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Karmarkar EN, O'Donnell K, Prestel C, Forsberg K, Gade L, Jain S, Schan D, Chow N, McDermott D, Rossow J, Toda M, Ruiz R, Hun S, Dale JL, Gross A, Maruca T, Glowicz J, Brooks R, Bagheri H, Nelson T, Gualandi N, Khwaja Z, Horwich-Scholefield S, Jacobs J, Cheung M, Walters M, Jacobs-Slifka K, Stone ND, Mikhail L, Chaturvedi S, Klein L, Vagnone PS, Schneider E, Berkow EL, Jackson BR, Vallabhaneni S, Zahn M, Epson E. Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings-Orange County, California, 2019. Ann Intern Med 2021; 174:1554-1562. [PMID: 34487450 PMCID: PMC10984253 DOI: 10.7326/m21-2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Candida auris, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of Candida that were detected in urine specimens to enhance surveillance of C auris, and C auris was identified in February 2019 in a patient in an Orange County (OC), California, LTACH. Further investigation identified C auris at 3 associated facilities. OBJECTIVE To assess the prevalence of C auris and infection prevention and control (IPC) practices in LTACHs and vSNFs in OC. DESIGN Point prevalence surveys (PPSs), postdischarge testing for C auris detection, and assessments of IPC were done from March to October 2019. SETTING All LTACHs (n = 3) and vSNFs (n = 14) serving adult patients in OC. PARTICIPANTS Current or recent patients in LTACHs and vSNFs in OC. INTERVENTION In facilities where C auris was detected, PPSs were repeated every 2 weeks. Ongoing IPC support was provided. MEASUREMENTS Antifungal susceptibility testing and whole-genome sequencing to assess isolate relatedness. RESULTS Initial PPSs at 17 facilities identified 44 additional patients with C auris in 3 (100%) LTACHs and 6 (43%) vSNFs, with the first bloodstream infection reported in May 2019. By October 2019, a total of 182 patients with C auris were identified by serial PPSs and discharge testing. Of 81 isolates that were sequenced, all were clade III and highly related. Assessments of IPC identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning. The outbreak was contained to 2 facilities by October 2019. LIMITATION Acute care hospitals were not assessed, and IPC improvements over time could not be rigorously evaluated. CONCLUSION Enhanced laboratory surveillance and prompt investigation with IPC support enabled swift identification and containment of C auris. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Ellora N Karmarkar
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, and the California Department of Public Health, Richmond, California (E.N.K.)
| | - Kathleen O'Donnell
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Christopher Prestel
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Kaitlin Forsberg
- Centers for Disease Control and Prevention and IHRC, Atlanta, Georgia (K.F.)
| | - Lalitha Gade
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Seema Jain
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Douglas Schan
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Nancy Chow
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Darby McDermott
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - John Rossow
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Mitsuru Toda
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Ryan Ruiz
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Sopheay Hun
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Jennifer L Dale
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Annastasia Gross
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Tyler Maruca
- Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.)
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Richard Brooks
- Centers for Disease Control and Prevention, Atlanta, Georgia, and the Maryland Department of Health, Infectious Disease Epidemiology and Outbreak Response Bureau, Baltimore, Maryland (R.B.)
| | - Hosniyeh Bagheri
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Teresa Nelson
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Nicole Gualandi
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Zenith Khwaja
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Sam Horwich-Scholefield
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Josh Jacobs
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Michele Cheung
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Maroya Walters
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Kara Jacobs-Slifka
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Nimalie D Stone
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Lydia Mikhail
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | | | - Liore Klein
- Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.)
| | - Paula Snippes Vagnone
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Emily Schneider
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Elizabeth L Berkow
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Brendan R Jackson
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Snigdha Vallabhaneni
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Matthew Zahn
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Erin Epson
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
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Shugart A, Mahon G, Huang JY, Karlsson M, Valley A, Lasure M, Gross A, Pattee B, Vaeth E, Brooks R, Maruca T, Dominguez CE, Torpey D, Francis D, Bhattarai R, Kainer MA, Chan A, Dubendris H, Greene SR, Blosser SJ, Shannon DJ, Jones K, Brennan B, Hun S, D'Angeli M, Murphy CN, Tierney M, Reese N, Bhatnagar A, Kallen A, Brown AC, Spalding Walters M. Carbapenemase production among less-common Enterobacterales genera: 10 US sites, 2018. JAC Antimicrob Resist 2021; 3:dlab137. [PMID: 34514407 PMCID: PMC8417453 DOI: 10.1093/jacamr/dlab137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Historically, United States’ carbapenem-resistant Enterobacterales (CRE) surveillance and mechanism testing focused on three genera: Escherichia, Klebsiella, and Enterobacter (EsKE); however, other genera can harbour mobile carbapenemases associated with CRE spread. Objectives From January through May 2018, we conducted a 10 state evaluation to assess the contribution of less common genera (LCG) to carbapenemase-producing (CP) CRE. Methods State public health laboratories (SPHLs) requested participating clinical laboratories submit all Enterobacterales from all specimen sources during the surveillance period that were resistant to any carbapenem (Morganellaceae required resistance to doripenem, ertapenem, or meropenem) or were CP based on phenotypic or genotypic testing at the clinical laboratory. SPHLs performed species identification, phenotypic carbapenemase production testing, and molecular testing for carbapenemases to identify CP-CRE. Isolates were categorized as CP if they demonstrated phenotypic carbapenemase production and ≥1 carbapenemase gene (blaKPC, blaNDM, blaVIM, blaIMP, or blaOXA-48-like) was detected. Results SPHLs tested 868 CRE isolates, 127 (14.6%) were from eight LCG. Overall, 195 (26.3%) EsKE isolates were CP-CRE, compared with 24 (18.9%) LCG isolates. LCG accounted for 24 (11.0%) of 219 CP-CRE identified. Citrobacter spp. was the most common CP-LCG; the proportion of Citrobacter that were CP (11/42, 26.2%) was similar to the proportion of EsKE that were CP (195/741, 26.3%). Five of 24 (20.8%) CP-LCG had a carbapenemase gene other than blaKPC. Conclusions Participating sites would have missed approximately 1 in 10 CP-CRE if isolate submission had been limited to EsKE genera. Expanding mechanism testing to additional genera could improve detection and prevention efforts.
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Affiliation(s)
- Alicia Shugart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Garrett Mahon
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Jennifer Y Huang
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Maria Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Ann Valley
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Megan Lasure
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | | | | | | | - Richard Brooks
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA.,Maryland Department of Health, Baltimore, MD, USA
| | - Tyler Maruca
- Maryland Department of Health, Baltimore, MD, USA
| | | | - David Torpey
- Maryland Department of Health, Baltimore, MD, USA
| | - Drew Francis
- Arizona Department of Health Services, Phoenix, AZ, USA
| | | | | | - Allison Chan
- Tennessee Department of Health, Nashville, TN, USA
| | - Heather Dubendris
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Shermalyn R Greene
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Sara J Blosser
- Indiana State Department of Health, Indianapolis, IN, USA
| | - D J Shannon
- Indiana State Department of Health, Indianapolis, IN, USA
| | - Kelly Jones
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Brenda Brennan
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Sopheay Hun
- Washington State Department of Health, Tumwater, WA, USA
| | | | - Caitlin N Murphy
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, NE, USA
| | - Maureen Tierney
- Nebraska Department of Health and Human Services, Lincoln, NE, USA
| | - Natashia Reese
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Amelia Bhatnagar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA.,Goldbelt C6 Inc, Juneau, AK, USA
| | - Alex Kallen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Allison C Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
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3
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Bousquet J, Onorato GL, Bachert C, Barbolini M, Bedbrook A, Bjermer L, de Sousa JC, Chavannes NH, Cruz AA, De Manuel Keenoy E, Devillier P, Fonseca J, Hun S, Kostka T, Hellings PW, Illario M, Ivancevich JC, Larenas-Linnemann D, Millot-Keurinck J, Ryan D, Samolinski B, Sheikh A, Yorgancioglu A, Agache I, Arnavielhe S, Bewick M, Annesi-Maesano I, Anto JM, Bergmann KC, Bindslev-Jensen C, Bosnic-Anticevich S, Bouchard J, Caimmi DP, Camargos P, Canonica GW, Cardona V, Carriazo AM, Cingi C, Colgan E, Custovic A, Dahl R, Demoly P, De Vries G, Fokkens WJ, Fontaine JF, Gemicioğlu B, Guldemond N, Gutter Z, Haahtela T, Hellqvist-Dahl B, Jares E, Joos G, Just J, Khaltaev N, Keil T, Klimek L, Kowalski ML, Kull I, Kuna P, Kvedariene V, Laune D, Louis R, Magnan A, Malva J, Mathieu-Dupas E, Melén E, Menditto E, Morais-Almeida M, Mösges R, Mullol J, Murray R, Neffen H, O'Hehir R, Palkonen S, Papadopoulos NG, Passalacqua G, Pépin JL, Portejoie F, Price D, Pugin B, Raciborski F, Simons FER, Sova M, Spranger O, Stellato C, Todo Bom A, Tomazic PV, Triggiani M, Valero A, Valovirta E, VandenPlas O, Valiulis A, van Eerd M, Ventura MT, Wickman M, Young I, Zuberbier T, Zurkuhlen A, Senn A. CHRODIS criteria applied to the MASK (MACVIA-ARIA Sentinel NetworK) Good Practice in allergic rhinitis: a SUNFRAIL report. Clin Transl Allergy 2017; 7:37. [PMID: 29075437 PMCID: PMC5654064 DOI: 10.1186/s13601-017-0173-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/18/2017] [Indexed: 02/06/2023] Open
Abstract
A Good Practice is a practice that works well, produces good results, and is recommended as a model. MACVIA-ARIA Sentinel Network (MASK), the new Allergic Rhinitis and its Impact on Asthma (ARIA) initiative, is an example of a Good Practice focusing on the implementation of multi-sectoral care pathways using emerging technologies with real life data in rhinitis and asthma multi-morbidity. The European Union Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS) has developed a checklist of 28 items for the evaluation of Good Practices. SUNFRAIL (Reference Sites Network for Prevention and Care of Frailty and Chronic Conditions in community dwelling persons of EU Countries), a European Union project, assessed whether MASK is in line with the 28 items of JA-CHRODIS. A short summary was proposed for each item and 18 experts, all members of ARIA and SUNFRAIL from 12 countries, assessed the 28 items using a Survey Monkey-based questionnaire. A visual analogue scale (VAS) from 0 (strongly disagree) to 100 (strongly agree) was used. Agreement equal or over 75% was observed for 14 items (50%). MASK is following the JA-CHRODIS recommendations for the evaluation of Good Practices.
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Affiliation(s)
- J Bousquet
- Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.,INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France.,CHU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - G L Onorato
- Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - C Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | - M Barbolini
- Regione Emilia Romagna - Agenzia Sanitaria e Sociale, Reference Site of the European Innovation Partnership on Healthy and Active Ageing, Bologna, Italy
| | - A Bedbrook
- Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - L Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - J Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - N H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - A A Cruz
- ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil.,GARD Executive Committee, Salvador, Brazil
| | - E De Manuel Keenoy
- Kronikgune, International Centre of Excellence in Chronicity Research Barakaldo, Bizkaia Bilbao, Spain
| | - P Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220, Pôle des Maladies Respiratoires, Hôpital Foch, Suresnes Université Versailles Saint-Quentin, Versailles, France
| | - J Fonseca
- Center for Health Technology and Services Research- CINTESIS, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Allergy Unit, CUF Porto Instituto and Hospital, Porto, Portugal
| | - S Hun
- Public Health Agency Northern Ireland, Belfast, UK
| | - T Kostka
- Department of Geriatrics, Medical University of Lodz, Healthy Ageing Research Centre (HARC), Lodz, Poland
| | - P W Hellings
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
| | - M Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | - J C Ivancevich
- Allergy and Immunology Department, Santa Isabel, Buenos Aires, Argentina
| | | | - J Millot-Keurinck
- Caisse Assurance Retraite et Santé Au Travail Languedoc-Roussillon (CARSAT-LR), 34000 Montpellier, France
| | - D Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - B Samolinski
- Department of Prevention of Envinronmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - A Sheikh
- Asthma UK Centre for Applied Research, Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - A Yorgancioglu
- Department of Pulmonology, Celal Bayar University, Manisa, Turkey.,GARD Executive Committee, Manisa, Turkey
| | - I Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | | | - M Bewick
- iQ4U Consultants Ltd, London, UK
| | - I Annesi-Maesano
- EPAR U707 INSERM, Paris and EPAR UMR-S UPMC, Paris VI, Paris, France
| | - J M Anto
- Centre for Research in Environmental Epidemiology (CREAL), ISGLoBAL, Barcelona, Spain.,IMIM (Hospital del Mar Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - K C Bergmann
- Comprehensive Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Global Allergy and Asthma European Network (GA2LEN), Berlin, Germany
| | - C Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - S Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW Australia.,Personalized Medicine Clinic Asthma and Allergy, Humanitas University, Humanitas Research Hospital, Rozzano, Milan Italy
| | - J Bouchard
- Laval's University, Quebec City, Canada.,Hôpital de la Malbaie, Quebec City, Canada
| | - D P Caimmi
- CHRU de Montpellier, Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France.,Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - P Camargos
- Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - G W Canonica
- CHRU de Montpellier, Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - V Cardona
- Allergologia, S Medicina Interna, Hospital Vall d'Hebron, Barcelona, Spain
| | - A M Carriazo
- Regional Ministry of Health of Andalusia, Seville, Spain
| | - C Cingi
- ENT Department, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - E Colgan
- Department of Health, Social Services and Public Safety, Belfast, Northern Ireland, UK
| | - A Custovic
- Department of Pediatric, Imperial College London, London, UK
| | - R Dahl
- ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil.,GARD Executive Committee, Salvador, Brazil
| | - P Demoly
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - G De Vries
- Peercode DV, Gerdermalsen, The Netherlands
| | - W J Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - B Gemicioğlu
- Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - N Guldemond
- Institute of Health Policy and Management iBMG, Erasmus University, Rotterdam, The Netherlands
| | - Z Gutter
- University Hospital Olomouc - National eHealth Centre, Olomouc, Czech Republic
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - B Hellqvist-Dahl
- Department of Respiratory Diseases, Odense University Hospital, Odense, Denmark
| | - E Jares
- Libra Foundation, Buenos Aires, Argentina
| | - G Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - J Just
- Allergology Department, Centre de l'Asthme et des Allergies Hôpital d'Enfants Armand-Trousseau (APHP), Paris, France.,UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Sorbonne Universités, 75013 Paris, France
| | | | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - M L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, and HARC, Lodz, Poland
| | - I Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - V Kvedariene
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology, Vilnius University, Vilnius, Lithuania
| | | | - R Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, Belgium
| | - A Magnan
- Service de Pneumologie, UMR INSERM, UMR1087 and CNR 6291, l'institut du thorax, University of Nantes, Nantes, France
| | - J Malva
- Institute of Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | | | - E Melén
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E Menditto
- CIRFF, Federico II University, Naples, Italy
| | - M Morais-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisbon, Portugal
| | - R Mösges
- Institute of Medical Statistics, Informatics and Epidemiology, Medical Faculty, University of Cologne, Cologne, Germany
| | - J Mullol
- Clinical and Experimental Respiratory Immunoallergy, ENT Department, Hospital Clínic, IDIBAPS, CIBERES, Universitat de Barcelona, Barcelona, Spain
| | - R Murray
- Medical Communications Consultant, MedScript Ltd, Dundalk, Co Louth Ireland
| | - H Neffen
- Argentina Center for Allergy and Immunology, Alassia Children's Hospital, Santa Fe, Santa Fe, Argentina
| | - R O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC Australia.,Department of Immunology, Monash University, Melbourne, VIC Australia
| | - S Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - N G Papadopoulos
- Center for Pediatrics and Child Health, Institute of Human Development, Royal Manchester Children's Hospital, University of Manchester, Manchester, M13 9WL UK.,Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou,", University of Athens, Athens, 11527 Greece
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino Hospital, IST-University of Genoa, Genoa, Italy
| | | | - F Portejoie
- Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - D Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Optimum Patient Care, Cambridge, UK.,Academic Centre of Primary Care, University of Aberdeen, Aberdeen, UK
| | - B Pugin
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
| | - F Raciborski
- Department of Prevention of Envinronmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - F E R Simons
- Department of Pediatrics and Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba Canada
| | - M Sova
- University Hospital Olomouc, Olomouc, Czech Republic
| | - O Spranger
- Global Allergy and Asthma Platform GAAPP, Altgasse 8-10, 1130 Vienna, Austria
| | - C Stellato
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - A Todo Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - P V Tomazic
- Department of ENT, Medical University of Graz, Graz, Austria
| | - M Triggiani
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - A Valero
- Pneumology and Allergy Department Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - E Valovirta
- Pneumology and Allergy Department Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - O VandenPlas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - A Valiulis
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - M van Eerd
- Peercode DV, Gerdermalsen, The Netherlands
| | - M T Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - M Wickman
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - I Young
- Queen's University Belfast, Belfast, Northern Ireland, UK
| | - T Zuberbier
- Comprehensive Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Global Allergy and Asthma European Network (GA2LEN), Berlin, Germany
| | - A Zurkuhlen
- Gesundheitsregion KölnBonn - HRCB Projekt GmbH, Kohln, Germany
| | - A Senn
- EC-CNECT-H2, European Commission, Brussels, Belgium
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