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Recurrent health emergencies threaten global health security. International Health Regulations (IHR) aim to prevent, detect and respond to such threats, through increase in national public health core capacities, but whether IHR core capacity implementation is necessary and sufficient has been contested. With a longitudinal study we relate changes in national IHR core capacities to changes in cross‐border infectious disease threat events (IDTE) between 2010 and 2016, collected through epidemic intelligence at the European Centre for Disease Prevention and Control (ECDC). By combining all IHR core capacities into one composite measure we found that a 10% increase in the mean of this composite IHR core capacity to be associated with a 19% decrease (p=0.017) in the incidence of cross‐border IDTE in the EU. With respect to specific IHR core capacities, an individual increase in national legislation, policy & financing; coordination and communication with relevant sectors; surveillance; response; preparedness; risk communication; human resource capacity; or laboratory capacity was associated with a significant decrease in cross‐border IDTE incidence. In contrast, our analysis showed that IHR core capacities relating to point‐of‐entry, zoonotic events or food safety were not associated with IDTE in the EU. Due to high internal correlations between core capacities, we conducted a principal component analysis which confirmed a 20% decrease in risk of IDTE for every 10% increase in the core capacity score (95% CI: 0.73, 0.88). Globally (EU excluded), a 10% increase in the mean of all IHR core capacities combined was associated with a 14% decrease (p=0.077) in cross‐border IDTE incidence. We provide quantitative evidence that improvements in IHR core capacities at country‐level are associated with fewer cross‐border IDTE in the EU, which may also hold true for other parts of the world.

Infectious disease threat events (IDTEs) are increasing in frequency worldwide. We analyzed underlying drivers of 116 IDTEs detected in Europe during 2008-2013 by epidemic intelligence at the European Centre of Disease Prevention and Control. Seventeen drivers were identified and categorized into 3 groups: globalization and environment, sociodemographic, and public health systems. A combination of >= 2 drivers was responsible for most IDTEs. The driver category globalization and environment contributed to 61% of individual IDTEs, and the top 5 individual drivers of all IDTEs were travel and tourism, food and water quality, natural environment, global trade, and climate. Hierarchical cluster analysis of all drivers identified travel and tourism as a distinctly separate driver. Monitoring and modeling such disease drivers can help anticipate future IDTEs and strengthen control measures. More important, intervening directly on these underlying drivers can diminish the likelihood of the occurrence of an IDTE and reduce the associated human and economic costs.

Emerging infectious diseases are of international concern because of the potential for, and impact of, pandemics; however, they are difficult to predict. To identify the drivers of disease emergence, we analyzed infectious disease threat events (IDTEs) detected through epidemic intelligence collected at the European Centre for Disease Prevention and Control (ECDC) between 2008 and 2013, and compared the observed results with a 2008 ECDC foresight study of projected drivers of future IDTEs in Europe. Among 10 categories of IDTEs, foodborne and waterborne IDTEs were the most common, vaccine-preventable IDTEs caused the highest number of cases, and airborne IDTEs caused the most deaths. Observed drivers for each IDTE were sorted into three main groups: globalization and environmental drivers contributed to 61% of all IDTEs, public health system drivers contributed to 21%, and social and demographic drivers to 18%. A multiple logistic regression analysis showed that four of the top five drivers for observed IDTEs were in the globalization and environment group. In the observational study, the globalization and environment group was related to all IDTE categories, but only to five of eight categories in the foresight study. Directly targeting these drivers with public health interventions may diminish the chances of IDTE occurrence from the outset., Special Issue: Human Health in the Face of Climate Change

Background: Ixodes ricinus is the main vector in Europe of human-pathogenic Lyme borreliosis (LB) spirochaetes, the tick-borne encephalitis virus (TBEV) and other pathogens of humans and domesticated mammals. The results of a previous 1994 questionnaire, directed at people living in Central and North Sweden (Svealand and Norrland) and aiming to gather information about tick exposure for humans and domestic animals, suggested that Ixodes ricinus ticks had become more widespread in Central Sweden and the southern part of North Sweden from the early 1980s to the early 1990s. To investigate whether the expansion of the tick's northern geographical range and the increasing abundance of ticks in Sweden were still occurring, in 2009 we performed a follow-up survey 16 years after the initial study. Methods: A questionnaire similar to the one used in the 1994 study was published in Swedish magazines aimed at dog owners, home owners, and hunters. The questionnaire was published together with a popular science article about the tick's biology and role as a pathogen vector in Sweden. The magazines were selected to get information from people familiar with ticks and who spend time in areas where ticks might be present. Results: Analyses of data from both surveys revealed that during the near 30-year period from the early 1980s to 2008, I. ricinus has expanded its distribution range northwards. In the early 1990s ticks were found in new areas along the northern coastline of the Baltic Sea, while in the 2009 study, ticks were reported for the first time from many locations in North Sweden. This included locations as far north as 66 degrees N and places in the interior part of North Sweden. During this 16-year period the tick's range in Sweden was estimated to have increased by 9.9%. Most of the range expansion occurred in North Sweden (north of 60 degrees N) where the tick's coverage area doubled from 12.5% in the early 1990s to 26.8% in 2008. Moreover, according to the respondent, Medicinsk entomologi

In Sweden, the geographical distribution of Lyme borreliosis corresponds to that of its vector Ixodes ricinus. Both tick activity and the length of the vegetation period are determined by daily mean temperatures ≥5 °C. We analysed the correspondence between the distribution of I. ricinus in Sweden, the start date, end date, and length of the vegetation period, and the distributions of tick habitat-associated plant species. The geographical distribution of I. ricinus in Sweden corresponds to a vegetation period averaging ∼170 days, an early start (before May 1st) of spring, and to the distribution of black alder (Alnus glutinosa). Based on scenario models for these parameters, changes in the range and abundance of I. ricinus were projected for the periods 2011–2040, 2041–2070, and 2071–2100. We conclude that climate change during this century will probably increase the geographic range of I. ricinus as vegetation communities and mammals associated with high tick densities will increase their geographic ranges due to a markedly prolonged vegetation period. By the end of this century, the ranges of I. ricinus and Borrelia burgdorferi sensu lato may, in suitable habitats, encompass most of Sweden, Norway, and Finland as far as 70°N, except the mountainous regions. This will lead to an increased Lyme borreliosis risk in northern Scandinavia., Medicinsk entomologi

Recent observed changes in Earth's climate, to which humans have contributed substantially, are affecting various health outcomes. These include altered distributions of some infectious disease vectors (ticks at high latitudes, malaria mosquitoes at high

Till statsrådet och chefen för Miljödepartementet Andreas Carlgren och den parlamentariska beredningen för översyn av klimatpolitiken (M 2007:03) Statsrådet Andreas Carlgren tillsatte genom beslut den 21 decem- ber 2006 Vetenskapliga rådet för klimatfrågor inom Miljövårds- beredningen (Jo 1968:A). Rådet har haft i uppdrag att bidra med vetenskapliga bedömningar som underlag till den parlamentariska beredningen för översyn av klimatpolitiken (M 2007:03). En viktig uppgift har varit att ge underlag och rekommendationer till mål för den svenska klimatpolitiken nationellt, i EU och internationellt. Rådet tillsattes för tiden 1 januari till 1 september 2007. Vetenskapliga rådet för klimatfrågor överlämnar härmed sin rapport Vetenskapligt underlag för klimatpolitiken (Miljövårds- beredningens rapport 2007:03). Ledamöter i Rådet har varit professor Lisa Sennerby Forsse (ordförande), professor Christian Azar, professor Sten Bergström, professor Anders Biel, professor Runar Brännlund, professor Katarina Eckerberg, professor Thomas B. Johansson, professor Erland Källén, professor Caroline Leck, doktor Elisabet Lindgren och professor Markku Rummukainen. I arbetet har från Miljövårdsberedningens kansli deltagit kansli- chefen Pernilla Knutsson, departementssekreteraren Åsa Guilamo, departementsrådet Lars Lundberg och docent Fredrik von Malmborg. Departementssekreteraren Anna Forsgren har deltagit som Miljödepartementets representant. Stockholm den 31 augusti 2007 Lisa Sennerby Forsse Ordförande Vetenskapliga rådet för klimatfrågor Miljövårdsberedningen (Jo 1968:A)

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