Gianfranco Spiteri

European Centre for Disease Prevention and Control | ECDC · Unit of Surveillance and Response Support (SRS)

We assess monkeypox vaccination acceptance among male adults in the European Region. We conducted an online survey through two dating apps targeting men who have sex with men, from 30 July to 12 August 2022. We developed Bayesian hierarchical logistic regression models to investigate monkeypox vaccination acceptance. Overall crude vaccination accep...

Up to 27 May 2022, Portugal has detected 96 confirmed cases of monkeypox. We describe 27 confirmed cases (median age: 33 years (range: 22–51); all males), with an earliest symptom onset date of 29 April. Almost all cases (n = 25) live in the Lisbon and Tagus Valley health region. Most cases were neither part of identified transmission chains, nor l...

Because cefixime and ceftriaxone resistance in Neisseria gonorrhoeae and gonorrhoea treatment failures were increasing, a response plan to control and manage multidrug-resistant N. gonorrhoeae (MDR-NG) in Europe was published in 2012. The three main areas of the plan were to: (i) strengthen surveillance of antimicrobial resistance (AMR), (ii) imple...

Background Genomic surveillance using quality-assured whole-genome sequencing (WGS) together with epidemiological and antimicrobial resistance (AMR) data is essential to characterise the circulating Neisseria gonorrhoeae lineages and their association to patient groups (defined by demographic and epidemiological factors). In 2013, the European gono...

This report focuses on COVID-19 vulnerabilities and the need for infection prevention and control in temporary reception centres, in the context of the large numbers of people currently fleeing Ukraine.

Despite high COVID-19 vaccine coverage in the EU/EEA, there are increasing reports of SARS-CoV-2 infections and hospitalisations in vaccinated individuals. Using surveillance data from Estonia, Ireland, Luxembourg and Slovakia (January–November 2021), we estimated risk reduction of severe outcomes in vaccinated cases. Increasing age remains the mos...

We estimated risks of severe outcomes in 820,404 symptomatic paediatric COVID-19 cases reported by 10 European Union countries between August 2020 and October 2021. Case and hospitalisation rates rose as transmission increased but severe outcomes were rare: 9,611 (1.2%) were hospitalised, 640 (0.08%) required intensive care and 84 (0.01%) died. Des...

Prioritisation of elderly people in COVID-19 vaccination campaigns aimed at reducing severe outcomes in this group. Using EU/EEA surveillance and vaccination uptake, we estimated the risk ratio of case, hospitalisation and death notifications in people 80 years and older compared with 25–59-year-olds. Highest impact was observed for full vaccinatio...

To guide evidence-based prevention of COVID-19 in children, we estimated risks of severe outcomes in 820,404 symptomatic paediatric cases reported by 10 EU Member States between August 2020 and October 2021. Case and hospitalisation rates rose as overall transmission increased but severe outcomes were rare: 9,611 (1.2%) were hospitalised, 640 (0.08...

Since December 2019, over 1.5 million SARS-CoV-2-related fatalities have been recorded in the World Health Organization European Region - 90.2% in people ≥ 60 years. We calculated lives saved in this age group by COVID-19 vaccination in 33 countries from December 2020 to November 2021, using weekly reported deaths and vaccination coverage. We estim...

We compared 19,207 cases of SARS-CoV-2 variant B.1.1.7/S gene target failure (SGTF), 436 B.1.351 and 352 P.1 to non-variant cases reported by seven European countries. COVID-19 cases with these variants had significantly higher adjusted odds ratios for hospitalisation (B.1.1.7/SGTF: 1.7, 95% confidence interval (CI): 1.0-2.9; B.1.351: 3.6, 95% CI:...

Rapid antigen tests can contribute to overall COVID-19 testing capacity, offering advantages in terms of shorter turnaround times and reduced costs, especially in situations in which RT-PCR testing capacity is limited. • Test sensitivity for rapid antigen tests is generally lower than for RT-PCR. • Rapid antigen tests perform best in cases with hig...

The main objective of this guidance is to provide scientific advice on public health principles and considerations for infection and prevention control of COVID-19 in migrant and refugee reception and detention centres in the European Union and European Economic Area (EU/EEA) and the United Kingdom (UK).

This document aims to support the implementation of after-action reviews (AARs) and in-action reviews (IARs) focused on the public health response to COVID-19. After-action reviews are structured, qualitative reviews of the actions taken during the response to identify best practices, gaps and lessons learned. After-action reviews may address all d...

Objectives: There are substantial variations between different populations in the susceptibility of Neisseria gonorrhoeae to antimicrobials, and the reasons for this are largely unexplored. We aimed to assess whether the population-level consumption of antimicrobials is a contributory factor. Methods: Using antimicrobial susceptibility data from...

Background: The Accelerated Development of VAccine beNefit-risk Collaboration in Europe (ADVANCE) is a public-private collaboration aiming to develop and test a system for rapid benefit-risk (B/R) monitoring of vaccines using European healthcare databases. Event misclassification can result in biased estimates. Using different algorithms for ident...

Objectives Understanding the public health impact of lymphogranuloma venereum (LGV) in Europe is hampered by inadequate diagnostics and surveillance systems in many European countries. We developed and piloted LGV surveillance in three European countries without existing systems and performed a preliminary investigation of LGV epidemiology, where l...

Background Confidence in any diagnostic and antimicrobial susceptibility testing data is provided by appropriate and regular quality assurance (QA) procedures. In Europe, the European Gonococcal Antimicrobial Susceptibility Programme (Euro-GASP) has been monitoring the antimicrobial susceptibility in Neisseria gonorrhoeae since 2004. Euro-GASP incl...

Syphilis can cause severe complications and sequelae. Following a decrease in reported cases in European Union/European Economic Area (EU/EEA) and other high-income countries in the 1980s and 1990s as a result of the HIV epidemic and ensuing changes in sexual behaviour, trends started to increase in the 2000s in a number of EU/EEA Member States wit...

Objective Currently, seven European countries provide HIV pre-exposure prophylaxis (PrEP) through public health services, although there are numerous reports of off-licence use. The objective of this study was to examine current use of PrEP, likelihood of future use and indicators of potential PrEP candidacy among an opportunistic sample of men who...

Background The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) performs annual sentinel surveillance of Neisseria gonorrhoeae susceptibility to therapeutically relevant antimicrobials across the European Union/European Economic Area (EU/EEA). We present the Euro-GASP results from 2016 (25 countries), linked to patient epidemiol...

Since 2012, tick-borne encephalitis (TBE) is a notifiable in the European Union. The European Centre for Disease Prevention and Control annually collects data from 28 countries plus Iceland and Norway, based on the EU case definition. Between 2012 and 2016, 23 countries reported 12,500 TBE cases (Ireland and Spain reported none), of which 11,623 (9...

From 1 January to 30 June 2018, 11 cases of Lymphogranuloma venereum (LGV; all preserved samples (n = 4) genovar L2b) were identified at the Genitourinary Clinic (GUC), Mater Dei Hospital, Msida, Malta. All cases were diagnosed in men who have sex with men (MSM); six participated in three group-sex parties. Here, we describe the outbreak and risk f...

Background: Traditional methods for molecular epidemiology of Neisseria gonorrhoeae are suboptimal. Whole-genome sequencing (WGS) offers ideal resolution to describe population dynamics and to predict and infer transmission of antimicrobial resistance, and can enhance infection control through linkage with epidemiological data. We used WGS, in con...

Surveillance of Zika virus (ZIKV) infection in the European Union/European Economic Area (EU/EEA) was implemented in 2016 in response to the large outbreak reported in the Americas in 2015 associated with an increased number of infants born with microcephaly. Between June 2015 and January 2017, 21 EU/EEA countries reported 2,133 confirmed cases of...

Abstract Background Surveillance of Neisseria gonorrhoeae antimicrobial susceptibility in Europe is performed through the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP), which additionally provides data to inform the European gonorrhoea treatment guideline; currently recommending ceftriaxone 500 mg plus azithromycin 2 g as fir...

Introduction Euro-GASP antimicrobial resistance (AMR) data informs gonorrhoea (GC) treatment guidelines, therefore the data needs to be robust and reliable. We assessed whether Euro-GASP appropriately reflects the AMR situation across Europe. Methods We compared data from Euro-GASP and national systems from 12 countries for azithromycin (AZ), cefi...

Introduction The European Gonococcal Antimicrobial Surveillance Programme aims to monitor rates of antimicrobial resistance in Neisseria gonorrhoeae and provide data to inform the European gonorrhoea treatment guidelines; currently ceftriaxone 500 mg plus azithromycin (Az) 2 g as dual-therapy. This analysis reports on Euro-GASP resistance patterns...

Travel may be associated with a higher risk of gonorrhoea and infection by antibiotic-resistant strains. The objective of this study was to estimate the risk for gonorrhoea among travellers from four Nordic European countries using surveillance data and to identify at-risk travellers to help target interventions. We retrieved gonorrhoea surveillanc...

Since February 2016, 24 hepatitis A cases infected with two distinct strains of sub-genotype IA have been reported by five EU countries. Most cases are reported among adult men who have sex with men (MSM), with only a few women affected, including one suspected person who injects drugs (PWID). Eight cases reported having travelled to Spain within t...

Objectives: To elucidate the genome-based epidemiology and phylogenomics of azithromycin-resistant (MIC >2 mg/L) Neisseria gonorrhoeae strains collected in 2009-14 in Europe and clarify the azithromycin resistance mechanisms. Methods: Seventy-five azithromycin-resistant (MIC 4 to >256 mg/L) N. gonorrhoeae isolates collected in 17 European countr...

Visitors to the 2016 Olympics and Paralympics Summer Games in Rio de Janeiro, Brazil will be most at risk of gastrointestinal illness and vector-borne infections. Therefore, they should pay attention to standard hygiene measures to reduce the risk of gastrointestinal illness and protect themselves against mosquito/other insect bites using insect re...

ECDC held a meeting in Stockholm on 27-28 April 2016 to discuss considerations for PrEP implementation in Europe. The main objectives of the meeting were to discuss key issues relating to PrEP implementation in the EU/EEA and to advise ECDC on how it might support EU/EEA Member States. Participants included clinicians, epidemiologists, researchers...

The emerging resistance to the extended-spectrum cephalosporins (ESCs) in Neisseria gonorrhoeae together with increasing incidence of gonorrhoea cases in many countries have been global public health concerns. However, in recent years the levels of ESC resistance have decreased in several regions worldwide. We describe the European Gonococcal Antim...

Human immunodeficiency virus (HIV) transmission remains significant in Europe. Rates of acquired immunodeficiency syndrome (AIDS) have declined, but not in all countries. New HIV diagnoses have increased among native and foreign-born men who have sex with men. Median CD4(+) T-cell count at diagnosis has increased, but not in all groups, and late di...

Human immunodeficiency virus (HIV) transmission remains significant in Europe. Rates of acquired immunodeficiency syndrome (AIDS) have declined, but not in all countries. New HIV diagnoses have increased among native and foreign-born men who have sex with men. Median CD4+ T-cell count at diagnosis has increased, but not in all groups, and late diag...

In 2004, the 31 countries of the European Union and European Economic Area (EU/EEA) adopted the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia. In 2013, 29,157 persons were diagnosed with HIV in 30 EU/EEA countries (adjusted rate: 6.2/100,000); new diagnoses have increased by 33% since 2004 among men who have sex wit...

Neisseria gonorrhoeae has consistently developed resistance to antimicrobials used therapeutically for gonorrhoea and few antimicrobials remain for effective empiric first-line therapy. Since 2009 the European gonococcal antimicrobial surveillance programme (Euro-GASP) has been running as a sentinel surveillance system across Member States of the E...

There is a need for updated guidance on detection, management and surveillance of sexually transmitted infections (STIs). Chlamydia, gonorrhoea and syphilisreporting needs to be mandatory in more European countries to aid collection of data. More widespread Chlamydia screening is needed in many countries as this is the only way to reduce complicati...

In 2012, newly reported human immunodeficiency virus diagnoses in the European Union /European Economic Area remained stable at around 30,000 cases. Since 2003, cases in men who have sex with men (MSM) aged 20 to 29 years-old doubled, while the proportion of late presenters in this group remained stable. Persistent declines occurred among older MSM...

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae has emerged for essentially all antimicrobials following their introduction into clinical practice. During the latest decade, susceptibility to the last remaining options for antimicrobial monotherapy, the extended-spectrum cephalosporins (ESC), has markedly decreased internationally and treat...

Antimicrobial resistance in Neisseria gonorrhoeae is monitored in the European Union/European Economic Area through the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) coordinated by the European Centre for Disease Prevention and Control. Euro-GASP includes a sentinel surveillance programme which aims to detect in a timely mann...

The European Gonococcal Antimicrobial Surveillance Programme performs antimicrobial resistance surveillance and is coordinated by the European Centre for Disease Prevention and Control. This study used epidemiological and behavioral data combined with the gonococcal susceptibility profiles to determine risk factors associated with harboring resista...

Introduction Although majority of countries in the European Union (EU/EEA) offer antenatal screening for HIV and syphilis, mother-to-child transmission (MTCT) is still occurring. We aim to analyse the performance and effectiveness of antenatal screening programmes to strengthen these programmes across the EU/EEA Methods Surveillance for HIV and syp...

Introduction MSM in the European Union and European Economic Area (EU/EEA) are disproportionately affected by STI: 39% of all HIV diagnoses, 33% of gonorrhoea and 55% of syphilis cases were reported among MSM in 2011. Methods Analyses of surveillance data and information from countries responses for Dublin Declaration monitoring were combined wit...

Background Since 2003, outbreaks of lymphogranuloma venereum (LGV), caused by Chlamydia trachomatis genotypes L1-L3, have been described in men who have sex with men (MSM) in Europe. Awareness increased and enhanced surveillance systems were implemented and several countries in the European Union (EU/EEA) reported high numbers of LGV cases. Methods...

Background Recent reports have described increasing trends of gonorrhoea among men who have sex with men (MSM) in the United Kingdom and women in Sweden. European Union (EU/EEA) surveillance data has also shown increasing rates of gonorrhoea since 2008. We analysed surveillance data to identify the contributions of key populations to this increase....

Background STI are a significant cause of morbidity in Europe, particularly among young adults and men who have sex with men (MSM). Monitoring the spread of STI across key populations allows development of targeted prevention interventions. Methods Surveillance for chlamydia, gonorrhoea and syphilis in the European Union (EU/EEA) is coordinated by...

Background Increasing reports of Neisseria gonorrhoeae in vitro decreased susceptibility and resistance, and treatment failures with third generation cephalosporins are of major concern as these drugs are the last remaining options for effective antimicrobial therapy in many settings. Methods The European Gonococcal Antimicrobial Surveillance Progr...

At the request of Malta’s Infectious Disease Prevention and Control Unit (IDCU), the European Centre for Disease Prevention and Control (ECDC) organized an expert mission in Malta in 2009 to provide support for a vector-borne disease (VBD) risk assessment. As these diseases are clearly related to the presence of competent and efficient vectors, and...

The paper describes weekly fluctuations of all-cause mortality observed in eight European countries during the period between week 27 and 51, 2009, in comparison with three previous years. Our preliminary data show that the mortality reported during the 2009 influenza pandemic did not reach levels normally seen during seasonal influenza epidemics....

Since 1996, Malta has experienced an upsurge of invasive meningococcal disease (IMD) following an almost 30 year period with a negligible number of annually reported cases. We reviewed the 233 IMD cases notified during a 14 year period (1994-2007), and analysed epidemiological and laboratory surveillance data. The crude incidence per 100,000 inhabi...

A cluster of rubella has been identified by the Infectious Disease Prevention and Control Unit (IDCU) of Malta in the beginning of January 2008. Two men and a woman aged between 23 and 28 years were affected. The index case had onset of illness on 23 December 2007. The second case had onset of rash on 3 January and the third case displayed symptoms...

The aim of this study was to estimate the burden of infectious intestinal disease (IID) and cost of illness at the community level from a societal aspect. A retrospective, age-stratified cross-sectional telephone study was carried out in Malta in 2004-2005. The number of cases, resources used and cost of resources were computed. The resources invol...

Routine sources of information on infectious intestinal disease (IID) capture a fraction of the actual disease burden. Population studies are required to measure the burden of illness. A retrospective age-stratified cross-sectional telephone study was carried out in Malta in order to estimate the magnitude and distribution of IID at population leve...

An influenza pandemic is inevitable and recent reports from Southeast Asia on avian influenza viruses infecting humans have served to fuel worries that a new pandemic is near. The purpose of this article is to provide an overview of the epidemiological and public health aspects of seasonal, avian and pandemic influenza through a literature review a...