The emergence of mosquito-borne viruses (MBVs) in Europe emphasizes the need for preparedness and response plans. This requires knowledge integration and collaboration across the human, animal, vector, and environmental health domains, aligning with the One Health approach. Despite the importance of a One Health approach, engaging stakeholders from each domain remains challenging. This study aims to identify stakeholders in the field of preparedness and response to MBVs in the Netherlands and map collaborations, knowledge- and information-sharing between these stakeholders, their domains and governance levels. In addition, we aim to identify bottlenecks in these networks and uncover underlying reasons. This study combined stakeholder- and social network analysis. Stakeholders were identified through document analysis and snowballing. Semi-structured interviews were conducted with eligible stakeholders. Stakeholders’ collaborations, dependencies, and their roles in MBV preparedness and response were discussed. Interviewees not currently active in MBV policy were given the opportunity to share their experiences regarding ‘zoonotic infectious diseases’ or ‘healthy living environments’. Interview transcripts were coded to identify collaborations and information- and knowledge sharing between stakeholders. Stakeholders were categorized into domains (animal, vector, human, environment, other) and governance levels (international, national, regional, local, other). Networks were visualized and analysed using Cytoscape and R. Stakeholder analysis identified 87 stakeholders who influence or are (likely to be) influenced by MBV preparedness and response, of whom 47 were identified as having an active role in the MBV interaction network. Network visualisation unveiled 153 connections among these 47 stakeholders, encompassing all domains and governance levels but showed underrepresentation of regional, local and environmental stakeholders. Transcript analysis revealed low urgency for MBVs among these stakeholders as an underlying reason for their underrepresentation in the MBV interaction network. Analysis and visualisation of the networks for the other two themes (“healthy living environment” and “(zoonotic) infectious diseases”) did show multiple connections with environmental and regional/local stakeholders. The underrepresentation of the environment domain, regional and local stakeholders in the MBV preparedness and response network underlines the remaining challenge of including all relevant stakeholders. We recommend utilising existing collaborations, identified in this study, and central stakeholders to overcome these bottlenecks.

To prevent the spread of multidrug-resistant organisms (MDROs), medical information exchange between healthcare professionals about MDRO carriage is essential to timely initiate infection prevention and control measures. This study investigates information exchange about MDRO carriage between healthcare professionals and to explores the perceived clarity about collaborative roles and responsibilities. Quantitative methods were used to explore information exchange networks through an online survey. A realistic clinical scenario was presented to healthcare professionals in primary, secondary and home-based nursing care (N = 122) reflecting their current daily practice. Social network analysis techniques were used to analyse the networks on a network and node level, which provided insight into collaborative structures and potential brokers. Additionally, respondents reflected on the (clarity of) roles and responsibilities of all involved, and on current frameworks and guidelines. Information exchange structures were visualized in a network graph, illustrating the information flow following established MDRO carriage during, or after recent, hospital admission. Several healthcare professionals were identified who could potentially take on a brokerage role in information exchange towards home-based nursing care. Healthcare professionals expressed a need for more clarity about roles and responsibilities, more uniform and timely information exchange, and indicated a preference as to which healthcare professionals could take on a coordinating role. Current information exchange structures have a promising basis to achieve effective communication about MDRO carriage between healthcare professionals in different care settings. Improving uniformity and clarity about roles and responsibilities, could aid in timely initiation of infection prevention and control measures and contribute to sustainable care for MDRO carriers. • Information exchange between healthcare professionals about MDRO carriage is essential to ultimately prevent transmission and spread of MDROs. • Improving uniformity of information exchange and clarity about roles and responsibilities is needed to move towards sustainable care for MDRO carriers.

During the COVID-19 pandemic, a great amount of regular healthcare across Europe was adjusted, postponed, or even stopped. The disruptions involved the entire spectrum of care, with delays in treatment for elective surgeries, chronic conditions, cancer care, and mental health. Noy only pandemic care impaired the delivery of regular care, but also patients themselves avoided necessary regular care despite having health problems, being afraid not to become infected with COVID-19 in healthcare setting or being afraid to pose a high burden on healthcare resources that were, in their view, more justified for pandemic patients. Disrupting or interrupting regular care during a pandemic or other health emergency proved to have long-term consequences for patients and healthcare systems. The RAPIDE Horizon EU project has the ambition to systematically study and understand the lessons of the COVID-19 pandemic and explore new research avenues to prepare for the next pandemic by working on models for healthcare optimisation and forecasting, experiment with more flexible and adaptable ways to deliver healthcare and make an optimal use of community and at-home care to make acute hospital resources available to deal with crises. The new models can also help to improve healthcare efficiency during ‘peace-time’. RAPIDE stands for Regular and Unplanned Care Adaptive Dashboard for Cross-border Emergencies. The consortium includes academic and healthcare institutions, companies, and organizations from Slovenia, Norway, Ireland, Italy, Malta, and Estonia, as well as the European Forum for Primary Care.

Despite extensive research on vaccine hesitancy across various scientific domains, its definition and measurement remain inconsistent, resulting in lacking comparison across studies and an unclear relation with vaccine behavior (i.e., accepting, refusing, postponing, or partially vaccinating). Recent work argues that vaccine hesitancy is best understood as a psychological state of indecisiveness in vaccination decisions. This enables crucial comparisons across studies. This meta-analysis uses this definition to clarify the association between vaccine hesitancy and behavior, including potential moderating factors. We conducted a preregistered systematic review and meta-analysis of quantitative studies (2010 onwards) on vaccine hesitancy and behavior. PubMed, Embase, Web of Science, and PsycINFO were searched and the retrieved articles were screened. In addition to the expected variability in the measurement of vaccine hesitancy, we also found variation in how vaccine behavior was defined - particularly in terms of timeliness and completeness of uptake - prompting us to develop four distinct operationalizations. Raw data were requested from authors and obtained in 16 cases. Currently, we are meta-analytically examining the correlation between vaccine hesitancy and behavior, and exploring moderating factors. Of 5740 articles, 95 were included. For 10 datasets, preliminary results show that sample sizes range from 66 to 1388, a majority of geographical continents is covered, and the data mainly focuses on childhood vaccinations. The correlation between vaccine hesitancy and behavior ranges from -0.21 to -0.66. Preliminary results indicate a negative association between vaccine hesitancy and behavior, as expected. During EPHC, we will present further insights from the meta-analysis. • This study provides a clean, meta-analytic correlation between vaccine hesitancy (defined as indecisiveness) and behavior, and explores the role of moderators. • Like hesitancy, vaccination behavior is multifaceted. We propose to address timeliness and completeness in future work.

Although vaccines are safe and effective, vaccination rates are declining, partly due to vaccine hesitancy: a major global health threat marked by indecision around vaccination. Understanding the vaccination decision-making process is essential, yet the role of emotions and the related support parents need is understudied. This study explores the emotional factors and support needs influencing vaccination decisions among parents of young children, both hesitant and non-hesitant. A qualitative study was conducted using semi-structured interviews with parents of 3- to 6-month-old children facing vaccination decisions. Interviews were transcribed and analyzed using Atlas.TI. Nine respondents were vaccine-hesitant, and thirteen were not. While non-hesitant parents can be either accepting or refusing, all non-hesitant respondents in this study accepted vaccination. Vaccine-hesitant parents mainly expressed fear of side effects from vaccination, distrust in government, anger about feeling pressured to vaccinate, confusion over conflicting information, and heightened vigilance. In contrast, non-hesitant parents primarily felt fear about vaccine-preventable diseases, happiness, trust in immunization programs, and calm about their decision. In terms of support needs, both groups sought well-balanced information and validation from healthcare professionals. Our study shows that emotions play a role in parent's decision-making on vaccination and demonstrates clear emotional differences between vaccine-hesitant and non-hesitant parents, though both groups reported fear. We advise healthcare professionals to align their support to parents deciding on vaccinations to their emotional and support needs. • Hesitant and non-hesitant parents’ vaccination decisions evoke (different) emotions. All parents seek well-balanced information and validation. • Addressing parents’ emotions and needs can improve support during vaccination decisions.

INTRODUCTION:Antimicrobial resistance (AMR) has become one of the leading global health threats. It is critical to understand the burden of AMR, particularly among vulnerable populations such as people with intellectual disabilities residing in long-term care facilities (ID-LTCFs). Traditional study methods to estimate the burden of AMR in these settings, such as rectal swabs to measure the prevalence of MDRO carriage, are considered burdensome for this population. This underscores the importance of a non-invasive method to assess the burden of AMR among people living in ID-LTCFs. This publication describes a study protocol for an alternative approach to estimate AMR, specifically Extended Spectrum Beta-Lactamase (ESBL) and carbapenemase-producing Enterobacterales (CPE), in ID-LTCFs in the Netherlands, through wastewater measurements combined with analysis of stool collected from diaper material. The protocol provides detailed information about the study design and methodologies proposed for a pilot study. METHODS AND ANALYSIS:Wastewater samples will be obtained from the sewers of ID-LCTFs using passive samplers. Additionally, as a considerable part of ID-LTCF residents are incontinent, stool samples will be collected from diaper material which will be obtained from incontinent residents living in participating ID-LTCFs. The wastewater and stool samples will be cultured on selective media to detect ESBL-producing Enterobacterales and carbapenem producing Enterobacterales (CPE) strains. Determination of strains will be carried out using MALDI-TOF and phenotypical tests will be carried out to confirm ESBL and CPE producing strains. In wastewater samples, bacterial concentrations will be determined, expressed in colony forming unit (CFU) per passive sampler, while in stool from diaper material the presence or absence of ESBL and CPE will be reported in proportions. ETHICS AND DISSEMINATION:The procedures described in this study protocol will be conducted in line with principles outlined in the Declaration of Helsinki, Code of Conduct for Health research, as well as the General Data Protection Regulation. Approval in advance by an ethical research committee or institutional review board is deemed unnecessary by current national and European legislation.

BACKGROUND:The COVID-19 pandemic has demonstrated the imperative for multisectoral collaboration and a whole-of-society approach to managing public health emergencies (PHE). However, there are currently no guidelines available on which sectors should be included in public health emergency preparedness and response (PHEPR). There is also a lack of guidance on how to encourage multisectoral collaboration during emergencies. This study gathers insights from European experts to identify key sectors for PHE preparedness, response, and recovery. METHODS:A multi-stage Delphi study was conducted with European PHE experts to compile (i) a consensus-driven list of priority sectors for PHE decision-making, and (ii) a list of recommendations on how to incorporate multisectoral collaboration in PHEPR plans. RESULTS:Of the 28 predefined sectors, consensus was reached among experts on 12 sectors that should be included in decision-making during preparedness, response, and recovery. One additional sector was identified as relevant during the response phase. Furthermore, consensus was reached for ten suggested recommendations on how to incorporate multisectoral collaboration in national PHEPR plans. CONCLUSIONS:This study provides the collective opinion of European PHE experts on a list of 13 sectors that should be included in decision-making during PHE preparedness, response, and/or recovery. It also provides ten recommendations on how to improve multisectoral collaboration. These can be used as systematic checklists when PHEPR experts consider how to integrate different sectors and multisectoral collaboration in PHE management. TRIAL REGISTRATION:Not applicable.

BACKGROUND:The World Health Organisation emphasises the importance of a whole-of-society approach to the management of health emergencies, which includes a need to involve citizens. Yet, little guidance is found on how this should occur and, more importantly, the citizen's current perspective of their role. Understanding citizens' perceptions is the first step in preparing for citizen engagement during a future pandemic. METHODS:A qualitative research study of 16 focus groups comprising 89 participants was conducted in Finland, Slovenia, Spain, and the Netherlands. Four age-stratified focus groups in each country were organised online in the country's primary language. Inductive analysis of each focus group transcript was used to identify important themes that captured the participants' perceptions of their role in COVID-19 preparedness, response, and recovery. RESULTS:Three common themes were found in the cross-country analysis. The first theme was the citizen's personal involvement, with specific references to the citizen's responsibilities and their concrete actions during COVID-19 preparedness, response, and recovery. The second theme was that of the citizen as an information receiver, with specific references to the quantity and quality of the information received. The final theme was the relationship between the citizen and decision-makers, with specific references to the citizen's level of trust in the decision-maker, the decision-maker's communication style as perceived by the citizens, as well as the level of interaction between the citizens and decision-makers as perceived by the citizens. CONCLUSIONS:Generally, citizens included in this study from Finland, the Netherlands, Slovenia, and Spain felt a shared responsibility in curbing the spread of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) during the pandemic. However, they emphasised the imperative need to be better informed about the likelihood of, and the developments during a pandemic in their country. Furthermore, the quality of the information provision emerged as an important theme.

Background The WHO and the European Center for Disease Prevention and Control (ECDC) advocated for extensive testing as a crucial pillar in managing the COVID-19 pandemic. Yet, public health emergency responses varied across European countries. In particular, there were differences in the national laboratory capacities and diagnostic testing strategies. This study was conducted during the pandemic to identify the key factors in developing national, SARS-CoV-2 testing strategies across a selection of European countries.Methods A mixed-methods study, comprising an interview phase and a survey phase, was performed. First, laboratory, policy-making and/or public health experts from different European countries were interviewed between 8 January 2021 and 19 March 2021, to review the development and implementation of national testing strategies.Second, a cross-sectional survey was conducted among ECDC National Focal Points (NFP) for Preparedness and Response and/or Microbiology between July and October 2022 to validate the interview findings.Results 12 European experts were interviewed and identified the following key factors determining the development of the national SARS-COV-2 testing strategies in their countries: (1) changing testing goals over time, (2) the prevailing epidemiological situation, (3) testing capacities, (4) availability of reference laboratories, (5) supply and stockpiling of testing material, (6) availability of human resources and (7) quality management standards across laboratories. The experts interviewed stressed the important role of stockpile management, the existence of expert networks, as well as the centralisation of decision-making. Lastly, determining the actors responsible for the testing strategy and putting in place ‘coordination, accountability and governance’ proved to be pivotal.The survey outcome with 15 European NFPs demonstrated that the testing strategies generally changed over time to include a broader group of individuals. Furthermore, the actors ‘Ministry of Health’, ‘Public health officials’, ‘National public health institutes’ and ‘National Expert and/or advisory groups’ were selected as key players by survey respondents.Conclusions In general, the scope of the testing strategy in European countries included in this study expanded as the pandemic progressed. This study identified key factors discussed by European experts interviewed that contributed to the development of SARS-CoV-2 testing strategies across European countries.

ABSTRACTIntroductionThe COVID‐19 pandemic was a public health emergency (PHE) of unprecedented magnitude and impact. It provided the possibility to investigate the Dutch citizens' understanding and perception of the actors involved in the Dutch pandemic response as a PHE unfolded.MethodsThree focus groups (FGs) were held with 16 Dutch citizens in June 2020. Citizens were recruited using the Dutch Health Care Consumer Panel. During the FGs, participants were asked to fill in a table with actors they thought were involved in the management of the COVID‐19 pandemic. They also received information on actors involved in Dutch outbreak responses. Then, the actors named and omitted by the participants were discussed.ResultsAn analysis of the FGs suggests that the Dutch citizens participating in the study were not fully aware of the scope of actors involved in the Dutch COVID‐19 pandemic response. Some participants would have appreciated more information on the actors involved. This would help them have an informed opinion of the actors involved in the decision‐making process, and accept non‐pharmaceutical interventions implemented. Lastly, most participants recognised that they played a role in limiting the spread of the COVID‐19 pandemic. Yet, very few spontaneously mentioned themselves as actors within the COVID‐19 pandemic response.ConclusionThis study suggests that early in the COVID‐19 pandemic, the Dutch citizens participating in this study's FG did not have a complete understanding of the scope of actors involved in the Dutch COVID‐19 pandemic response, or the potential role of the citizen. Future research can build on these results to explore the citizen's perception of their role during PHEs of another origin, as well as other geographical and historical contexts.Patient or Public ContributionThe public participated in the focus groups and received a non‐expert report summarising the outcomes of the focus groups.

Background Antimicrobial resistance (AMR) has become one of the major public health threats worldwide, emphasizing the necessity of preventing the development and transmission of drug resistant microorganisms. This is particularly important for people with vulnerable health conditions, such as people with intellectual disabilities (ID) and long-term care residents. This study aimed to assess the current status of AMR, antimicrobial stewardship (AMS) and infection prevention and control (IPC) in Dutch long-term care facilities for people with intellectual disabilities (ID-LTCFs). Methods A web-based cross-sectional survey distributed between July and November 2023, targeting (both nonmedically and medically trained) healthcare professionals working in ID-LTCFs in The Netherlands, to study knowledge, attitudes and perceptions regarding AMR, AMS and IPC. Results In total, 109 participants working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. The knowledge levels of AMR and IPC among nonmedically trained professionals (e.g., social care professionals) were lower than those among medically trained professionals (p = 0.026). In particular regarding the perceived protective value of glove use, insufficient knowledge levels were found. Furthermore, there was a lack of easy-read resources and useful information regarding IPC and AMR, for both healthcare professionals as well as people with disabilities. The majority of the participants (> 90%) reported that AMR and IPC need more attention within the disability care sector, but paradoxically, only 38.5% mentioned that they would like to receive additional information and training about IPC, and 72.5% would like to receive additional information and training about AMR. Conclusion Although the importance of AMR and IPC is acknowledged by professionals working in ID-LTCFs, there is room for improvement in regards to appropriate glove use and setting-specific IPC and hygiene policies. As nonmedically trained professionals comprise most of the workforce within ID-LTCFs, it is also important to evaluate their needs. This can have a substantial impact on developing and implementing AMR, AMS and/or IPC guidelines and policies in ID-LTCFs.

Abstract Background Antimicrobial resistance (AMR) has become one of the major public health threats worldwide. However, little is known about antimicrobial resistance and infection prevention and control (IPC) in long-term care facilities for people with intellectual disabilities. This study aims to assess knowledge, attitudes and perceptions towards AMR and IPC among healthcare professionals working in long-term care facilities for people with intellectual disabilities (ID-LTCFs) in the Netherlands. Methods We conducted a web-based cross-sectional survey study among medical and nonmedical trained healthcare professionals working in ID-LTCFs in the Netherlands. The survey study was carried out between July and November 2023 and consisted of validated survey items expanded with expert opinion and setting-specific items. Results In total, 109 medical and nonmedical trained healthcare professionals working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. Overall, knowledge levels about AMR and IPC differed between medical and nonmedical trained healthcare professionals working in ID-LCTFs, with medically trained professionals having a significant overall higher score on both topics. Knowledge regarding the perceived protective value of glove use was found to be insufficient. Moreover, healthcare professionals expressed a need for easy-to-read resources and tailored setting-specific information on AMR and IPC targeting both healthcare professionals as well as people with disabilities. Conclusions There is room for improvement regarding setting-specific IPC and hygiene policies, such as appropriate glove use in ID-LTCFs. As nonmedically trained professionals comprise most of the workforce within this setting, it is important to further tailor follow-up studies to the underlying factors that influence knowledge, attitudes and perceptions of these specific professionals within ID-LTCFs. Key messages • Developing setting and context-specific policies for infection prevention and control is crucial, particularly in long-term care facilities for people with intellectual disabilities. • Inclusive policy-making is key to combating antimicrobial resistance, and improving infection prevention and control in long-term care facilities for people with intellectual disabilities.

Abstract Background Outbreaks with multidrug-resistant organisms (MDROs) are a significant burden on the healthcare system and the wellbeing of affected patients and carriers. Cross-institutional MDRO outbreaks require a concerted multidisciplinary effort for effective outbreak management. This presents challenges regarding cooperation, coordination and communication between stakeholders. In this study, we investigate collaborative structures and coordination roles in Dutch outbreak response networks and how Dutch healthcare professionals engage in preparedness activities relating to MDRO outbreaks. These findings form the basis for the development of a stress test exercise for improving professional and organizational collaboration and coordination during MDRO outbreaks. Methods Using a mixed-methods design, an online survey and qualitative interviews are conducted among healthcare professionals in two healthcare regions in the Netherlands. Social network analysis is used to gain insight in collaborative structures and brokerage roles. To investigate preparedness activities, the survey is combined with qualitative interviews to explore respondents’ experiences, preferences and needs regarding preparedness activities for MDRO outbreak management. Results During the workshop we will show the cross-organizational network structures, the strengths and weakness of the mutual connections and provide insight in positions in networks, roles and responsibilities. Also, we provide insight in how the use of and experience with training and exercise activities, such as stress tests, contribute to preparedness for MDRO outbreaks in vulnerable patient populations. Conclusions This study shows how healthcare professionals from different organizations collaborate during MDRO outbreaks, and how they engage with preparedness activities. This provides valuable input for development of a stress test specific to MDRO outbreak management, and other interventions to improve outbreak preparedness.

Abstract Background People with intellectual disabilities (ID) are an often overlooked high-risk group for health-related issues. In the Netherlands, people with ID may reside at home, in small communities, or within long-term care facilities. This diverse living arrangement challenges the healthcare system, with responsibilities spread among multiple formal and informal caregivers. During an outbreak with multidrug-resistant organisms (MDROs), coordinated efforts should be made to prevent further spread throughout all healthcare settings. Therefore, adequate infection prevention and control (IPC) practices, are required to improve or maintain individual health outcomes. To understand the complexity of MDROs in long-term care for people with ID, it is important to gain insight into knowledge, attitudes and perceptions of involved healthcare professionals and, investigate innovative strategies that could play a role in surveillance or monitoring an outbreak within this setting. Methods We conduct several studies in long-term care for people with ID, using a wide scale of methodologies including a cross-sectional survey study and innovative quantitative methods, such as wastewater surveillance. Results We have identified several challenges in long-term care for people with ID related to IPC and MDROs. First, while IPC and MDRO guidelines exist, they lack specific context and applicability to the long-term care setting. Second, proper use of hand gloves among healthcare professionals demands increased attention as knowledge about this preventive measure seems to be insufficient. Finally, given the challenges in sample collection for MDRO screening, non-invasive strategies are needed to offer insight during outbreaks, serving surveillance or outbreak management purposes. Conclusions Insights from these studies could inform future strategies to prevent or respond early in case of an MDRO outbreak within long-term care for people with ID.

Abstract Background The burden and complexity of home-based nursing care have intensified due to earlier discharges from hospitals and patients living longer at home with increasing co-morbidities. This growing population of vulnerable patients, combined with the worldwide increase in the prevalence of multidrug-resistant organisms (MDROs), poses a new burden on home-based nursing staff. Home-based nursing care differs significantly from hospitals and nursing homes, challenging implementation of infection prevention and control (IPC) measures. It is therefore important to gain insight into the attitudes, experiences and needs of home-based nursing staff. Also, to better understand the scope of MDRO carriage and transmission in this setting, including its challenges. Methods Cross-sectional studies were conducted in the Netherlands including a survey and focusgroup study among home-based nursing staff, supplemented by a report of cases of MDRO clusters. Results We have identified several factors adding to the complexity of responding to an MDRO outbreak with involvement of home-based nursing care. First, inapplicable recommendations in guidelines/protocols or from infection preventionists, often aimed at intramural care. Second, nursing staff questioned the proportionality of IPC measures, potentially influenced by behaviour of colleagues and patients. Third, inadequate information transfers about patients carrying MDROs. Fourth, uncertainty about the roles and responsibilities of involved healthcare professionals. Finally, the need for organisational support in providing education and sufficient resources, and clarity about financial aspects. Conclusions Insights from these studies have aided in aligning upcoming MDRO guidelines for home-based nursing care in the Netherlands, which factor in the above mentioned complexity. Furthermore, these findings can aid in future strategies to prevent or respond early in MDRO outbreaks with involvement of home-based nursing care.

Background Contact tracing (CT) is a key strategy when dealing with outbreaks of infectious diseases such as COVID-19. The scale of the COVID-19 pandemic has often left public health professionals (PHPs), who are responsible for the execution of CT, unable to keep up with the rapid and largescale spread of the virus. To enhance or support its execution, and potentially lower the workload for PHPs, citizens may be more actively involved in CT-tasks that are commonly executed by PHPs (referred to as ‘self-led CT’). There is limited insight into citizens’ perspectives on and needs for self-led CT for COVID-19. This study aims to explore the perspectives and needs of Dutch citizens on taking more responsibilities in the execution of CT for COVID-19, potentially through the use of digital tools. Methods An exploratory qualitative study was performed, in which online semi-structured interviews were conducted. Questions were based on the Reasoned Action Approach and Health Belief Model. Interviews were audio-recorded and transcribed verbatim. A thematic analysis was conducted to identify citizens’ perspectives and needs to participate in self-led CT. Results We conducted 27 interviews with Dutch citizens. Seven main themes were identified from the interviews: 1) ‘Citizens’ perspectives on self-led CT are influenced by prior experiences with regular CT’, 2) ‘Citizens’ felt responsibilities and the perceived responsibilities of the PHS in CT shape their perspectives on self-led CT’, 3) ‘Anticipated impacts of self-led CT on the CT-process’, 4) ‘Citizens’ attitude towards the application of self-led CT depends on their own perceived skills and the willingness and skills of others’, 5) ‘Shame and social stigma may hamper participation in self-led CT’, 6) ‘Concerns about privacy and data security: a barrier for self-led CT’, and 7) ‘Citizens’ perspectives and anticipated needs for the implementation and application of self-led CT in practice’. Conclusions Most interviewees hold a positive attitude towards self-led CT and using digital tools for this purpose. However, their intention for self-led CT may depend on various factors, such as prior experiences with regular CT, and their perceived self-efficacy to participate. Perspectives and needs of citizens should be considered for the future implementation of self-led CT in practice.

Abstract Background and objectives Healthcare professionals (HCP) have a key role in raising awareness and informing older adult patients about vaccines. However, HCPs are sometimes unaware of existing vaccines or have little knowledge on them. This study aimed to identify the information flows within HCP networks and to find out which HCPs play a key role in interprofessional information transfer. Methods An online questionnaire was distributed in Hungary (HU), Italy (IT), the Netherlands (NL) and France (FR) among HCPs, such as general practitioners (GP), medical specialists (MS), public health physicians (PHP), pharmacists, specialists elderly care (SEC) and nurses. The questionnaire included a case study in which a new vaccine for older adults was about to be made available. HCPs were asked whom they would contact for additional information and by whom they would be contacted on their turn, to reveal the information flow. Data were analyzed using social network analysis, comparing the results between countries. Results Preliminary results show the top three information providers. These were identical for NL and IT, with the MS being contacted by the highest number of different HCP-types, followed by the GP and PHP. FR and HU had GP ranked first and MS second. The PHP ranked also third in HU, but in FR it was the geriatrician instead. The main requesters of information were pharmacists (IT, HU), GPs (NL) and community nurses (FR). Hospital nurses (IT, FR), SEC (NL) and GPs (HU) ranked second on the number of HCP-types they would contact for information on a new vaccine. Conclusions In each country GPs and MS were the most important information providers in the HCP network when a new vaccine is introduced. Main information requesters varied per country and were pharmacists, GPs, nurses, and SEC. Thus, GPs were both main information providers and requesters (NL, HU). Key messages • Our study identified the HCP-(information)network regarding (new) vaccines for older adults. GPs and MS are the main providers of information, while pharmacists, nurses, and GPs are main requesters. • Identifying the HCPs in the information network makes it possible to specifically target key HCPs and to provide them with tailormade information on new vaccines.

BACKGROUND:Central and Eastern European (CEE) migrant workers in essential industries are at higher risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure and transmission. We investigated the relationship of CEE migrant status and co-living situation with indicators of SARS-CoV-2 exposure and transmission risk (ETR), aiming to find entry points for policies to reduce health inequalities for migrant workers. METHODS:We included 563 SARS-CoV-2-positive workers between October 2020 and July 2021. Data on ETR indicators were obtained from source- and contact-tracing interviews via retrospective analysis of medical records. Associations of CEE migrant status and co-living situation with ETR indicators were analyzed using chi-square tests and multivariate logistic regression analyses. RESULTS:CEE migrant status was not associated with occupational ETR but was with higher occupational-domestic exposure [odds ratio (OR) 2.92; P = 0.004], lower domestic exposure (OR 0.25, P < 0.001), lower community exposure (OR 0.41, P = 0.050) and transmission (OR 0.40, P = 0.032) and higher general transmission (OR 1.76, P = 0.004) risk. Co-living was not associated with occupational and community ETR but was with higher occupational-domestic exposure (OR 2.63, P = 0.032), higher domestic transmission (OR 17.12, P < 0.001) and lower general exposure (OR 0.34, P = 0.007) risk. CONCLUSIONS:The workfloor poses an equal SARS-CoV-2 ETR for all workers. CEE migrants encounter less ETR in their community but pose a general risk by delaying testing. When co-living, CEE migrants encounter more domestic ETR. Coronavirus disease preventive policies should aim at occupational safety for essential industry workers, reduction of test delay for CEE migrants and improvement of distancing options when co-living.

Abstract Background To control the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) were implemented worldwide, that heavily impacted the daily lives of citizens. Occasionally, the public expressed discontent about NPIs, as NPIs did not always corresponded with their preferences. The question is if and how public engagement (PE) could aid in development and implementation of NPIs, in order to improve legitimacy, quality and compliance. Methods An online survey was conducted from 27 October to 9 November 2021, with a representative sample of the public in the Netherlands on gender, age, education, place of residency and migration background. In total 4981 respondents participated. Perceptions and preferences about PE in decision-making on NPIs to control COVID-19 was collected. Four NPIs were used: Nightly curfew (NC); Digital Covid Certificate (DCC); Closure of schools and daycares (CSD); and 1.5meter social distance. Results Around 25% of respondents expressed a desire to engage in decision-making, as it would increase understanding and quality of NPIs, and their trust in the government. Especially for the NPIs DCC and NC, respondents found it valuable to engage, by providing their perspective on certain trade-offs in values in decision-making (e.g. opening up society vs division in society by vaccination status). The public could play a role by giving feedback on bottlenecks during decision-making, however overall responsibility should stay with experts and policy-makers. Desire for engagement was lowest for CSD. Around 50% of the respondents did not want to engage, as they felt they were not knowledgeable enough to do so and did not perceive a need to engage. The other 25% had a neutral disposition. Conclusions Engagement was not self-evident for most respondents, yet the ones willing to engage revealed important possibilities for future outbreaks. Next, a deliberative process for PE in decision-making could be executed, in order to implement our findings in practice. Key messages Although engagement was not self-evident, respondents who were willing to engage revealed important possibilities to shape future public engagement practices in decision-making in COVID-19 control. Respondents were mostly willing to engage in NPIs with no consensus in the trade-offs of relevant values in decision-making, such as the Nightly Curfew and the Digital Covid Certificate.

Contact tracing (CT) is an important, but resource-intensive tool to control outbreaks of communicable diseases. Under pandemic circumstances, public health services may not have sufficient resources at their disposal to effectively facilitate CT. This may be addressed by giving cases and their contact persons more autonomy and responsibility in the execution of CT by public health professionals, through digital contact tracing support tools (DCTS-tools). However, the application of this approach has not yet been systematically investigated from the perspective of public health practice. Therefore, we investigated public health professionals’ perspectives and needs regarding involving cases and contact persons in CT for COVID-19 through DCTS-tools. Between October 2020 and February 2021, we conducted online semi-structured interviews (N = 17) with Dutch public health professionals to explore their perspectives and needs regarding the involvement of cases and contact persons in CT for COVID-19 through DCTS-tools, in the contact identification, notification, and monitoring stages of the CT-process. Interviews were audio recorded and transcribed verbatim. A thematic analysis was performed. Four main themes related to Dutch public health professionals’ perspectives and needs regarding involving cases and contact persons in CT for COVID-19 through DCTS-tools emerged from the data: ‘Distinct characteristics of CT with DCTS-tools’; ‘Anticipated benefits and challenges of CT for COVID-19 with DCTS- tools’; ‘Circumstances in CT for COVID-19 that permit or constrain the application of DCTS-tools’; and ‘Public health professionals’ needs regarding the development and application of DCTS-tools for CT’. Public health professionals seem to have a positive attitude towards involving cases and contact persons through DCTS-tools. Public health professionals’ (positive) attitudes seem conditional on the circumstances under which CT is performed, and the fulfilment of their needs in the development and application of DCTS-tools. Dutch public health professionals seem positive towards involving cases and contact persons in CT for COVID-19 through DCTS-tools. Through adequate implementation of DCTS-tools in the CT-process, anticipated challenges can be overcome. Future research should investigate the perspectives and needs of cases and contact persons regarding DCTS-tools, and the application of DCTS-tools in practice.