Excess mortality in Europe coincides with peaks of COVID-19, influenza and respiratory syncytial virus (RSV), November 2023 to February 2024

Since the end of November 2023, the European Mortality Monitoring Network (EuroMOMO) has observed excess mortality in Europe. During weeks 48 2023-6 2024, preliminary results show a substantially increased rate of 95.3 (95% CI:  91.7-98.9) excess all-cause deaths per 100,000 person-years for all ages. This excess mortality is seen in adults aged 45 years and older, and coincides with widespread presence of COVID-19, influenza and respiratory syncytial virus (RSV) observed in many European countries during the 2023/24 winter season.

Longitudinal testing for respiratory and gastrointestinal shedding of SARS-CoV-2 in day care centres in Hesse, Germany

Background

With the pandemic of SARS-CoV-2 ongoing in Europe in June of 2020, day care centres were reopened in the state of Hesse, Germany, after the lockdown. The role young children play in the dynamics of the transmission was unknown.

Methods

We conducted a longitudinal study over a period of 12 weeks and two days (18 ^th of June 2020 to 10 ^th of September, 2020) to screen attendees and staff from day care centres in the state of Hesse, Germany, for both respiratory and gastrointestinal shedding of SARS-CoV-2. 859 children (age range 3 months to 8 years) and 376 staff members from 50 day care centres, which were chosen representatively from throughout the state, participated in the study. Parents were asked to perform both a buccal mucosa and an anal swab on their children once a week. Staff were asked to self-administer the swabs. RT-PCRs for SARS-CoV-2 were performed in a multiple-swab pooling protocol.

Results

7,366 buccal mucosa swabs and 5,907 anal swabs were analysed. No respiratory or gastrointestinal shedding of SARS-CoV-2 was detected in any of the children. Shedding of SARS-CoV-2 could be detected in two staff members from distinct day care centres. One was asymptomatic at the time of testing, and one was symptomatic and did not attend the facility on that day.

Conclusion

Detection of either respiratory or gastrointestinal shedding of SARS-CoV-2 RNA in children and staff members attending day care centres was rare in the context of limited community activity and with infection prevention measures in the facilities in place.

2760. Accounting for Vaccination History in Estimates of Current Season Vaccine Effectiveness in the US Flu VE Network, 2012–2013 Through 2017–2018

Background

Current season vaccine effectiveness (VE) and influenza risk may vary in persons based on vaccination history. United States Influenza Vaccine Effectiveness (US Flu VE) Network studies have explored prior vaccination effects using a single referent group of patients unvaccinated in both the prior and current seasons. We investigated vaccine benefit among those with and without prior season vaccination.

Methods

Our analysis included data from the US Flu VE Network among patients aged ≥9 years old with acute respiratory illness during 6 influenza seasons, 2012–2013 through 2017–2018. We determined current and prior season vaccination status from documented immunizations. Current season VE against laboratory confirmed influenza was estimated using multivariate logistic regression with an interaction term for prior and current season vaccination. Models were adjusted for age, calendar time, high-risk status, and site.

Results

Of 31,819 patients included in the analysis over 6 seasons, 9188 were influenza positive by RT–PCR. Percent flu positivity was greatest among those unvaccinated (34%), followed by those vaccinated in the prior season only (29%), those vaccinated in both seasons (25%), and those vaccinated in the current season only (23%). Among patients with prior season vaccination, current season VE against any influenza was 14% (95% CL: 5, 22) and against A(H3N2), A(H1N1)pdm09, and B was 10% (95% CL: 3, 17), 36% (95%CL: 25, 46), and 40% (95% CL: 33, 46), respectively. Among patients unvaccinated in the prior season, VE was 42% (95% CL: 37, 46) against any influenza in the current season and was 31% (95%CL: 22, 39), 57% (95% CL: 47, 65), and 55% (95% CL: 48, 61) against A(H3N2), A(H1N1)pdm09, and B, respectively. We observed significant interaction of prior season vaccination on current season VE in 4 of 6 seasons (P < 0.20).

Conclusion

Current season vaccination was overall protective regardless of vaccination history. Among those vaccinated in the prior season, current season vaccination may provide some benefit in addition to residual protection from previous vaccination.

Disclosures

All authors: No reported disclosures.

An evidence-based systematic review of gymnema (Gymnema sylvestre R. Br.) by the Natural Standard Research Collaboration

An evidence-based systematic review of gymnema (Gymnema sylvestre R. Br.), including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Effects of latitude and longitude on the population structure of Culex pipiens s.l., vectors of West Nile virus in North America

We assessed the structure and latitudinal selection that might result in sensitivities to critical day-lengths that trigger diapause between Culex pipiens populations distributed along North-South and East-West axes in eastern North America. Strong population structure between Cx. p. pipiens and Cx. p. quinquefasciatus existed. Among Cx. p. pipiens, a 100-km increase in the latitudinal change resulted in an increased square root of F(ST) by 0.002. A 100-km increase in the longitudinal change caused an increased square root of F(ST) by 0.035. A lack of latitudinal influence on the structure between Cx. p. pipiens populations suggests a uniform signal using the 12 microsatellite markers, which might increase the risk of West Nile virus (WNV) transmission toward northern areas because of longer breeding season, extend host-seeking period, and larger population size. Northern Cx. p. pipiens may have undergone additional generations before diapause is triggered, magnifying population size when WNV amplification is peaking.

Fenugreek (Trigonella foenum-graecum L. Leguminosae): an evidence-based systematic review by the natural standard research collaboration

An evidence-based systematic review including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology and dosing.

An evidence-based systematic review of Aloe vera by the natural standard research collaboration

An evidence-based systematic review including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Increase in West Nile neuroinvasive disease after Hurricane Katrina

After Hurricane Katrina, the number of reported cases of West Nile neuroinvasive disease (WNND) sharply increased in the hurricane-affected regions of Louisiana and Mississippi. In 2006, a >2-fold increase in WNND incidence was observed in the hurricane-affected areas than in previous years.

Rapid fixation of a distinctive sequence motif in the 3' noncoding region of the clade of West Nile virus invading North America

Phylogenetic analysis of complete genomes of West Nile virus (WNV) by a variety of methods supported the hypothesis that North American isolates of WNV constitute a monophyletic group, together with an isolate from Israel and one from Hungary. We used ancestral sequence reconstruction in order to obtain evidence for evolutionary changes that might be correlated with increased virulence in this clade (designated the N.A. clade). There was one amino acid change (I-->T at residue 356 of the NS3 protein) that occurred in the ancestor of the N.A. clade and remained conserved in all N.A. clade genomes analyzed. There were four changes in the upstream portion of the 3' noncoding region (the AT-enriched region) that occurred in the ancestor of the N.A. clade and remained conserved in all N.A. clade genomes analyzed, changes predicted to alter RNA secondary structure. The AT-enriched region showed a higher rate of substitution in the branch ancestral to the N.A. clade, relative to polymorphism, than did the remainder of the noncoding regions, synonymous sites in coding regions, or nonsynonymous sites in coding regions. The high rate of occurrence of fixed nucleotide substitutions in this region suggests that positive Darwinian selection may have acted on this portion of the 3'NCR and that these fixed changes, possibly in concert with the amino acid change in NS3, may underlie phenotypic effects associated with increased virulence in North American WNV.

Marigold (Calendula officinalis L.): an evidence-based systematic review by the Natural Standard Research Collaboration

An evidence-based systematic review including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology and dosing.

Evidence-Based Systematic Review of Saw Palmetto by the Natural Standard Research Collaboration*

Here presented is an evidence-based systematic review including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Lavender (Lavandula angustifolia Miller)

An evidence-based systematic review including scientific evidence, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Lavender (Lavandula angustifolia Miller)

An evidence-based systematic review including scientific evidence, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

St John's wort: a systematic review of adverse effects and drug interactions for the consultation psychiatrist

St. John's wort is an herb commonly used in Europe for decades and more recently the topic of scientific investigation in this country. St. John's wort has been found more effective than placebo and equally as effective as tricyclic antidepressants in the short-term management of mild-to-moderate depression. Comparisons to selective serotonin reuptake inhibitors have provided equivocal data. While it is generally well tolerated in clinical use, there is accumulating evidence of significant interactions with drugs. This evidence-based presentation of the literature includes a brief description of pharmacodynamics and clinical applications, followed by a systematic review of adverse effects, toxicity, and drug interactions.

A focus of deer tick virus transmission in the northcentral United States

We screened salivary glands from adult deer ticks collected near Spooner and Hayward, Wisconsin, to determine whether deer tick virus, a recently described flavivirus, occurs with other tickborne agents in the upper Midwest. Intraacinar inclusions suggestive of replicating virus were detected in 4 (4.6%) of 87 ticks. The virus was isolated by suckling-mouse inoculation.

Power and sample size calculations for case-control studies of gene-environment interactions with a polytomous exposure variable

Genetic polymorphisms may appear to the epidemiologist most commonly as different levels of susceptibility to exposure. Epidemiologic studies of heterogeneity in exposure susceptibility aim at estimating the parameter quantifying the gene-environment interaction. In this paper, the authors use a general approach to power and sample size calculations for case-control studies, which is applicable to settings where the exposure variable is polytomous and where the assumption of independence between the distribution of the genotype and the environmental factor may not be met. It was found through exploration of different scenarios that in the cases explored, power calculations were relatively insensitive to assumptions about the odds ratio for the exposure in the referent genotype category and to assumptions about the odds ratio for the genetic factor in the lowest exposure category, yet they were relatively sensitive to assumptions about gene frequency, particularly when gene frequency was low. In general, to detect a small to moderate gene-environment interaction effect, large sample sizes are needed. Because the examples studied represent only a small subset of possible scenarios that could occur in practice, the authors encourage the use of their user-friendly Fortran program for calculating power and sample size for gene-environment interactions with exposures grouped by quantiles that are explicitly tailored to the study at hand.

A new tick-borne encephalitis-like virus infecting New England deer ticks, Ixodes dammini

To determine if eastern North American Ixodes dammini, like related ticks in Eurasia, maintain tick-borne encephalitis group viruses, we analyzed ticks collected from sites where the agent of Lyme disease is zoonotic. Two viral isolates were obtained by inoculating mice with homogenates from tick salivary glands. The virus, which was described by reverse transcriptase polymerase chain reaction and direct sequencing of the amplification products, was similar to, but distinct from, Powassan virus and is provisionally named "deer tick virus." Enzootic tick-borne encephalitis group viruses accompany the agents of Lyme disease, babesiosis, and granulocytic ehrlichiosis in a Holarctic assemblage of emergent deer tick pathogens.

The relation of self-reported back pain to psychosocial, behavioral, and health-related factors in a working population in Switzerland

Back pain causes a considerable loss of working days as well as health care costs and therefore represents a major public health problem in industrialized countries. Psychosocial factors have received increasing attention from researchers studying the causal factors of non-specific back pain. However, most studies focus on few dimensions, like individual or work-related factors. We studied the simultaneous association of various factors representing psychosocial, behavioral, and health-related dimensions to self-reported back pain. Data from the Berne Workplace Health Project on 850 employed men and women was analyzed. Back pain was operationalized by a dichotomized variable (having suffered moderately to severely from back pain in the preceding four weeks). The theoretical model guiding the underlying project was a general demand-resource model. Variables that--according to that model--were hypothesized to be related to back pain as well as more specific factors--like physical work load--were analyzed by stepwise logistic regression analysis. In men, there was a statistical trend (P < 0.1) for several work-related factors (low job discretion, high job demands, low job satisfaction). In women, dissatisfaction with salary was the only work-related factor associated with back pain. There was no significant association between private context factors, like poor social network or high demands/low control, and back pain. Only in men, the likelihood of back pain increased with age, while only in women, back pain was associated with emotional problems (individual factors). Among the behavioral factors, smoking was associated to back pain in men, while in women none of the behavioral factors was significant. In both men and women reporting more than two functional symptoms and a history of intestinal problems were associated to back pain. All of our findings were in the expected direction, i.e., it was invariably unfavorable categories of explanatory variables that were associated with higher prevalence of back pain. However, most associations seem to be quite unspecific. There is a need for theoretically guided research aiming at the development of a more complex process model of back pain.

[Occupational status and prevalence of cardiovascular risk indicators in employed men in German-speaking Switzerland]

Based on a sample of 623 employed men from the Berne Workplace Health Project ("Härz-As-Project") we studied the relationship between the occupational status and prevalence of cardiovascular risk indicators. Besides "biological" risk indicators, like high total cholesterol, low HDL-cholesterol, hypertension, and overweight, we also studied two behavioral risk indicators (current smoking, physical inactivity in leisure time) and a summary risk score. Odds ratios for several risk indicators controlled for age, were markedly different among different occupational status groups. High cholesterol/HDL-cholesterol ratios were more common in lower occupational status groups, while the likelihood for hypertension and high total cholesterol was highest among qualified workers. There was a strong association between occupational status and the behavioral risk indicators smoking and physical inactivity in leasure time. Similarly, 1 or more risk indicators, and more than 2 risk indicators, respectively, were also found to be strongly related to occupational status. Our results confirm former findings of unequal distribution of cardiovascular disease risk indicators among groups of different occupational status. Future studies will have to focus upon the underlying causes for these inequities.

The relation of reported symptoms to social, individual, and behavioral indicators of ill-health: is the number of reported symptoms a unique general dimension of ill-health?

Counts of functional symptoms are an accepted measure of ill-health in general populations. However, their relation to other indicators of ill-health are still poorly understood. The aim of this study was to investigate such relations in order to reach a better understanding of the 'meaning' of the number of symptoms. The data analyzed was drawn from a telephone health survey conducted among a representative sample of 2111 Swiss adults as part of the Intercantonal Health Indicators Project in 1989. In a logistic regression analysis the Number of symptoms (a summery score of eleven severe function symptoms) was found to be strongly associated with eight social, behavioral, and psychological indicators of ill-health ('Unable to work', 'Frequently consulting a physician', 'Use of analgesics', 'Use of sedatives', 'Poor coping with ill-health', 'Social impairment', 'Poor health', and 'Poor psychological well-being'). To control for effects due to individual symptoms, they were included in the models by stepwise procedure. Although individual symptoms became predictive for all indicators (except for Poor coping with illness), the association between the Number of symptoms and the indicators (except for Social impairment) remained statistically significant. Despite methodological provisos our results seem to support an interpretation of the Number of symptoms as a distinct and general dimension of ill-health.

Reported disease and psychological well-being in Swiss adults

In Switzerland, and in many other countries as well, the distribution of morbidity and perceived health in the general population and their determining factors have not been systematically studied so far. This article reports on exploratory study of prevalence of two complex health indicators, long-standing disease (Disease) and psychological well-being (Well-being) and of their environmental, person-specific and behavioural determinants. Data from a health survey conducted in five cantons and three language regions as part of the Swiss Intercantonal Health Indicators Project were used. Whereas distributions of prevalence of Disease according to gender, age, level of education and place of living confirm results of other studies, unexpected prevalence patterns were found for Well-being, especially with regard to gender differences. Multivariate analyses by general linear models (independent sub-samples of the study population were used to develop and validate models) showed different sets of environmental, person-specific and behavioural factors to explain inter-individual differences of Disease and Well-being, both in the total validation sample and in sub-samples of women and men. The results are discussed with regard to implications for socioepidemiological health research.

[Health, health-related behavior and gainful employment]

Based on data collected in a survey as part of the Swiss Intercantonal Health Indicators Project (random sample stratified by age of 20-75 year old persons, n = 2106) relationships between level of employment (full, part-time, none) and health/disease as well as health behaviour were studied. Employed men and to some extent employed women as well were found to be less frequently sick and to feel more frequently well than non-employed men and women. Overall employment appears to affect health/disease in men more strongly than in women, whereas influence on health behaviour appears to be similar in both gender groups. The results of the study are discussed both with regard to further hypotheses of health research and opportunities of health promotion.

Oral, pharyngeal and laryngeal cancer as a cause of death among Swiss cooks

In an analysis of Swiss mortality data (1979-1987) excess mortality due to oral, pharyngeal and laryngeal cancer was found among cooks, and the rate was very high in the age group < 55 years. The peak number of cases was observed among cooks in the age category 45-49 years. In the standard population the highest number of such deaths was observed between 65 and 69 years of age. The numbers of alcohol-related causes of death were also elevated among the cooks, while the numbers of smoking-related deaths were not. Although the dominant role of combined alcohol and tobacco consumption for the development of oral, pharyngeal and laryngeal cancer has been confirmed by many studies, other factors (eg, volatile carcinogenic compounds formed during the cooking process) may contribute to the excess mortality from oral, pharyngeal and laryngeal cancer among cooks. The question of the relevance of such factors will have to be answered by further studies.