Stockholm, Sweden
Stockholm, Sweden

Time filter

Source Type

Harbarth S.,University of Geneva | Hawkey P.M.,University of Birmingham | Tenover F.,Cepheid Inc. | Stefani S.,University of Catania | And 2 more authors.
International Journal of Antimicrobial Agents | Year: 2011

Based on the failure of conventional control strategies, some experts and public health officials have promoted active screening to detect asymptomatic carriers of meticillin-resistant Staphylococcus aureus (MRSA) as an effective prevention strategy. Data regarding the (cost-) effectiveness of MRSA screening have recently grown and have produced mixed results. Several clinical studies have not only provided conflicting findings but have also raised numerous issues about the appropriate populations for universal versus targeted screening, screening method(s) and intervention(s). It must also be emphasised that screening alone is not effective. Results should be followed by appropriate interventions to reduce the risk of MRSA transmission and infection. We believe a reasonable approach in most European hospitals with an MRSA on-admission prevalence of <5% is to use targeted rather than universal screening (predominantly with chromogenic media, except for high-risk units and critically ill patients for whom molecular tests could be cost effective), after carefully considering the local MRSA epidemiology, infection control practices and vulnerability of the patient population. This strategy is likely to be cost effective if linked to prompt institution of control measures. © 2010 Elsevier B.V. and the International Society of Chemotherapy.


Semenza J.C.,Scientific Advice Unit | Ploubidis G.B.,London School of Hygiene and Tropical Medicine | George L.A.,Portland State University
Environmental Health: A Global Access Science Source | Year: 2011

Background: Global climate change impacts on human and natural systems are predicted to be severe, far reaching, and to affect the most physically and economically vulnerable disproportionately. Society can respond to these threats through two strategies: mitigation and adaptation. Industry, commerce, and government play indispensable roles in these actions but so do individuals, if they are receptive to behavior change. We explored whether the health frame can be used as a context to motivate behavioral reductions of greenhouse gas emissions and adaptation measures. Methods. In 2008, we conducted a cross-sectional survey in the United States using random digit dialing. Personal relevance of climate change from health threats was explored with the Health Belief Model (HBM) as a conceptual frame and analyzed through logistic regressions and path analysis. Results: Of 771 individuals surveyed, 81% (n = 622) acknowledged that climate change was occurring, and were aware of the associated ecologic and human health risks. Respondents reported reduced energy consumption if they believed climate change could affect their way of life (perceived susceptibility), Odds Ratio (OR) = 2.4 (95% Confidence Interval (CI): 1.4 - 4.0), endanger their life (perceived severity), OR = 1.9 (95% CI: 1.1 - 3.1), or saw serious barriers to protecting themselves from climate change, OR = 2.1 (95% CI: 1.2 - 3.5). Perceived susceptibility had the strongest effect on reduced energy consumption, either directly or indirectly via perceived severity. Those that reported having the necessary information to prepare for climate change impacts were more likely to have an emergency kit OR = 2.1 (95% CI: 1.4 - 3.1) or plan, OR = 2.2 (95% CI: 1.5 -3.2) for their household, but also saw serious barriers to protecting themselves from climate change or climate variability, either by having an emergency kit OR = 1.6 (95% CI: 1.1 - 2.4) or an emergency plan OR = 1.5 (95%CI: 1.0 - 2.2). Conclusions: Motivation for voluntary mitigation is mostly dependent on perceived susceptibility to threats and severity of climate change or climate variability impacts, whereas adaptation is largely dependent on the availability of information relevant to climate change. Thus, the climate change discourse could be framed from a health perspective to motivate behaviour change. © 2011 Semenza et al; licensee BioMed Central Ltd.


Bauer M.P.,National Institute for Public Health and the Environment | Bauer M.P.,Leiden University | Notermans D.W.,National Institute for Public Health and the Environment | Van Benthem B.H.,National Institute for Public Health and the Environment | And 6 more authors.
The Lancet | Year: 2011

Little is known about the extent of Clostridium difficile infection in Europe. Our aim was to obtain a more complete overview of C difficile infection in Europe and build capacity for diagnosis and surveillance. We set up a network of 106 laboratories in 34 European countries. In November, 2008, one to six hospitals per country, relative to population size, tested stool samples of patients with suspected C difficile infection or diarrhoea that developed 3 or more days after hospital admission. A case was defined when, subsequently, toxins were identified in stool samples. Detailed clinical data and stool isolates were collected for the first ten cases per hospital. After 3 months, clinical data were followed up. The incidence of C difficile infection varied across hospitals (weighted mean 4·1 per 10 000 patient-days per hospital, range 0·0-36·3). Detailed information was obtained for 509 patients. For 389 of these patients, isolates were available for characterisation. 65 different PCR ribotypes were identified, of which 014/020 (61 patients [16]), 001 (37 [9]), and 078 (31 [8]) were the most prevalent. The prevalence of PCR-ribotype 027 was 5. Most patients had a previously identified risk profile of old age, comorbidity, and recent antibiotic use. At follow up, 101 (22) of 455 patients had died, and C difficile infection played a part in 40 (40) of deaths. After adjustment for potential confounders, an age of 65 years or older (adjusted odds ratio 3·26, 95 CI 1·08-9·78; p=0·026), and infection by PCR-ribotypes 018 (6·19, 1·28-29·81; p=0·023) and 056 (13·01; 1·14-148·26; p=0·039) were significantly associated with complicated disease outcome. PCR ribotypes other than 027 are prevalent in European hospitals. The data emphasise the importance of multicountry surveillance to detect and control C difficile infection in Europe. European Centre for Disease Prevention and Control. © 2011 Elsevier Ltd.


Ebi K.L.,Stanford University | Lindgren E.,Karolinska Institutet | Suk J.E.,Scientific Advice Unit | Semenza J.C.,Scientific Advice Unit
Climatic Change | Year: 2013

Climate change has the potential to increase the challenge of preventing and controlling outbreaks of infectious diseases. An adaptation assessment is an important aspect of designing and implementing policies and measures to avoid, prepare for, and effectively respond to infectious diseases outbreaks. The main steps in conducting an adaptation assessment include: 1) evaluating the effectiveness of policies and measures that address the burden of climate-sensitive infectious diseases; 2) identifying options to manage the health risks of current and projected climate change; 3) evaluating and prioritizing the options; 4) identifying human and financial resources needs, and possible barriers, constraints, and limits to implementation; and 5) developing monitoring and evaluation programs to ensure continued effectiveness of policies and measures in a changing climate. Optimally, relevant stakeholders are optimally included throughout the adaptation assessment. Although the process of conducting an assessment is similar across nations and regions, the context and content will vary depending on local circumstances, socioeconomic conditions, legal and regulatory frameworks, and other factors. The European Centers for Disease Prevention and Control developed guidelines for conducting assessments, with sufficient consistency to facilitate learning lessons across assessments. © 2012 Springer Science+Business Media Dordrecht.


Manissero D.,Scientific Advice Unit | Hollo V.,Surveillance Unit | Huitric E.,Scientific Advice Unit | Kodmon C.,Surveillance Unit | Amato-Gauci A.,Surveillance Unit
Eurosurveillance | Year: 2010

An analysis of surveillance data was performed to assess treatment outcomes of patients belonging to selected calendar year cohorts. Twenty-two countries in the European Union (EU) and European Economic Area (EEA) reported treatment outcome monitoring data for culture-confirmed pulmonary tuberculosis (TB) cases reported in 2007. The overall treatment success rate was 73.8% for all culture-confirmed pulmonary cases and 79.5% for new culture-confirmed pulmonary cases. For the cohort of new culture-confirmed TB cases, only three countries achieved the target of 85% success rate. This underachievement appears to be a result of relative high defaulting and unknown outcome information. Case fatality remains high particularly among cases of national origin. This factor appears attributable to advanced age of the national cohort. Treatment outcomes for multidrug-resistant tuberculosis were reported by 15 countries, with a range of 19.8% to 100% treatment success at 24 months. The data underline the urgent need for strengthening treatment outcome monitoring in the EU and EEA in order to ensure an effective programme implementation and case management that will ultimately contribute to TB elimination.


Llor C.,Primary Healthcare Center Jaume I | Monnet D.L.,Scientific Advice Unit | Cots J.M.,Primary Healthcare Center La Marina
Eurosurveillance | Year: 2010

The aim of this study was to explore the relationship between pharmacy size and the likelihood of obtaining antibiotics without medical prescription at a pharmacy. In 2008 in Catalonia, two actors presented three different cases in a randomised sample of pharmacies and asked pharmacists for an antibiotic. Pharmacies were considered as small when having limited space with only one counter and a maximum of two professionals selling medicines, as medium sized with three or four attending professionals, and as large with a large selling space and more than four attending professionals. Of the 197 pharmacies visited, 88 (44.7%) were considered as small while only 25 (12.7%) were large. Antibiotics were obtained without a medical prescription in 89 (45.2%) pharmacies, mainly in small pharmacies (63.6%), followed by medium-sized pharmacies (35.7%) and large pharmacies (12%) (p<0.001). Large pharmacies, that probably have a greater income, more closely followed the prevailing legislation of not selling antibiotics to patients without a medical prescription. This observation should now be confirmed in other countries where over-the-counter sales of antibiotics are prevalent and should be taken into account by programmes aiming at achieving a more prudent use of antibiotics.


Struelens M.J.,Scientific Advice Unit | Monnet D.L.,Scientific Advice Unit
Infection Control and Hospital Epidemiology | Year: 2010

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of disease across Europe, except for Scandinavian countries and the Netherlands. Recently, MRSA incidence has decreased in many European countries following national interventions, including structural and regulatory changes in health care, promotion of hand hygiene, antibiotic stewardship, and targeted screening, isolation, and decolonization of hospitalized carriers of MRSA. © 2010 by The 5th Decennial on Healthcare-Associated Infections, LLC. All rights reserved.


Semenza J.C.,Scientific Advice Unit
Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin | Year: 2010

Systematic health inequalities exist in all European countries today. Individuals with lower socio-economic status suffer disproportionally from adverse health outcomes. While this is widely accepted for chronic diseases, a literature review covering the years 1999-2010 reveals that infectious diseases are also distributed unevenly throughout society, with vulnerable groups bearing a disproportionate burden. This burden is not restricted to a few 'signature infections of social determinants' such as tuberculosis or human immunodeficiency virus (HIV) infections, but also a wide array of other infectious diseases. Tremendous advances in public health over the last century have reduced the absolute magnitude of inequalities but relative differences remain. In order to explore the underlying reasons for such persistent inequalities in Europe, I examined interventions targeting social determinants of infectious diseases: interventions on social determinants tend to focus on chronic diseases rather than infectious diseases, and interventions for these mainly focus on HIV/AIDS or other sexually transmitted infections. Thus, there seems to be a need to intervene on inequalities in infectious diseases but ideally with a comprehensive public health approach. Three intervention strategies are discussed: population-at-risk, population, and vulnerable population approaches. Strengths and weaknesses of these options are illustrated.


Manissero D.,Scientific Advice Unit
Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin | Year: 2010

An analysis of surveillance data was performed to assess treatment outcomes of patients belonging to selected calendar year cohorts. Twenty-two countries in the European Union (EU) and European Economic Area (EEA) reported treatment outcome monitoring data for culture-confirmed pulmonary tuberculosis (TB) cases reported in 2007. The overall treatment success rate was 73.8% for all culture-confirmed pulmonary cases and 79.5% for new culture-confirmed pulmonary cases. For the cohort of new culture-confirmed TB cases, only three countries achieved the target of 85% success rate. This underachievement appears to be a result of relative high defaulting and unknown outcome information. Case fatality remains high particularly among cases of national origin. This factor appears attributable to advanced age of the national cohort. Treatment outcomes for multidrug-resistant tuberculosis were reported by 15 countries, with a range of 19.8% to 100% treatment success at 24 months. The data underline the urgent need for strengthening treatment outcome monitoring in the EU and EEA in order to ensure an effective programme implementation and case management that will ultimately contribute to TB elimination.


Deplano A.,Free University of Colombia | Denis O.,Free University of Colombia | Rodriguez-Villalobos H.,Free University of Colombia | Rodriguez-Villalobos H.,Catholic University of Louvain | And 4 more authors.
Journal of Clinical Microbiology | Year: 2011

Fast, reliable, and versatile typing tools are essential to differentiate among related bacterial strains for epidemiological investigation and surveillance of health care-associated infection with multidrug-resistant (MDR) pathogens. The DiversiLab (DL) system is a semiautomated repetitive-sequence- based PCR system designed for rapid genotyping. The DL system performance was assessed by comparing its reproducibility, typeability, discriminatory power, and concordance with those of pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) and by assessing its epidemiological concordance on well-characterized MDR bacterial strains (n = 165). These included vanA Enterococcus faecium, extended-spectrum β-lactamase (ESBL)-producing strains of Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii, and ESBL- or metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa strains. The DL system showed very good performance for E. faecium and K. pneumoniae and good performance for other species, except for a discrimination index of <95% for A. baumannii and E. coli (93.9% and 93.5%, respectively) and incomplete concordance with MLST for P. aeruginosa (78.6%) and E. coli (97.0%). Occasional violations of MLST assignment by DL types were noted for E. coli. Complete epidemiological concordance was observed for all pathogens, as all outbreak-associated strains clustered in identical DL types that were distinct from those of unrelated strains. In conclusion, the DL system showed good to excellent performance, making it a reliable typing tool for investigation of outbreaks caused by study pathogens, even though it was generally less discriminating than PFGE analysis. For E. coli and P. aeruginosa, MLST cannot be reliably inferred from DL type due to phylogenetic group violation or discordance. Copyright © 2011, American Society for Microbiology. All Rights Reserved.

Loading Scientific Advice Unit collaborators
Loading Scientific Advice Unit collaborators