Influenza, tuberculosis and HIV/AIDS have the highest burden in Europe among the most common community-acquired infections. Vaccine-preventable diseases have a lower burden, but in countries where vaccination coverage is low the burden can be comparable to the top three diseases. Moreover, the burden of AMR was comparable to the cumulative burden of influenza, tuberculosis and HIV/AIDS, concluded fresh PhD Alessandro Cassini.

In his PhD thesis, that he defended on September 29 2023 at Utrecht University, Alessandro Cassini (Lausanne University Hospital, Lausanne, Switzerland) described tools, resources and methodological options for estimating the burden of infectious diseases (IDs) in the European Union (EU)/European Economic Area (EEA), expressed in disability-adjusted life years (DALYs). The objectives of his research were to promote evidence-based methods in epidemiology, facilitate planning and prioritization of public health decision making, identify gaps in surveillance data availability and quality, and provide a comprehensive framework for communicating complex information to decision-makers. Cassini’s thesis presents the methodological challenges and solutions for calculating DALYs for the main community-acquired infections, antimicrobial resistance (AMR), and health care-associated infections (HAIs), while taking into consideration different approaches to efficiently use data sources depending on their availability and quality. The results were put into perspective and compared with data from other studies estimating DALYs for IDs.

Key findings

• Influenza, tuberculosis and HIV/AIDS have the highest burden measured in DALYs among the most common community-acquired infections. Vaccine-preventable diseases have a lower burden, although in countries where vaccination coverage is low, the burden can be comparable to the top three diseases.
• The burden of AMR was comparable to the cumulative burden of influenza, tuberculosis and HIV/AIDS. It is mainly healthcare-associated (which has increased significantly in the past decades), hence, antibiotic stewardship and enforced infection prevention & control in hospitals are the most effective interventions.
• The burden of HAIs was twice of the other IDs under surveillance in EU/EEA countries, making HAIs the major infectious disease problem in the region.
• The burden of IDs varies greatly between countries and interventions to reduce the burden need to be adapted or tailored.

The methods developed by Alessandro Cassini and colleagues in this thesis were used to provide data to decision-makers and promote evidence-based change. Examples included in the thesis was the shift towards universal vaccination against tick-borne encephalitis in children in Slovenia, EU/EEA legislation for campylobacter control in the poultry industry and the validation of strategies to combat AMR in Swiss hospitals.

PhD defense