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Surveillance épidémiologique de la diphtérie : Corynebactéries toxinogènes - 2023
No full text
Grâce à une couverture vaccinale élevée dans toutes les régions du pays, la diphtérie est devenue et reste une maladie rare en Belgique. En 2023, 14 cas ont été enregistrés : 9 à C. diphtheriae et 5 à C. ulcerans.
Depuis 2022, une épidémie d’infections à C. diphtheriae toxinogène est survenue chez les demandeurs d’asile et touche aussi d’autres pays européens. En 2023, 4 cas ont été diagnostiqués parmi des demandeurs d’asile dont 1 cas est décédé.
En dehors de l’épidémie chez les demandeurs d’asile, 5 autres cas d’infection à C. diphtheriae ont été diagnostiqués dont 3 parmi des personnes sans domicile fixe.
Tous les cas de C. ulcerans étaient autochtones, avec pour la plupart, une clinique de diphtérie cutanée. L’âge médian des cas était de 55 ans.
De l’antitoxine diphtérique a dû être administrée à 3 reprises en 2023.
La diphtérie est une urgence médicale et de santé publique. Dès lors, tout cas suspect doit être déclaré le plus rapidement possible aux autorités sanitaires régionales, afin de mettre en place les mesures nécessaires.
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Magnitude and determinants of excess total, age-specific and sex-specific all-cause mortality in 24 countries worldwide during 2020 and 2021: results on the impact of the COVID-19 pandemic from the C-MOR project.
No full textINTRODUCTION: To examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age.
METHODS: Total, age-specific and sex-specific weekly all-cause mortality was collected for 2015-2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015-2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models.
RESULTS: Excess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively.
CONCLUSION: This study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.</p
METABOLIC SYNDROME IN PEOPLE LIVING WITH TYPE 1 DIABETES IN BELGIUM : A CROSS-SECTIONAL, REAL-WORLD OBSERVATIONAL STUDY
No full textIntroductie van de HPV test in baarmoederhalskanker screening in België
No full textIn december 2022 besliste de Interministeriële Conferentie (IMC) Volksgezondheid (in lijn met eerdere beslissingen van de IMC tijdens de vorige regeerperiode), om voor baarmoederhalskanker screening over te schakelen van cytologie naar primaire HPV-screening (vanaf de leeftijd van 30 jaar). Deze beslissing is gebaseerd op beschikbare wetenschappelijke evidentie, gaande van het KCE-rapport 238 uit 2015 tot zeer recente analyses van de Wereldgezondheidsorganisatie (WGO) en het Internationaal Agentschap voor Kankeronderzoek (IARC). De wijziging wordt van kracht op 01/0½025.
Hierbij vindt u een kort overzicht van de klinische richtlijnen met de nieuwe screeningsalgoritmes, de wijzigingen in de nomenclatuur, de lijst van goedgekeurde HPV-testen, bijzondere bepalingen voor de accreditatie van medische laboratoria en de regelgeving voor de registratie van screeningsresultaten. Vanaf december 2024 zal alle informatie samengevat worden op Baarmoederhalskanker screening | sciensano.be.</p
Introduction du test HPV dans le dépistage du Cancer du Col de l'utérus en Belgique
No full textEn décembre 2022, la Conférence interministérielle Santé publique a décidé (conformément aux décisions antérieures de la CIM au cours de la législature précédente) de passer de l’examen cytologique au dépistage primaire du HPV pour le cancer du col de l’utérus (à partir de l’âge de 30 ans). Cette décision se fonde sur des preuves scientifiques disponibles, allant du rapport 238 du KCE de 2015 aux analyses très récentes menées par l’Organisation Mondiale de la Santé (OMS) et le Centre International de Recherche sur le Cancer (CIRC). Ce changement entrera en vigueur le 01/0½025.
Nous vous présentons ici un bref aperçu des directives cliniques accompagnant les nouveaux algorithmes de dépistage, les changements de nomenclature, la liste de tests HPV acceptés, les dispositions particulières concernant l’accréditation de laboratoires médicaux et les réglementations relatives à l’enregistrement des résultats de dépistage. À partir de décembre 2024, toutes les informations seront résumées sur la page Screening cancer du col de l’utérus.</p
Healthcare-Associated Infections and Antimicrobial Use in Belgian Acute Care Hospitals: Results of the 2022 ECDC Point Prevalence Survey
No full textBackground: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose significant challenges in healthcare systems worldwide, leading to prolonged hospital stays, increased costs, and elevated morbidity and mortality rates. The 2017 European Centre for Disease Prevention and Control (ECDC) point prevalence survey (PPS) revealed a 5.9% HAI prevalence in European acute care hospitals, with Belgium reporting a higher rate of 7.3%. Additionally, in 2017, a crude prevalence of 28.1% of inpatients receiving at least one antimicrobial was recorded in Belgian hospitals. In 2022, the ECDC PPS was repeated in Belgian acute care hospitals to reassess both HAI prevalence and antimicrobial use.
Methods: Data collection for the 2022 survey was conducted from September to November, following the ECDC protocol (version 6.0) at hospital/ward/patient levels. Modifications from the 2017 protocol included updated infection definitions and microorganism codes for COVID-19, along with the incorporation of HAIs associated with long-term care facilities.
Findings: A total of 56 acute care hospital sites participated, encompassing 10,142 patients. The 2022 survey revealed that 9.2% (95% confidence interval (CI): 8.7-9.8%) of patients had at least one HAI. This prevalence was 8.5% (95% CI: 7.5-9.5%) when excluding HAI associated with long-term care facilities. Predominant infections included pneumonia and lower respiratory tract infections (32.8%, including COVID-19 infections at 8.5%), surgical site infections (13.6%), urinary tract infections (18.5%), bloodstream infections (12.2%) and gastrointestinal infections (9.0%). Microbiological results were positive for 65.6% of HAIs, with Escherichia coli, Staphylococcus aureus, and Klebsiella spp. being the most common isolates.
Regarding antimicrobial use, the survey found that 29.3% (95% CI: 28.4-30.2%) of patients were receiving at least one antimicrobial, with higher prevalence observed in patients over 65 years (31.1%). Intensive care units (56.3%) and surgical wards (38.7%) demonstrated the highest antimicrobial use prevalence, while psychiatric wards exhibited the lowest (3.0%). Common indications for antimicrobial treatment included community-acquired infections (48.6%) and HAIs (26.1%). Indication for surgical prophylaxis was recorded for 12.4% of prescribed antimicrobials. Notably, 22.7% of surgical prophylaxis courses lasted more than one day. The top three most prescribed antimicrobial agents were amoxicillin in combination with a beta-lactamase inhibitor, cefazolin, and piperacillin in combination with a beta-lactamase inhibitor.
Conclusion: The 2022 ECDC PPS revealed an increased prevalence of both HAIs and antimicrobial use in Belgian acute care hospitals compared to previous surveys. This emphasizes the ongoing need for rigorous infection prevention and control measures, as well as robust antimicrobial stewardship programs, to address these challenges effectively. Future investigations should focus on prescription attitudes and modifiable practices to optimize patient outcomes and mitigate the spread of AMR.</p
Challenges in Chlamydial Serology: Insights from a Belgian and a Dutch Population Cohort.
No full textSerology routinely serves as a diagnostic tool to confirm infections in humans. Particularly in delayed settings, such as post-outbreak scenarios where the acute phase of infection has subsided, serology is invaluable. Multiple studies, nonetheless, indicate deficiencies in specificity and sensitivity of current chlamydial antibody detection assays. Incorporation of multiple antigens per target is known to improve the accuracy of chlamydial serological assays. We, therefore, used the recomLine test (Mikrogen diagnostics) on serological samples of two cohorts, as it is the only commercially available test allowing detection of antibodies against three human pathogenic species (, and ) using multiple antigens per target. The first cohort (n = 156; samples collected between 2008 and 2022 during a screening initiative) comprised women from the Netherlands (NL) with past exposure to , while the second cohort (n = 44; samples collected in 2018 in a health examination survey) consisted of Belgian citizens (BE) with occupational or recreational exposure to chickens, representing a risk population for . The test indicated a statistically equivalent seroprevalence in both cohorts (39.10% in NL and 34.09% in BE; p = 0.337). As expected seroprevalence was significantly higher (p < 0.001) in the Dutch cohort (48.72%), as compared to the Belgian cohort (4.55%). Lastly, seroprevalence did not significantly differ between the two groups (2.27% in BE and 1.92% in NL; p = 0.633), even though a higher prevalence was expected for the Belgian cohort. This prompts us to question whether the Belgian cohort truly constituted a risk population or whether the recomLine test is susceptible to cross-reaction of species-specific antibodies, thereby increasing prevalence in the Dutch cohort. We advocate for the development of affordable, highly sensitive antibody detection assays that can effectively distinguish between chlamydial species, addressing the increasing demand for enhanced serological testing methodologies.</p
Variability in Alternaria alternata spore characteristics under different culture conditions: implications for automatic detection using air flow cytometry
No full textAirborne fungal spores of the genus Alternaria pose challenges for accurate airborne spore identification by automatic bioaerosol monitors, because of their significant implications for public health and agriculture due to their role as airborne allergen and plant pathogen. These systems require high-quality reference data for training algorithms by machine learning. Alternaria alternata was cultured on three different media, including exposure to UV light to favor sporulation. Spore morphology was evaluated both macroscopically and microscopically, and chemical analysis was conducted using micro-Raman spectroscopy to assess spore composition. Significant differences were observed in colony morphology and spore characteristics among culture media. While typical spores predominated, atypical forms were also identified, which may represent a potential bias for identification. Comparative analysis with air samples by the Hirst method also revealed overall differences in spore morphology pattern. Standardizing culture conditions and accounting for variability in spore properties are essential for improving the reliability of bioaerosol monitoring systems. Further research is needed to refine detection methods for A. alternata and other airborne fungal spores.</p
