Eurosurveillance

BackgroundInitial reports from the Netherlands indicate a decline in routine childhood vaccination uptake during and after the COVID-19 pandemic, with emerging evidence of reduced parental vaccine confidence. This study aimed to evaluate the long-term impact of the COVID-19 pandemic on routine childhood vaccination uptake. MethodsWe conducted a retrospective nationwide cohort study including all children born in the Netherlands in 2016-2024. First-dose DTaP-IPV vaccination status by age six months was obtained from the national immunisation register. National trends in vaccination uptake across pre-pandemic, pandemic, and post-pandemic periods were assessed using interrupted time series analyses. To further assess the independent effect of the pandemic, a matched-sibling analysis compared vaccination uptake within families before, during and after the pandemic. ResultsInterrupted time series analyses showed significant immediate decreases in vaccination uptake both at the start and end of the pandemic, accompanied by a continuing downward trend during the pandemic (OR 0.984, 95%CI 0.982-0.985) that further declined after its end (OR 0.995, 95%CI 0.994-0.997). In the matched-sibling analysis children eligible during and after the pandemic had lower odds of being vaccinated (pandemic: OR 0.66, 95%CI 0.55-0.80; post-pandemic: OR 0.20, 95%CI 0.17-0.25) compared to their pre-pandemic siblings. Also, later birth order was associated with lower odds compared to first-born siblings (second-born: OR 0.42, 95%CI 0.37-0.48). ConclusionsBoth analyses indicate a negative impact of the COVID-19 pandemic on parental vaccination decisions, which may reflect lingering pandemic effects or new post-pandemic factors, highlighting the need for further research into the drivers of vaccination uptake changes in the post-pandemic era.

Background: Human metapneumovirus (hMPV) is commonly associated with respiratory tract infections (RTIs) in young children. Methods: We estimated the annual hospital incidence of hMPV RTIs in children under 5 years in Scotland from 2017 to 2023 using national hospital and laboratory data. Incidence outside Lothian, where testing practices were uncertain, was extrapolated from Lothian laboratory data, where hMPV testing was advised for all RTI admissions. We also examined the severity and mortality of laboratory-confirmed hMPV cases. We developed similar estimates for RSV and Influenza A for comparison. Results: This analysis included 1,462 laboratory-confirmed hMPV hospitalisations in children aged under 5 years. The extrapolated hMPV hospital incidence ranged from 19 per 100,000 to 537 per 100,000 in children aged under 5 years. The extrapolated incidence was two to three times higher than that based on laboratory-confirmed data. Hospital incidence was higher in infants than in toddlers. hMPV incidence dropped substantially during the 2020/21 season, followed by a rebound during the 2021/22 season. About 10% of hMPV RTI hospital admissions required hospital stay [&ge;]5 days, but <1% required intensive care unit admissions or resulted in in-hospital death. RSV hospital incidence appeared substantially higher than the hMPV hospital incidence in this population. Conclusions: hMPV RTIs contribute to a substantial hospital burden in young children in Scotland. However, the RSV RTI burden is likely to be higher in the population unvaccinated against both viruses. Improved surveillance and diagnosis strategies are required to develop robust hospital burden estimates.

We conducted a systematic review (PROSPERO CRD42023393345) characterising the epidemiology, outbreaks and mathematical models of Nipah virus (NiV), an important public health threat in South and Southeast Asia. We extracted 243 parameters, 89 risk factors, 39 models and 23 distinct outbreaks from 119 papers. IgG seroprevalence estimates ranged from 0% to 12.5%. NiV causes severe disease, with pooled case-fatality ratio estimates ranging widely from 9.1% (95%CI: 0.2%-41.3%) in Singapore to 81.9% (95%CI: 71.9%-88.9%) in Bangladesh. NiV's natural history is poorly characterised; we estimated a median incubation period of 8.77 days (95%CI: 7.53-10.02) based on 8 studies. Transmission parameter estimates were scarce, and all but one central estimate of the basic reproduction number were below 1. NiV mathematical models (n=39) were rarely fitted to data (n=8). All extracted information is accessible via our R package, epireview, a dynamic resource for informing responses to future outbreaks of NiV and related pathogens.

BackgroundSerotype 3 (S3) has remained a major cause of invasive pneumococcal disease (IPD) despite its inclusion in 13-valent pneumococcal conjugate vaccine (PCV). In October 2023, a 15-valent PCV (PCV15) including S3 was introduced into the Catalan universal childhood immunization program. MethodsWe conducted a retrospective pre-post surveillance study to compare pediatric IPD incidence in Catalonia during a pre-PCV15 period (October 1, 2022-September 30, 2023) and two post-PCV15 periods (October 1, 2023-September 30, 2024, and October 1, 2024-September 30, 2025). All IPD episodes in children <18 years attended in 34 hospitals were included. IPD was defined as detection of S. pneumoniae in a sterile site by culture or PCR. Results323 IPD episodes were identified in 319 children (mean age, 4.5 years). Overall IPD incidence declined from 13.0 to 9.4 episodes per 100,000 children in the first post-PCV15 period compared with the pre-PCV15 period (28% reduction; p=0.02), but returned to baseline in the second post-PCV15 period. S3-IPD incidence decreased significantly from 4.1 to 1.6 episodes per 100,000 (60% reduction; p=0.001) in the first post-PCV15 period and remained lower in the second period: 2.3 episodes per 100,000 (42% reduction compared with baseline; p=0.04). In contrast, IPD incidence caused by PCV7 serotypes increased from 0.3 in the pre-PCV15 and first post-PCV15 period to 2.7 episodes per 100,000 in the second post-PCV15 period (690% increase; p<0.001). ConclusionPCV15 introduction was associated with a sustained reduction in S3-IPD over two years. However, a marked increase in PCV7 serotypes offset overall gains in IPD incidence. SUMMARYPCV15 introduction in Catalonia achieved sustained reduction in serotype 3 invasive pneumococcal disease over two years, but a marked increase in PCV7 serotypes offset the overall disease reduction in the second post-vaccination year.

Many studies have identified antibiotic resistant (ABR) Escherichia coli on meat. Appropriate hand hygiene and cooking practices should minimise the risk of gastrointestinal colonisation with ABR E. coli found on meat, and the subsequent chance of causing resistant opportunistic extraintestinal infection. There are large gaps in our understanding of the prevalence, origins and zoonotic potential of ABR E. coli found on meat, however, and particularly for meat reared in extensive farming systems. Wales is a devolved nation within the United Kingdom having large populations of extensively-reared sheep and beef cattle. To help address knowledge gaps around ABR E. coli on extensively reared meat, therefore, beef mince and lamb loin/leg steaks/chops were purchased from 50 (beef) and 46 (lamb) independent butchers across Wales. Following enrichment culture, 200 g meat samples were found to be positive for E. coli resistant to amoxicillin (31% positivity), streptomycin (28%), spectinomycin (29%), amoxicillin-clavulanate (11%), 3rd generation cephalosporins (2%) and fluoroquinolones (5%). Phylogenetic analysis confirmed that Welsh lamb meat ABR E. coli isolates (n=79) are more closely related to those found in faecal samples collected around sheep (n=352) than around beef cattle (n=361) on Welsh farms. This suggests that faecal contamination at or around slaughter is their primary origin. We found no closely related meat/infection clones (<20 SNPs distant and the same antibiotic resistance genes) when comparing ABR E. coli from Welsh meat (n=92) and those causing extraintestinal infections in people (n=2387) in an English region bordering Wales. We conclude, therefore, that the wider zoonotic implications of finding ABR E coli on beef and lamb meat sold at independent butchers in Wales are small.

Neural tube defects (NTDs) represent frequent and severe congenital anomalies of the central nervous system, including anencephaly, spina bifida, and encephalocele. This retrospective study evaluates the occurrence, prenatal diagnosis, and sex distribution of NTDs in the Czech Republic during the period 1961-2020. Data were obtained from the National Registry of Congenital Anomalies within the National Registry of Reproductive Health. Both prenatally and postnatally diagnosed cases of anencephaly, spina bifida, and encephalocele were analyzed. A total of 2,521 cases of anencephaly, 3,391 cases of spina bifida, and 704 cases of encephalocele were recorded. Prenatal diagnosis with subsequent termination of pregnancy accounted for a substantial proportion of cases, particularly in anencephaly. The mean total incidence per 10,000 live births was 2.91 for anencephaly, 4.38 for spina bifida, and 1.24 for encephalocele. Sex distribution analysis across six consecutive decades demonstrated a persistent predominance of affected females in spina bifida, with statistically significant differences in selected periods. In contrast, anencephaly and encephalocele showed a female predominance only in earlier decades, whereas a higher proportion of affected males has been observed in recent years. Although advances in prenatal diagnostics have markedly reduced the incidence of NTDs among live-born children, the overall population incidence of these defects has remained stable.

Background Social contact surveys, which measure who-contacts-whom, are widely used to inform infectious disease transmission models and estimate the reproduction number (R), a key metric for assessing epidemic risk. Despite their widespread use, sample size calculations are not routinely performed. Aims To assess the impact of sample size on estimates of R and determine a practical target sample size for social contact surveys used in epidemic modelling. Methods We conducted a review of social contact surveys (2008-2025) to characterise current practice. We characterised the impact of survey size on epidemic metrics using two social contact surveys, the UK Social Contact Survey and POLYMOD (Europe) and two methods. For each dataset and approach, we generated repeated subsamples and calculated the resulting reproduction numbers, characterised their distributions and measured uncertainty. Results We identified 107 unique social contact surveys from 57 studies. Sample sizes ranged from 30 to more than 10,000 participants, with a median of 1,438. One quarter of surveys contained fewer than 1,000 participants. From our simulations, we find that sample sizes below 200 individuals can result in highly variability reproduction numbers. Increasing sample size increases precision, and the most meaningful gains are up to 1,300 individuals. Increasing sample sizes over 3,000 individuals leads to smaller gains. Conclusions A minimum sample size of approximately 1,200-1,300 participants appears sufficient for general-purpose use. These findings support the inclusion of sample size considerations in the design, reporting and interpretation of social contact surveys used for epidemic intelligence and public health decision-making.

Since the cessation of real-time monitoring of COVID-19 hospitalizations in early 2024, the burden of and vaccine effectiveness (VE) against severe COVID-19 in the Netherlands was largely unknown. Recently, hospitalization data from 2024 were made available for the purpose of monitoring and evaluating the COVID-19 vaccination campaigns. These data were linked to the population registry, vaccination registry and healthcare use data (for classification into medical risk groups). We analyzed the number and incidence of COVID-19 hospitalizations in 2023 and 2024 by age and medical risk group. VE against hospitalisation of the autumn booster of 2023 (by time since vaccination, 25 September 2023 to 16 September 2024) and of the autumn booster of 2024 (16 September to 31 December 2024) were estimated by medical risk group among persons aged 60 years and older using Cox proportional hazards models with calendar time as underlying time scale and vaccination status as time-varying exposure. Models were adjusted for age, sex, region and household socio-economic status. From around age 60 onward, intermediate and high medical risk groups had a markedly higher incidence than younger age groups, increasing with age. Persons in the low medical risk group had a low incidence up to the age of 80. In 2024, incidence was lower than in 2023. For both autumn booster rounds, estimated VE against hospitalisation was moderate at 55-67% in the first 3 months post-vaccination. In the high medical risk group, 2023 VE decreased fast and was no longer significant at 6 months post-vaccination. For both years, estimates of the number of averted hospitalizations and number needed to vaccinate to prevent one hospitalization indicated that significant health benefit can be achieved by vaccinating the intermediate and high medical risk groups aged 60 years and older. Efforts to increase the moderate vaccine uptake among risk groups could potentially prevent a considerable disease- and healthcare burden. Highlights- In 2023 and 2024, incidence of COVID-19 hospitalization was highest among medical risk groups aged 60 years and older, despite vaccination campaigns. - Estimated VE against hospitalisation of the 2023 and 2024 autumn booster campaigns was moderate (55-67%) in the first year-quarter post-vaccination among persons aged 60 years and older. - Estimated VE of the 2023 autumn booster decreased over the year, and faster among persons with a medical risk condition. Data availability precluded estimates of 2024 VE beyond the first 3 months since the start of the campaign. - Despite lower and waning VE, the estimated number needed to vaccinate to prevent one COVID-19 hospitalization was much lower among intermediate and high medical risk groups compared with the low medical risk group.

Zoos may serve as sentinel sites for zoonotic vector-borne diseases. West Nile virus (WNV) and Usutu virus (USUV) are closely related orthoflaviviruses transmitted between Culex mosquitoes and a bird reservoir. Both viruses can also infect mammals, including humans, where they may cause symptoms and, more rarely, hospitalization and death. However, serological cross-reactivity between WNV and USUV complicates their differential diagnosis. Here, we aimed to reconstruct the dynamics of emergence of WNV in a zoo located in a newly affected area in Europe, using ELISA and Virus Neutralization Test (VNT) serological analysis of 1707 animal sera collected between 2015 and 2024. Combining this data in a model accounting for cross-reactivity with USUV, we estimated yearly forces of infection (FOI) by both viruses, and thus found that WNV likely circulated in the area one year prior to the first cases reported to the passive surveillance system. Our results also showed that, in the zoo, mammals and reptiles had a lower risk of infection than birds (relative risk of 0.14 [0.05; 0.28]), and that the exposure of birds to water (aquatic lifestyle or proximity to stagnant water) affected the risk. Finally, we estimated diagnosis parameters, including the sensitivity of the VNT (80.4% [76.5%; 84.3%]), the expected VNT titer value, and the level of serological cross-reactivity between viruses during the VNT. To conclude, our modelling framework allowed to disentangle the co-circulation of two closely related viruses, a crucial point in ensuring the reliable sentinel surveillance of these vector-borne zoonotic pathogens.

BackgroundThe epidemiology of suspected pediatric meningoencephalitis has shifted in the era of conjugate vaccines and multiplex PCR diagnostics, with viral pathogens now predominating over bacterial causes. Updated epidemiologic data are essential to adapt diagnostic and therapeutic algorithms to current clinical practice. MethodsThis retrospective single-center study included children and adolescents <18 years who underwent lumbar puncture with cerebrospinal fluid multiplex PCR for suspected central nervous system infection at a tertiary-care pediatric hospital in Germany between 2016 and 2024. Clinical, laboratory, and outcome data were extracted from electronic medical records. Cerebrospinal fluid was analyzed using the BioFire(R) FilmArray(R) Meningitis/Encephalitis Panel. Statistical analyses included descriptive statistics, nonparametric group comparisons, receiver operating characteristic analyses. ResultsAmong 1,198 included children, definite bacterial meningitis was diagnosed in 13 (1.1%), definite viral meningitis in 80 (6.7%), aseptic meningitis of unknown etiology in 131 (11.0%), confirmed/probable encephalitis in 53 (4.4%), and possible encephalitis in 34 (2.8%). Bacterial meningitis accounted for 5.8% of all meningitis cases. A causative pathogen was identified in all bacterial meningitis cases, most commonly Streptococcus pneumoniae (n = 7). Enterovirus (n = 52) and parechovirus (n = 9) predominated in viral meningitis, whereas an infectious etiology was identified in only 13 of 53 confirmed/probable encephalitis cases. The Bacterial Meningitis Score showed a sensitivity of 80.0% and a specificity of 57.6%. The recently published UK-ChiMES-pre- and post-lumbar puncture scores demonstrated sensitivities of 84.6% and 76.9% and specificities of 86.3% and 92.7%, respectively. DiscussionBacterial meningitis was rare in this contemporary cohort, while viral and etiologically unresolved infections predominated despite routine multiplex PCR diagnostics. Clinical prediction scores supported risk stratification, with the UK-ChiMES-pre-lumbar puncture score showing the most favorable balance between sensitivity and specificity and potential to guide diagnostic decisions and antiinfective therapy.

BackgroundClimate change is increasingly recognised as a threat to population health and healthcare systems, yet the effects of environmental variability on pharmaceutical prescribing remain poorly characterised in the UK. Using a wide array of open-source datasets, we examine the effect of environmental, geographic and socioeconomic factors on prescribing habits in England. MethodsWe linked monthly, practice-level prescribing data for England (2010-2025) to meteorological, air-quality, flooding and demographic datasets using spatial nearest-neighbour matching. Prescribing volumes for cardiovascular, respiratory and antibiotic medications were analysed using log-transformed outcomes in mixed-effects models with practice-level random effects, adjusting for region, seasonality, deprivation and temporal trends, using both continuous environmental measures and extreme-condition indicators. A complementary Bayesian hierarchical model jointly estimated the conditional effects of multiple correlated environmental exposures, with partial pooling across practices and support for distributed lag effects. ResultsIn mixed-effects analyses, temperature showed the most consistent associations with prescribing, with higher temperatures linked to increased respiratory and cardiovascular prescriptions and reduced antibiotic use, while rainfall, flooding and most pollutants had small or negligible effects. Environmental predictors exhibited strong correlations, motivating multivariate modelling. Bayesian multivariate models confirmed temperature as the dominant environmental driver after adjustment for correlated exposures, with substantially larger variation attributable to regional and socioeconomic factors than to environmental conditions. ConclusionsTemperature is the most consistent environmental determinant of GP prescribing in England, with higher temperatures associated with increased cardiovascular and respiratory prescribing and reduced antibiotic use. Rainfall, flooding and most air pollutants show little evidence of meaningful effects once seasonal and meteorological structure is accounted for. Environmental associations are modest in magnitude relative to persistent socioeconomic and regional drivers of prescribing, indicating that climate-related influences operate within broader structural determinants of healthcare utilisation. These results suggest that, at monthly timescales, prescribing demand is relatively stable to environmental variability, supporting a focus on long-term adaptation and surveillance rather than short-term demand shocks in climate-resilient healthcare planning.

BackgroundAlthough the impact of COVID-19 vaccination is widely documented in the general population, the evidence on its effectiveness in children under 5 years of age is still limited. In this context, the continuation of vaccination programs in this age group has been debated globally. Consequently, we estimated the effectiveness of the 3-dose series of BNT162b2 (Pfizer-BioNTech) in children aged 6 months to 4 years and the complete 2-dose series of CoronaVac (Sinovac) in children aged 3 to 4 in reducing the risk of hospitalizations due to COVID-19-attributed severe acute respiratory infection (SARI) in Brazil. MethodsWe conducted a retrospective cohort study in 24 Brazilian municipalities, using surveillance data. We evaluated vaccine effectiveness in reducing the incidence rate of COVID-19-attributed SARI hospitalizations from July 2023 to December 2024. Covariate adjustments, defined a priori based on a conceptual model represented by a directed acyclic graph (DAG), were implemented using random-effects Poisson regression models. We also analyzed alternative vaccination schedules and obtained age-specific estimates of effectiveness. ResultsThe cohort comprised 37.6 million person-months of follow-up and 1,384 COVID-19-attributed SARI hospitalizations, including 27 associated deaths. The 3-dose series of BNT162b2 vaccine had an effectiveness of 97% (IRR 0.03, 95%CI 0.01-0.10) in the group aged 6 months to 4 years, with no significant differences among age-specific estimates. No deaths occurred among children who completed the 3-dose series, whereas four deaths were observed among those with fewer doses. The effectiveness of CoronaVac was small and not statistically significant (IRR 0.96, 95%CI 0.57-1.62). However, no deaths were recorded among children who received any number of CoronaVac doses, and no COVID-19-attributed SARI hospitalizations were observed among those who received a third dose of this vaccine. ConclusionsThe 3-dose series of the mRNA vaccine (BNT162b2) had high and consistent effectiveness in protecting against severe COVID-19 in children aged 6 months to 4 years. These findings support the maintenance of routine COVID-19 vaccination in this age group.

BackgroundAntimicrobial resistance (AMR) surveillance is essential for quantifying and monitoring the burden of AMR among World Health Organization (WHO) priority pathogens. We analysed Tunisian AMR surveillance system (TARSS) data across five sentinel hospitals from 2014 to 2022. MethodsWe conducted a retrospective isolate-level analysis for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp. Temporal, ward, and specimen associations were quantified using multivariable logistic regression models. Sex and age categories were explored in secondary models due to missingness. Temporal trends were assessed using Cochran-Armitage test, and co-resistance was summarised for third-generation cephalosporin and carbapenem phenotypes. We also evaluated temporal dynamics of 3GCR and CR profiles. ResultsA total of 35,525 E. coli, 14,325 K. pneumoniae, 9,679 P. aeruginosa, and 5,597 Acinetobacter spp. were reported to TARSS between 2014 and 2022. Mean annual MDR prevalence was high for Acinetobacter spp. (85.1%), moderate for K. pneumoniae (45.5%) and for P. aeruginosa (27.1%), and lower for E. coli (17.5%). Adjusted models indicated increased odds of resistance to several antibiotics, whereas E. coli showed decreased odds. Intensive care unit (ICU) and blood isolates were associated with higher odds of resistance in all pathogens. ConclusionThis nine-year multi-hospital analysis reveals a high prevalence of AMR across the four WHO priority pathogens, settings, and specimen types, with increasing resistance for some pathogen-antibiotic combinations. The higher odds of clinically important resistance amongst ICU and blood isolates support the use of ward-level antibiograms and stratified stewardship and infection prevention measures.

Household transmission of EV-D68 was identified in 35 of 1040 households (3.4%) in the Pacific Northwest between 2022-2024, with an estimated secondary attack rate of 15%. Sequences from within households clustered closely with 0 to 2 pairwise nucleotide differences (median 1) between cases 6-14 days apart (median 7).

Objectives: Group B Streptococcus (GBS) is a leading cause of neonatal mortality worldwide. However, the global burden of early-onset GBS disease (EOD-GBS) has not been fully elucidated. We aimed to describe the geographical distribution and epidemiological characteristics of the EOD-GBS burden, and analyze its association with socio-economic development and universal health coverage. Methods: We used data from the Global Burden of Disease Study 2021 and the Universal Health Coverage Service Coverage Index (UHC-SCI) to calculate estimated annual percentage changes (EAPCs) of EOD-GBS mortality. Sex differences were analyzed using the conservative overlap assessment. The geographical distribution of EOD-GBS clinical presentations and mortality was mapped. Health inequality analysis was conducted to evaluate the relationship between the sociodemographic index (SDI), UHC-SCI, and EOD-GBS burden. Results: Global EOD-GBS mortality decreased by nearly 50% from 1990 (693.41 per 100,000) to 2021 (348.80 per 100,000). However, the decline was not uniform: the most significant decrease occurred in high-middle SDI regions (EAPC: -7.17%), and the slowest in low SDI regions (EAPC: -2.23%). Male neonates accounted for the most EOD-GBS deaths, particularly in high SDI regions. Lower respiratory infections were common in Asia and Oceania; meningitis was more prominent in Europe. Inequality analysis revealed a phenomenon of "absolute convergence but relative differentiation": as social development and universal health coverage improves, the absolute mortality gap between countries narrowed, but relative burden concentrated increasingly among the poorest populations. Conclusions: The global burden of EOD-GBS has decreased substantially, but there are marked differences among countries. Continued socioeconomic development and expanded universal health coverage are critical to further reduce neonatal mortality.

Highly pathogenic avian influenza (HPAI) viruses of H5N1 clade 2.3.4.4b, are spreading worldwide, posing a threat to wildlife, domestic animals, and humans. In 2025, a multidisciplinary collaboration for HPAI H5N1 surveillance among birds within Galveston County, Texas, was initiated. Between November and December 2025, oropharyngeal and cloacal swabs were collected from wild and domestic birds reported as dead or dying by Galveston County residents. Specimens were studied with molecular assays, Sanger sequencing, virus isolation, and next-generation sequencing. Molecular evidence of HPAI H5N1 was detected in 7 of 10 (70%) birds, and the virus was successfully cultured in MDCK cells. Next-generation sequencing analysis of eight influenza A genome segments demonstrated a 4:4 gene segment reassortant constellation within clade 2.3.4.4b, consistent with genotype D1.1. Community members exposed to HPAI were offered antiviral prophylaxis. No human infections were identified. This surveillance demonstrates that community involvement combined with cross-sectoral collaboration can ensure rapid detection and characterization of circulating avian influenza viruses. Sustained local surveillance is essential for early warning, risk assessment, and prevention of virus spread to poultry, mammals, and humans.

AimBesides registries, healthcare databases can provide useful information for assessing major congenital malformations (MCMs) frequency and investigating their risk factors, particularly medications exposures. This study aimed to assess the validity of MCMs identification based on French national, comprehensive healthcare databases. MethodsUsing information on hospital discharge diagnoses, medical procedures (e.g. surgery) and death causes from the EPI-MERES register nested in the French National Health Data System, 72 specific MCMs grouped in 11 organ groups were assessed among all births occurred after 22 weeks of amenorrhea in France between 2010 and 2023. MCMs prevalence rates were estimated and compared to those from EUROCAT, and associations with prenatal exposure to valproate were assessed. ResultsAmong 10.5 million births, 213,153 live born infants with at least one MCM, i.e. 203.0 cases per 10,000 births, were identified. MCMs prevalence rates among live births were close to those reported in EUROCAT overall (difference: -1.76 per 10,000 births [-1%]), for each organ group (differences ranging from -9.10 [-13%] to +3.44 [+16%] per 10,000 births), and for the 72 specific MCMs (median prevalence difference: 1%). Prenatal exposure to valproate was significantly associated with increased risks of any MCM (adjusted odds ratio (aOR) 2.82, 95% CI [2.33-3.41]) and of 15 specific MCMs including spina bifida (aOR 17.88 [7.88-40.53]). ConclusionThis study supports the validity of MCMs identification based on data of the EPI-MERES register. The EPI-MERES register provides a highly powerful, reactive and operational tool complementing MCMs registries for improving real-life knowledge on drug teratogenicity. Plain language summaryMajor congenital malformations are serious structural abnormalities present at birth that can have lasting consequences on childrens health. Better understanding their risk factors, particularly medication exposures during pregnancy, is crucial. Population-based registries are today the primary source of information on malformations, but healthcare databases could offer a faster and broader alternative. This study tested whether the EPI-MERES register, built upon the French National Health Data System (SNDS), could accurately identify 72 specific malformations across 10.5 million births between 2010 and 2023. Prevalence estimates closely matched those from the European EUROCAT registry, confirming good data accuracy. As expected, valproate (a known teratogen) was associated with an increased risk of various malformations, including spina bifida, EPI-MERES thus constitutes a promising tool for studying medication risks during pregnancy.

Purpose To systematically review population preferences for expanded carrier screening programmes to inform service delivery and health policy. Methods PubMed, CINAHL, and Scopus were searched from 1995 to 2025 on carrier screening for autosomal or X-linked recessive genetic conditions across adult general populations. Included studies elicited preferences on attributes regarding the design or delivery of carrier screening programs. We extracted preferences for each attribute, mapped qualitative findings to these preferences, assessed risk of bias and performed meta-analysis on the willingness-to-pay for screening using Bayesian multilevel modelling. All findings are reported in 2024 USD. Results Thirty one studies, including 16 quantitative, 11 qualitative, and 4 mixed-methods studies were included. Participants expressed preferences for which conditions to include in ECS, joint vs individual screening, the value of information provided before screening, in-person over online counselling, type of healthcare provider, and preconception testing. Willingness-to-pay was right-skewed with 9% of participants not willing to pay any amount, a median of $107 and an interquartile range between $41 and $226. Most studies demonstrated a high risk of bias. Conclusions We report preferences of the general population regarding expanded carrier screening programmes, including suggested amounts for copayment if subsidised by the health system.

World Health Organization recommendations to reduce road deaths were examined to assess the potential reductions that could be realized in countries that have not adopted them. Data from 72 countries on recommended speeding laws, alcohol laws, and vehicle safety standards were analyzed, controlling statistically for differences in average temperatures and population density per square kilometer. Using regression coefficients, estimates of the reductions that would be realized if each countermeasure were adopted in countries not currently employing it were calculated. The coefficient on alcohol laws was not significant, but deaths in these countries would likely decline by about 23 percent if speeding laws were improved. The road death would have been about 55 percent lower if vehicle safety standards for imported vehicles had been adopted. New and used vehicles that did not adhere to the standards were sold in low-income countries. Better data identifying clusters of specific collision types (pedestrians in the dark, animals, fixed objects) could lead to the adoption of countermeasures known to be effective.

Background: Since September 2024, France has implemented a national reform allowing prescription-free access (PFA) to sexually transmitted infection (STI) screening in medical biological laboratories (MBLs). This study aims to characterize the populations undergoing STI testing according to their access modality and evaluate the probability of test positivity in relation to testing pathway, sex, and age groups. Methods: We conducted a cross-sectional analysis of all individuals screened for Chlamydia trachomatis, Gonorrhoea, human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis by treponemal-specific immunoassay (TSI) in Cerballiance MBLs between Mars 2025 and February 2026. Multivariable logistic regression models stratified by sex and adjusted for age and region assessed associations between screening modality and STI positivity. Results: Among 1,008,737 individuals included, 27.8% were under PFA and 72.2 under prescription-based access (PBA). PFA users were more frequently male (47.4% vs. 36.3%, p<0.001) and aged 20-39 years (34.0%, p<0.001). Overall positivity rates differed by modality: PFA was associated with higher detection of Chlamydia (4.6% vs. 3.6%). PBA group showed more positive cases of syphilis (3.4% vs. 1.2%), HBV (1.3% vs. 0.4%), and HIV infections (0.3% vs. 0.2%, all p<0.001). Co-infection and gonorrhoea proportions did not significantly differ between modalities. Conclusions: PFA substantially increased STI screening uptake, particularly among young adults and men, and enhanced detection of bacterial STIs. PBA remains essential for diagnosing viral and chronic infections. These findings highlight the complementary roles of both access strategies and support PFA screening as an effective public health intervention to broaden STI detection and reduce transmission.