Background Migrants from tuberculosis (TB) high-incidence countries are at increased risk of TB, therefore, screening for TB is frequently implemented in host countries, but evidence for systematic screening for TB infection (TBI) is limited. We evaluated the national migrant TB/TBI screening programme in the Netherlands to assess TB yield, TBI prevalence, and the subsequent cascade of care. Methods This retrospective observational study included all immigrants and asylum seekers screened for TB and TBI in the Netherlands in 2019–2023. We linked data from the national TB client information system to the Netherlands TB Register to assess TB yield (cases detected per 100,000 screened), TBI prevalence, and treatment initiation and completion, by migrant group, country of birth, and age group. Findings 149,214 migrants were included (87,511 immigrants; 61,703 asylum seekers). TB at entry was diagnosed in 69 immigrants and 170 asylum seekers, corresponding to yields of 79 per 100,000 (95% CI 62–100) and 276 per 100,000 (237–320), respectively. Among 202 pulmonary TB cases, 129 (63.9%) was bacteriologically confirmed and 147 (72.8%) did not report cough symptoms. TB treatment completion was 92.8% (64/69) among immigrants and 81.2% (138/170) among asylum seekers. TBI screening included 20,378 immigrants. TBI prevalence increased with age, from 0.6% in children <12 years, 4.4% in adolescents 12–17 years, to 12.9% in adults ≥ 18 years. Among them, 64.6% (31/48), 81.5% (66/81), and 64.7% (663/1024), respectively, initiated and completed treatment. Interpretation Systematic TB and TBI screening among migrants in the Netherlands effectively identifies people with TB, including those without symptoms, and enables TB prevention. These findings support targeted screening policies as a core component of TB prevention and control in low-incidence settings. Funding This work was supported by the Ministry of Health, Welfare and Sports (VWS), the Netherlands.
Background Pull incentives aim to improve the commercial viability of antibacterials, but the criteria determining which products and companies qualify have not been compared across countries. We compared product and company eligibility and evaluation criteria across these incentives. Methods We conducted an umbrella review of MEDLINE and Embase for English-language reviews of pull incentives targeting antibacterial innovation and access (2014 to 14 October 2024), supplemented by grey literature searches and the Global AMR R&D Hub dashboard (December 2025). Two reviewers independently extracted criteria from official documentation, using a framework of six product domains (high-priority medical need, relative effectiveness, unmet clinical need, innovative characteristics, health-system impact, and other) and five company domains (antibacterial sustainability, patient access, environmental health, economic criteria, and other). Findings We identified 28 pull incentives: 20 implemented (UK, Sweden, Germany, France, Italy, US, Japan, and EU) and 8 proposed or in development (US, Japan, Canada, Australia, Switzerland, and EU). As mechanisms overlapped within countries, the 20 implemented incentives were analysed as nine groups. All nine targeted high-priority medical need and seven (78%) included unmet clinical need. Relative effectiveness featured in six (67%), economic criteria in five (56%), and innovative characteristics, health-system impact, patient access, and antibacterial sustainability in four each (44%); environmental health in two (22%). The UK Subscription Model applied all 11 domains and Sweden's Annual Revenue Guarantee eight (73%). Priority pathogen lists were widely referenced but varied in breadth. Interpretation Eligibility and evaluation criteria vary substantially across countries in scope and specificity. Company-level obligations on stewardship, access, and environmental safeguards are applied inconsistently, and most comprehensive in the UK and Swedish models. Greater international alignment around a shared core of criteria, while retaining flexibility for national context and operational feasibility, could reduce uncertainty for developers and strengthen the global incentive ecosystem. Funding World Health Organization Regional Office for Europe.
The European Academy of Paediatrics reaffirms its strong support for comprehensive childhood immunisation programmes. At a time when vaccine hesitancy, policy instability, and funding gaps threaten established achievements, public health policy must remain firmly grounded in scientific evidence, transparency, and ethical responsibility. Based on established evidence and current post-pandemic data, we urgently endorse Europe-wide harmonised surveillance systems for vaccine-preventable diseases, interoperable Immunisation Information Systems (IIS), and a Pan-European standard for digital vaccination records or routine measurement of vaccine confidence and access barriers; and equity-focused catch-up immunisation for under-immunised groups. Investment is also needed in training and tools that equip paediatricians and all other healthcare professionals involved in immunisation to build confidence in vaccination. Coordinated, multilingual public information campaigns should proactively counter misinformation and visibly align political decisions with scientific evidence.
Autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid syndrome, and systemic vasculitis, are associated with increased risk of thrombosis, accelerated atherosclerosis, cardiovascular-events, and premature mortality. Heparin-induced thrombocytopaenia and vaccine-induced thrombocytopaenia and thrombosis (VITT) or VITT like syndrome are autoimmune thrombotic disorders that do not have additional features of autoimmune diseases. We summarise the epidemiology, pathophysiology, diagnosis, and management of autoimmune thrombosis. Key mechanisms include autoantibody-mediated coagulation activation, endothelial dysfunction, complement activation, platelet activation, neutrophil extracellular-trap formation, and thrombo-inflammation, promoting thrombin generation, impaired fibrinolysis, and vascular injury. Traditional cardiovascular risk factors, such as smoking, obesity, hypertension, diabetes mellitus, and infection, further amplify thrombotic risk. Management requires integrated strategies combining anticoagulation, immunomodulatory therapy, cardiovascular-risk reduction, and long-term surveillance. Autoimmune thrombosis is an under-recognised contributor to cardiovascular disease and premature mortality across Europe. Earlier diagnosis, improved risk stratification, multidisciplinary care, and integration of autoimmune diseases into European cardiovascular prevention and health-system strategies are essential to reduce morbidity and premature mortality. Funding DJA is funded by Medical Research Council UK (MR/Z505274/1) and infrastructure support was provided by the NIHR Imperial Biomedical Research Centre.
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide and a public health concern, with 75% of cases considered preventable. Biannual liver ultrasound, with or without serum alpha-fetoprotein, is recommended as surveillance for patients at high risk of HCC. While the rationale for surveillance is strong and it continues to be recommended by all professional societies, there is ongoing debate about the strength and relevance of the evidence supporting surveillance for all populations with cirrhosis. European surveillance uptake is suboptimal, with high rates of late-stage diagnosis and subsequent poor prognosis. In this paper, we provide an overview of surveillance focusing on Europe and draw lessons from across the world. We discuss lessons learnt from the implementation of national and coordinated surveillance programmes in Asian countries and the global challenges resulting from the changing epidemiology of chronic liver disease, particularly the rise of MASLD. We consider the patient perspective, including stigma and inequalities in access and delivery. We explore emerging approaches to surveillance, including biomarkers, abbreviated MRI and risk-stratification, which may improve early diagnosis. Finally, we address the lack of funding and political willpower arising from an insufficient evidence base.
Primary liver cancer, of which hepatocellular carcinoma (HCC) represents the vast majority, is on the rise globally. Despite an expected decrease in viral hepatitis-related HCCs, the number of new cases and deaths from liver cancer is predicted to increase by over 30% in 2050 in Europe. This is largely driven by an increase in metabolic dysfunction-associated steatotic liver disease-related HCC and an aging population. Since HCC usually develops in patients with underlying chronic liver disease, over half of all cases appear to be preventable by targeting modifiable risk factors. This series paper summarizes epidemiological and etiological trends of HCC in Europe and their implications for the clinical management of HCC across different disease stages. We discuss public health initiatives and policies to counteract the rising incidence of HCC by focusing on prevention, and highlight additional benefits of etiological treatment for the management and prognosis of patients with HCC.
The management of unresectable and advanced hepatocellular carcinoma (HCC) has been transformed by the introduction of immune checkpoint inhibitor-based combinations, which have improved response and survival and expanded first-line treatment options. The availability of multiple effective regimens has introduced new challenges in therapeutic decision making. In the absence of validated predictive biomarkers or head-to-head comparisons, first-line treatment selection remains largely guided by clinical characteristics, contraindications and anticipated toxicity, while the optimal sequencing of therapy following first-line immunotherapy remains uncertain. Locoregional therapies continue to play an important role in selected patients with liver-confined disease, further broadening the range of therapeutic strategies available in clinical practice. In Europe, these evolving treatment paradigms are implemented within a heterogeneous landscape of regulatory approval, reimbursement and access, resulting in important differences in care across countries. In this Series paper, we discuss contemporary systemic treatment strategies for HCC from a European perspective, focusing on treatment selection and sequencing, the role of predictive biomarkers and locoregional therapies, and disparities in access to effective treatments. Generating prospective evidence to inform treatment selection and sequencing, while ensuring more timely and equitable access to effective therapies will be essential to optimise HCC care across Europe.
Incretin-based therapies have transformed obesity treatment, producing substantial weight loss and benefits across cardiometabolic outcomes. However, translating therapeutic efficacy into sustainable population-level benefit remains challenging across European healthcare systems that vary in workforce capability, multidisciplinary care, reimbursement, access, and monitoring infrastructure. We describe this mismatch as the EASO Integration Paradox: therapeutic innovation has advanced more rapidly than the health-system structures required for its optimal, equitable, and sustainable implementation. In this EASO Position Statement, we propose the EASO Integration Framework, a model for integrating incretin-based therapies into comprehensive obesity care. The framework is organized around five interdependent pillars: Right Patient, Right Care, Right Workforce, Right Data, and Right Access. We also outline a European research and implementation agenda focused on real-world evidence, harmonised monitoring, workforce development, pharmacovigilance, and equitable access. The challenge is no longer whether incretin-based therapies should be used, but how they should be implemented responsibly within comprehensive obesity care pathways.
Summary: Background: Prior international studies indicate that 9–36% of people with cerebral palsy (CP) have a monogenic condition. However, the utility of whole genome sequencing (WGS) as a diagnostic tool for United Kingdom (UK) National Health Service (NHS) patients has not been evaluated. Methods: This prospective pilot study recruited 86 individuals with CP from specialist clinics in Bedford, Cambridge, Colchester, Newcastle, and Luton NHS Foundation Trusts. Gene-agnostic trio WGS was performed using AI-based variant prioritisation, with subsequent application of a CP gene list. Candidate diagnostic pathogenic (P) or likely pathogenic (LP) variants were reviewed at multidisciplinary meetings and confirmed in an NHS Genomic Laboratory Hub prior to issuing a clinical report. The use of human phenotype ontology (HPO) terms was evaluated to estimate probability of a diagnostic variant using a supervised linear discriminant analysis (PCA + LDA) model. Findings: 86/157 (54.7%) individuals approached consented to the study. Variants meeting P/LP diagnostic criteria were identified in 11/86 cases (12.8%). 8/86 participants (9.3%) carried variants strongly suggestive of disease causation. Variants of uncertain significance were identified in 27/86 cases (31.4%). In all cases with P/LP variants, findings informed patient prognosis, specialist care, clinical management, and familial recurrence risk. Machine learning approaches were used to segregate the probability of diagnosis for participants based on HPO terms. Interpretation: WGS is clinically useful for diagnosis and management of genetic conditions associated with CP in the UK. Validation of these findings in a larger cohort is warranted. Funding: Rosetrees Charitable Trust, Isaac Newton Trust, NIHR Cambridge Biomedical Research Centre, and the Wellcome Trust.
Summary: Background: Treatment for Ménière’s disease remains a subject of debate. A surgical technique in which the endolymphatic duct is blocked was proposed as a new treatment modality for patients with intractable Ménière’s disease, but a double-blind trial was lacking. Therefore, the aim of this double-blind trial was to assess whether EDB is more effective than ESD in patients with intractable Ménière’s disease. Methods: This is a double-blind, randomised, multicentre trial comparing endolymphatic duct blockage (EDB) to endolymphatic sac decompression (ESD). Patients had unilateral, active Ménière’s disease despite treatment with at least two corticosteroid injections. All patients were recruited from two university and five non-university hospitals in the Netherlands. During surgery, patients were randomly assigned to either the EDB or ESD group. Following surgery, patients were followed for 1 year, with both physical visits and an app in which attacks could be reported. Both patients and investigators were blinded throughout the follow-up period. The primary outcome was freedom from vertigo attacks at 12 months, defined as no attacks during the preceding 6 months. Secondary outcome measures included attack incidence, quality of life, dizziness, tinnitus, and inner ear function. Analyses were performed according to the intention-to-treat principle. This trial was registered in the ISRCTN registry (registered 24-02-2021, https://www.isrctn.com/ISRCTN12074571). Findings: Between 23 June 2021 and 12 September 2023, 75 patients with definite Ménière’s disease were enrolled; 39 underwent EDB, while 36 underwent ESD. No loss to follow-up was recorded. At 12 months, 23/39 (59%) patients in the EDB group and 24/36 (67%) in the ESD group were free from vertigo attacks (OR 0.72, 95% CI 0.28–1.84; p = 0.65). Secondary outcomes, including quality of life, dizziness, tinnitus, and hearing function did not differ between groups. Higher baseline patients expectations were associated with treatment success. Three serious adverse events occurred (one in the EDB group, two in the ESD group) and no deaths were reported. Interpretation: This trial does not demonstrate a benefit of EDB over ESD for patients with refractory Ménière’s disease. Given the comparable outcomes between groups, EDB should not be preferred over ESD. The association between baseline expectations and outcome suggests that non-specific treatment effects may contribute to perceived benefit. Future studies should consider inclusion of a non-surgical or sham-surgery control to more definitely determine the effect of this type of surgery, although such trials would be challenging. Funding: Dutch National Healthcare Institute and ZonMw (‘Veelbelovende Zorg’ grant).
