John Paget

• BSc MSc DTM&H PhD
• Senior Researcher at Nivel – Research for better care

Background We previously reviewed methods for estimating the timing of respiratory syncytial virus (RSV) epidemics. This study examines the impact of various estimation methods on determining the start, end, duration, and capture rate of RSV epidemics. Methods We applied eight estimation methods to RSV surveillance data from the Global Epidemiolog...

Background Accurate cost estimates of respiratory syncytial virus (RSV) infections in primary care are limited, despite the majority of cases being managed in this setting. This study aims to estimate healthcare costs for children with RSV in primary care and the related costs of parental work absence. Methods Children < 5 years of age with sympto...

Background During the COVID‐19 pandemic, atypical respiratory syncytial virus (RSV) circulation patterns emerged, with the occurrence of RSV activity outside the typical winter season. This study investigates the impact of COVID‐19 and associated non‐pharmaceutical interventions (NPIs) on RSV seasonality. Methods The onset, offset and peak of RSV...

Respiratory syncytial virus (RSV) is the most common cause of acute respiratory infections in young children. Limited data are available on RSV disease burden in primary care and emergency departments (EDs). This review synthesizes the evidence on population‐based incidence rates of RSV infections in young children (< 5 years) in primary care and E...

Background The SARS-CoV-2 pandemic disrupted respiratory syncytial virus (RSV) seasonality. To optimise the use and evaluation of RSV infant immunisation strategies, monitoring changes in RSV epidemiology is essential. Methods Hospitalisations for acute respiratory infections (ARI) and RSV-coded ARI in children <2 years were extracted in four Euro...

Early after the start of the COVID-19 pandemic, the detection of influenza B/Yamagata cases decreased globally. Given the potential public health implications of this decline, in this Review, we systematically analysed data on influenza B/Yamagata virus circulation (for 2020–23) from multiple complementary sources of information. We identified rele...

Background Respiratory syncytial virus (RSV) infection in children under 5 years have a significant clinical burden, also in primary care settings. This study investigates the epidemiology and burden of RSV in Italian children during the 2019/20 pre-pandemic winter season. Methods A prospective cohort study was conducted in two Italian regions. Ch...

This cohort study compares the use of hospital resources related to human rhinovirus and respiratory syncytial virus infections among infants during 3 consecutive seasons before nirsevimab implementation.

Background There is currently no standardised approach to estimate respiratory syncytial virus (RSV) epidemics’ timing (or seasonality), a critical information for their effective prevention and control. Aim We aimed to provide an overview of methods to define RSV seasonality and identify factors supporting method choice or interpretation/comparis...

Background RSV infections affects people of all ages but the seasonality of RSV among different age groups have not been thoroughly examined. In this study, we investigated changes in the age distribution of RSV cases during the course of annual epidemics. Methods We analyzed surveillance data (2008-2019) from the Netherlands, the city of Lyon (Fr...

Background Individuals with comorbidities are at increased risk of severe RSV infection. We estimated RSV-associated respiratory tract infection (RTI) hospitalisation among adults aged 45 years and older with comorbidities in Denmark and Scotland. Methods By analysing national hospital and virological data, we estimated the annual average number a...

Background During the first year of life, one in four infants develops a symptomatic respiratory syncytial virus (RSV) infection, yet only half seek medical attention. The current focus on medically attended RSV, therefore, underrepresents the true societal burden of RSV. We assessed the burden of non-medically attended RSV infections and compared...

Introduction Early after the start of the COVID-19 pandemic, a major drop in the number of influenza B/Yamagata detections was observed globally. Given the potential public health implications, particularly with regards to influenza vaccination, we conducted a systematic review of influenza B/Yamagata virus circulation data from multiple complement...

Background Individuals with comorbidities are at increased risk of severe RSV infection. We estimated RSV-associated respiratory tract infection (RTI) hospitalisation among adults aged 45 years and older with comorbidities in Denmark and Scotland. Methods By analysing national hospital and virological data, we estimated annual average number and ra...

Background Vaccination can prevent bacterial and viral infections that could otherwise increase the chances of receiving (unnecessary) antibiotic treatment(s). As a result, vaccination may provide an important public health intervention to control antimicrobial resistance (AMR). Objectives Perform a systematic literature review to better understan...

Background Previous studies reported inconsistent findings regarding the association between respiratory syncytial virus (RSV) subgroup distribution and timing of RSV season. We aimed to further understand the association by conducting a global-level systematic analysis. Methods We compiled published data on RSV seasonality through a systematic li...

Background: No overall estimate of RSV-associated hospitalisations in children under 5 years has been published for the European Union (EU). We aimed to estimate the RSV hospitalisation burden in children under 5 years in EU countries and Norway, by age group. Methods: We collated national RSV-associated hospitalisation estimates calculated usin...

Background: Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in adults that can result in hospitalisations. Estimating RSV-associated hospitalisation is critical for planning RSV-related healthcare across Europe. Methods: We gathered RSV-associated hospitalisation estimates from the RSV Consortium in Europ...

Background The Global Influenza Hospital Surveillance Network (GIHSN) was established in 2012 to conduct coordinated worldwide influenza surveillance. Here we describe underlying comorbidities, symptoms, and outcomes in hospitalized patients with influenza. Methods Between November/2018 and October/2019, GIHSN included 19 sites in 18 countries usi...

The emergence of SARS-CoV-2 and the resulting coronavirus disease 2019 (COVID-19) pandemic has led to the reconsideration of surveillance strategies for respiratory syncytial virus (RSV) and other respiratory viruses. The COVID-19 pandemic and the non-pharmaceutical interventions for COVID-19 had a substantial impact on RSV transmission in many cou...

Background: Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in older adults that can result in hospitalisations and death. Estimating RSV-associated hospitalisation is critical for planning RSV-related healthcare needs for the ageing population across Europe. Methods: We gathered national RSV-associated hosp...

Background: Respiratory syncytial virus (RSV) infections cause an estimated 22-50 million episodes of acute lower respiratory infections (ALRI) every year in children younger than 5 years. To date, no overall estimate of RSV-associated hospitalisations in children under 5 years has been published for the European Union (EU). Through statistical mod...

Background: The emergence of COVID-19 triggered the massive implementation of non-pharmaceutical interventions (NPI) which impacted the circulation of respiratory syncytial virus (RSV) during the 2020/2021 season. Methods: A time-series susceptible-infected-recovered (TSIR) model was used early September 2021 to forecast the implications of this...

Background: WHO estimates that seasonal influenza epidemics result in three to five million cases of severe illness (hospitalisations) every year. We aimed to improve the understanding of influenza-associated hospitalisation estimates at a national and global level. Methods: We performed a systematic literature review of English- and Chinese-lan...

We analysed the influenza epidemic that occurred in Australia during the 2022 winter using an age‐structured dynamic transmission model, which accounts for past epidemics to estimate the population susceptibility to an influenza infection. We applied the same model to five European countries. Our analysis suggests Europe might experience an early a...

Background Vaccination can reduce antibiotic use by decreasing bacterial and viral infections and vaccines are highlighted in the WHO Global Action Plan on Antimicrobial Resistance (AMR) as an infection prevention measure to reduce AMR. Our study aimed to analyze whether WHO Member States have developed AMR national action plans that are aligned wi...

While two influenza B virus lineages have co-circulated, B/Yamagata-lineage circulation has not been confirmed since March 2020. The WHO FluNet database indicates that B/Yamagata-lineage detections were reported in 2021 and 2022. However, detections can result from use of quadrivalent live-attenuated vaccines. Of the type B viruses detected post-Ma...

Background Primary Sjögren’s Syndrome (pSS) is a rare autoimmune disease that is difficult to diagnose due to a variety of clinical presentations, resulting in misdiagnosis and late referral to specialists. To improve early-stage disease recognition, this study aimed to develop an algorithm to identify possible pSS patients in primary care. We buil...

Background: Knowledge on age-specific hospitalizations associated with RSV infection is limited due to limited testing, especially in older children and adults in whom RSV infections are not expected to be severe. Burden estimates based on RSV coding of hospital admissions are known to underestimate the burden of RSV. We aimed to provide robust an...

Background: Respiratory syncytial virus (RSV) commonly causes lower respiratory tract infections (LRTI) and hospitalisation in children. In 2019/20, the Europe-wide RSV ComNet standardised study protocol was developed to measure the clinical and socio-economic disease burden of RSV infections amongst children <5 years of age in primary care. RSV...

Background: Respiratory syncytial virus (RSV) commonly causes lower respiratory tract infections (LRTI) and hospitalisation in children. In 2019-2020, the Europe-wide RSV ComNet standardised study protocol was developed to measure the clinical and socio-economic disease burden of RSV infections amongst children <5 years of age in primary care. RSV...

Aims The aim of this systematic review is to assess the effects of community pharmacist‐led interventions to optimise the use of antibiotics and identify which interventions are most effective. Methods This review was conducted according to the PRISMA guidelines (PROSPERO: CRD42020188552). PubMed, EMBASE and the Cochrane Central Register of Contro...

Background: Seasonal influenza viruses undergo unpredictable changes, which may lead to antigenic mismatch between circulating and vaccine strains and to a reduced vaccine effectiveness. A continuously updated knowledge of influenza strain circulation and seasonality is essential to optimize the effectiveness of influenza vaccination campaigns. We...

Background: Influenza and respiratory syncytial virus (RSV) are among the leading causes of lower respiratory tract infections worldwide. We conducted a comparative analysis of the age distribution and spatiotemporal epidemiology of influenza and RSV in Russia using sentinel surveillance data from 2013-14 to 2018-19 in six cities located in the we...

Background The European Centres for Disease Prevention and Control (ECDC) estimates that seasonal influenza causes 4–50 million symptomatic infections in the EU/EEA each year and 15,000–70,000 European citizens die of causes associated with influenza. We used modelling methods to estimate influenza-associated mortality for the European Union by age...

Background A better understanding of the burden of respiratory syncytial virus (RSV) infections in primary care is needed for policymakers to make informed decisions regarding new preventive measures and treatments. The aim of this study was to develop and evaluate a protocol for the standardised measurement of the disease burden of RSV infection i...

Since the introduction of non-pharmacological interventions to control COVID-19, respiratory syncytial virus (RSV) activity in Europe has been limited. Surveillance data for 17 countries showed delayed RSV epidemics in France (≥ 12 w) and Iceland (≥ 4 w) during the 2020/21 season. RSV cases (predominantly small children) in France and Iceland were...

Background: Respiratory syncytial virus (RSV) infections are one of the leading causes of lower respiratory tract infections and have a major burden on society. For prevention and control to be deployed effectively, an improved understanding of the seasonality of RSV is necessary. Objectives: The main objective of this study was to contribute to a...

The global response to infectious diseases has seen a renewed interest in the use of community engagement to support research and relief efforts. From a perspective rooted in the social sciences, the concept of vulnerability offers an especially useful analytical frame for pursuing community engagement in a variety of contexts. However, few have cl...

Objectives. The aim of this systematic review is to assess the effects of community pharmacist-led interventions to optimize the use of antibiotics and identify which interventions are most effective. Methods. This review was conducted according to the PRISMA-P guidelines (PROSPERO: CRD42020188552). PubMed, EMBASE and the Cochrane Central Register...

Sinds de invoering van de COVID-19-maatregelen is in Europa nauwelijks circulatie van respiratoir synctieel virus (RS-virus). Alleen in Frankrijk en IJsland is in de winter van 2020-2021 een RS-virusepidemie vastgesteld; 4 maanden later dan gebruikelijk. Ook op het zuidelijk halfrond stopte de RS-viruscirculatie vanaf het invoeren van de COVID-19-m...

Background Influenza and respiratory syncytial virus (RSV) contribute significantly to the burden of acute lower respiratory infection (ALRI) inpatient care, but heterogeneous coding practices and availability of inpatient data make it difficult to estimate global hospital utilization for either disease based on coded diagnoses alone. Methods This...

Introduction We aimed to develop an innovative population-based method to estimate the health effect of influenza vaccination based on electronic medical records collected within a general practitioner (GP)-based influenza surveillance system in the Netherlands. Methods In each season between 2006/07 and 2015/16, we fitted multilevel Poisson regre...

Background: In December 2019, a novel coronavirus named SARS-CoV-2 started circulating in China and this led to a major epidemic in Northern Italy between February and May 2020. Young children (aged <5 years) seem to be less affected by this coronavirus disease (COVID-19) compared to adults, although there is very little information on the circulat...

Respiratory syncytial virus (RSV) is a common cause of acute lower respiratory tract infections (ALRI) and hospitalisations among young children and is globally responsible for many deaths in young children, especially in infants below 6 months of age. Furthermore, RSV is a common cause of severe respiratory disease and hospitalisation among the el...

Temporal variation of respiratory syncytial virus (RSV) epidemics was recently reported to be determined by the dominant RSV subtype. However, when we repeated the analysis for 4 countries in the Northern and Southern Hemispheres, the dominant subtype did not seem to affect temporal variation of RSV epidemics.

Background Respiratory syncytial virus (RSV) is one of the leading causes of acute respiratory tract infections. To optimize control strategies, a better understanding of the global epidemiology of RSV is critical. To this end, we initiated the Global Epidemiology of RSV in Hospitalized and Community care study (GERi). Methods Focal points from 44...

Infectious threats, including pandemics, require a careful understanding of local contexts and global processes. Here, the social sciences can offer important contributions.

The integration of the fields of traditional infectious diseases and social science provide a promising approach for the productive utilisation of community engagement as it relates to the mitigation of particularly situated vulnerabilities, including unequal access to vital resources. We examine here four elements surrounding these issues within e...

Objectives Understanding the proportion of pandemic deaths captured as ‘laboratory-confirmed’ deaths is crucial. We assessed the ability of laboratory-confirmed deaths to capture mortality in the EU during the 2009 pandemic, and examined the likelihood that these findings are applicable to the SARS-CoV-2 pandemic. Methods We present unpublished re...

Background: Influenza vaccination prevents people from influenza-related diseases and thereby mitigates the burden on national health systems when COVID-19 circulates and public health measures controlling respiratory viral infections are relaxed. However, it is challenging to maintain influenza vaccine services as the COVID-19 pandemic has the po...

Background Influenza vaccination prevents people from influenza-related diseases and thereby mitigates the burden on national health systems when COVID-19 circulates and public health measures controlling respiratory viral infections are relaxed. However, it is challenging to maintain influenza vaccine services as the COVID-19 pandemic has the pote...

We reviewed the association between seasonal influenza vaccination and the risk of SARS-CoV-2 infection or complicated illness or poor outcome (e.g., severe disease, need for hospitalization or ventilatory support, or death) among COVID-19 patients. None of the studies that were reviewed (n = 12) found a significant increase in the risk of infectio...

Background Compared to men, women have lower treatment rates for cardiovascular disease (CVD), are at higher risk for medication non-adherence and have different reasons for being non-adherent. The aim of this study was to synthesize and evaluate gender-specific adherence-promoting interventions for cardiovascular medication and gender-specific eff...

We reviewed the association between seasonal influenza vaccination and the risk of SARS-CoV-2 infection or complicated illness or poor outcome (e.g. severe disease, need for hospitalization or ventilatory support, or death) among COVID-19 patients. None of the studies that were reviewed (n=12) found a significant increase in the risk of infection o...

We reviewed the association between seasonal influenza vaccination and the risk of SARS-CoV-2 infection or complicated illness or poor outcome (e.g. severe disease, need for hospitalization or ventilatory support, or death) among COVID-19 patients. None of the studies that were reviewed (n=12) found a significant increase in the risk of infection o...

Background: Respiratory syncytial virus (RSV) is the predominant viral pathogen associated with acute lower respiratory infection (ALRI) in children who are younger than 5 years. Little is reported on the national estimates of RSV-associated ALRI hospitalisations in these children on the basis of robust epidemiological data. We aimed to generate n...

Prior to updating global influenza-associated mortality estimates, the World Health Organization convened a consultation in July 2017 to understand differences in methodology and implications on results of three influenza mortality projects from the United States Centers for Disease Control and Prevention (CDC), the Netherlands Institute for Health...

Background This study is part of the EU‐funded project HarmonicSS, aimed at improving the treatment and diagnosis of primary Sjögren's syndrome (pSS). pSS is an underdiagnosed, long‐term autoimmune disease that affects particularly salivary and lachrymal glands. Objectives We assessed the usability of routinely recorded primary care and hospital c...

Background: Since 2011, the Global Influenza Hospital Surveillance Network (GIHSN) has used active surveillance to prospectively collect epidemiological and virological data on patients hospitalized with influenza virus infection. Here, we describe influenza virus strain circulation in the GIHSN participant countries during 2017-2018 season and ex...

We reviewed the diagnostic accuracy of SARS-CoV-2 serological tests. Random-effects models yielded a summary sensitivity of 82% for IgM, and 85% for IgG and total antibodies. For specificity, the pooled estimate were 98% for IgM and 99% for IgG and total antibodies. In populations with ≤ 5% of seroconverted individuals, unless the assays have perfe...

Background Despite the early development of Google Flu Trends in 2009, standards for digital epidemiology methods have not been established and research from European countries is scarce.AimIn this article, we study the use of web search queries to monitor influenza-like illness (ILI) rates in the Netherlands in real time.Methods In this retrospect...

Serology-based tests have become a key public health element in the COVID-19 pandemic to assess the degree of herd immunity that has been achieved in the population. These tests differ between one another in several ways. Here, we conducted a systematic review and meta-analysis of the diagnostic accuracy of currently available SARS-CoV-2 serologica...

Background: Since 2011, the Global Influenza Hospital Surveillance Network (GIHSN) has used active surveillance to prospectively collect epidemiological and virological data on patients hospitalized with influenza virus infection. Here, we describe influenza virus strain circulation in the GIHSN participant countries during 2017–2018 season and exa...

Background: Since 2011, the Global Influenza Hospital Surveillance Network (GIHSN) has used active surveillance to prospectively collect epidemiological and virological data on patients hospitalized with influenza virus infection. Here, we describe influenza virus strain circulation in the GIHSN participant countries during 2017–2018 season and exa...

Background: Since 2011, the Global Influenza Hospital Surveillance Network (GIHSN) has used active surveillance to prospectively collect epidemiological and virological data on patients hospitalized with influenza virus infection. Here, we describe influenza virus strain circulation in the GIHSN participant countries during 2017–2018 season and exa...

Background: Until recently, the World Health Organization (WHO) estimated the annual mortality burden of influenza to be 250 000 to 500 000 all-cause deaths globally; however, a 2017 study indicated a substantially higher mortality burden, at 290 000-650 000 influenza-associated deaths from respiratory causes alone, and a 2019 study estimated 99 0...

We describe the epidemiological characteristics, pattern of circulation, and geographical distribution of influenza B viruses and its lineages using data from the Global Influenza B Study. We included over 1.8 million influenza cases occurred in thirty-one countries during 2000–2018. We calculated the proportion of cases caused by influenza B and i...

Background: We estimated the cost-per-episode and the annual economic burden associated with influenza in Kenya. Methods: From July 2013-August 2014, we recruited patients with severe acute respiratory illness (SARI) or influenza-like illness (ILI) associated with laboratory-confirmed influenza from 5 health facilities. A structured questionnair...

Background Description of the epidemiology of influenza is needed to inform influenza vaccination policy. Here we examined influenza virus circulation in countries in the Asia-Pacific region and compared the timing of seasonal epidemics with the timing of influenza vaccination. Methods Data were obtained from the World Health Organization (WHO) Fl...

Background Antimicrobial resistance (AMR) is an increasing public health problem worldwide. We studied some patient-related factors that might influence the antimicrobial resistance. and whether the volume of antibiotic prescribing of the primary care physicians correlate with the antibiotic resistance rates of commensal nasal Staphylococcus aureus...

Background: Self-medication with antibiotics, which comes in different forms [e.g., leftover or over-the-counter (OTC) use], contributes to antimicrobial resistance as it often happens in a non-prudent manner. In order to tackle this persistent public health problem, its drivers need to be known. The aim of this study was therefore to identify dete...