic animals poses a pandemic risk as it provides new opportunities for zoonotic infections. The recent emergence of H5N1 IAV in cows and subsequent spread over multiple states within the USA, together with reports of spillover infections in humans, cats and mice highlight this issue. The horse is a domestic animal in which an avian-origin IAV lineage has been circulating for >60 years . In 2018/19, a Florida Clade 1 (FC1) virus triggered one of the largest epizootics recorded in the UK , which led to the replacement of the Equine Influenza Virus (EIV) Florida Clade 2 (FC2) lineage that had been circulating in the country since 2003. We integrated geographical, epidemiological, and virus genetic data to determine the virological and ecological factors leading to this epizootic. By combining newly-sequenced EIV complete genomes derived from UK outbreaks with existi...

Abstract Background A surge of cases of Corynebacterium diphtheriae infection was observed in reception centers for migrants in Europe beginning in the summer of 2022. Most of the cases were cutaneous , although some respiratory cases as well as one death were reported. A pan-European consortium was created to assess the clinical, epidemiologic, and microbiologic features of this outbreak. Methods We assessed cases of toxigenic C. diphtheriae infection that were reported in 10 European countries from January through November 2022. Data regarding countries of origin and transit routes were obtained from interviews with the patients. Whole-genome sequencing and antimicrobial-susceptibility testing were performed on bacterial isolates that were obtained from the patients. The phylogenetic relationships of the isolates and their antimicrobial-resistance genes were evaluated. Results A total of 363 toxigenic C. diphtheriae isolates were identified among 362 patients during the study period....

ABSTRACT H1 and H3 influenza A viruses (IAVs) circulating in European pigs are markedly distinct from those circulating in other global swine populations . These viruses exhibit significant genetic diversity , further expanded by periodic interspecies transmission of IAVs from humans into pigs , followed by sustained circulation. Several zoonotic IAV infections in humans in Europe have been associated with the 1C lineage of H1 IAVs . Given the predominance of H1 detections in pigs and their zoonotic potential, we quantified antigenic evolution of H1 viruses in European pigs using ferret and pig models and assessed diversity relative to swine IAV vaccine strains. Ferret and swine antisera comparisons revealed no significant differences in antibody responses . Viruses of the 1A.3.3.2 clade exhibited reduced cross-reactivity to human seasonal vaccine strains from 2009. Viruses of the 1B.1.2.2 clade showed no cross-reactivity to the 1978 human seasonal influenza viruses nor to candidate va...

Abstract H5Nx clade 2.3.4.4b high-pathogenicity avian influenza viruses (HPAIVs) have decimated wild bird and poultry populations globally since the autumn of 2020. In the United Kingdom (UK) and in continental Europe , the H5N8 subtype predominated during the first epizootic wave of 2020/21 , with few detections of H5N1. However, during the second (2021/22) and third (2022/23) epizootic waves, H5N1 was the dominant subtype. The rapid shift in dominance from H5N8 to H5N1 was likely driven by a combination of virological, immunological, and/or host-related factors. In this study, we compared viral fitness and immunological responses in ducks , a key reservoir species, using dominant genotypes of H5N1 (genotype AB) and H5N8 (genotype A) from the second wave. While viral shedding dynamics were similar for both viruses, H5N8 was more pathogenic . Antigenic analysis of post-infection duck sera revealed that the haemagglutinin (HA) protein was antigenically similar across clade 2.3.4.4b H5 H...

Abstract In Europe, highly pathogenic avian influenza (HPAI) virus circulates in avian wildlife, undergoing frequent reassortment , sporadic introductions in domestic birds , and spillover to mammals . An H5N1 clade 2.3.4.4b reassortant, EA-2023-DG, affecting wild and domestic birds was detected in western Europe in November 2023. Six of its RNA segments came from the EA-2021-AB genotype, but the polymerase basic 2 and polymerase acidic segments originated from low pathogenicity avian influenza viruses . Discrete phylogeographic analyses of concatenated genomes and single polymerase basic 2 and polymerase acidic segments suggested reassortment in summer 2023 near the southwestern Baltic Sea . Subsequent continuous phylogeographic analysis of all concatenated EA-2023-DG genomes highlighted circulation in northwestern Europe until June 2024 and long-distance dispersal toward France, Norway, England, Slovakia, Switzerland, and Austria . Those results illustrate the value of phylodynamic a...

Abstract Highly pathogenic avian influenza (HPAI) represents a threat to animal and human health , with the ongoing H5N1 outbreak within the H5 2.3.4.4b clade being the largest on record. However, it remains unclear what factors have contributed to its intercontinental spread . We use Bayesian additive regression trees, a machine learning method designed for probabilistic modelling of complex nonlinear phenomena, to construct species distribution models (SDMs) for HPAI clade 2.3.4.4b presence. We identify factors driving geospatial patterns of infection and project risk distributions across Europe . Our models are time-stratified to capture both seasonal changes in risk and shifts in epidemiology associated with the succession of H5N6/H5N8 by H5N1 within the clade . While previous studies aimed to model HPAI presence from physical geography, we explicitly consider wild bird ecology by including estimates of bird species richness, abundance of specific taxa, and "abundance indices...

Highlights •  Enterovirus D68 (EV-D68) was circulating in Europe in 2023 •  Most EV-D68 cases were captured through clinical EV surveillance •  Phylogenetic analysis of the VP1 region revealed a distinct B3-derived lineage •  The identified B3 lineage presented a previously undescribed residue change, D554E Abstract Background Enterovirus D68 (EV-D68) causes respiratory disease ranging from mild to severe and in rare cases a paralytic syndrome, called acute flaccid myelitis (AFM). Since the global EV-D68 outbreak in 2014, the virus has mainly circulated in biennial epidemic cycles with peaks detected during even years. However, following the COVID-19 pandemic, the seasonal pattern of EV-D68 has been characterized by large yearly upsurges . Here, we describe the circulation of EV-D68 in Europe in 2023 and track its genetic evolution. Study design Data was compiled from members of the European Non-Polio Network (ENPEN). This included monthly data on the total number of...

Abstract Background The direct and indirect impacts of the COVID-19 pandemic on life expectancy (LE) and years of life lost with and without disability remain unclear. Accounting for pre-pandemic trends in morbidity and mortality, we assessed these impacts in 18 European countries, for the years 2020–2022. Methods and Findings We used multi-state Markov modeling based on several data sources to track transitions of the population aged 35 or older between eight health states from disease-free, combinations of cardiovascular disease, cognitive impairment, dementia, and disability, through to death . We quantified separately numbers and rates of deaths attributable to COVID-19 from those related to mortality from other causes during 2020–2022, and estimated the proportion of loss of life expectancy and years of life with and without disability that could have been avoided if the pandemic had not occurred. Estimates were disaggregated by COVID-19 versus non-COVID causes of deaths, calendar...

Summary Background Arboviruses have expanded into new regions in Europe , yet data indicate gaps in disease notifications and a risk of further spread. We aimed to report on prevalence, clinical management, and outcomes of endemic arbovirus infections in southeast Europe. Methods In this prospective observational study (MERMAIDS-ARBO), we enrolled adults (age ≥18 years) hospitalised with an arbovirus-compatible disease syndrome within 21 days of symptom onset across 21 hospitals in seven countries in southeast Europe over four arbovirus seasons (May 1–Oct 31, during 2016–19). We obtained data from case report forms completed by site investigators on admission and discharge. Participants were excluded if they had non-infectious CNS disorders, symptoms of another confirmed cause, an identified focal source of infection, or symptoms caused by recurrence of a pre-existing condition. The primary outcome was the proportion of participants with confirmed or probable acute infections with West...

 {Excerpt} Abstract   Between 21 September and 6 December 2024 , 657 highly pathogenic avian influenza (HPAI) A(H5N1) and A(H5N5) virus detections were reported in domestic (341) and wild (316) birds across 27 countries in Europe . Many HPAI outbreaks in domestic birds were clustered in areas with high poultry density and characterised by secondary farm-to-farm spread . Waterfowl , particularly the mute swan , were primarily affected during this reporting period, with HPAI virus detections focused on south-eastern Europe . Notably, A(H5N5) viruses expanded their geographic and host range, resulting in a surge in detections and mortality events described in gulls and crows . No new HPAI virus detections in mammals were reported in Europe during this reporting period, but the number of dairy cattle farms reportedly affected in the United States of America (USA) rose to > 800 in 16 States, and HPAI virus was identified in two pigs in a mixed-species farm. Between 21 September ...