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The International cookbook for wastewater practitioners - Vol. 1 SARS-CoV-2
No full textDuring the 2020-2023 COVID-19 Global Public Health Emergency of International Concern, rapid
progress was made with the application of Wastewater-Based Surveillance (WBS) (also known as
Wastewater-Based Epidemiology (WBE)) to provide population-scale evidence of SARS-CoV-2
shedding into wastewater. The information gained was used to help monitor, communicate, and
manage the COVID-19 pandemic.
Rapid and significant innovations in the field of WBS were realised in parallel in multiple
jurisdictions globally. Global collaboration resulted in step-change improvements in multiple
aspects of WBS simultaneously, including: health sector leadership; integration with public health
surveillance; social and ethical guidance; high-level tactical wastewater catchment sampling
strategies; wastewater sampling techniques; transport and storage of samples; laboratory
analysis; normalisation and standardisation; data analysis and interpretation; and communication
of results.
Innovations in WBS relating to COVID-19 continue to take place, and the benefits of those
improvements are now being applied to other targets, such as other pathogens and genes. There
are many journal articles and other publications describing these innovations. However, valuable
lessons from the COVID-19 pandemic for WBS have not been systematically documented into a
practical and readily digestible format.
The purpose of this ‘Cookbook’ is to provide practical and proven ‘recipes’ for WBS for SARS-CoV-2
for two reasons: firstly to help those considering new or extended WBS programmes targeting
SARS-CoV-2; and secondly to provide a valuable record of what has been learned from the 2020-
2023 period to help inform WBS programmes to respond to future pandemics and for surveillance
of other targets.
The Cookbook is structured into eight parts: 1. Introduction; 2. High-level Overview; 3. Health
Sector Perspectives; 4. Methods and Methodologies — From data to action; 5. Methods and
Methodologies — Measurement and testing; 6. Methods and Methodologies — Sampling; 6. Methods
and Methodologies — Transportation protocols; 8. Conclusions. Multiple authors have contributed to
each part, primarily from the European Union, as well as others from the global community of
practice.
The Cookbook has been drafted by a global team of authors, with one or more lead authors
identified for each chapter and working with their co-authors. The chapters were then subjected to
extensive peer review from the external review group. These authors and reviewers are
acknowledged in the Cookbook.</p
Installment of the Sciensano biobanks and their data quality management : lessons learned from the practical implementation of data quality control measures
No full textThe biobanks of the Sciensano health institute
were installed in accordance to the Belgian
biobanking legislation of 2018. This in order to
keep preserving and using Sciensano’s existing
as well as future collections of human body
material for scientific research. In 2020, the
Central Biobank Platform (CBP) has been
developed at Sciensano to support these divers
Sciensano biobanks, having 171.345 samples of
various types being currently preserved. Since
its installment, the CBP has optimized the
biobanking data management procedures and
implemented various data quality control
measures.
After a requirements collection, a biobanking
laboratory information management system
with audit trail (SLIMS from Agilent) was
introduced and configured for the Sciensano
biobanks. Critical data fields were defined
taking into account the applicable legislative
framework as well as quality standards for these
biobank registers (i.e. datasets). The ALCOA and
FAIR principles were hereby followed. Several
data security measures were also implemented
in SLIMS together with CBP admin support and
end-user trainings. Completeness and
consistency of these biobank datasets is
managed by defining rules and required field
attributes as well as findable and reusable data
by applying regular quality control checks.
Several lessons were learned by the CBP over
the years after introducing the SLIMS system for
biobanking data management at Sciensano.
One of the most important conclusions is that
data entries can only be streamlined by applying
a strategy including a close end-user support
with regular data quality checks. Only then will
high-quality data be maintained and be
available for future research with biobanked
samples.</p
Epidemiologische surveillance van mazelen (Morbillivirus) - 2023
No full text Mazelen is één van de meest besmettelijke infectieziekten met soms ernstige complicaties. Alle Europese landen engageerden zich in samenwerking met de Wereldgezondheidsorganisatie (WGO) om mazelen te elimineren.
• Er werden 67 gevallen van mazelen gemeld in 2023, waarbij de diagnose voor 54 gevallen in het labo bevestigd werd, 12 gevallen gelinkt waren aan een labo-bevestigd geval en 1 persoon enkel op basis van symptomen als mogelijk geval geregistreerd werd.
• Na zeer lage aantallen in 2020-2022 ten gevolge van de COVID-pandemie is er opnieuw een duidelijke en onrustwekkende stijging, vooral op het einde van 2023. Meer dan de helft van de besmettingen (39 gevallen) werden geregistreerd in het laatste kwartaal, met een uitschieter tot 31 besmettingen in de maand november.
• De meerderheid van de gevallen (3⅚7) kwam voor bij kinderen <10 jaar, en in het bijzonder bij kinderen <1 jaar (n=8) die nog te jong zijn voor vaccinatie.
• Van alle gevallen was ruim de helft ongevaccineerd (3⅚7) en voor 15 gevallen ontbrak informatie over de vaccinatiestatus. Gevallen bij volledig gevaccineerde personen zijn mogelijk maar blijven zeldzaam (n=4, allen >20 jaar).
• Vijftien besmettingen werden opgelopen in het buitenland. Deze besmettingen vormden het startpunt van 7 clusters met in totaal 29 gevallen.
• Voor 24 gevallen was een ziekenhuisopname nodig.
• De WGO kende aan België voor de jaren 2020-2022 de status ‘measles eliminated’ toe. Dit betekent niet dat er geen gevallen van mazelen meer voorkwamen in België, maar wel dat geen enkele keten van besmettingen langer dan 12 maanden duurde en dat de incidentie van niet-geïmporteerde gevallen laag was (<1/1 miljoen inwoners).
• Voor 2023 is er nog geen officiële beslissing van de WGO. De incidentie van niet-geïmporteerde gevallen lag te hoog (4,4/miljoen inwoners) maar de keten van besmetting werd wel steeds succesvol onderbroken: er was geen enkele keten die het hele jaar bleef circuleren</p
Linking animal and human health burden: challenges and opportunities
No full textQuantifying the impact of poor animal health outcomes on human health represents a complex challenge. Using the disability-adjusted life year (DALY) metric as an endpoint, this article discusses how animal health outcomes can impact humans through three key processes: directly through zoonotic disease, indirectly via changes in yields and their impacts on nutrition and wealth, and finally, through indirect features associated with the agricultural industry, such as pharmaceuticals and climate change. For each process, the current state of the art and feasibility of global DALY-associated estimates are discussed. Existing frameworks for zoonoses already consider some key pathogens; ensuring completeness in the pathogens considered and consistency in methodological decisions is an important next step. For diet, risk factor frameworks enable a calculation of attributable DALYs; however, significant economic methodological developments are needed to ensure that local production changes are appropriately mapped to both local and global changes in dietary habits. Concerning wealth-related impacts, much work needs to be done on method development. Industry-related impacts require a focus on key research topics, such as attribution studies for animal antimicrobial resistance contributing to human outcomes. For climate change, a critical next step is identifying to what extent associated industry emissions are amenable to change should animal health outcomes improve. Allocation of finite funds to improve animal health must also consider the downstream impact on humans. Leveraging DALYs enables comparisons with other human health-related decisions and would represent a transformative way of approaching animal health decision-making should the obstacles in this article be addressed and new methods be developed.</p
A preliminary estimate of the environmental burden of disease associated with exposure to pyrethroid insecticides and ADHD in Europe based on human biomonitoring
No full textHuman biomonitoring (HBM) data indicate that exposure to pyrethroids is widespread in Europe, with significantly higher exposure observed in children compared to adults. Epidemiological, toxicological, and mechanistic studies raise concerns for potential human health effects, particularly, behavioral effects such as attention deficit hyperactivity disorder (ADHD) in children at low levels of exposure. Based on an exposure-response function from a single European study and on available quality-assured and harmonized HBM data collected in France, Germany, Iceland, Switzerland, and Israel, a preliminary estimate of the environmental burden of disease for ADHD associated with pyrethroid exposure was made for individuals aged 0–19 years. The estimated annual number of prevalence-based disability-adjusted life years (DALYs) per million inhabitants were 27 DALYs for Israel, 21 DALYs for France, 12 DALYs for both Switzerland and Iceland, and 3 DALYs for Germany; while the annual ADHD cases per million inhabitants attributable to pyrethroids were 2189 for Israel, 1710 for France, 969 for Iceland, 944 for Switzerland, and 209 for Germany. Direct health costs related to ADHD ranged between 0.3 and 2.5 million EUR yearly per million inhabitants for the five countries. Additionally, a substantial number of ADHD cases, on average 18%, were associated with pyrethroid exposure. Yet, these figures should be interpreted with caution given the uncertainty of the estimation. A sensitivity analysis showed that by applying a different exposure-response function from outside the EU, the population attributable fraction decreased from an average of 18 to 7%. To ensure more robust disease burden estimates and adequate follow-up of policy measures, more HBM studies are needed, along with increased efforts to harmonize the design of epidemiological studies upfront to guarantee meta-analysis of exposure-response functions. This is particularly important for pyrethroids as evidence of potential adverse health effects is continuously emerging.</p
BIOMONITORING SPÉCIFIQUE VISANT À DÉTERMINER LES NIVEAUX D’IMPRÉGNATION DES RIVERAINS DES SITES DES BROYEURS À MÉTAUX EN WALLONIE. BioBro Rapport complet.
No full textEpidemiology of vaccine-preventable infectious diseases, Annual summary report 2023
No full textThe vaccines introduced into Belgian vaccination programmes have considerably changed the epidemiology of the infectious diseases they target, sharply reducing their incidence. Some infections have become sporadic, such as tetanus, or have been eliminated in Belgium, such as congenital rubella and poliomyelitis. Vaccination and surveillance are still necessary, however, because of the risk of importation and the severity of these diseases.
After a general decline in the number of cases of vaccine-preventable infectious diseases in 2020-2022 as a result of the covid-19 pandemic, the year 2023 shows quite different trends:
A steady increase in the number of cases of pertussis (since August 2023) and measles (last quarter of 2023), which has continued into 2024.
For other pathogens, such as pneumococcus and haemophilus influenzae, the number of cases was the highest seen in the last 10 years.
For meningococcus, the number of cases rose in 2023, but has not yet reached the trends seen before covid-19. There was also a slight increase in mumps cases.
The increase in the number of measles cases was to be expected, as measles vaccination coverage is still too low. More than half the cases were unvaccinated, and one in four people had no information about their vaccination status. Belgium, like other European countries and the WHO, is committed to eliminating measles, but inadequate vaccination coverage (<95% for two doses) makes it difficult to achieve the WHO’s objectives.
As far as pertussis is concerned, vaccination coverage among children is sufficiently high, but because of the weakening of immunity over time, less serious infections can occur later in life. A typical pattern can therefore be observed, with cyclical epidemics occurring every 4 to 5 years. Infants aged between 0 and 3 months are the most vulnerable to complications. These very young children can only be protected by vaccination during pregnancy. Unfortunately, vaccination coverage of pregnant women is very low in Wallonia and Brussels.
For invasive meningococcal, pneumococcal and Haemophilus influenzae infections, the coverage rates achieved are satisfactory, but the vaccines available/present in the vaccination schedule do not protect against all serogroups/serotypes. In addition, changes or replacements of circulating serotypes/serogroups occur over time.
In the case of pneumococcus, for example, there has been a clear increase in the number of serotypes not covered by the free 13-valent PCV13 vaccine. However, some of these serogroups are contained in 15- or 20-valent vaccines, which have not yet been introduced into the vaccination schedule. In the case of meningococcus, an increase in serotypes W and Y has been observed, and this will continue in 2024. The vaccine against ACWY serotypes is available free of charge for one-year-olds, but only since mid-2023. What’s more, this vaccine, which has also been recommended for adolescents by the Superior Health Council since 2019, is not free for this age group, despite the fact that adolescents are the main carriers (and therefore contaminators), along with young adults. Most cases of Haemophilus influenzae are linked to non-encapsulated strains for which there is no vaccine.
These developments and this increase are not in themselves unexpected, and do not constitute a failure of the vaccination policy: the total number of cases remains well below what it was before vaccination was introduced.</p
PRRSV-Vaccinated, Seronegative Sows and Maternally Derived Antibodies (II): Impact on PRRSV-1 Vaccine Effectiveness and Challenge Outcomes in Piglets.
No full textVaccination against the Porcine Reproductive and Respiratory Syndrome virus (PRRSV) is widely practiced in both sows and piglets. However, it has been shown that multivaccinated sows sometimes lack a detectable antibody response, testing seronegative in ELISA (non-responders). Moreover, PRRSV-vaccinated piglets can remain seronegative as well, which is mainly attributed to the interference of maternally derived antibodies (MDAs). The current study investigated the impact of the sow’s immune status on the PRRSV vaccine effectiveness in the progeny. The experimental trial included forty-eight piglets ( = 48) originating from a commercial Belgian breeding herd, with twenty-four piglets born from PRRSV vaccinated responder sows (E+ piglets) and twenty-four piglets born from PRRSV vaccinated non-responder sows (E- piglets). Eight piglets in each group were either non-vaccinated (NoVac piglets; = 8), intramuscularly vaccinated (IM piglets; = 8), or intradermally vaccinated (ID piglets; = 8), with the same PRRSV-1 vaccine as used in the sow population. Vaccination was performed at weaning at three weeks of age, and all study piglets were challenged with a high dose of the PRRSV-1 07V063 strain at 6 weeks of age. A clear interference of MDAs was observed in the E+ piglets: 66.7% of the vaccinated E+ piglets lacked an antibody response at 3 weeks post-vaccination (non-responders). Consequently, post-challenge, only the responding E+ piglets had a significantly reduced serum viremia compared to the E+ NoVac piglets. The observed viremia in the non-responding E+ piglets was similar to the viremia of the E+ NoVac piglets. In the vaccinated E- piglets, a lack of antibody response at 3 weeks post-vaccination was observed in 18.8% of the piglets. Interestingly, despite the lack of a vaccine antibody response, the non-responding E- piglets had a significantly reduced serum viremia compared to the NoVac E- piglets. In contrast, the viremia of the responding E- piglets was only numerically reduced compared to the NoVac E- piglets. Finally, some clear differences were observed in both the kinetics of infection and the immune responses post-challenge between the E+ and E- piglets. The results of this study confirm the consequences of the MDA interference on the induced partial protection of PRRSV vaccination in experimentally challenged piglets. More research is warranted to understand the immunological mechanisms behind MDA interference in PRRSV vaccination and to explain the observed differences between E+ and E- piglets.</p
