No 51 - 2021

Relevant SSI links for use in connection with COVID-19 vaccination

Within the Department of Infectious Disease Epidemiology and Prevention, the Guidance and Dissemination Team serves , among others, to assist healthcare workers with COVID-19 vaccine-related questions. At the SSI’s COVID-19 sub-site (in Danish language), you will find information about COVID-19 vaccination for healthcare workers who partake in vaccination or provide advice to patients on the topic. Among others, the site offers information about available COVID-19 vaccines. The site has a left-hand menu with various tabs by which users can access different sections of information. The more important tabs are explained below (all in Danish language).

Under the tab “Vaccines” (Vacciner), you will find general information about all of the approved COVID-19 vaccines along with vaccine-specific infographics that may serve as an overall summary of information about storage, resuspension, vaccination and choice of syringes and needles.

Under the tab “Questions and answers” (Spørgsmål og svar), you will find answers to frequently asked questions about COVID-19 vaccination, including special target groups, vaccination and intervals, side effects and precautionary measures.

Under the tab “Registering vaccines in the DVR” (Registrering af vacciner i DDV), you will find instructions allowing you to register COVID-19 vaccines in the Danish Vaccination Register. The instructions describe the assignment of COVID-19 vaccination courses, including cases in which the patient was fully or partly vaccinated abroad, and assignment of vaccination courses allowing those patients to receive the third dose who have not received an invitation and have therefore not been assigned this course automatically.

Under the tab “COVID Certificate” (Coronapas), you will find information about the Danish COVID Certificate. You will also find contact information allowing you to reach out to various hotlines that may assist you in answering any questions related to the COVID Certificate.

In addition to the COVID-19 sub-site described above, you may also access information about COVID-19 vaccination in the “Vaccine Encyclopaedia” (Vaccineleksikon). Here, you will find a brief description and an overview of each COVID-19 vaccine and you may access each vaccine’s summary of product characteristics. The summary of product characteristics includes specific information about the vaccine, including information about posology and administration, contraindications, side effects and safety profile. Please note that health-professional decisions may have been adopted in Denmark that are not fully in line with the recommendations made in the summary of product characteristics.

External instructions and information, not disseminated by Statens Serum Institut

In addition to the above information sources, the Danish Health Authority has prepared a joint document providing guidelines on the handling of COVID-19 vaccination.

The Danish Health Authority has also prepared a Knowledge bank for general practitioners and vaccinators.

Additionally, the Danish Medicines Agency offers a theme page on COVID-19 vaccines .

The Danish Medical Practitioners Association (PLO) has collected information about COVID-19 vaccination in general practice (in Danish language), including the agreement covering participation in the vaccination agreed upon by PLO and the various Danish regions. The page also holds instructions relating to posology and time intervals, recording of vaccinations, changes and cancellations of vaccination appointments and general guidelines on COVID-19 vaccination in general practice.

If needed, healthcare workers may, as always, contact the SSI for further advice by phone or in writing. Phone-based guidance is available on working days 8.30 a.m. - 11.00 a.m., barring Wednesdays: 12.30 p.m - 3.00 p.m. Written advice about COVID-19 vaccination is available by contacting epiinfo@ssi.dk. (Please send any written questions you may have about the COVID-19 condition and its monitoring, including about the data published at the SSI Dashboards to covidinfo@ssi.dk)

(S.B. Asmussen, P.H. Andersen, Department of Infectious Disease Epidemiology and Prevention)

Gonorrhoea 2019 and 2020

Gonorrhoea diagnosed in 2019

• A total of 3,303 cases of gonorrhoea were recorded in the Danish Microbiology Database (the MiBa).

• In all, 2,211 cases were notified to the Notification System for Infectious Diseases (NSID); hereof 1,482 among men and 729 among women, distributed among a total of 2,135 persons.

• Among men, 749 (51%) were notified as homosexual transmissions. The corresponding number for women was seven (1%).

• Nine (1%) of the women notified with gonorrhoea were pregnant.

• The most frequently occurring age group was 30-39 years for men and 20-24 years for women, and the City of Copenhagen was the area where most cases occurred.

Gonorrhoea diagnosed in 2020

• A total of 3,464 gonorrhoea cases were recorded in the MiBa.

• In all, 2,670 cases were notified to the NSID; hereof 1,826 among men and 844 among women, distributed among a total of 2,484 persons.

• Among men, 1,012 (55%) were notified as homosexual transmissions. The corresponding number for women was 20 (2%).

• A total of 24 (2%) of the women notified with gonorrhoea were pregnant.

• The most frequently occurring age group was 30-39 years for men and 20-24 years for women, and the City of Copenhagen was the area where most cases occurred.

• The prevalence of ciprofloxacin resistance increased slightly in 2019 and 2020. The drug can be used once susceptibility has been established.

For a detailed epidemiological description of the incidence in 2019 and 2020, please see the 2019-2020 Annual Gonorrhoea Report.

 

The number of gonorrhea cases has followed an increasing trend for a number of years. The increase has been more pronounced in the MIS, which is owed to an increased notification percentage. In 2020, the notification percentage reached a full 78%, which contributes to improved monitoring, Figure 1. The increase continued from 2019 to 2020 despite restrictions and lock-down introduced due to the COVID-19 situation.

The shift to electronic notification via the Danish Health Authority’s Electronic Notification System (Sundhedsdatastyrelsens Elektroniske Indberetningssystem (SEI)) will be introduced gradually in 2021-2022, EPI-NEWS no. 38-39/21, and will hopefully serve to boost the notification percentage even further. Currently, hospital departments cannot notify via the SEI, but the regions are aiming to introduce this option as soon as possible.

In the MiBa, the 2019-2020 period recorded 28 gonorrhoea cases among 25 children below 15 years of age.

Eight of the children were 13 or 14 years of age, whereas the remaining 17 were 0-8 years of age. The affected children included nine neonates who had gonorrhoeal conjunctivitis. The other minors were presumably abuse victims. Only eight of the 25 children registered in the MiBa were also notified with the NSID.

Healthcare workers are encouraged to be particularly attentive to gonococci as a cause of conjunctivitis in neonates – particularly in the first two weeks of life. Gonorrhoeal conjunctivitis, which is not exclusively seen in neonates, is a potentially very serious condition that may cause destruction of the eyeball if it goes untreated. These patients must therefore be referred urgently to a specialised department to ensure that correct and immediate eyesight-preserving treatment is initiated.

The prevalence of ciprofloxacin resistance increased slightly. The drug may be used once susceptibility has been confirmed, see the 2019-2020 Annual Gonorrhoea Report.

As is the case for other sexually transmissible infections, gonorrhoea is a so-called HIV indicator condition, which means that more than 0.1% of the patients with a sexually transmissible infection have also become infected with HIV. It is therefore encouraging that a considerable share of the notified patients had been tested for HIV. Additionally, testing for syphilis and chlamydia is encouraged.

One important effort to curb the spreading of gonorrhoea is thorough laboratory-based diagnostics, including sampling from all relevant anatomical localisations. We recommend that asymptomatic patients are PCR tested from the pharynx and urethra for men, and from the vagina for women. For symptomatic patients, the same applies for men and women. However, the PCR test from the vagina needs to be replaced by a PCR test from the urethra and the cervix. Symptomatic and asymptomatic patients alike, information of anal intercourse should trigger a rectal PCR test.

All men who have sex with men should always be PCR tested from the pharynx, urethra and rectum, regardless of any information of sexual practices. In case of positive PCR findings, additional PCR tests should be made based on non-PCR-tested anatomic localisations along with a test for culture from the pharynx, urethra and rectum in men and from the pharynx, urethra, cervix and rectum in women.

Furthermore, barrier protection with a condom and partner tracing (3-4 weeks back; if relevant, up to three months) are important. Gonorrhoea of the pharynx and rectum are generally low or asymptomatic. If the infection is located to these anatomical sites exclusively and if it is not diagnosed, the patient constitutes an infection reservoir.

(A.K. Hvass, S. Cowan, Department of Infectious Disease Epidemiology and Prevention, J. Tolstrup, Department of Dermatology, Zeeland University Hospital, Roskilde, K.D. Bjerre, the Data Integration and Analysis Secretariat, S. Hoffmann, Department of Bacteria, Parasites & Fungi)

Merry Christmas & Happy New Year

Unless special circumstances arise, EPI-NEWS will not be published until week 2, 2022. The editorial team wishes everyone a merry Christmas and a happy New Year.

(Department of Infectious Disease Epidemiology and Prevention)

22 December 2021