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- ADELIA–Acidentes Domésticos e de Lazer: Informação Adequada : relatório 2003Publication . Nunes, Baltazar; Brandão, João; Valadares, IsabelO sistema ADÉLIA – Acidentes Domésticos e de Lazer Informação Adequada, foi criado em 2000, e é coordenado pelo Observatório Nacional de Saúde do Instituto Nacional de Saúde Dr. Ricardo Jorge. Em termos sucintos é um sistema de recolha de informação sobre acidentes domésticos e de lazer (ADL) que implicaram recurso às urgências das unidades de saúde do Serviço Nacional de Saúde. Este sistema é desenvolvido em estreita colaboração com o Instituto de Gestão Informática e Financeira da Saúde (IGIF). Mais especificamente os principais objectivos do sistema ADÉLIA são: · a curto prazo: determinar frequências e tendências dos ADL em geral e das suas diversas formas, bem como as características das vítimas, das situações e dos agentes envolvidos; · a um prazo mais dilatado: identificar situações de risco, bem como produtos perigosos, que propiciem a ocorrência de ADL; estabelecendo assim uma base de apoio para a definição de políticas de prevenção baseadas na evidência. O presente relatório tem como objectivo a apresentação de uma análise descritiva dos dados recolhidos pelo sistema ADÉLIA durante o ano de 2003.
- Annual epidemiological report Reporting on 2009 surveillance data and 2010 epidemic intelligent dataPublication . European Center for Disease Prevention and ControlThis edition of the Annual Epidemiological Report presents the surveillance data reported to ECDC for 2009 and an analysis of the public health threats detected in 2010 through ECDC’s routine epidemic intelligence. It provides an overview of communicable diseases in the European Union and describes areas where a more concerted public health response is required in order to decrease the burden of disease on society and healthcare systems.
- Antimicrobial resistance surveillance in Europe 2010. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net)Publication . EARS-Net Management Team & National representatives of EARS-NetAntimicrobial resistance data reported to EARS-Net by 28 countries in 2010 and trend analyses including EARSS data from previous years, show that the Europewide increase of antimicrobial resistance observed in Escherichia coli during recent years is continuing unimpeded. The highest resistance proportions in E. coli were reported for aminopenicillins ranging up to 83 %. Despite the already high level of resistance the increase continues even in countries presenting resistance well above 50 %. The percentage of third-generation cephalosporin resistance reported among E. coli isolates has increased significantly over the last four years in half of the reporting countries, while a decreasing trend was observed in only one country. This resistance is directly linked to the high proportions (65–100 %) of ESBL-positives among cephalosporin-resistant E. coli isolates reported in 2010. A high frequency of multi-drug resistant Klebsiella pneumoniae was observed in southern, central and eastern Europe. In half of the reporting countries, the proportion of multiresistant K. pneumoniae isolates (combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides) was above 10 % and five countries show an increasing trend of carbapenem resistant K. pneumoniae. Carbapenems have been widely used in many countries due to the increasing rate of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae with a consequent impact on the emergence of carbapenemase production (VIM, KPC and NDM-1). Other trends in the occurrence of resistance reported to EARS-Net bring hope that national efforts on infection control and efforts targeted at containment of resistance may in some cases bring the development of resistance to a halt, or even reverse undesirable resistance trends, as exemplified by the development for meticillin-resistant Staphylococcus aureus (MRSA). Even though the proportion of MRSA among S. aureus is still above 25 % in eight out of 28 countries, the occurrence of MRSA is stabilising or decreasing in some countries and a sustained decrease has been observed in Austria, France, Ireland, Latvia, the UK and Cyprus. Furthermore, the United Kingdom has shown a consistent reduction of resistant proportions in K. pneumoniae for all antimicrobial classes under surveillance, and in a few countries (Germany, Greece, Italy and the UK) the efforts to control glycopeptide resistance in Enterococcus faecium seem to be successful and resulting in a continuous decrease of proportions of resistant isolates. Meanwhile, high-level aminoglycoside resistance in Enterococcus faecalis is stabilising in Europe at a level of 25–50%. For Streptococcus pneumoniae, non-susceptibility to penicillin remains generally stable in Europe and non-susceptibility to macrolides has declined in five countries while an increasing trend was observed in only one country. For Pseudomonas aeruginosa, high proportions of resistance to fluoroquinolones, carbapenems and combined resistance have been reported by many countries, especially in southern and eastern Europe. For several antimicrobial and pathogen combinations, e.g. fluoroquinolone resistance in E. coli, K. pneumoniae, P. aeruginosa and for MRSA, a north to south gradient is evident in Europe. In general, lower resistance proportions are reported in the north and higher proportions in the south of Europe. This is likely to be a reflection of differences in infection control practices, presence or absence of legislation regarding prescription of antimicrobial drugs. However, for K. pneumoniae, increasing trends of resistance to specific antimicrobial classes and of multiresistance have also been observed in northern European countries, like Denmark and Norway, which traditionally have a prudent approach to antimicrobial use. In addition to the regular trend analysis and situation overview, this 2010 EARS-Net report contains a focus chapter providing in-depth analysis for carbapenem resistant K. pneumoniae and P. aeruginosa. Results from susceptibility testing to carbapenems for these two pathogens reported since 2005, reveal a significant decrease of susceptibility to carbapenems in invasive K. pneumoniae over the period 2005–2010. Carbapenems are some of the few effective antimicrobials for the treatment of infections caused by bacteria that produce extended-spectrum beta-lactamases and thus resistance to carbapenems leaves very few therapeutic options available. Based on EARS-Net data, the antimicrobial resistance situation in Europe displays large variation depending on pathogen type, antimicrobial substance and geographical region. Besides evidence of stabilisation of the situation for some pathogens (e.g. MRSA) in a number of countries, the data show the unimpeded decline of antimicrobial susceptibility in other major pathogens (e.g. E. coli) and the alarming emergence of carbapenem resistance in K. pneumonia, leading to an unfortunate loss of antimicrobial treatment options.
- Antimicrobial resistance surveillance in Europe 2011. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net)Publication . EARS-Net Management Team & National representatives of EARS-NetThe results presented in this report are based on antimicrobial resistance data from invasive isolates reported to EARS-Net by 29 EU/EEA countries in 2012 (data referring to 2011), and on trend analyses of EARSS/EARS-Net data reported by the participating countries during the period 2008 to 2011. The results show a general Europe-wide increase of antimicrobial resistance in the gram-negative pathogens under surveillance (Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa), whereas the occurrence of resistance in the gram-positive pathogens (Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis) appears to be stabilising or even decreasing in some countries. For most pathogen–antimicrobial combinations, large inter-country variations are evident. In 2011, the most alarming evidence of increasing antimicrobial resistance in Europe came from data on combined resistance (resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides) in E. coli and in K. pneumoniae. For both of these pathogens, more than one third of the reporting countries had significantly increasing trends of combined resistance over the last four years. The high and increasing percentage of combined resistance observed for K. pneumoniae means that for some patients with life-threatening infections, only a few therapeutic options remain available, e.g. carbapenems. However since 2010, carbapenem-resistance has increased in a number of countries, further aggravating the situation. For P. aeruginosa, combined resistance is also common, with 15% of the isolates resistant to at least three of the antimicrobial classes under surveillance. The seemingly unimpeded increase of antimicrobial resistance in the major gram-negative pathogens will unavoidably lead to loss of therapeutic treatment options. In parallel, other trends of antimicrobial resistance reported to EARS-Net indicate that national efforts on infection control and containment of resistance are effective, as illustrated by the trends for meticillinresistant S. aureus (MRSA), antimicrobial-resistant S. pneumoniae and antimicrobial-resistant enterococci, for which the situation appears generally stable or even improving in some countries. For MRSA, these observations are consistent with reports from the national surveillance programmes of some Member States and recent scientific studies on the results of infection control efforts. Large inter-country variations can be noted for S. pneumoniae, but non-susceptibility to commonly used antimicrobials has remained relatively stable in Europe during recent years, and this observation was confirmed by the 2011 data. High-level aminoglycoside resistance in E. faecalis seems stable in Europe and several countries which previously reported relatively high levels of resistance now have decreasing trends. Likewise, the occurrence of vancomycin-resistance in E. faecium is stabilising or decreasing. For several antimicrobial–pathogen combinations, e.g. fluoroquinolone-resistance in E. coli, K. pneumoniae, P. aeruginosa and for MRSA, a north-to-south gradient is evident in Europe. In general, lower resistance percentages are reported in the north and higher percentages in the south of Europe. These geographical differences may reflect differences in infection control practices and antimicrobial use in the reporting countries. Prudent use of antimicrobial agents and comprehensive infection control measures should be cornerstones of effective prevention and control efforts aimed at reducing the selection and transmission of antimicrobial-resistant bacteria.
- Antimicrobial resistance surveillance in Europe 2013: Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net)Publication . European Antimicrobial Resistance Surveillance Network (EARS-Net)The results presented in this report are based on antimicrobial resistance data from invasive isolates reported to EARS-Net by 30 EU/EEA countries in 2014 (data referring to 2013), and on trend analyses of EARS-Net data reported by the participating countries during the period 2010 to 2013. The antimicrobial resistance situation in Europe displays large variations depending on bacteria, antimicrobial group and geographical region. For several antimicrobial group and bacterium combinations, a north-to-south and west-to-east gradient is evident in Europe. In general, lower resistance percentages are reported by countries in the north and higher percentages reported by countries in the south and east of Europe. Overall, the most concerning trends in Europe in 2013 were related to the occurrence of resistance in gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter species). For E. coli and K. pneumoniae, a continuous increase in resistance to key antimicrobial groups was noted. A majority of the isolates reported to EARS-Net in 2013 was resistant to at least one of the antimicrobial groups under surveillance, and many of these showed combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides. Over the last four years (2010 to 2013), resistance to third-generation cephalosporins in K. pneumoniae and E. coli increased significantly at EU/EEA level, as well as in many of the individual Members States. Many of the isolates resistant to third-generation cephalosporins were ESBL-positive and showed resistance to additional antimicrobial groups. In addition, resistance to fluoroquinolones, aminoglycosides and carbapenems, as well as combined resistance to fluoroquinolones, third-generation cephalosporins and aminoglycosides increased significantly at EU/EEA level for K. pneumoniae, but not for E. coli. Interestingly, there was a decrease in fluoroquinolone resistance in P. aeruginosa, which was seen for both the EU/EEA population-weighted mean percentage as well as in the trends for several individual countries, whereas fluoroquinolone resistance increased in K. pneumoniae. While the EU/EEA population-weighted mean for carbapenem resistance was 8.3% for K. pneumoniae, carbapenem resistance remained very low in E. coli (0.2%). However, five countries reported trends of increasing carbapenem resistance in E. coli in 2013; four of them belonging to the countries with the highest levels of resistance. Carbapenem resistance and resistance to multiple antimicrobial groups were also common in Pseudomonas aeruginosa and Acinetobacter spp. isolates. Data for polymyxin resistance (colistin and polymyxin B) were limited but indicated the presence of polymyxin resistance in all gram-negative bacterial species included in EARS-Net reporting, especially in countries with already high levels of carbapenem resistance. Resistance trends for gram-positive bacteria showed a more diverse pattern across Europe. For meticillin-resistance in Staphylococcus aureus (MRSA), the population-weighted EU/EEA mean has decreased significantly over the last four years. The decrease has, however, been less pronounced compared with the previous four-year period. The trends for Streptococcus pneumoniae were generally stable, but with large inter-country variations in the percentage of resistant isolates. Macrolide non-susceptibility in S. pneumoniae was, for most countries, higher than the percentages for penicillin-non-susceptibility. For enterococci, the population-weighted EU/EEA mean percentage for vancomycin resistance in E. faecium increased significantly between 2010 and 2013. The decrease in the percentage of high-level aminoglycoside resistant E. faecalis observed in a number of countries in recent years continued in 2013, although the populationweighted EU/EEA mean showed no significant change.
- Antimicrobial resistance surveillance in Europe 2015: annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net)Publication . EARS-Net Management Team & National representativesThe results presented in this report are based on antimicrobial resistance data from invasive isolates reported to EARS-Net by 30 EU/EEA countries in 2016 (data referring to 2015), and on trend analyses of data reported by the participating countries for the period 2012–2015. As in previous years, the antimicrobial resistance situation in Europe displays wide variations depending on the bacterial species, antimicrobial group and geographical region. For several species–antimicrobial group combinations, a north-to-south and west-to-east gradient is evident in Europe. In general, lower resistance percentages are reported by countries in the north and higher percentages by countries in the south and east of Europe. These differences are most likely related to differences in antimicrobial use, infection prevention, infection control practices, and healthcare utilisation patterns in the countries.
- Antimicrobial resistance surveillance in Europe 2016: annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net)Publication . EARS-Net Management Team & National representativesThe results presented in this report are based on antimicrobial resistance data from invasive isolates reported to EARS-Net by 30 European Union (EU) and European Economic Area (EEA) countries in 2017 (data referring to 2016), and on trend analyses of data reported by the participating countries for the period 2013 to 2016. As in previous years, the antimicrobial resistance situation in Europe displays wide variations depending on the bacterial species, antimicrobial group and geographical region. For several bacterial species–antimicrobial group combinations, a north-to-south and a west-to-east gradient is evident in Europe. In general, lower resistance percentages were reported by countries in the north while higher percentages were reported in the south and east of Europe. These differences are most likely related to variations in antimicrobial use, infection prevention and control practices, and dissimilarities in diagnostic and healthcare utilisation patterns in the countries.
- Avaliação do Programa Nacional de Vacinação: 2º Inquérito Serológico Nacional Portugal Continental 2001-2002Publication . Freitas, Maria Graça; Paixão, Maria TeresaPNV cumprido é um indicador que corresponde à percentagem de indivíduos de uma determinada idade/coorte que foram vacinados com determinada vacina, de acordo com o esquema recomendado ou com os esquemas cronológicos de recurso (em atraso e tardio), relativamente ao número total de indivíduos dessa idade/coorte, numa determinada região geográfica, num período de tempo de referência. O ISN tem como principal objetivo conhecer o estado imunitário da população para as doenças evitáveis pela vacinação e a frequência de outras doenças infeciosas.
- Case control study for measuring influenza vaccine effectiveness in Portugal - Season 2010-11- Final reportPublication . Nunes, Baltazar; Pechirra, Pedro; Machado, Ausenda; Falcão, Isabel; Gonçalves, Paulo; Conde, Patricia; Batista, Inês; Guiomar, Raquel; Marinho Falcão, JoséEvery year, influenza virus is responsible for epidemics that affect human health causing respiratory infections that could lead to serious health complications of individuals belonging to risk groups, as well as on the functioning of health services. In order to mitigate influenza impacts, vaccination has been one of the main measures, being recognized its role in reducing the risk of developing the disease and the occurrence of their complications. Thus, since the vaccine is reformulated every season estimating the influenza vaccine effectiveness (VE) every season and in an early stage is of major importance to support public health decisions. Since 2008-2009, Portugal has been participating in I-MOVE project that aims to estimate seasonal and pandemic vaccine effectiveness during and after the influenza season. Last season, 2010-2011, Portugal once again joined the I-MOVE multi-center case control study (with the national VE study- Euroeva) together with Spain, Ireland, France, Italy, Romania, Hungary and Poland, using a common protocol and with the objective of estimate the 2010-11 seasonal influenza vaccine effectiveness respectively in the elderly (65+) and in all age groups. Additionally, using information on 2010-11 seasonal vaccine coverage in the population, it has been also proposed to estimate 2010-11 seasonal vaccine effectiveness using the screening method. Material and Methods Two different approaches were used so as to estimate vaccine effectiveness: a) For the test negative design (TND), a case-control approach was used, where laboratory confirmed influenza cases (ILI+) were compared to laboratory negative influenza ILI patients (ILI-). On a weekly basis, each GP selected systematically ILI patients (two per week from all ages and all ILI patients with 65 years and more) using the EU ILI case definition. Data on confounding factors and effect modifiers was collected using a standardized questionnaire. VE was estimated as one minus the odds ratio of being vaccinated in cases versus controls adjusted for confounders by logistic regression. b) For the screening method, the 2010-11 seasonal vaccine coverage was compared between a sample of ILI cases and a sample of ILI cases laboratory confirmed for influenza with the vaccine coverage estimated in the general population. ILI cases and ILI Positive cases were the same as the one used in the TND. Vaccine coverage in the population was obtained from a sample of 1074 households stratified by region (homogeneous allocation) selected from a dual sample frame – random digit dialing mobile and landline phones (ECOS sample). The relevant information was collected by CATI (Computer Assisted Telephone interview) with the same questionnaire – one respondent by household (proxy for the rest of the household members). VE was estimated by comparing the proportion of cases vaccinated to the vaccine coverage in the source population using the Orenstein formula and the Farrington method to adjust for confounders. For both methods an ILI patient was considered vaccinated if he/she had received one dose of the vaccine at least 14 days prior onset of symptoms. Data analysis comprised ILI positive cases selected between week 45 of 2010 and week 11 of 2011. Results In Portugal, the 2010-2011 influenza season was characterized by a mixed circulation of influenza virus. In the early beginning of the season, B type virus dominated the season, until week 1 where A(H1N1)2009 virus started to dominate. Also in circulation, but in a minor proportion was the A(H3) virus. a) Test negative design results: Considering TND results, 58 GP’s accepted to participate in the study, with 60% participation rate (35 GP’s effectively participated in the study by selecting patients). Excluding 33 ILI cases (for not meeting the inclusion criteria) the final sample for analyses consisted on 253 ILI patients with a high positive rate (57%). Among cases, 73 were positive for B virus, 69 for A(H1N1)2009 and 2 for A(H3). For analysis purposes three groups of cases were defined: All influenza, Influenza B and Influenza A(H1N1)2009 that were compared to ILI cases that tested negative for influenza virus (109 Controls). After adjustment for age group, pandemic and seasonal vaccine 2009-10 season, any chronic disease, target group, GP visits and month of onset, VE point estimates were: • 58% (CI95% -61 – 89) for All influenza • 34% (CI95% -98 – 97) for Influenza A(H1N1)2009 and • 75% (CI95% -255 – 88) for Influenza B. Nevertheless, no statistical significance was obtained for either the analysis. b) Screening method results In season 2010-2011, 903 households of the ECOS-sample were interviewed (which corresponds to 2684 individuals). The final estimated vaccine coverage was 17.5% (CI95% 15.1-20.3), with a gradient evolution since September 2010 (3.5%) till December 2010 (16.6%). Crude and adjusted VE (using the Farrington method) estimates were computed for medically attended ILI cases and ILI influenza positive cases. Overall results indicate that after adjustment for confounding (age group and presence of chronic diseases), VE point estimates decreased from 47.0% to 33.3% in ILI cases and from 70.1% to 63.7% in ILI positive cases. Due to the small sample size, no VE estimates were computed for the individuals of the vaccination target group, i.e., individuals with 65 years and more and the ones with at least one chronic disease. Conclusions Overall results obtained by the Euroeva study indicate that crude 2010-11 seasonal VE estimate against medically attended influenza was 79% (CI95% 43-94) and 70% (CI95% 32-87), respectively for the TND and screening method. After adjustment the respective VE estimates decreased: 58 (CI95% -61-89) and 64% (CI95% 17-84). These results were in accordance to the up to now published results (42-65%). The TND study was also able to provide strain specific 2010-11 seasonal VE estimates: influenza B, crude VE=87% (CI95% 41-99) and adjusted VE=75% (CI95% -98-97) and for influenza A(H1N1)2009, crude VE=74% (CI95% 14-94) and adjusted VE=34% (CI95% -254-88). These results suggest that the 2010-11 seasonal VE was lower than the monovalent A(H1N1)2009 VE estimated by the IMOVE multicenter study in the season 2009-10: 72% (CI95% 46-86). Our study was unable to estimate VE for specific seasonal vaccine target groups. This result enhances, as in previous studies, the unavoidable need for pooling data from network of VE studies with common protocol as IMOVE. Recommendations The main recommendations focused on: • To calculate sample size taking into consideration: o the context of the multicentre case-control study: minimum sample size per site in order to assure a minimum homogeneity for pooled analysis; o different expected VE point estimates, i.e. for low, medium and high VE; o minimum set of factors for stratified analysis; o the adjustment for confounders. • To increase sample size, mainly in the elderly population (aged 65 years or more); • To increase the total number of participating GP’s in the study by exploring other sources of GP’s recruitment; • To study the inclusion of the population based vaccine coverage uncertainty in the screening method; • To explore with participating GP’s the best way to obtain estimates of the Euroeva ILI sample fraction. Finally we also recommend continuing the harmonization of the study designs between participating countries with the multi-centre study objective.
- Collaborative study to evaluate a candidate World Health Organization international standard for chikungunya virus for nucleic acid amplification technique (NAT)-based assaysPublication . KreB, J.A.; Hanschmann, K-M.O.; Chudy, M.; Collaborative Study GroupThis report describes the World Health Organization (WHO) project to develop an international standard (IS) for Chikungunya virus (CHIKV) RNA for use with nucleic acid amplification technique (NAT)-based assays. An international collaborative study was conducted to determine the potency of the candidate standard using a range of NAT-based assays for CHIKV, and to evaluate the suitability of the candidate for the calibration of secondary reference materials and the standardization of CHIKV viral load measurements. The candidate standard consisted of a heat inactivated CHIKV strain of the East/South/Central African genotype (ESCA), also known as the Indian Ocean Lineage, isolated from a patient returning from India to the United States in 20061 , diluted in human negative plasma. The lyophilized candidate preparation (Sample 1), the corresponding liquid-frozen bulk material (Sample 2) and three different clinical samples (Sample 3, Sample 4 and Sample 5) were included in the collaborative study. Twenty-five laboratories representing 14 countries participated in the study to evaluate the material using their routine CHIKV NAT assays. Twenty-four laboratories returned 31 data sets from 17 commercial assays and 14 in-house methods. Of these 31 methods, 11 were quantitative and 20 were qualitative. The results of the study indicate the suitability of the candidate material of the CHIKV strain of ESCA genotype (Sample 1) as the proposed 1st WHO IS for CHIKV. It is therefore proposed that the candidate material (PEI code 11785/16) is established as the 1st WHO IS for CHIKV RNA for NAT-based assays with an assigned potency of 2,500,000 International Units (IU)/mL when reconstituted in 0.5 mL of nuclease-free water. On-going studies for real-time and accelerated stability of the proposed IS indicate that the preparation is stable and suitable for long-term use under the proposed storage conditions.