The Roma are the most populous marginalised community in Europe and have some of the greatest health needs. There is a higher prevalence of communicable and non-communicable diseases within the community and significantly shorter life expectancies than national averages. Efforts by governments across Europe to address these health inequalities have been relatively weak and the Roma suffer poorer access to health care, education and employment in every country that they inhabit in comparison to the majority population. As the socioeconomic determinants of health become better understood over the past decade, it is becoming clear that societies with greater inequalities are less healthy overall. It is important for public health across Central and Eastern Europe that the health needs of the Roma are prioritised by governments concerned. We provide a review of the literature on the health inequalities of the Roma community in Europe.

/pdf/health-inequalities-of-the-roma-in-europe-a-literature-1rv6l6qowx.pdf

Health inequalities of the Roma in Europe: a literature review.

Monkeypox is a zoonotic disease that was once endemic in west and central Africa caused by monkeypox virus. However, cases recently have been confirmed in many nonendemic countries outside of Africa. WHO declared the ongoing monkeypox outbreak to be a public health emergency of international concern on July 23, 2022, in the context of the COVID-19 pandemic. The rapidly increasing number of confirmed cases could pose a threat to the international community. Here, we review the epidemiology of monkeypox, monkeypox virus reservoirs, novel transmission patterns, mutations and mechanisms of viral infection, clinical characteristics, laboratory diagnosis and treatment measures. In addition, strategies for the prevention, such as vaccination of smallpox vaccine, is also included. Current epidemiological data indicate that high frequency of human-to-human transmission could lead to further outbreaks, especially among men who have sex with men. The development of antiviral drugs and vaccines against monkeypox virus is urgently needed, despite some therapeutic effects of currently used drugs in the clinic. We provide useful information to improve the understanding of monkeypox virus and give guidance for the government and relative agency to prevent and control the further spread of monkeypox virus. 

/pdf/monkeypox-epidemiology-pathogenesis-treatment-and-prevention-2y7yzkvx.pdf

Monkeypox: epidemiology, pathogenesis, treatment and prevention

Background Measles outbreaks continue to occur in Europe as a result of suboptimum vaccination coverage. This article aims to describe individuals susceptible to measles, and provide an overview of affected groups and the public settings in which measles transmission occurred in Europe in 2005-2009. Methods Individuals susceptible to measles were described and categorized on the basis of factors leading to nonvaccination and vaccine failure. A literature search was conducted to identify affected groups and public settings in which measles transmission occurred. Results Most individuals susceptible to measles are previously uninfected and unvaccinated. The reasons for nonvaccination in individuals eligible for vaccination ranged from lack of information to poor access to health care. Several outbreaks have emerged in Roma and Sinti, Traveller, anthroposophic, and ultra-orthodox Jewish communities, and immigrants identifying them as being particularly at risk. Public settings for transmission included mostly educational and health care facilities. Conclusions Improved efforts are needed to strengthen immunization programs, identify barriers for measles-containing vaccine uptake, and explore methods to target vulnerable populations that are not being reached with routine immunization delivery services. Specific measures are needed to prevent and control measles in educational and health care facilities. Failure to identify who gets measles and implement the elimination strategies raises concerns for the successful and sustainable elimination of measles in Europe.

/pdf/who-gets-measles-in-europe-30a1gv9acr.pdf

Who Gets Measles in Europe

Despite effective national immunisation programmes in Europe, some groups remain incompletely or un-vaccinated (‘under-vaccinated’), with underserved minorities and certain religious/ideological groups repeatedly being involved in outbreaks of vaccine preventable diseases (VPD). Gaining insight into factors regarding acceptance of vaccination of ‘under-vaccinated groups’ (UVGs) might give opportunities to communicate with them in a trusty and reliable manner that respects their belief system and that, maybe, increase vaccination uptake. We aimed to identify and describe UVGs in Europe and to describe beliefs, attitudes and reasons for non-vaccination in the identified UVGs. We defined a UVG as a group of persons who share the same beliefs and/or live in socially close-knit communities in Europe and who have/had historically low vaccination coverage and/or experienced outbreaks of VPDs since 1950. We searched MEDLINE, EMBASE and PsycINFO databases using specific search term combinations. For the first systematic review, studies that described a group in Europe with an outbreak or low vaccination coverage for a VPD were selected and for the second systematic review, studies that described possible factors that are associated with non-vaccination in these groups were selected. We selected 48 articles out of 606 and 13 articles out of 406 from the first and second search, respectively. Five UVGs were identified in the literature: Orthodox Protestant communities, Anthroposophists, Roma, Irish Travellers, and Orthodox Jewish communities. The main reported factors regarding vaccination were perceived non-severity of traditional “childhood” diseases, fear of vaccine side-effects, and need for more information about for example risk of vaccination. Within each UVG identified, there are a variety of health beliefs and objections to vaccination. In addition, similar factors are shared by several of these groups. Communication strategies regarding these similar factors such as educating people about the risks associated with being vaccinated versus not being vaccinated, addressing their concerns, and countering vaccination myths present among members of a specific UVG through a trusted source, can establish a reliable relationship with these groups and increase their vaccination uptake. Furthermore, other interventions such as improving access to health care could certainly increase vaccination uptake in Roma and Irish travellers.

/pdf/under-vaccinated-groups-in-europe-and-their-beliefs-4wud6w2z2j.pdf

Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews

BACKGROUND
People living with HIV have accounted for 38-50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm3).


METHODS
A network of clinicians from 19 countries provided data of confirmed mpox cases between May 11, 2022, and Jan 18, 2023, in people with HIV infection. Contributing centres completed deidentified structured case report sheets to include variables of interest relevant to people living with HIV and to capture more severe outcomes. We restricted this series to include only adults older than 18 years living with HIV and with a CD4 cell count of less than 350 cells per mm3 or, in settings where a CD4 count was not always routinely available, an HIV infection clinically classified as US Centers for Disease Control and Prevention stage C. We describe their clinical presentation, complications, and causes of death. Analyses were descriptive.


FINDINGS
We included data of 382 cases: 367 cisgender men, four cisgender women, and ten transgender women. The median age of individuals included was 35 (IQR 30-43) years. At mpox diagnosis, 349 (91%) individuals were known to be living with HIV; 228 (65%) of 349 adherent to antiretroviral therapy (ART); 32 (8%) of 382 had a concurrent opportunistic illness. The median CD4 cell count was 211 (IQR 117-291) cells per mm3, with 85 (22%) individuals with CD4 cell counts of less than 100 cells per mm3 and 94 (25%) with 100-200 cells per mm3. Overall, 193 (51%) of 382 had undetectable viral load. Severe complications were more common in people with a CD4 cell count of less than 100 cells per mm3 than in those with more than 300 cells per mm3, including necrotising skin lesions (54% vs 7%), lung involvement (29% vs 0%) occasionally with nodules, and secondary infections and sepsis (44% vs 9%). Overall, 107 (28%) of 382 were hospitalised, of whom 27 (25%) died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. Among people with CD4 counts of less than 200 cells per mm3, more deaths occurred in those with high HIV viral load. An immune reconstitution inflammatory syndrome to mpox was suspected in 21 (25%) of 85 people initiated or re-initiated on ART, of whom 12 (57%) of 21 died. 62 (16%) of 382 received tecovirimat and seven (2%) received cidofovir or brincidofovir. Three individuals had laboratory confirmation of tecovirimat resistance.


INTERPRETATION
A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death.


FUNDING
None.

Mpox in people with advanced HIV infection: a global case series

We describe a local indigenous outbreak of measles in a susceptible Roma community, which occurred in Pulawy, a town of 50,000 citizens in the Lubelskie province (eastern Poland) during summer 2009. From 22 June to 30 August 2009, 32 measles cases were reported, and additionally nine possible cases were actively identified. A mass immunisation campaign was organised to stop measles transmission in the Roma community. Active surveillance of rash-febrile illnesses allowed documentation of the impact of mass immunisation in preventing further measles spread in the Roma community, and the surrounding population of Pulawy.

Spotlight on measles 2010: A measles outbreak in a Roma population in Pulawy, eastern Poland, June to August 2009

During a mass immunisation campaign following an outbreak of measles in a Roma community settled in the town of Pulawy, Poland, we performed an estimation of the size of this Roma population and an assessment of its vaccination uptake. We obtained a list of Roma residing in Pulawy from the local municipality and estimated using a simple capture-recapture formula that Pulawy had 377 Roma residents (43% under 20 years old), which was 27% more than the 295 registered at the municipality. During the vaccination campaign, demographic information was recorded that could be linked to information from the municipality list as well as to prior immunisation status. Among the people whose data were recorded during the vaccination campaign, 14% were not registered at the primary healthcare centres, and were therefore deprived of access to healthcare. Among 102 screened subjects under the age of 20 years, 51% were vaccinated according to schedule. Vaccine uptake for the first dose of measles-containing vaccine was 56% (54/96) and for the second dose 37% (18/49). The present study indicates the need to get a better demographic overview of Roma communities living in Poland and to understand the barriers limiting their access to healthcare and social services. Organisation of catch-up immunisations of this vulnerable population is necessary.

Mass immunisation campaign in a Roma settled community created an opportunity to estimate its size and measles vaccination uptake, Poland, 2009.

CĂ­lem ÄlĂĄnku je shrnout hlavnĂ­ principy veĹejnĂŠho zdravotnictvĂ­ zaloĹženĂŠho na dĹŻkazech a vymezit, ÄĂ­m pĹedevĹĄĂ­m se odliĹĄuje od klinickĂŠ medicĂ­ny zaloĹženĂŠ na dĹŻkazech. Paradigma medicĂ­ny zaloĹženĂŠ na dĹŻkazech dominuje klinickĂŠ lĂŠkaĹskĂŠ praxi jiĹž 30 let. PĹĂ­stup zaloĹženĂ˝ na dĹŻkazech by vĹĄak mÄl bĂ˝t aplikovĂĄn takĂŠ ve veĹejnÄ-zdravotnickĂŠ praxi. MĂĄ bĂ˝t zaloĹžen na syntĂŠze metodologicky nejkvalitnÄjĹĄĂ­ch a nejrelevantnÄjĹĄĂ­ch dostupnĂ˝ch dĹŻkazĹŻ, aplikovatelnĂ˝ch teoretickĂ˝ch modelĹŻ, profesionĂĄlnĂ­ch zkuĹĄenostĂ­ a zevrubnĂŠ znalosti specifickĂŠ populace, vÄetnÄ adaptace preferencĂ­ tĂŠto populace. VÄdeckĂĄ argumentace jednotlivĂ˝ch diskutovanĂ˝ch veĹejnÄ-zdravotnickĂ˝ch problĂŠmĹŻ mĂĄ vyuĹžĂ­vat systematickĂŠ prĂĄce s Ăşdaji a informaÄnĂ­mi systĂŠmy, pĹiÄemĹž by mÄla hodnotit populaÄnĂ­ celky. VĂ˝stupy slouĹžĂ­ pĹi tvorbÄ zdravotnĂ­ch programĹŻ a politik. FinĂĄlnĂ­ch rozhodnutĂ­ je dosahovĂĄno vÄtĹĄinou formou konsenzu, proto je vhodnĂŠ se s metodikou konsenzuĂĄlnĂ­ch metod seznĂĄmit. OdbornĂ­ci pracujĂ­cĂ­ v oblasti veĹejnĂŠho zdravotnictvĂ­ na vĹĄech ĂşrovnĂ­ch by mÄli bĂ˝t v praxi zaloĹženĂŠ na dĹŻkazech prĹŻbÄĹžnÄ vzdÄlĂĄvĂĄni. 

Evidence-based public health: why it is important and how it differs from evidence-based clinical medicine

INTRODUCTION
Q fever is a zoonosis with a worldwide occurrence. Coxiella burnetii infection is most commonly transmitted by inhalation of air containing contaminated dust in cow, sheep and goat farming areas. The other modes of transmission are alimentary route (ingestion) and through sucking ticks. We set ourselves the goal of presenting a descriptive analysis of cases of Q fever in the Czech Republic (CZ) and former Czechoslovakia and draw attention to this often-overlooked issue.


METHODS
Summary of available information about Q fever was processed, and a narrative search of published cases of Q fever in the CZ and former Czechoslovakia, in Czech, Slovak and English, without time restrictions was performed. Furthermore, a descriptive analysis of Q fever cases reported to the Czech infectious diseases reporting system in 1982-2021 was done. After analysis, the available information system data were supplemented with data from a search of published scientific literature and weekly reports on the current epidemiological situation of the public health protection authorities of the CZ.


RESULTS
The disease has been reported in former Czechoslovakia and then in CZ since 1952. In 1952-1954, six outbreaks were reported with a total of 150 cases, mostly in connection with work with cattle. In 1980, a large-scale outbreak of Q fever affected 526 employees of the cotton production plant at Staré Město near Uherské Hradiště. Otherwise, units to dozens of cases were reported. From 1993 to 2021, 27 cases of the disease were detected in the CZ, of which 22 (81.5%) occurred in men. The age range was 0-60 years (mean 31, median 30 years). Seasonality by reporting month was highest in January and September.


CONCLUSION
There has been a decline in human cases of Q fever in the European Union (EU) in recent years, and only few cases of the disease occur in the CZ. Still, due to potential severity of the disease, the current climate change with the consequent increase in the spread of ticks as vectors of Coxiella, and animal movements associated with the global market, it is important to consider Q fever in the differential diagnosis. As part of the prevention, it is necessary to ensure compliance with basic hygiene rules, especially in at-risk occupations, and to consume only pasteurized dairy products. Vaccination of humans is not available in EU countries, although vaccination of livestock is possible.

Peculiarities of Q fever and human cases reported so far in the Czech Republic.

BÄhem 21. stoletĂ­ se objevilo mnoho globĂĄlnĂ­ch zdravotnĂ­ch hrozeb souvisejĂ­cĂ­ch se zoonĂłzami, novĂ˝mi Äi znovu se objevujĂ­cĂ­mi infekÄnĂ­mi onemocnÄnĂ­mi, zmÄnou klimatu a/nebo udrĹžitelnostĂ­ ĹživotnĂ­ho prostĹedĂ­. DosaĹženĂ­ harmonizovanĂ˝ch pĹĂ­stupĹŻ k detekci a prevenci tÄchto zdravotnĂ­ch rizik je mnohdy obtĂ­ĹžnĂŠ, protoĹže tradiÄnĂ­ pĹĂ­stupy jsou Äasto urÄovĂĄny hranicemi finanÄnÄ i legislativnÄ oddÄlenĂ˝ch vÄdnĂ­ch oborĹŻ, jako jsou napĹĂ­klad vĂ­cemĂŠnÄ samostatnÄ fungujĂ­cĂ­ humĂĄnnĂ­ a veterinĂĄrnĂ­ medicĂ­na, zemÄdÄlstvĂ­, klimatologie, sociologie, ekonomika aj. Hranice mezi tÄmito jednotlivĂ˝mi obory by vĹĄak nemÄly bĂ˝t pevnĂŠ a spoluprĂĄce by mÄla bĂ˝t nastavena na zĂĄkladÄ potĹeby neboli ĂşÄelu. K lepĹĄĂ­ spoluprĂĄci vznikajĂ­ ÄetnĂŠ spolky, skupiny a sdruĹženĂ­, aĹĽ uĹž zĂĄjmovĂŠ nebo odbornĂŠ. MeziresortnĂ­ spoluprĂĄce se vĹĄak Äasto potĂ˝kĂĄ s legislativnĂ­mi, kompetenÄnĂ­mi a komunikaÄnĂ­mi uzly. Koncept Jedno zdravĂ­ se snaĹžĂ­ tyto bariĂŠry prolomit a na zĂĄkladÄ spoleÄnĂŠ potĹeby, kterĂĄ je definovĂĄna jako zajiĹĄtÄnĂ­ podpory blahobytu a moĹžnosti spoleÄnĂŠho ĹeĹĄenĂ­ hrozeb pro zdravĂ­ a ekosystĂŠmy, nastavit novĂŠ hranice. Je zaloĹžen na myĹĄlence dosĂĄhnout lepĹĄĂ­ch vĂ˝sledkĹŻ v oblasti veĹejnĂŠho zdravĂ­ na celĂŠm svÄtÄ pomocĂ­ interdisciplinĂĄrnĂ­ spoluprĂĄce. 

The concept of One health: from theory to practice

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