Tag: statistics

BJS Open. 2026 May 12;10(3):zrag022. doi: 10.1093/bjsopen/zrag022.

ABSTRACT

BACKGROUND: Long-term bowel dysfunction can impact a significant proportion of patients following anterior resection. The aim of this study was to assess the efficacy of transanal irrigation (TAI) to treat low anterior resection syndrome.

METHODS: Adults (≥ 18 years) with major low anterior resection syndrome (score > 30) at least 12 months after low anterior resection were enrolled at four European centres. Eligible patients were randomized 1 : 1 using block randomization to the TAI group or best supportive care group. The primary endpoint was the feasibility of TAI measured by treatment adherence or switch of therapy. Secondary endpoints included bowel function, quality of life and study-specific patient satisfaction questions. Outcome evaluators and the statistical team were blinded to allocation, whereas participants and caregivers were unblinded.

RESULTS: Forty-one patients were randomized, of which 40 (19 TAI; 21 best supportive care) completed follow-up; 1 patient in the TAI group was excluded due to fistula surgery. At 12 months, low anterior resection syndrome (median 3 (range 0-39) versus 36 (2-42); P < 0.001) and Wexner scores (median 0 (0-15) versus 13 (4-20); P < 0.001) were significantly lower in the TAI group compared with the control group. The Measure Yourself Medical Outcome Profile score was lower in the TAI group after 3 months (median 2 (0-11) versus 11 (7-12); P < 0.001). In addition, patients in the TAI group achieved higher Memorial Sloan Kettering Cancer Center Bowel Function Instrument scores after 12 months (median 89 (37-90) versus 39 (28-61); P < 0.001). Adherence was high, with 15 (75%) maintaining daily irrigation, and patient satisfaction measures favoured TAI. Two mild procedure-related adverse events (tenesmus, dizziness) were reported.

CONCLUSIONS: This randomized clinical feasibility study confirms that TAI is feasible and has high acceptability for patients. It leads to better functional outcomes and improvements in quality of life compared with the best supportive care for patients with low anterior resection syndrome.

REGISTRATION NUMBER: NCT05920681 (http://www.clinicaltrials.gov).

PMID:42141911 | DOI:10.1093/bjsopen/zrag022

Eur J Cardiovasc Nurs. 2026 May 16:zvag130. doi: 10.1093/eurjcn/zvag130. Online ahead of print.

ABSTRACT

Missing data are common in cardiovascular nursing and allied health research, especially in longitudinal studies. Common problems associated with missing data are reduced sample size, reduced statistical power and precision, and potentially biased results. There are several design strategies that can help minimize missing data including minimizing unnecessary items and incorporating reminders. It is important to understand common types of missingness, including item nonresponse, item-level missingness, wave nonresponse, and structural missingness, and to understand common mechanisms of missingness, including missing completely at random, missing at random, and missing not at random. This methods paper provides worked examples to illustrate several of these design and methodological considerations.

PMID:42141903 | DOI:10.1093/eurjcn/zvag130

Euro Surveill. 2026 Apr;31(15). doi: 10.2807/1560-7917.ES.2026.31.15.2500672.

ABSTRACT

BACKGROUNDVaccinations against COVID-19 were integrated into routine care in Germany in April 2023. However, evidence of the impact of seasonal vaccination remains limited.AIMTo assess the clinical and economic impact of COVID-19 vaccination in routine care during the early SARS-CoV-2-endemic phase in Germany.METHODSA retrospective cohort study using statutory health insurance data from two German federal states (Saxony and Thuringia), covering over 3 million individuals, was conducted. Adults aged ≥ 18 years vaccinated against COVID-19 between 1 September and 30 November 2023 were matched 1:1 with unvaccinated individuals using propensity scores. Outcomes during the 4-month follow-up included occurrence of SARS-CoV-2 infection, long COVID, other respiratory infections, hospitalisations, mortality, healthcare costs and indirect costs caused by sick leave. Rate and hazard ratios (RR, HR) with 95% confidence intervals (CI) were calculated. Sensitivity analyses tested robustness.RESULTSA total of 146,132 individuals (73,066 per group) were matched. COVID-19 vaccination was associated with reduced rates of long COVID (RR: 0.43; 95% CI: 0.26-0.70), respiratory infections (RR: 0.91; 95% CI: 0.87-0.95) and COVID-19-related hospitalisations (RR: 0.41; 95% CI: 0.31-0.54). All-cause mortality was 25% lower among COVID-19-vaccinated individuals (HR: 0.76; 95% CI: 0.70-0.82). Healthcare costs were lower in the vaccinated cohort, particularly for inpatient care, e.g. EUR 1 million savings in COVID-19-related hospitalisations. Indirect costs caused by sick leave were also reduced by EUR 1.3 million.CONCLUSIONSeasonal COVID-19 vaccinations in routine care settings were associated with substantial clinical and economic benefits. These real-world findings support continued implementation of national immunisation recommendations during the endemic phase of SARS-CoV-2 circulation.

PMID:42141891 | DOI:10.2807/1560-7917.ES.2026.31.15.2500672

Euro Surveill. 2026 Apr;31(15). doi: 10.2807/1560-7917.ES.2026.31.15.2500919.

ABSTRACT

BACKGROUNDA surge in pertussis occurred in the Netherlands in 2023-24. Infant vaccination uptake decreased from 95% in 2011 to ca 86% in 2024. Maternal vaccination was introduced in 2019, with uptake ca 70%.AIMTo describe pertussis epidemiological trends in the Netherlands.METHODSWe conducted a retrospective study using pertussis notification data from 2012 to 2024 and estimated infant and maternal vaccine effectiveness (VE) with the screening method.RESULTSDuring the COVID-19 pandemic, pertussis notifications dropped from ca 6,000 in 2013-19 to 79 in 2021 (incidence ca 35 to < 0.01/100,000 population). Notifications surged from May 2023, peaking in March 2024, resulting in 18,208 notifications in 2024 (102/100,000). Notifications and hospitalisations in 2024 were highest among infants aged 0-5 months (573 and 304/100,000) followed by infants aged 6-11 months (446 and 92/100,000). Annually, 0-2 deaths were reported; in 2023-24, 10 deaths were reported (6 infants, 4 ≥ 60-year-olds). In 2024, 83% of mothers of notified infants aged 0-2 months were unvaccinated. In 2020-24, maternal VE against pertussis in infants aged 0-2 months was 91%. In 2012-24 primary series VE was 98% at age 1, 92% at age 3, 92% post-booster at age 5, and 71% at age 9 years.CONCLUSIONLow population immunity after 2 years of reduced circulation likely contributed to the highest pertussis incidence ever recorded in the Netherlands, posing a particular threat to unprotected infants. Maternal and infant VE are high, underscoring the public health priority of enhancing vaccination uptake.

PMID:42141889 | DOI:10.2807/1560-7917.ES.2026.31.15.2500919

Euro Surveill. 2026 Apr;31(15). doi: 10.2807/1560-7917.ES.2026.31.15.2600288.

ABSTRACT

An unusually large outbreak of invasive meningococcal disease affecting young adults occurred in South East England between 13 and 18 March 2026, with 21 confirmed cases including two fatalities. Thirteen cases were university students and 19 had attended the same nightclub over a 3-day period. The outbreak strain was a distinct genome within the previously seen type B: P1.12-1,16-183: F1-5: ST-485 (cc41/44). Over 13,000 chemoprophylaxis doses and 11,000 meningococcal B vaccinations were provided to possible contacts.

PMID:42141888 | DOI:10.2807/1560-7917.ES.2026.31.15.2600288

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