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Objective This study aimed to estimate the proportion and number of incident upper-extremity musculoskeletal disorders (UEMSD) cases attributable to occupational risk factors in a working population. Methods Between 2002-2005, occupational physicians randomly selected 3710 workers, aged 20-59, from the Pays de la Loire (PdL) region. All participants underwent a standardized clinical examination. Between 2007-2010, 1611 workers were re-examined. This study included 1246 workers who were free of six main clinically diagnosed UEMSD at baseline but were diagnosed with at least one of these UEMSD at follow-up [59% of men, mean age: 38 (standard deviation 8.6) years]. Relative risks and population-attributable fractions (PAF) were calculated using Cox multivariable models with equal follow-up time and robust variance. The total number of incident UEMSD in the PdL region was estimated after adjustment of the sample weights using 2007 census data. The estimated number of potentially avoidable UEMSD was calculated by multiplying PAF by the total number of incident UEMSD in PdL. Results At follow-up, 139 new cases of UEMSD (11% of the study sample) were diagnosed. This represented an estimated 129 320 incident cases in the PdL in 2007. Following adjustment for personal factors, 26 381 (20.4% of all incident UEMSD) were attributable to high physical exertion, 16 682 (12.9%) to low social support, and 8535 (6.6%) to working with arms above shoulder level. Conclusions A large number and important proportion of incident UEMSD may be preventable by reducing work exposures to physical exertion and working with arms above shoulder level as well as improving social support from co-workers/supervisors.

The objective of this paper is to assess the combined effect of occupational biomechanical and psychosocial risk factors on the incidence of work-related upper-extremity musculoskeletal disorders (UEMSDs) and estimate the proportion and number of incident cases attributable to these risk factors in a working population. Using data from the French COSALI (COhorte des SAlariés LIgériens) cohort (enrolment phase: 2002–2005; follow-up phase: 2007–2010), a complete case analysis including 1246 workers (59% men, mean age: 38 years ± 8.6 at baseline) was performed. All participants underwent a standardized clinical examination at enrolment and 1611 workers were re-examined at follow-up. Population attributable fractions and the number of UEMSD cases attributable to occupational risk factors were calculated. During follow-up, 139 UEMSD cases were diagnosed, representing an estimated 129,320 projected incident UEMSD cases in the working population. After adjusting for personal factors, in model 1, 8664 cases (6.7%) were attributable to low social support, 19,010 (14.7%) to high physical exertion, and 20,443 (15.8%) to co-exposure to both factors. In model 2, 16,294 (12.6%) cases were attributable to low social support, 6983 (5.4%) to posture with arms above shoulder level, and 5043 (3.9%) to co-exposure to both factors. Our findings suggest that many cases of UEMSD could be potentially prevented by multidimensional interventions aimed at reducing exposure to high physical exertion and improving social support at work.

Context:In UK and French, but not World Health Organization (WHO), guidelines for combined hormonal contraception (CHC), family history of a venous thromboembolism (VTE) is a condition for which the theoretical risks usually outweigh the advantages of using CHC.Objective:We estimated the prevalence of inappropriate prescriptions of CHC according to several international guidelines and their impact on VTE.Design:A single-center observational study.Setting:Hemostasis unit outpatient clinic (Paris, France).Population:A total of 2088 French CHC users of childbearing age with a first documented VTE who were referred to our unit between 2000 and 2009.Methods:Data were collected by a standardized questionnaire during a medical consultation. Family history of VTE was analyzed according to definitions from international recommendations (VTE before age 45 years, United Kingdom; before age 50 years, France). A CHC prescription was considered inappropriate for women with vascular contraindications and/or a family history of VTE. Cross-sectional analysis of the clinical and biological characteristics was performed.Main Outcome Measures:Prevalence of inappropriate prescription of CHC and potentially preventable events were estimated.Results:According to the WHO, UK, or French guidelines, 8.8%, 18.9%, and 25.9%, respectively, of CHC prescriptions were considered inappropriate. Compliance with these guidelines could reduce the corresponding number of VTEs by 6.3%, 13.5%, and 18.5%, respectively. Characteristics of the women were similar.Conclusion:Our results suggest inappropriate CHC prescriptions are prevalent among CHC users with first VTE. The appropriate way to take family history of VTE into account should be further clarified.Inappropriate CHC prescriptions are prevalent among CHC users with a first venous thrombosis event. The appropriate way to take family history of VTE into account should be further clarified.

Migrants in Europe often face barriers to vaccination, increasing their vulnerability to vaccine-preventable diseases (VPDs). Despite policies promoting catch-up immunisation on arrival, data on VPD burden and outcomes among migrants remain limited. This systematic review synthesises evidence on the prevalence, incidence, mortality, and outcomes of VPDs in migrants across EU/EEA countries, UK, and Switzerland. We searched Medline, Embase, Global Health, and grey literature sources (including websites of national public health organisations and agencies) for primary studies and reports on VPD cases among migrants (foreign-born individuals) in 32 European countries, published between January 2010 and April 2024. Data on demographics, VPD type, vaccination status, and outcomes were extracted. We focused on diphtheria, measles, mumps, pertussis, rubella, and tetanus. Study quality was assessed using Joanna Briggs Institute tools. Fifty-seven studies met inclusion criteria, reporting 1950 VPD cases in migrants across 16 countries (2010–2024). Most studies were in Germany (n = 12), Spain (n = 11), Switzerland (n = 8), Greece (n = 6), and the UK (n = 7). Reported cases included: measles (n = 992; 50.8 %), diphtheria (n = 546; 28.0 %), pertussis (n = 267; 13.7 %), and mumps (n = 137; 7.0 %). No cases of rubella or tetanus were reported. Migrants affected mainly included asylum seekers (n = 23 studies), refugees (n = 6), labour migrants (n = 2). Six studies from Greece, Germany, and Spain accounted for 1942 cases (99.6 %). Over half of diphtheria cases (n = 307; 55.4 %) occurred in reception centres. Diphtheria primarily affected adolescents and adults (n = 10 studies), while measles cases were mostly in children. Migrants from the Eastern Mediterranean and Africa were disproportionately affected by diphtheria. Non-EU/EEA European migrants (WHO EUR), mainly from Bosnia and Herzegovina and Serbia, accounted for most measles cases (87 %), and non-European migrants were from Somalia (n = 112), Afghanistan (n = 94), Eritrea (n = 76), and Syria (n = 64). Vaccination status was unknown or unreported in over 60 % of cases. Five VPD related deaths were reported of which 4/5 were due to measles. Migrants are at increased risk of VPDs due to gaps in vaccination. Strengthening catch-up vaccination, particularly in adolescents and adults, and improving data collection are essential next steps. •Migrants are considered an under-vaccinated group with increased risk of vaccine-preventable diseases (VPDs).•We found that most VPD cases in migrants in Europe were measles and diphtheria, mainly in Germany, Spain, and Greece.•Vaccination status was unknown in over the majority of reported VPD cases.•There is an urgent need to strengthen catch-up vaccination efforts particularly among adult and adolescent migrants.

Mexico and the United States share an international boundary with a considerable extension. The objective of this retrospective study is to assess the morbidity of viral vaccine preventable diseases in the six Mexican states bordering the U.S. from 2014 to 2023. Viral vaccine preventable diseases are a major health concern because they can cause serious illness and death. From the analysis of 9 nationally notifiable viral vaccine preventable diseases, only varicella and mumps had a significant higher incidence than the national average. A higher incidence of varicella was also observed in the U.S. border states for the years of the study. A deeper analysis revealed that varicella is seasonal in the Mexican border states and its incidence is steadily declining throughout the years of study. For mumps, the higher incidence in the border states can be attributed to outbreaks in the years 2018 and 2019. Of importance, we observed an increasing morbidity of the viral vaccine preventable diseases after the emergence of COVID-19 in 2020. These data indicate that the incidence of certain infectious diseases is historically higher in the border states than the national average, and that continuous surveillance is crucial, especially after the COVID-19 pandemic.

Abstract Background Bacterial meningitis is a major cause of morbidity and mortality in sub-Saharan Africa. We analyzed data from the World Health Organization’s (WHO) Invasive Bacterial Vaccine-preventable Diseases Surveillance Network (2011–2016) to describe the epidemiology of laboratory-confirmed Streptococcus pneumoniae (Spn), Neisseria meningitidis, and Haemophilus influenzae meningitis within the WHO African Region. We also evaluated declines in vaccine-type pneumococcal meningitis following pneumococcal conjugate vaccine (PCV) introduction. Methods Reports of meningitis in children <5 years old from sentinel surveillance hospitals in 26 countries were classified as suspected, probable, or confirmed. Confirmed meningitis cases were analyzed by age group and subregion (South-East and West-Central). We described case fatality ratios (CFRs), pathogen distribution, and annual changes in serotype and serogroup, including changes in vaccine-type Spn meningitis following PCV introduction. Results Among 49 844 reported meningitis cases, 1670 (3.3%) were laboratory-confirmed. Spn (1007/1670 [60.3%]) was the most commonly detected pathogen; vaccine-type Spn meningitis cases declined over time. CFR was the highest for Spn meningitis: 12.9% (46/357) in the South-East subregion and 30.9% (89/288) in the West-Central subregion. Meningitis caused by N. meningitidis was more common in West-Central than South-East Africa (321/954 [33.6%] vs 110/716 [15.4%]; P < .0001). Haemophilus influenzae (232/1670 [13.9%]) was the least prevalent organism. Conclusions Spn was the most common cause of pediatric bacterial meningitis in the African region even after reported cases declined following PCV introduction. Sustaining robust surveillance is essential to monitor changes in pathogen distribution and to inform and guide vaccination policies. We describe the epidemiology of meningitis cases due to Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae across 26 African countries participating in the World Health Organization’s Invasive Bacterial Vaccine-preventable Diseases Network, including trends in vaccine-type pneumococcal meningitis post–pneumococcal conjugate vaccine introduction.

•Reported to SAGE on immunization and surveillance data quality & use, October 2019.•Improvements since 2011, but gaps persist in data quality (fit-for-purpose) and use.•Improving data quality and use requires better governance, people, tools, and processes.•Better use of existing data needed to continuously improve programme performance.•Report relevant for “data-guided” implementation of the Immunization Agenda 2030. Concerns about the quality and use of immunization and vaccine-preventable disease (VPD) surveillance data have been highlighted on the global agenda for over two decades. In August 2017, the Strategic Advisory Group of Experts (SAGE) established a Working Group (WG) onthe Quality and Use of Global Immunization and Surveillance Data to review the current status and evidence to make recommendations, which were presented to SAGE in October 2019. The WG synthesized evidence from landscape analyses, literature reviews, country case-studies, a data triangulation analysis, as well as surveys of experts. Data quality (DQ) was defined as data that are accurate, precise, relevant, complete, and timely enough for the intended purpose (fit-for-purpose), and data use as the degree to which data are actually used for defined purposes, e.g., immunization programme management, performance monitoring, decision-making. The WG outlined roles and responsibilities for immunization and surveillance DQ and use by programme level. The WG found that while DQ is dependent on quality data collection at health facilities, many interventions have targeted national and subnational levels, or have focused on new technologies, rather than the people and enabling environments required for functional information systems. The WG concluded that sustainable improvements in immunization and surveillance DQ and use will require efforts across the health system — governance, people, tools, and processes, including use of data for continuous quality improvement (CQI) — and that the approaches need to be context-specific, country-owned and driven from the frontline up. At the country level, major efforts are needed to: (1) embed monitoring DQ and use alongside monitoring of immunization and surveillance performance, (2) increase workforce capacity and capability for DQ and use, starting at the facility level, (3) improve the accuracy of immunization programme targets (denominators), (4) enhance use of existing data for tailored programme action (e.g., immunization programme planning, management and policy-change), (5) adopt a data-driven CQI approach as part of health system strengthening, (6) strengthen governance around piloting and implementation of new information and communication technology tools, and (7) improve data sharing and knowledge management across areas and organizations for improved transparency and efficiency. Global and regional partners are requested to support countries in adopting relevant recommendations for their setting and to continue strengthening the reporting and monitoring of immunization and VPD surveillance data through processes periodic needs assessment and revision processes. This summary of the WG’s findings and recommendations can support “data-guided” implementation of the new Immunization Agenda 2030.

In January, 2021, a vaccination campaign against COVID-19 was initiated with the rAd26-rAd5, ChAdOx1 nCoV-19, and BBIBP-CorV vaccines in Argentina. The objective of this study was to estimate vaccine effectiveness at reducing risk of SARS-CoV-2 infection and COVID-19 deaths in people older than 60 years. In this test-negative, case-control, and retrospective longitudinal study done in Argentina, we evaluated the effectiveness of three vaccines (rAd26-rAd5, ChAdOx1 nCoV-19, and BBIBP-CorV) on SARS-CoV-2 infection and risk of death in people with RT-PCR confirmed COVID-19, using data from the National Surveillance System (SNVS 2.0). All individuals aged 60 years or older reported to SNVS 2.0 as being suspected to have COVID-19 who had disease status confirmed with RT-PCR were included in the study. Unvaccinated individuals could participate in any of the analyses. People with suspected COVID-19 who developed symptoms before the start of the implementation of the vaccination programme for their age group or district were excluded from the study. The odds ratio of SARS-CoV-2 infection was evaluated by logistic regression and the risk of death in individuals with RT-PCR confirmed COVID-19 was evaluated by proportional hazard regression models, adjusted for possible confounders: age at the time of the symptom onset date, sex, district of residence, epidemiological week corresponding to the symptom onset date, and history of COVID-19. The estimation of vaccine effectiveness to prevent death due to COVID-19 was done indirectly by combining infection and death estimates. In addition, we evaluated the effect of the first dose of viral vector vaccines across time. From Jan 31, to Sept 14, 2021, 1 282 928 individuals were included, of whom 687 167 (53·6%) were in the rAd26-rAd5 analysis, 358 431 (27·6%) in the ChAdOx1 nCoV-19 analysis, and 237 330 (18·5%) in the BBIBP-CorV analysis. Vaccine effectiveness after two doses was high for all three vaccines, adjusted odds ratio 0·36 (95% CI 0·35–0·37) for rAd26-rAd5, 0·32 (0·31–0·33) for ChAdOx1 nCoV-19, and 0·56 (0·55–0·58) for BBIBP-CorV. After two doses, the effect on deaths was higher than that on risk of infection: adjusted hazard ratio 0·19 (95% CI 0·18–0·21) for rAd26-rAd5, 0·20 (0·18–0·22) for ChAdOx1 nCoV-19, and 0·27 (0·25–0·29) for BBIBP-CorV. The indirectly estimated effectiveness on deaths was 93·1% (95% CI 92·6–93·5) for rAd26-rAd5, 93·7% (93·2–94·3) for ChAdOx1 nCoV-19, and 85·0% (84·0–86·0) for BBIBP-CorV following two doses. First dose effect of viral vector vaccines remained stable over time. The vaccines used in Argentina showed effectiveness in reducing infection and death by SARS-CoV-2 and COVID-19. None.

ObjectivesTo investigate mortality and its causes in adults over the age of 20 years with intellectual disability (ID).Design, setting and participantsRetrospective population-based standardised mortality of the ID and Comparison cohorts. The ID cohort comprised 42 204 individuals who registered for disability services with ID as a primary or secondary diagnosis from 2005 to 2011 in New South Wales (NSW). The Comparison cohort was obtained from published deaths in NSW from the Australian Bureau of Statistics (ABS) from 2005 to 2011.Main outcome measuresWe measured and compared Age Standardised Mortality Rate (ASMR), Comparative Mortality Figure (CMF), years of productive life lost (YPLL) and proportion of deaths with potentially avoidable causes in an ID cohort with an NSW general population cohort.ResultsThere were 19 362 adults in the ID cohort which experienced 732 (4%) deaths at a median age of 54 years. Age Standardised Mortality Rates increased with age for both cohorts. Overall comparative mortality figure was 1.3, but was substantially higher for the 20–44 (4.0) and 45–64 (2.3) age groups. YPLL was 137/1000 people in the ID cohort and 49 in the comparison cohort. Cause of death in ID cohort was dominated by respiratory, circulatory, neoplasm and nervous system. After recoding deaths previously attributed to the aetiology of the disability, 38% of deaths in the ID cohort and 17% in the comparison cohort were potentially avoidable.ConclusionsAdults with ID experience premature mortality and over-representation of potentially avoidable deaths. A national system of reporting of deaths in adults with ID is required. Inclusion in health policy and services development and in health promotion programmes is urgently required to address premature deaths and health inequalities for adults with ID.

Background. In the current era, most pertussis deaths occur in infants <3 months of age. Leukocytosis with lymphocytosis and pneumonia are commonly observed among cases of severe pertussis. Methods. Risk factors associated with fatal pertussis were identified by comparing fatal pertussis cases among patients <120 days of age occurring from 1 January 1998 through 26 December 2014, matched by age (<120 days), county of residence, and closest symptom onset date with 1–4 nonfatal hospitalized cases. California Department of Public Health surveillance data were reviewed to identify cases; demographics, clinical presentation, and course were abstracted from corresponding birth and medical records. Logistic regression and classification tree analyses were used to examine the risk of fatal pertussis with respect to identified factors. Results. Fifty-three fatal infant pertussis cases were identified and compared with 183 nonfatal hospitalized pertussis cases. Fatal cases had significantly lower birth weight, younger gestational age, younger age at time of cough onset, and higher peak white blood cell (WBC) and lymphocyte counts. Fatal cases were less likely to have received macrolide antibiotics and more likely to have received steroids or nitric oxide and to develop pulmonary hypertension, seizures, encephalitis, and pneumonia. Additionally, exchange transfusion, extracorporeal membrane oxygenation, and intubation occurred significantly more frequently among fatal cases. In multivariate analyses, peak WBC count, birth weight, intubation, and receipt of nitric oxide were predictors of death. Conclusions. Early recognition of pertussis in young infants and treatment with appropriate antibiotic therapy are important in preventing death. Several risk factors are strongly associated with fatal pertussis in infants.