The document provides information on measles and rubella cases in the WHO European Region from September 2020 to August 2021. It summarizes that Turkey, Ukraine, and Poland reported the most measles cases, while Poland, Ukraine, and Turkey reported the most rubella cases. Overall measles and rubella cases have declined compared to previous years but outbreaks still occur periodically in some countries. The document also provides links to additional measles and rubella surveillance resources on the WHO website.
Reported measles cases for the period November 2020—October 2021 (data as of 02 December 2021).A monthly summary of the epidemiological data on selected vaccine-preventable diseases in the WHO European Region
Reported measles cases for the period November 2020—October 2021 (data as of 02 December 2021).A monthly summary of the epidemiological data on selected vaccine-preventable diseases in the WHO European Region
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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How many patients does case series should have In comparison to case reports.pdfpubrica101
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How many patients does case series should have In comparison to case reports.pdf
EpiData 9/2021 for the period September 2020—August 2021 (data as of 30 September 2021)
1. Vaccine-preventable Diseases and Immunization programme
Division of country health programmes
Data as of 30 September 2021
Measles and rubella monthly update—
WHO European Region
www.euro.who.int
5. 3
5
5
5
6
10
16
19
22
30
0 5 10 15 20 25 30 35
Belarus,Italy &
Kazakhstan*
Ireland
Germany
Georgia
Kyrgyzstan
France
Poland
Belgium
Ukraine
Turkey
Number of cases
5
Ten countries with the highest numbers of measles cases—
WHO European Region, September 2020–August 2021
Out of 135 measles cases reported for September 2020 to
August 2021, 127 (94%) cases were reported by these 12
countries.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 30 September 2021
* Belarus, Italy and Kazakhstan had three cases each for rolling 12-months.
18 (34%) countries reported measles cases in the rolling 12-months.
6. 6
Measles cases by month—WHO European Region,
2019–August 2021
Criteria for date of case inclusion September differ in accordance with Member States’ surveillance systems.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 30 September 2021
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
2019
(n=104442)
2020
(n=12198)
2021
(n=91)
Number
of
cases
Month
Lab confirmed Epi linked Clinically compatible
7. 30604
33254
26788
32857
18869
28413
5273
25872
88693
104442
12198
91
93 94 95 95 94 94 93
95 95 96
94
80
82 83
89 89 89 88
90 91 91 91
0
20
40
60
80
100
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021*
0
20000
40000
60000
80000
100000
120000
%
Coverage
Year
Number
of
cases
Measles cases MCV1 coverage MCV2 coverage
7
Measles cases, MCV1 and MCV2 coverage by year—
WHO European Region, 2010–August 2021
Data source: 1) Measles cases – monthly aggregated and case-based data reported by Member States to WHO/Europe or via ECDC/TESSy as of 30 September 2021.
2) MCV1 and MCV2 coverage - WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2021.
MCV1: first dose of measles-containing vaccine
MCV2: second dose of measles-containing vaccine
*January –August 2021
12. 12
Ten countries with the highest numbers of measles cases—
WHO European Region, 2020
168
211
240
245
603
714
976
1100
3269
4053
0 500 1000 1500 2000 2500 3000 3500 4000 4500
Tajikistan
Ukraine
France
Bulgaria
Turkey
Kyrgyzstan
Romania
Russian Federation
Kazakhstan
Uzbekistan
Number of cases
Out of 12 198 measles cases reported for 2020, 11 579 (95%) cases were
reported by these 10 countries.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 30 September 2021
13. 13
Measles cases by month—WHO European Region,
2018–2020
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2018
(n=88693)
2019
(n=104442)
2020
(n=12198)
Number
of
cases
Month
Lab confirmed Epi linked Clinically compatible
Criteria for date of case inclusion September differ in accordance with Member States’ surveillance systems.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 30 September 2021
14. 14
Measles cases and incidence by age group* and vaccination
status—WHO European Region, 2020
*Age was unknown for 31 cases.
Population source: United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2019 Revision.
390
71
17 12 9 9 3
0
50
100
150
200
250
300
350
400
450
0
500
1000
1500
2000
2500
3000
3500
4000
4500
<1
(n=4201)
1–4
(n=3212)
5–9
(n=1009)
10–14
(n=652)
15–19
(n=463)
20–29
(n=1061)
30+
(n=1569)
Incidence
per
million
population
Number
of
cases
Age group (years)
0 dose 1 dose 2+ doses Unknown Incidence
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 30 September 2021
16. 16
Five countries with the highest numbers of rubella cases—
WHO European Region, September 2020–August 2021
3
8
10
14
46
0 5 10 15 20 25 30 35 40 45 50
Italy
Germany
Turkey
Ukraine
Poland
Number of cases
Out of 83 rubella cases reported for September 2020 to August
2021, 81 (98%) cases were reported by these 5 countries.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 30 September 2021
7 (14%) countries reported rubella cases in the rolling 12-months.
17. 17
Rubella cases by month—WHO European Region,
2019–August 2021
0
20
40
60
80
100
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
2019
(n=630)
2020
(n=190)
2021
(n=62)
Number
of
cases
Month
Lab confirmed Epi linked Clinically compatible
Criteria for date of case inclusion September differ in accordance with Member States’ surveillance systems.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 30 September 2021
19. 19
Five countries with the highest numbers of rubella cases—
WHO European Region, 2020
15
15
17
27
96
0 10 20 30 40 50 60 70 80 90 100
Turkey
Italy
Germany
Ukraine
Poland
Number of cases
Out of 190 rubella cases reported for 2020, 170 (89%) cases
were reported by these 5 countries.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 30 September 2021
20. 20
Rubella cases by month—WHO European Region,
2018–2020
0
20
40
60
80
100
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2018
(n=839)
2019
(n=630)
2020
(n=190)
Number
of
cases
Month
Lab confirmed Epi linked Clinically compatible
Criteria for date of case inclusion September differ in accordance with Member States’ surveillance systems.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 30 September 2021
21. 21
Links to measles and rubella information
• WHO EpiData
www.euro.who.int/en/health-topics/disease-prevention/vaccines-and-immunization/publications/surveillance-and-data/who-epidata
• Country slides for measles and rubella
www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/
• WHO EpiBrief
www.euro.who.int/en/health-topics/disease-prevention/vaccines-and-immunization/publications/surveillance-and-data/who-epibrief