Category: Statistics

Euro Surveill. 2026 Apr;31(14). doi: 10.2807/1560-7917.ES.2026.31.14.2500322.

ABSTRACT

BACKGROUNDUp-to-date estimates of chronic hepatitis B virus (HBV) prevalence in both general and key populations are challenging to obtain because of underdiagnosis, heterogeneous surveillance systems and underrepresentation of key populations.AIMWe aimed to test the Workbook Method to estimate chronic HBV prevalence in 2022 across the EU/EEA, by country and among men who have sex with men (MSM), people who inject drugs (PWID) and migrants.METHODSWe used the Robert Koch Institute’s version of the Joint United Nations Programme on HIV/AIDS (UNAIDS) Workbook Method to generate HBV prevalence estimates for each EU/EEA country and for MSM, PWID and migrants within each country. We combined data on population size and HBV prevalence for each population group gathered from scientific sources and reviewed by the European Centre for Disease Prevention and Control’s hepatitis national contact points.RESULTSOverall, 0.7% (lower bound-upper bound: 0.5-0.9%) of the EU/EEA population (3,226,000 (2,397,000-4,149,000) individuals) were estimated to be living with HBV in 2022. National HBV prevalence ranged from 0.1% (0.1-1.0%) to 3.1% (2.8-3.3%). Prevalence estimates varied from 0.8% (0.5-1.0%) to 10.5% (9.3-11.9%) for migrants, < 0.1% to 8.7% (lower and upper bounds not available) for PWID and from < 0.1% (< 0.1- < 0.1%) to 10.5% (10.2-10.8%) for MSM.DISCUSSIONDespite limitations, including the inability to address overlapping populations, these estimates confirm substantial chronic HBV prevalence in the EU/EEA, with considerable variation between countries and population groups. This relatively straightforward method offers an alternative means of generating HBV prevalence estimates.

PMID:42141879 | DOI:10.2807/1560-7917.ES.2026.31.14.2500322

Euro Surveill. 2026 May;31(18). doi: 10.2807/1560-7917.ES.2026.31.18.2600331.

ABSTRACT

BACKGROUNDThe Canadian Sentinel Practitioner Surveillance Network routinely undertakes multiplex respiratory virus testing, vaccine effectiveness (VE) estimation by test-negative design (TND), and whole genome sequencing (WGS) of vaccine-targeted viruses.AIMTo estimate 2025/26 LP.8.1 VE against community-based COVID-19, including variant-specific, and explore the impact of other respiratory viruses among COVID-19 cases and/or controls.METHODSParticipants were ≥ 12-year-old outpatients presenting with acute respiratory illness between 26 October 2025 and 07 March 2026. COVID-19 vaccination information was registry-based. Primary TND analyses excluded influenza virus-infected controls. Sensitivity analyses explored inclusion and/or exclusion of influenza and other respiratory viral infections among COVID-19 cases and/or controls. WGS supported VE interpretation and variant-specific estimation.RESULTSWe included 3,802 participants (2,832 (74%) aged 12-64 years; 970 (26%) aged ≥ 65 years), with 310 COVID-19 cases (29 vaccinated; 9%) and 3,492 controls (577 vaccinated; 17%). At median 9 weeks post-vaccination, LP.8.1 VE was 48% (95%CI: 21 to 66): 44% (95%CI: -12 to 72) for 12-64 and 53% (95%CI: 21 to 73) for ≥ 65-year-olds. In sensitivity analyses, VE was stable for ≥ 65-year-olds. Among 12-64-year-olds, VE decreased when including influenza virus infections among controls but increased when excluding co-infections, recognising uncertainty with reduced sample size. Against viruses that failed vs succeeded WGS, VE was 26% (95%CI: -63 to 66) vs 53% (95%CI: 24 to 71), 63% (95%CI: 30 to 80) against the XFG variant. Most SARS-CoV-2 co-infections with semi-quantification, including those failing WGS, showed higher viral load for the non-SARS-CoV-2 infection.CONCLUSIONThe 2025/26 LP.8.1 vaccine approximately halved the medically attended COVID-19 risk. Multiplex testing to identify primary co-infections among cases, or correlated vaccine-preventable infections among controls, may address VE under-estimation.

PMID:42141877 | DOI:10.2807/1560-7917.ES.2026.31.18.2600331

Euro Surveill. 2026 May;31(19). doi: 10.2807/1560-7917.ES.2026.31.19.2500736.

ABSTRACT

BACKGROUNDAlthough electronic health records are increasingly used for automated surveillance (AS) of healthcare-associated infections (HAIs), implementation is still a challenge. To develop more targeted implementation initiatives across Europe, knowledge about the current state of AS and potential to implement AS systems is needed.AIMTo assess the adoption and feasibility of AS based on the 2022-2023 European Centre for Disease Prevention and Control (ECDC) Point Prevalence Survey (PPS).METHODSThe 2022-2023 ECDC PPS included questions on the degree of AS and digital data storage for seven HAIs. Descriptive analyses of the responses were performed and stratified by geographic region and hospital characteristics. Categorical variables were analysed as such and converted to ordinal scales.RESULTSOverall, 992 hospitals from 24 European countries participated. Across all seven HAIs, fully manual surveillance was the most common method (from healthcare-associated pneumonia (HAP) 38.8% to Clostridioides difficile infection (CDI) 45.4%). A considerable proportion, i.e. 19.3% (HAP) to 29.8% (CDI), employed some form of automation (automated denominator 5.3-11.3%; semi-automated 12.2-16.9%; fully automated 1.8-2.9%). Many hospitals not employing AS had required source data digitally stored. Generally, tertiary hospitals had higher levels of automation and digital data storage compared with other hospital types. Smaller hospitals (≤ 250 beds) had lower levels of automation, but a similar level of digital data storage compared with larger hospitals.CONCLUSIONThis study highlights variability in AS implementation and digital potential across European hospitals and underscores the need for targeted strategies to advance AS adoption and optimise surveillance.

PMID:42141872 | DOI:10.2807/1560-7917.ES.2026.31.19.2500736

Euro Surveill. 2026 May;31(19). doi: 10.2807/1560-7917.ES.2026.31.19.2500699.

ABSTRACT

BACKGROUNDInvasive Haemophilus influenzae type b (iHib) disease incidence in < 5-year-olds decreased after vaccine introduction but increased between 2011 and 2023 in the Netherlands. The National Immunisation Programme changed products in 2011 (from DTaP-IPV/Hib to DT3aP-HBV-IPV/Hib) and 2018 (to DT5aP-HBV-IPV-Hib) and schedule from 3 + 1 to 2 + 1 doses in 2020.AIMWe aimed to estimate overall, product- and schedule-specific vaccine effectiveness (VE) against iHib disease to inform vaccination strategies.METHODSWe conducted a matched case-control study extracting iHib cases born ≥ 2005 and aged 6-119 months from 2005-2023 national reference laboratory data. We selected 10 controls per case matched on birth date and sex from the population register and obtained vaccination data from the vaccination registry. Using conditional logistic regression, we estimated matched odds ratios (mOR) and VE among 6-10-month-olds (eligible only for the primary series) and 11-119-month-olds.RESULTSWe included 250 iHib cases and 2,487 controls. Among children aged 11-119 months, VE against iHib of the full schedule was 96% (95% CI: 88-99), 95% (95% CI: 91-97) and 98% (95% CI: 94-99) for any DTaP-IPV/Hib, DT3aP-HBV-IPV/Hib and DT5aP-HBV-IPV-Hib, respectively. It was 97% (95% CI: 93-99) for 2 + 1, 96% (95% CI: 93-98) for 3 + 1 doses, and > 95% for the respective primary series. No differences in VE by time since vaccination were observed between products or schedules.CONCLUSIONChanges in VE against iHib after recent product or schedule changes do not explain the increasing iHib incidence. The high VE supports pursuing optimal vaccination coverage.

PMID:42141871 | DOI:10.2807/1560-7917.ES.2026.31.19.2500699

Euro Surveill. 2026 Apr;31(13). doi: 10.2807/1560-7917.ES.2026.31.13.2500706.

ABSTRACT

BACKGROUNDInfluenza infection is a recognised trigger of acute myocardial infarction (AMI) and stroke, but whether influenza vaccination modifies this risk remains unclear.AIMWe aimed to quantify the short-term cardiovascular risk after laboratory-confirmed influenza infection and assess whether vaccination attenuates it.METHODSWe conducted a nationwide self-controlled case series study using Danish health registries (2014-2025) and included individuals aged ≥ 40 years with a first-ever hospital admission for AMI or stroke within ± 365 days of a PCR-confirmed influenza infection. We defined days 1-7 after specimen date as the risk period and excluded a 14-day pre-exposure period to reduce reverse causality, where influenza testing might be prompted by cardiovascular disease symptoms. We linked testing, hospitalisation, vaccination and mortality data deterministically via unique personal identifiers. We estimated incidence rate ratios (IRRs) and 95% confidence intervals (CI) with conditional Poisson regression.RESULTSAmong 1,221 individuals with a first-ever AMI (n = 429; 35%) or stroke (n = 792; 65%), median age was 75 years (interquartile range: 66-82); 561 (46%) were female. After calendar-month adjustment, the IRR for cardiovascular events during the risk period was 3.5 (95% CI: 2.6-4.7), higher for AMI (IRR = 4.7; 95% CI: 3.1-7.4) than stroke (IRR = 2.9; 95% CI: 2.0-4.2). Prior influenza vaccination during the same influenza season, recorded in 610 (50%) episodes, reduced the excess risk of AMI or stroke associated with influenza infection (interaction p = 0.020).CONCLUSIONSInfluenza infection conferred a transiently increased risk of first-time AMI and stroke. Vaccination substantially attenuated this risk, supporting its role in preventing cardiovascular complications after breakthrough infection.

PMID:42141868 | DOI:10.2807/1560-7917.ES.2026.31.13.2500706

Euro Surveill. 2026 Apr;31(13). doi: 10.2807/1560-7917.ES.2026.31.13.2500586.

ABSTRACT

BACKGROUNDMany countries use school-based vaccination for adolescent vaccination; it has been shown to reduce inequities in uptake compared with other delivery routes. In England, coverage for human papillomavirus (HPV), meningococcal groups A, C, W and Y (MenACWY) and tetanus, diphtheria and inactivated polio virus (Td/IPV) vaccine programmes exceeded 80% before the COVID-19 pandemic. However, recent data show declining uptake.AIMThis study examined the relationship between socio-economic deprivation and coverage over time.METHODSWe conducted an ecological analysis of first-dose coverage for HPV (females and males), MenACWY and TdIPV in adolescents across 150 local authorities in England from 2017 to 2024. Coverage data were linked to 2025 Index of Multiple Deprivation (IMD) scores. Associations between IMD quintile, academic year and vaccination coverage were estimated using beta regression models.RESULTSBetween 2020 and 2024, lower coverage was consistently associated with higher deprivation, and differences in coverage between the most and least deprived IMD quintiles more than doubled. In 2024 these differences were 17.7%, 18.2%, 16∙8% and 16.9% for HPV (females), HPV (males), MenACWY and Td/IPV, respectively. The consistency of these findings suggests the effect of deprivation on coverage is not vaccine-specific.CONCLUSIONWe demonstrated a consistent and strengthening association between coverage and deprivation across multiple adolescent school-based vaccination programmes in England over time. Contributory factors may be numerous, and further research is needed to understand which factors are driving trends for different populations. Addressing these inequalities will require sustained targeted interventions to improve awareness of and access to vaccination.

PMID:42141866 | DOI:10.2807/1560-7917.ES.2026.31.13.2500586

Euro Surveill. 2026 Mar;31(12). doi: 10.2807/1560-7917.ES.2026.31.12.2500628.

ABSTRACT

BACKGROUNDVaccination of residents and healthcare workers (HCWs) against influenza in nursing homes is an important prevention strategy.AIMTo describe trends in influenza vaccination coverage (VC) among HCWs working in nursing homes in France and measures implemented to support vaccination campaigns from 2007 to 2025, and to identify effectiveness of these measures.METHODSWe analysed data from seven nationwide cross-sectional studies conducted between seasons 2007/08 and 2024/25 and performed multivariate analysis using negative binomial regressions, to identify determinants.RESULTSNational influenza VC among HCWs decreased from 37.2% (95% CI: 35.7-39.4) in 2007/08 to 24.2% (95% CI: 23.2-25.1) in 2024/25 (mean: 39,740 HCWs per season, 6 seasons). Vaccination coverage disparities by category of HCWs (2024/25 VC of physicians: 56.3%; nurses: 34.2%; nursing assistants: 19.3%) were observed throughout the period. Measures to promote influenza vaccination were less frequently implemented over time: support of vaccination campaigns by the management team (from 2018/19: 89% to 2024/25: 52%), implementation of collective (68% to 49%) or individual information sessions (19% to 9%), distribution of information on influenza vaccines (64% to 53%) or influenza (83% to 69%). Seven measures exhibited effectiveness in 2018/19 compared to only four in 2024/25, which had less effectiveness. Management teams highlighted the strong reluctance of HCWs to receive influenza vaccination.CONCLUSIONSInfluenza VC among HCWs in nursing homes is marked by disparities among professional categories. To mitigate the decline in VC among HCWs, it is essential to implement effective measures to support the campaigns.

PMID:42141864 | DOI:10.2807/1560-7917.ES.2026.31.12.2500628

Euro Surveill. 2026 Mar;31(12). doi: 10.2807/1560-7917.ES.2026.31.12.2600235.

ABSTRACT

Following the first detection of monkeypox virus (MPXV) clade Ib in Berlin, Germany, in December 2025, clade Ib rapidly predominated over clade IIb among notified mpox cases. The 35 clade Ib cases were primarily due to autochthonous transmission, with high genetic relatedness among strains circulating in men in Berlin, despite no identified epidemiological links. Sexual contact between men was reported as a potential source of infection in 28 cases, while for the remaining seven cases this information was unknown.

PMID:42141863 | DOI:10.2807/1560-7917.ES.2026.31.12.2600235

Euro Surveill. 2026 Apr;31(17). doi: 10.2807/1560-7917.ES.2026.31.17.2500733.

ABSTRACT

BACKGROUNDTick-borne encephalitis (TBE), a neuroinvasive disease in humans, is endemic in north-east Italy and nationally notifiable since 2017. Domestic TBE incidence, although low, has increased in recent years while TBE vaccination coverage remains < 10%.AIMWe aimed to estimate the burden of TBE virus (TBEV) infections in north-east Italy (Triveneto) in 2017-2024.METHODSWe estimated disability-adjusted life years (DALYs) with 95% uncertainty intervals (UI) using the Burden of Communicable Diseases in Europe software. Input data included TBE cases notified in 2017-2024 with residence and/or infection or exposure in Triveneto (autonomous provinces (AP) of Trento and Bolzano and regions of Veneto and Friuli-Venezia Giulia) and correction factors for TBE underdiagnosis and TBEV infection under-ascertainment.RESULTSIn 2017-2024, 295 TBE cases were notified in Triveneto. The mean annual burden of TBEV infections was estimated at 0.58 (95% UI: 0.55-0.62) DALYs per 100,000 population. Estimates were highest in 2022 (1.07; 95% UI: 1.00-1.14 DALYs/100,000). The areas with the highest burden were Belluno province (4.17; 95% UI: 3.88-4.46 DALYs/100,000/year) and the AP of Trento (2.84; 95% UI: 2.65-3.05 DALYs/100,000/year). Males accounted for 67.0% of DALYs. All age groups experienced on average ≤ 1 DALYs per 100,000 population per year.CONCLUSIONThe burden of TBEV infections in north-east Italy is relatively low and with an uneven geographical distribution. Increasing TBE vaccination coverage across age groups, prioritising elevated impact areas, may reduce the burden of TBEV infections in north-east Italy and maintain TBE as a low-burden disease.

PMID:42141861 | DOI:10.2807/1560-7917.ES.2026.31.17.2500733

Workplace Health Saf. 2026 May 16:21650799261440222. doi: 10.1177/21650799261440222. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic revealed stressful working conditions experienced by health care workers in long-term care and seniors’ (LTCS) homes worldwide. However, differences in job strain among regulated and unregulated health care workers and its relationship to their health are understudied. This study examined associations between job strain-related working conditions and health changes, exploring differences between nurses and personal support workers (PSWs).

METHODS: This cross-sectional study used the Survey of Health Care Workers’ Experiences During the Pandemic (2021). Job strain-related working conditions included workload increases, working overtime, and beyond-role work. Outcomes were workers’ perceived changes in general health and mental health during the pandemic. Descriptive statistics and multivariable logistic regression models were employed, stratified by occupation, and controlled for covariates.

FINDINGS: Job strain prevalence during the pandemic was high, with more nurses reporting job strain-related working conditions (increased workloads, overtime, or beyond-role work) than PSWs. Associations between job strain working conditions and worsened health varied by occupation. Beyond-role work was associated with worsened mental health for both workers, but only worsened general health for nurses, not PSWs.

CONCLUSIONS: Differences among nurses and PSWs demonstrate the importance of understanding variations in roles, occupational experiences and policies regulating health care workers.

APPLICATION TO PRACTICE: These findings support the need for targeted monitoring of mental and general health among nurses and PSWs in LTCS settings. Occupational health practitioners can identify experiences of job strain among staff and provide counsel for solutions, collaborating with management to ensure the LTCS workforce’s health and safety.

PMID:42141859 | DOI:10.1177/21650799261440222