We describe an outbreak of Legionnaires’ disease linked to an exclusive cold-water source in a private residential setting in Yorkshire. The cold-water source was identified following microbiological testing of clinical and environmental samples. Legionella pneumophila was only detected in the cold-water system. Three cases were identified over the course of the outbreak: two confirmed and one probable. Conditions favourable to bacterial growth included system ‘dead legs’ and significant heat transfer to the cold-water system. We describe challenges in implementing control measures at the venue and highlight the importance of using enforcement powers, where necessary, to reduce risk.

Gastrointestinal infections significantly impact African low- and middle-income countries, although, accurate data on acute gastrointestinal illness (AGI) for all ages are lacking. This study aimed to describe the epidemiology of AGI in Ethiopia, Mozambique, Nigeria, and Tanzania. A population survey was conducted in one urban and one rural site per country, from 01 October 2020 to 30 September 2021, using web-based and face-to-face tools (n = 4417). The survey tool was adapted from high-income countries, ensuring comparability through an internationally recommended AGI case definition. Ethiopia had the highest AGI incidence (0.87 episodes per person-year), followed by Mozambique (0.58), Tanzania (0.41), and Nigeria (0.34). Age-standardized incidence was highest in Mozambique (1.46) and Ethiopia (1.25), compared to Tanzania (0.58) and Nigeria (0.33). The 4-week prevalence was 6.4% in Ethiopia and 4.3% in Mozambique, compared to 3.1% in Tanzania and 2.6% in Nigeria. AGI lasted an average of 5.3 days in Ethiopia and 3.0 to 3.4 days elsewhere. Children under five had 4.4 times higher AGI odds (95% CI: 2.8, 6.7) than those aged 15-59. The study provides empirical data on the incidence and demographic determinants of AGI in these four countries.

Post COVID-19 condition (PCC) refers to persistent symptoms occurring ≥12 weeks after COVID-19. This living systematic review (SR) assessed the impact of vaccination on PCC and vaccine safety among those with PCC, and was previously published with data up to December 2022. Searches were updated to 31 January 2024 and standard SR methodology was followed. Seventy-eight observational studies were included (47 new). There is moderate confidence that two doses pre-infection reduces the odds of PCC (pooled OR (pOR) 0.69, 95% CI 0.64–0.74, I2 = 35.16%). There is low confidence for remaining outcomes of one dose and three or more doses. A booster dose may further reduce the odds of PCC compared to only a primary series (pOR 0.85, 95% CI 0.74–0.98, I2 = 16.85%). Among children ≤18 years old, vaccination may not reduce the odds (pOR 0.79, 95% CI 0.56–1.11, I2 = 37.2%) of PCC. One study suggests that vaccination within 12 weeks post-infection may reduce the odds of PCC. For those with PCC, vaccination appears safe (four studies) and may reduce the odds of PCC persistence (pOR 0.73, 95% CI 0.57–0.92, I2 = 15.5%).

Hand, foot, and mouth disease (HFMD) shows spatiotemporal heterogeneity in China. A spatiotemporal filtering model was constructed and applied to HFMD data to explore the underlying spatiotemporal structure of the disease and determine the impact of different spatiotemporal weight matrices on the results. HFMD cases and covariate data in East China were collected between 2009 and 2015. The different spatiotemporal weight matrices formed by Rook, K-nearest neighbour (KNN; K = 1), distance, and second-order spatial weight matrices (SO-SWM) with first-order temporal weight matrices in contemporaneous and lagged forms were decomposed, and spatiotemporal filtering model was constructed by selecting eigenvectors according to MC and the AIC. We used MI, standard deviation of the regression coefficients, and five indices (AIC, BIC, DIC, R2, and MSE) to compare the spatiotemporal filtering model with a Bayesian spatiotemporal model. The eigenvectors effectively removed spatial correlation in the model residuals (Moran’s I < 0.2, p > 0.05). The Bayesian spatiotemporal model’s Rook weight matrix outperformed others. The spatiotemporal filtering model with SO-SWM was superior, as shown by lower AIC (92,029.60), BIC (92,681.20), and MSE (418,022.7) values, and higher R2 (0.56) value. All spatiotemporal contemporaneous structures outperformed the lagged structures. Additionally, eigenvector maps from the Rook and SO-SWM closely resembled incidence patterns of HFMD.

Health-related quality of life (HRQoL) in the context of COVID-19 is not fully understood. We assessed HRQoL using Patient-Reported Outcomes Measurement Information System® measures among 559 former COVID-19 patients and 298 non-infected individuals. HRQoL was captured once up to 2 years after the initial test. Additionally, we described associations of characteristics with impaired HRQoL. Overall, HRQoL scores were inferior among former patients. A meaningful group difference of at least three T-score points was discernible until 12 months after testing for fatigue (3.1), sleep disturbance (3.5), and dyspnoea (3.7). Cognitive function demonstrated such difference even at >18 months post-infection (3.3). Following dichotomization, pronounced differences in impaired HRQoL were observed in physical (19.2% of former patients, 7.3% of non-infected) and cognitive function (37.6% of former patients, 16.5% of non-infected). Domains most commonly affected among former patients were depression (34.9%), fatigue (37.4%), and cognitive function. Factors that associated with HRQoL impairments among former patients included age (OR ≤2.1), lower education (OR ≤5.3), and COVID-19-related hospitalization (OR ≤4.7), among others. These data underline the need for continued attention of the scientific community to further investigate potential long-term health limitations after COVID-19 to ultimately establish adequate screening and management options for those affected.

The efficacy of COVID-19 vaccines against the Delta variant has been observed to be high, both against severe disease and infection. The full population level vaccine effectiveness, however, also contains the indirect effects of vaccination, which require analysis of transmission dynamics to uncover. Finland was close to naïve to SARS-CoV-2 infections before the Delta dominant era, and non-pharmaceutical interventions (NPIs) were at an internationally low level. We utilize Finnish register data and a mathematical model for transmission and COVID-19 disease burden to construct a completely unvaccinated control population and estimate the different components of the vaccine effectiveness. The estimated direct effectiveness was 72% against COVID-19 cases and 87–96% against severe disease outcomes, but the estimated indirect effectiveness was even better, 93% against cases and 94–97% against severe disease. The total and overall effectiveness, including both direct and indirect effects of vaccination, were thus excellent. Our results show how well the population was protected by vaccination during the Delta era, especially by the indirect effectiveness, providing protection also to the unvaccinated part of the population. The estimated averted numbers of hospitalizations, ICU admissions, and deaths in Finland during the Delta era under the implemented NPIs were about 100 times the observed numbers.

Denmark is one of the leading countries in establishing digital solutions in the health sector. When SARS-CoV-2 arrived in February 2020, a real-time surveillance system could be rapidly built on existing infrastructure. This rapid data integration for COVID-19 surveillance enabled a data-driven response. Here we describe (a) the setup of the automated, real-time surveillance and vaccination monitoring system for COVID-19 in Denmark, including primary stakeholders, data sources, and algorithms, (b) outputs for various stakeholders, (c) how outputs were used for action and (d) reflect on challenges and lessons learnt. Outputs were tailored to four main stakeholder groups: four outputs provided direct information to individual citizens, four to complementary systems and researchers, 25 to decision-makers, and 15 informed the public, aiding transparency. Core elements in infrastructure needed for automated surveillance had been in place for more than a decade. The COVID-19 epidemic was a pressure test that allowed us to explore the system’s potential and identify challenges for future pandemic preparedness. The system described here constitutes a model for the future infectious disease surveillance in Denmark. With the current pandemic threat posed by avian influenza viruses, lessons learnt from the COVID-19 pandemic remain topical and relevant.

In 2022, an increase in invasive group A streptococcal (iGAS) infections was observed in the Netherlands. A particular increase was seen among children; therefore, we aimed to assess risk factors for iGAS infection in children aged 6 months to 5 years. A prospective case–control study was conducted between February and May 2023. We approached parents of notified iGAS cases to complete a questionnaire on exposures during 4 weeks prior to disease onset. Controls were recruited via social media and matched to cases on sex and birthyear. Conditional logistic regression was performed to estimate odds ratios (OR) of exposures. For the analysis, we included 18 cases and 103 controls. Varicella prior to onset of iGAS disease was reported in two (11%) cases and one (1%) control (OR: 12.0, 95% CI: 1.1–139.0). Exposure to group A streptococcal (GAS)-like illnesses such as impetigo, pharyngitis, and scarlet fever was reported in 8 (44%) cases and 15 (15%) controls (OR: 7.1, 95% CI: 1.8–29.0). Our findings are in line with previous studies by identifying varicella as a risk factor for iGAS among young children and highlight the association with non-invasive GAS infections in the community as a possible source of transmission.

Invasive group A Streptococcal (iGAS) outbreaks have been linked to Community Healthcare Services Delivered at Home (CHSDH). There is, however, very limited evidence describing the epidemiology and mortality of iGAS cases associated with CHSDH. We used routine data to describe iGAS cases in adults who had received CHSDH prior to onset and compare characteristics between CHSDH-outbreak and non-outbreak CHSDH cases, in South East England between December 2021 and December 2023. There were 80/898 (8.9%) iGAS case episodes with CHSDH prior to onset; cases were in elderly people (50% aged 85 and over), and had primarily received wound or ulcer care (93.8%), with almost all care delivered by community nurses (98.8%). The 30-day all-cause case fatality was 26.3%. Emm 1.0 was the most common type (17.5%). In this period, 5/11 iGAS outbreaks (45.4%) were CHSDH-associated, and 25 cases with receipt of CHSDH prior to onset (31.3%, Confidence Interval [CI] 21.3–42.6%) were linked to these outbreaks. On univariate analysis, CHSDH-outbreak case episodes were more likely to be associated with emm pattern genotype E (OR 6.1 95% CI 1.8–20.9), and skin or soft tissue infection clinical presentation (OR 3.6, 95% CI 1.1–12.0) than non-outbreak CHSDH cases. There may be an increased risk of propagation of iGAS outbreaks in patients receiving CHSDH, emphasizing the need for rigorous early infection prevention and control, and outbreak surveillance.

New-generation pneumococcal conjugate vaccines (PCVs) are available to replace PCV-13 for childhood and adult immunization. Besides cost-effectiveness evaluations which have highly variable results, the comparative immunogenicity of these new vaccines (PCV15, PCV20, PCV21) and their coverage of invasive pneumococcal disease (IPD) and carriage strains in different age-groups should be regarded as well as the antibody susceptibility, antibiotic resistance, invasiveness and virulence of serotypes included in each vaccine. Based on the Canadian experience, these topics are discussed. The optimal strategy would be a 2+1 PCV20 schedule for children, PCV21 for elderly adults and a dual PCV20+PCV21 schedule for adults at very high IPD risk. Shifting from PCV-13 to PCV-15 for children entails a risk of increased IPD incidence in adults because additional serotypes are of low virulence and could be replaced by more invasive and virulent serotypes. This risk can be reasonably excluded if PCV-20 replaces PCV-13 as the former covers additional serotypes being highly invasive and virulent. It is recognized that off-label use of PCV-20 according to a 2+1 schedule could be problematic for some jurisdictions as this is not authorized in all countries. In Canada, however, the 2+1 PCV20 schedule was authorized based on the same dataset submitted elsewhere.

Within an infrastructure to monitor vaccine effectiveness (VE) against hospitalization due to COVID-19 and COVID-19 related deaths from November 2022 to July 2023 in seven countries in real-world conditions (VEBIS network), we compared two approaches: (a) estimating VE of the first, second or third COVID-19 booster doses administered during the autumn of 2022, and (b) estimating VE of the autumn vaccination dose regardless of the number of prior doses (autumnal booster approach). Retrospective cohorts were constructed using Electronic Health Records at each participating site. Cox regressions with time-changing vaccination status were fit and site-specific estimates were combined using random-effects meta-analysis. VE estimates with both approaches were mostly similar, particularly shortly after the start of the vaccination campaign, and showed a similar timing of VE waning. However, autumnal booster estimates were more precise and showed a clearer trend, particularly compared to third booster estimates, as calendar time increased after the vaccination campaign and during periods of lower SARS-CoV-2 activity. Moreover, the decrease in protection by increasing calendar time was more clear and precise than when comparing protection by number of doses. Therefore, estimating VE under an autumnal booster framework emerges as a preferred method for future monitoring of COVID-19 vaccination campaigns.

Methicillin-resistant Staphylococcus aureus (MRSA) spa type t4549 is increasingly prevalent in Denmark, yet its epidemiological sources remain unclear. This study aimed to generate hypotheses about possible risk factors that may be associated with MRSA t4549 infections. We conducted a nationwide case – case questionnaire study comparing MRSA t4549 cases to other MRSA types (t002, t008, t127, t304, and t223) reported between January 2022 and November 2023. The analysis, which included descriptive statistics and logistic regression, found that 75% of MRSA t4549 cases were male. Infections were significantly more frequent in the foot (28%) and toe (54%) compared to other MRSA types. Key risk factors identified were contact with pheasants (OR = 8.70; 95%CI 1.25–174.29), participation in indoor team sports (OR = 7.54, 95%CI: 1.58–54.82) and swimming (OR = 4.15, 95%CI: 1.97–9.03). Although the limited number of cases warrants cautious interpretation, it is crucial to emphasize the need for preventive measures at both the individual and sports facility levels. Further environmental studies are needed to clarify the role of the environment and wildlife in MRSA t4549 transmission. The increasing prevalence of this spa type in Denmark underlines the importance of implementing effective public health strategies to reduce the risk of MRSA transmission.

The study aimed to delve into the incidence and risk factors associated with myocarditis and pericarditis following SARS-COV-2-19 vaccination, addressing a notable gap in understanding the safety profile of vaccinations. Through meticulous data selection from the National Health Insurance System (NHIS) database of Korea, the researchers employed both a case-crossover study and a nested case-control design to analyze temporal patterns and risk factors related to carditis occurrences post-immunization. Key findings revealed a significant association between SARS-COV-2-19 vaccination and the occurrence of carditis, with a strong temporal correlation observed within 10 days post-vaccination. Noteworthy factors contributing to carditis risk included the duration between vaccination and carditis, specific comorbidities and medication use. The study concluded by recommending an extended post-vaccination surveillance duration of at least 10 days and underscored the importance of considering individual medical histories and concurrent medication use in assessing vaccine-induced carditis risk. This study might contribute to understanding vaccine safety profiles and emphasizes the significance of comprehensive post-vaccination monitoring protocols.

Leptospira are bacteria that cause leptospirosis in both humans and animals. Human Leptospira infections in Uganda are suspected to arise from animal–human interactions. From a nationwide survey to determine Leptospira prevalence and circulating sequence types in Uganda, we tested 2030 livestock kidney samples, and 117 small mammals (rodents and shrews) using real-time PCR targeting the lipL32 gene. Pathogenic Leptospira species were detected in 45 livestock samples but not in the small mammals. The prevalence was 6.12% in sheep, 4.25% in cattle, 2.08% in goats, and 0.46% in pigs. Sequence typing revealed that Leptospira borgpetersenii, Leptospira kirschneri, and Leptospira interrogans are widespread across Uganda, with 13 novel sequence types identified. These findings enhance the East African MLST database and support the hypothesis that domesticated animals may be a source of human leptospirosis in Uganda, highlighting the need for increased awareness among those in close contact with livestock.

This study examined global trends in influenza-associated lower respiratory infections (LRIs) deaths from 1990 to 2019 using data from the GBD 2019. The annual percentage change (APC) and average annual percentage change (AAPC) were used to analyze age-standardized death rates (ASDR). Globally, the ASDR of influenza-associated LRIs was 3.29/100,000 in 2019, which was higher in the African region (6.57/100,000) and among adults aged 70 years and older (29.88/100,000). The ASDR of influenza-associated LRIs decreased significantly from 1990 to 2019 (AAPC = −1.88%, P < 0.05). However, it was significantly increased among adults aged 70 years and older during 2017–2019 (APC = 2.31%, P < 0.05), especially in Western Pacific Region and South-East Asia Regions. The ratio of death rates between adults aged 70 years and older and children aged under 5 years increased globally from 1.63 in 1990 to 5.34 in 2019, and the Western Pacific Region experienced the most substantial increase, with the ratio soaring from 1.83 in 1990 to 12.98 in 2019. Despite a decline in the global ASDR of influenza-associated LRIs, it continues to impose a significant burden, particularly in the African, Western Pacific regions and among the elderly population.

The study aims were to present in vitro susceptibilities of clinical isolates from Gram-negative bacteria bloodstream infections (GNBSI) collected in China. GNBSI isolates were collected from 18 tertiary hospitals in 7 regions of China from 2018 to 2020. Minimum inhibitory concentrations were assessed using a Trek Diagnostic System. Susceptibility was determined using CLSI broth microdilution, and breakpoints were interpreted using CLSI M100 (2021). A total of 1,815 GNBSI strains were collected, with E. coli (42.4%) and Klebsiella pneumoniae (28.6%) being the most prevalent species, followed by P. aeruginosa (6.7%). Susceptibility analyses revealed low susceptibilities (<40%) of ESBL-producing E. coli and K. pneumonia to third-/fourth-generation cephalosporins, monobactamases, and fluoroquinolones. High susceptibilities to colistin (95.0%) and amikacin (81.3%) were found for K. pneumoniae, while Acinetobacter baumannii exhibited a high susceptibility (99.2%) to colistin but a low susceptibility to other antimicrobials (<27.5%). Isolates from ICUs displayed lower drug susceptibility rates of K. pneumoniae and A. baumannii than isolates from non-ICUs (all P < 0.05). Carbapenem-resistant and ESBL-producing K. pneumoniae detection was different across regions (both P < 0.05). E. coli and K. pneumoniae were major contributors to GNBSI, while A. baumannii exhibited severe drug resistance in isolates obtained from ICU departments.

The H3N2 canine influenza virus (CIV) emerged from an avian reservoir in Asia to circulate entirely among dogs for the last 20 years. The virus was first seen circulating outside Asian dog populations in 2015, in North America. Utilizing viral genomic data in addition to clinical reports and diagnostic testing data, we provide an updated analysis of the evolution and epidemiology of the virus in its canine host. CIV in dogs in North America is marked by a complex life history – including local outbreaks, regional lineage die-outs, and repeated reintroductions of the virus (with diverse genotypes) from different regions of Asia. Phylogenetic and Bayesian analysis reveal multiple CIV clades, and viruses from China have seeded recent North American outbreaks, with 2 or 3 introductions in the past 3 years. Genomic epidemiology confirms that within North America the virus spreads very rapidly among dogs in kennels and shelters in different regions – but then dies out locally. The overall epidemic therefore requires longer-distance dispersal of virus to maintain outbreaks over the long term. With a constant evolutionary rate over 20 years, CIV still appears best adapted to transmission in dense populations and has not gained properties for prolonged circulation among dogs.