Eurosurveillance - Volume 29, Issue 46, 14 November 2024

The National Surveillance for Invasive Meningococcal Disease (IMD) initiative started in Japan in April 2013. Multiple international mass gathering events have since been held in Japan, and the COVID-19 pandemic has occurred.

We summarised 10 years of national surveillance data for IMD in Japan to describe epidemiological characteristics of IMD and evaluate the influence of mass gatherings and the COVID-19 pandemic on IMD.

Upon diagnosis of IMD, patient information and specimens were collected and reported to local health centres. We analysed the epidemiology of IMD cases reported between 1 April 2013 and 31 March 2023.

Among 274 cases reported (median age: 55 years; 55% male), no outbreaks related to mass gathering events were identified. The annual reported incidence of IMD was 0.001–0.039 cases per 100,000 individuals between 2014 and 2022, with a notable decrease after 2020. The overall case fatality rate was 12% (33/274). The most frequent serogroups were Y and B (46 and 17%). Multilocus sequence typing revealed a predominance of clonal complex (cc) 23, followed by cc2057, while cc11 was detected in eight cases.

The reported incidence of IMD in Japan is low compared with high-endemic countries and decreased further during the COVID-19 pandemic. This unique epidemiology of IMD in Japan lacks a clear explanation. However, distribution of meningococcal strains, such as predominance of serogroup Y, could be a contributing factor. Maintaining high-quality surveillance, including of serogroups and sequence types, is crucial to manage and prevent future IMD cases in Japan effectively.

Antibiotic resistance poses a considerable public health threat, with data-driven stewardship a main prevention measure. While quantifying antibiotic consumption is a key component of antibiotic stewardship programmes, the choice of denominator for calculating this metric can impact comparative analyses and trend evaluations substantially, influencing targeted stewardship interventions.

We aim to evaluate how using hospital sector-specific antibiotic consumption rate denominators at country level impacts country rankings and trends, addressing the limitations of the commonly used 'defined daily doses (DDD) per 1,000 inhabitants per day' metric.

Hospital antibiotic consumption data from ESAC-Net and denominator data from Eurostat (‘inhabitants,’ ‘bed-days’ and ‘discharges’) for 2017–2021 were used to calculate hospital antibiotic consumption rates for 24 reporting European Union/ European Economic Area (EU/EEA) countries. Countries were ranked by their consumption rates and trends were analysed to assess the effects of using different denominators.

Country rankings and 5-year trend analyses varied depending on the denominator used. Antibiotic consumption rates were more similar when using hospital activity-based denominators ‘bed-days’ and ‘discharges’ compared with the population-based ‘inhabitants’ denominator. Differences in country rankings and trends were also seen among rates derived using ‘bed-days’ and ‘discharges’.

The study underscores the importance of using hospital activity-based denominators such as ‘bed-days’ and ‘discharges’ when evaluating hospital antibiotic consumption. ESAC-Net’s historical reliance on only ‘DDD per 1,000 inhabitants per day’ is challenged, advocating for the use of multiple hospital activity-based denominators. Corresponding hospital activity denominators for ESAC-Net data will more effectively inform national hospital antibiotic stewardship interventions.

Inappropriate antimicrobial consumption (AMC) drives the emergence of antimicrobial resistance. Institutionalised, older populations are associated with antimicrobial treatments of longer duration and broader spectrum than recommended, higher rates of multidrug-resistant infections and poorer outcomes for resistant infections. Yet systematic, national monitoring of AMC in nursing home (NH) residents is lacking.

To perform a retrospective analysis of antibiotic consumption in Belgian NHs, we compared analogous populations inside and outside NHs. We aimed to provide a blueprint for establishing surveillance of NH AMC, based on national reimbursement data.

The National Institute for Health and Disability Insurance supplied reimbursement AMC data for outpatients from 2016 to 2022. Data were classified by the Anatomical Therapeutic Chemical system, expressed as defined daily doses (DDD) and aggregated by prescription month, patient age, sex and residency inside/outside a NH. The number of ensured beneficiaries, aggregated by the same demographic variables, was collected from the Intermutualistic Agency. We compared the DDDs per 1,000 beneficiaries per day, along with secondary metrics for national and international targets for analogous populations inside and outside NHs.

Total antibiotic consumption decreased in both populations but remained twofold higher in NH residents. Proxy prescription quality metrics were consistently less favourable within NHs and diverged further during the COVID-19 pandemic. Distinct consumption patterns and greater seasonal fluctuations were observed in NH residents.

Given the different infection risks and higher antibiotic consumption of NH residents, AMC surveillance and antimicrobial stewardship efforts targeting this fragile population are needed.

Non-university hospitals are the major provider of inpatient care in Germany, serving 89% of acute care hospital beds. Although surveillance data on antimicrobial use in hospitals are widely available, data on prescription quality are rare.

We aimed to provide an in-depth analysis of antimicrobial prescribing patterns and quality in southwest German non-university hospitals.

During 2021, we performed three point prevalence surveys (PPS) in 10 non-university hospitals, representing ca 10% of hospital beds in the federal state of Baden-Württemberg (11 million inhabitants). Demographic and clinical information were collected. We assessed the overall performance of 14 validated process quality indicators (QI) covering infection diagnostics, antimicrobial therapy and documentation.

Of 8,560 patients analysed, 2,861 (33%) received at least one antimicrobial. Most (2,789, 80%) antimicrobial prescriptions were for therapeutic indications. Most frequently prescribed agents were beta-lactam/beta-lactamase inhibitors (1,120, 40%) in therapeutic and cefuroxime (269, 37%) in prophylactic indications. According to the World Health Organization’s Access, Watch, Reserve classification, the Access-to-Watch ratio was 0.73. Overall adherence to QIs was low and varied substantially (27–93%), with documentation, possible streamlining and switching to oral therapy exhibiting the lowest fulfilment rates (< 50%).

The results indicate a need to improve antimicrobial prescribing quality in non-university hospitals. The high prevalence of antimicrobial use in our setting underlines the demand for sustainable antimicrobial stewardship programmes in this sector. Our QI-based PPS approach can be used to identify key targets for future antimicrobial stewardship interventions. The results indicate a need for further legislation on antimicrobial stewardship.

Hepatitis C virus (HCV) infection is targeted for elimination as a public health threat by 2030. The World Health Organization goal for treatment uptake is ≥ 80% among cases diagnosed with an active HCV infection (RNA- or core antigen-positive), maintained for 2 years.

To calculate treatment uptake, time from diagnosis to treatment start and complete treatment dispensation among notified cases of HCV infection in Norway.

We linked national data on notified cases diagnosed from 1990–2022 to dispensed prescriptions for HCV treatment from January 2004–February 2023 and data on residence status at the end of 2022. We described treatment uptake by demographic and epidemiological characteristics. We calculated the median number of months from diagnosis to treatment start by year. For direct-acting antiviral treatment periods, complete dispensation was based on the treatment and number of defined daily doses.

Among 12,178 notified cases that had an active infection at diagnosis and were still resident, 10,091 (83%) had received treatment. Uptake among resident cases was > 80% in 2021 and 2022. The median number of months from diagnosis to treatment decreased over time to 3 (interquartile range: 1–5) among cases diagnosed in 2021 and 2022. From 2015–22, 89–93% of direct-acting antiviral treatment periods annually had complete treatment dispensed.

Norway has achieved the elimination goal for treatment uptake among notified cases diagnosed with an active HCV infection. This highlights the benefit of a strategy that includes unrestricted, simplified and integrated treatment options.