BackgroundCabo Verde, an island country in West Africa, has been affected since human colonization by epidemics of vector-borne diseases with major epidemics of dengue and zika in recent years. Although there is a national program for integrated vector control, innovative strategies that reinforce routine activities and strengthen vector control are necessary to prevent the emergence or reemergence of arboviruses and new epidemics of dengue and zika. Insecticide paints are evidenced as new technologies for the formulation of insecticides in a more residual and safe way. The TINTAEDES project aimed to assess the efficacy, acceptability, and operational deployment of an insecticide paint for Aedes control.Methodology/Principal findingsLaboratory and small-scale field trials were conducted, assessing mortality through World Health Organization cone bioassays. A community-based intervention study in the neighborhoods of Várzea and Tira Chapéu in the city of Praia, Cabo Verde, was developed. The intervention is a paint self-application model by homeowners and neighborhood volunteers. The intervention was evaluated based on entomological indicators and the responses given by the residents of the painted houses to a questionnaire on the knowledge, satisfaction, and safety of insecticidal paints. A transfluthrin-based insecticide paint was effective against wild Ae. aegypti for one year in the laboratory and semi-field conditions. Residents largely perceived a reduction in mosquito presence in the treated houses (98%).ConclusionInsecticide paints are presented as an effective innovation strategy for mosquito control, which could be implemented as a reinforcement of the measures carried out by the vector control program in the city of Praia and throughout the country.

Mosquitoes play a critical role as vectors of pathogens affecting both humans and animals. Therefore, understanding their biodiversity and distribution is crucial to developing evidence-based vector control strategies. The current study updated the composition and distribution of mosquito species through a comprehensive survey of all municipalities of Cabo Verde. From October 2017 to September 2018, mosquito larvae and pupae were collected from 814 aquatic habitats. Anopheles gambiae (Giles, 1902) and Culex pipiens (Linnaeus, 1758) complexes were subjected to PCR-based techniques for sibling species identification. Ten mosquito species from 5 genera were identified: Aedes aegypti (Linnaeus, 1762), Aedes caspius (Pallas, 1771), Anopheles arabiensis (Patton, 1905), Anopheles pretoriensis (Theobald, 1903), Culex bitaeniorhynchus (Giles, 1901), Cx. pipiens, Culex quinquefasciatus (Say, 1823), Culex tritaeniorhynchus (Giles, 1901), Culiseta longiareolata (Macquart, 1838), and Lutzia tigripes (de Grandpre & de Charmoy, 1901). Santiago Island reported the highest number of species (n = 8). Ae. aegypti and Cx. quinquefasciatus were the most widely distributed species across the country. An. arabiensis was the sole species identified within the An. gambiae complex. The findings from our study will help guide health policy decisions to effectively control mosquito-borne diseases.

Schistosomiasis is a public health problem with economic consequences in endemic areas. Cabo Verde is an insular country with no registry of schistosomiasis. In May 2022, a patient was reported with S. haematobium in urinalysis. An investigation was conducted to confirm diagnostic and outbreak, transmission sources to prevent additional illness. Two studies were conducted. First, using the snowball approach, starting with the first case identified. Second, using retrospective medical records. Suspected, confirmed, and discarded case definitions for urinary schistosomiasis (SCHu) were adopted. Interviews and urine samples were collected. An environmental investigation was conducted to identify the host snail. Identified 10 suspected cases, 8 (72.7%) were confirmed, the median age of 15 years (range: 7-24), all male with hematuria, living in a small community. In Schu's cases interviewed, 4(57.1%) walked barefoot in water and 3(75%) swam in water tanks. In a retrospective study, 28,702 medical records were evaluated, from which 49 suspected SCHu cases, 23(47%) interviewed, 19(82.6%) negatives, and 4(17.4%) did not collect samples. This is the first schistosomiasis record in Cabo Verde. The infection mechanism remains unknown as the specific reservoir was not found (Bulinus). We recommend epidemiological inspections and environmental assessment in communities to elucidate SCHu source transmission.

Context The emergence and increase of cases of the new coronavirus in Cabo Verde led to the implementation of several infection control measures. However, the success of these measures depends largely on the population's knowledge about the disease and their commitment to fighting it. This study aimed to analyze the knowledge, attitudes, perceptions, and practices of the resident Cabo Verdean population regarding COVID-19. Methodology A cross-sectional study was carried out among 2754 participants aged 12 and above. The data collection instrument, a questionnaire, was applied in the field by trained surveyors. Descriptive statistics, chi-square tests, Spearman correlation, and simple and multiple regression analyses were performed to assess the sample's determinants of knowledge, attitudes, and practices towards COVID-19. Results Of the 2754 study participants, 1331 (48.3%) were male. The mean age of the respondents was 28.5 years (SD = 14.1). The overall knowledge rate was 79%. Logistic regression analysis showed that knowledge was significantly associated with secondary education or higher (p < 0.001), marital status married or de facto partnership (p < 0.001), and residence in the urban area of São Vicente (p = 0.025). The rate of correct answers concerning attitudes was 75.7%, with the majority of respondents agreeing with the measures implemented by the authorities in managing the pandemic (n = 2272; 82.9%). The results show considerable hesitation concerning the vaccine, which is significantly associated with the age group 18 to 30 (p < 0.001). Practices obtained the lowest scores, and physical distancing was one of the preventive measures least complied with. Binary logistic regression revealed a significant association between sex, age, education, and marital status with practices. Knowledge (rho = 0.1436; p < 0.001) and attitudes (rho = 0.1068; p < 0.001) were significantly associated with practices. Conclusion Financial difficulties seem to hinder compliance with infection control measures. Public health policies may have greater adherence if accompanied by social and economic support strategies. Studies investigating the behavior of infected persons during the infection period may provide helpful information in understanding the mechanisms underlying the virus transmission in the country.

Health-related targets of the Sustainable Development Goals in Portuguesespeaking Countries, 1990 to 2030 the Study were used "Global Burden of Disease (GBD)" for analysis of 15 indicators and comparison of performance between countries.To estimate the projections, weighted averages of annualized rates of change were used, from 1990 to 2021, specific to each indicator and country.The best performances were observed for Portugal and Brazil, followed by Cape Verde and São Tomé and Príncipe.In other countries, high rates of infectious diseases, maternal and childhood mortality, malnutrition and low vaccination and sanitation coverage were observed.The CPLP presents internal differences regarding the health indicators analyzed, making it essential to advance cooperation between countries to achieve the SDG targets in 2030.

Health-related targets of the Sustainable Development Goals in Portuguesespeaking Countries, 1990 to 2030 the Study were used "Global Burden of Disease (GBD)" for analysis of 15 indicators and comparison of performance between countries.To estimate the projections, weighted averages of annualized rates of change were used, from 1990 to 2021, specific to each indicator and country.The best performances were observed for Portugal and Brazil, followed by Cape Verde and São Tomé and Príncipe.In other countries, high rates of infectious diseases, maternal and childhood mortality, malnutrition and low vaccination and sanitation coverage were observed.The CPLP presents internal differences regarding the health indicators analyzed, making it essential to advance cooperation between countries to achieve the SDG targets in 2030.

The spread of the COVID-19 pandemic at the end of 2019, with its well-known consequences in terms of morbidity and mortality, has triggered an intense mobilization of the scientific community in the search for knowledge about the SARS-Cov2 virus and the development of a vaccine. This study aims to investigate the knowledge, perceptions, attitudes, and intentions of the resident Cape Verdean population regarding the COVID-19 vaccine. This was a descriptive, cross-sectional, and analytical study involving 1704 resident Cape Verdeans, whose ages ranged from 16 to 60 years old and the majority of participants were male (52.6%). The data was collected using the Google form platform between March 9 and 15, 2021. The data indicated that the majority of participants (95.8%) knew of at least one approved vaccine against COVID-19, and this knowledge (74.9%) was obtained from television, radio, and newspapers. The Oxford-AstraZeneca vaccine was the best known (54.1%) among the study subjects and the majority of respondents (69.7%) had enough information to consciously decide whether or not to get vaccinated against COVID-19. The majority (68.0%) of participants were in favor of the COVID-19 vaccine being administered to all interested people. About 59% of participants considered the COVID-19 vaccine to be safe and 49.6% of participants intended to get vaccinated when the time came. The greatest vaccine hesitancy was related to fear of side effects (21.4%), followed by the fact that it was developed too quickly (12.8%). Health professionals were seen as the priority group (81.5%) to be vaccinated. The results show that the Cape Verdean population had a good level of knowledge about the COVID-19 vaccine. Despite initial hesitation, the vast majority of participants were willing to get vaccinated. These data suggest that awareness-raising, education, and information campaigns about the COVID-19 vaccine should be strengthened to reduce hesitation and increase confidence and adherence to the COVID-19 vaccine among Cape Verdean residents. La propagación de la pandemia de COVID-19 a finales de 2019, con sus conocidas consecuencias en términos de morbilidad y mortalidad, ha desencadenado una intensa movilización de la comunidad científica en la búsqueda de conocimientos sobre el virus SARS-Cov2 y el desarrollo de una vacuna. Este estudio pretende investigar los conocimientos, percepciones, actitudes e intenciones de la población caboverdiana residente en relación a la vacuna COVID-19. Se trata de un estudio descriptivo, transversal y analítico en el que participaron 1.704 caboverdianos residentes, cuyas edades oscilaban entre los 16 y los 60 años y la mayoría de los participantes eran hombres (52,6%). Los datos se recogieron utilizando la plataforma de formularios de Google entre el 9 y el 15 de marzo de 2021. Los datos indicaron que la mayoría de los participantes (95,8%) conocían al menos una vacuna aprobada contra el COVID-19, y este conocimiento (74,9%) lo obtuvieron de la televisión, la radio y los periódicos. La vacuna de Oxford-AstraZeneca era la más conocida (54,1%) entre los sujetos del estudio y la mayoría de los encuestados (69,7%) disponía de información suficiente para decidir conscientemente si vacunarse o no contra el COVID-19. La mayoría (68,0%) de los participantes estaba a favor de que la vacuna COVID-19 se administrara a todas las personas interesadas. Alrededor del 59% de los participantes consideraban que la vacuna COVID-19 era segura y el 49,6% de los participantes tenían intención de vacunarse llegado el momento. Las mayores dudas sobre la vacuna estaban relacionadas con el miedo a los efectos secundarios (21,4%), seguido del hecho de que se desarrollara demasiado rápido (12,8%). Los profesionales sanitarios se consideraron el grupo prioritario (81,5%) para vacunarse. Los resultados muestran que la población caboverdiana tenía un buen nivel de conocimiento sobre la vacuna COVID-19. A pesar de las dudas iniciales, la gran mayoría de los participantes estaban dispuestos a vacunarse. Estos datos sugieren que deberían reforzarse las campañas de concienciación, educación e información sobre la vacuna COVID-19 para reducir las dudas y aumentar la confianza y la adherencia a la vacuna COVID-19 entre los residentes de Cabo Verde.

T he public health context is becoming increasingly more complex, gradually associating traditional public health threats connected with infectious diseases with other health problems. This leads to a triple burden of diseases interrelated with growing threats to health security and new conceptual paradigms to approach them [1-3].

BackgroundIntegrated malaria vector control is crucial to eliminate or reduce infection risk. Understanding vector species distribution, behavior, and environmental factors such as climate, topography, and preferred aquatic habitats is essential.ObjectivesHerein, we aim to compile data from 2016 to 2023 on the primary malaria vector in Cabo Verde to support health surveillance and elimination certification.Materials and methodsMosquitoes larvae were collected using standard sampling tools, and adults using Biogents Sentinel traps, mechanical aspiration and CDC UV light traps, both indoor and in the surroundings of urban and rural areas.ResultsSix hundred fifty-seven specimens of Anopheles gambiae s.l. were identified by morphological methods and PCR-based techniques as Anopheles arabiensis in 12 municipalities from six of the nine inhabited islands, namely, São Vicente, São Nicolau, Maio, Boavista, Santiago, and Santo Antão.ConclusionsWe believe this is the first scientific report of the presence of An. arabiensis on the island of Santo Antão. The Anopheles arabiensis remains the only species in the An. gambiae complex in the Cabo Verde islands. These results offer vital insights for epidemiological surveillance and effective malaria control, especially in light of the recent WHO certification declaring the country malaria-free. However, it is imperative to conduct further studies that comprehensively address epidemiological and entomological aspects, with a special focus on bionomics, genetic determinants of the parasite-vector association, and the characterization of larval habitats. These investigations have the potential to guide a more informed and strategic implementation of malaria vector control measures in Cabo Verde.

Background Health Care Workers (HCW) faced a high risk of exposure to SARS-CoV-2. In the present study, we described the presence and duration of anti-S and anti-N IgG antibodies against SARS-CoV-2 among HCW to evaluate the immunity response induced by either SARS-CoV-2 infection or COVID-19 vaccination. Methods Case-cohort study of 465 HCW from hospitals from the islands of Santiago and São Vicente, conducted in 2021, of which 217 were cases (SARS-CoV-2 infection) and 248 controls (no SARS-CoV-2 infection). Study participants were followed-up until 6 months after recruitment for longitudinal analysis of antibody dynamics, independently of SARS-CoV-2 vaccination status. ELISA test for anti-N and anti-S1 SARS-CoV-2 IgG antibodies were performed on serum samples using collected at baseline (T0) and at 6 months (T6). Among vaccinated participants, these two time points corresponded to a mean time from vaccination of 115 (SD: 60 days) and 350 days (SD: 74 days) respectively. Results Of the 396/465 (85%) tested for anti-SARS-CoV-2 antibodies at T0, 36% (n=66/185) of cases and 12% of controls (n=26/211) were positive for anti-N. Among the vaccinated at T0 165/166 (96%) cases and 200/205 (97%) controls were positive for anti-S1. The anti-S1 among the case and control group remained high at T6, with 177/179 (99%) cases and 197/198 (99%) controls of HCW tested at 6 months being positive. Among 250 (67%) vaccinated, who were anti-N negative at T0-,115(32%) remain negative at T6. Conclusion These findings showed that only 31% of cases had anti-N. The results also showed positive results for IgG anti-N in HCW without previous SARS-CoV-2 infection, which could be considered asymptomatic cases. Most vaccinated participants had Anti-S after vaccination and they remained high during the 6 months of follow-up. Nonetheless, at least (65/354) had a new infection (32 cases, 33 controls). Funding: EDCTP (RIA2020EF-3049)

External causes continue to be one of the main causes of mortality in the world and Cabo Verde is no exception. Economic evaluations can be used to demonstrate the disease burden of public health problems such as injuries and external causes and support prioritization of interventions aimed at improving the health of the population. The objective of this study was to estimate the indirect costs of premature mortality in 2018 due to injuries and other consequences of external causes in Cabo Verde. Years of potential life lost, years of potential productive life lost and human capital approach were used to estimate the burden and indirect costs of premature mortality. In 2018, 244 deaths were registered due to injury and other consequences of external causes. Males were responsible for 85.4% and 87.73% of years of potential life lost and years of potential productive life lost, respectively. The cost of productivity lost due to premature death caused by injury was 4,580,225.91 USD. The social and economic burden due to trauma was substantial. There is a need for more evidence on the burden of disease due to injuries and their consequences, to support the implementation of targeted multi-sectoral strategies and policies for the prevention, management, and reduction of costs due to injuries in Cabo Verde.

Located in West Africa, Cabo Verde is a low income country, with significant gains in health indicators. Mortality is an important demographic factor. Its analysis provides essential statistical data for the design, implementation and evaluation of public health programs. The propose of this work is to analyze the spatio-temporal evolution of mortality in Cabo Verde between 1995 to 2018. This is an observational, quantitative study that performs demographic analysis of mortality data from the Ministry of Health of Cabo Verde. Specific mortality rates from standardized causes were calculated considering the population of the country as a reference in the year 2010 and also the standardized rate for all causes on each island, aiming at comparing the islands. During the period under analysis, the number of deaths in men was always higher than that of women. The main causes of death were diseases of the circulatory system and with a higher incidence in women. São Nicolau, Brava, and Santo Antão islands have mortality rates, higher than the national level (2010-2018). The main cause of premature death in women as identified as diseases of the circulatory system, while in men it is injuries, trauma, poisoning and external causes. There was a 72% decrease in the mortality rate due to unclassified symptoms and clinical signs, and an increase in respiratory diseases and tumours. With the exception of diseases of the circulatory system, mortality rates in men are higher than in women for all the considered causes. A decrease in specific mortality rates by age group is expected for both sexes, with a greater gain in men in the younger age groups. With these data, it is intended to alert health decision-makers about the best strategies to be defined in the reduction of mortality in the country.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

The recently emerged novel coronavirus, “severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2),” caused a highly contagious disease called coronavirus disease 2019 (COVID‐19). It has severely damaged the world's most developed countries and has turned into a major threat for low‐ and middle‐income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID‐19 for each country under one worldwide consortium. International COVID‐19 Research Network collaborators developed a cross‐sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID‐19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log‐transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual‐level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID‐19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID‐19.

Zika virus (ZIKV) diagnostics are crucial for proper antenatal and postnatal care and also for surveillance and serosurvey studies. Since the viremia during ZIKV infection is fleeting, serological testing is highly valuable to inform diagnosis. However, current serology tests using whole virus antigens frequently suffer from cross reactivity issues, delays, and technical complexity, especially in low and middle income countries (LMICs) and endemic countries. Here, we describe an indirect ELISA to detect specific IgG antibodies using the ZIKV envelope domain III (EDIII) protein expressed in Drosophila S2 cells as an immunogen. Using a total of 367 clinical samples, we showed that the EDIII-ELISA was able to detect IgG antibodies against ZIKV with high sensitivity of 100.0% and specificity of 94.7% when compared to plaque reduction neutralization tests (PRNTs) as the gold standard and using 0.208 as the cut-off OD value. These results show the usefulness of the recombinant envelope domain III as an alternative to standard whole virus proteins for ZIKV diagnostics as it improves the sensitivity and specificity of IgG ELISA assay when used as an immunogen. This method should, therefore, be extended to serological diagnostic techniques for other members of the flavivirus genus and for use in IgM diagnostic testing.

Background A consortium of African and European Universities, National Institutes of Public Health and Research Centers proposed a project to implement a Master’s in Field Epidemiology via blended-learning platforms based at University of Cape Verde. The field training is implemented with the National Institutes of Public Health of each country where strengthening of the local health systems in perspective. Thus, the presentation will describe the experience of implementing a blended-learning advanced field epidemiology training, the defining strategies for the internship and the first outputs produced by Epi Fellows. Methods The overall project will be described as well as processes in developing the curriculum and its accreditation at different levels and the establishment of International Steering Committee. We describe the recruitment of students, how sites for training were selected as well as the outputs of the first student internships. Results A total of 55 applications were received and 15 students were selected (6 from Cape Verde, 6 from Guinea-Bissau and 3 from São Tomé & Príncipe). Through a consultative process and field visits, tutors were identified for each student in their country of origin as well as field training sites considered relevant to enhance experiences and capacity of trainees in health surveillance and outbreak response at ministerial, municipality/district and hospital/health facility levels. The expected outputs from field training were defined and the 3 products of the first internships, focusing on the evaluation of the national health information systems of each country, the epidemiological surveillance from a one health perspective, the focus on antimicrobial resistance and outbreak investigations are critically described. Conclusion The practical training in the countries of origin complemented with theoretical training offered online will allow better insertion and retention of the trained cadres in their countries of origin and contribute for health system strengthening.

Background Africa’s weaknesses in responding to public health emergencies triggered the University of Cabo Verde’s EDCTP/Africa CDC supported b-learning Field Epidemiology Program (2022–2024), after Mozambique´s and Angola’s experiences. The Program targets 15 students from Cabo Verde (CV)(6), Guiné-Bissau (GB)(6) and São Tomé e Príncipe (3). Groups of three students completed their first field training, producing reports focusing on antimicrobial resistance (AMR) and/or One Health Surveillance within existing health information systems (HIS). Methods During field training students, supported by site supervisors and tutors, selected a HIS, described it, assessed its quality, and identified opportunities for improvements, namely on the possibility to expand its One Health scope. Results In the three countries, the HIS for human health is structured around the platform District Health Information System 2 (DHIS2) complemented by population-based surveys. Clinical and public health services, disease programs and surveillance systems are supposed to feed their data into the DHIS2, mostly manually, although this does not always happen. AMR is not regularly monitored for lack of laboratory capacity for antibiograms; when done, it is mostly related to tuberculosis. GB is the only country reporting a National HIS Strategic Plan. Private care providers/services are not included in the DHIS2 data/information circuits. Animal/plant health have separate information systems with variable degrees of sophistication. CV is the only country reporting the development of coordination structures with animal and environmental HIS. Besides these experiences, students analyzed disease related data (diarrhoeal diseases, malaria, HIV, tuberculosis) and participated in outbreak investigations (shigella, influenza, rubella). Conclusion Key obstacles to develop One Health Information Systems are siloed structures for human, animal and environmental HIS, but also significant blind spots in human HIS, related to programs and services that do not dialogue with DHIS2, lack of capacity to obtain laboratory-based data and a private sector growing outside relevant data/information circuits.

Abstract The COVID‐19 pandemic has exposed the vulnerabilities of Cape Verde's healthcare system, prompting a swift and effective response. This article examines Cape Verde's comprehensive approach to the pandemic, focusing on epidemiology, the healthcare system, and the vaccination campaign. Recognizing the critical role of COVID‐19 vaccination in global efforts, Cape Verde has implemented strategic measures to achieve herd immunity. Although the country has achieved relatively high vaccination coverage in Africa, it still falls short of the necessary threshold. Challenges, including vaccine hesitancy, viral mutations, and supply chain insecurities, must be addressed. Sustained efforts, involving community participation and improved vaccine availability, are crucial. Furthermore, a robust pharmacovigilance system is essential for ensuring vaccination safety and enhancing health outcomes.

Background COVID-19, or the new coronavirus, has spread globally since its emergence in December 2019, bringing enormous global health and socioeconomic challenges. Egypt confirmed the first case of COVID-19 in Africa on February 14, 2020, while Cabo Verde confirmed the first case on March 19, 2020. Contrary to forecasts that the virus would swiftly spread throughout Africa, which would soon become the infection’s epicenter, the evolution of the pandemic on the continent over the investigated time period has been slower than expected. Objective This study aims to comprehend the progression and consequences of the COVID-19 pandemic in Cabo Verde during its first six months of existence. After the first confirmed case of the new coronavirus, on March 19, 2020, the government of Cabo Verde closed its international borders. Consequently, a state of emergency was declared with stringent restrictions on the movement of persons and goods. Additionally, facilities for the isolation of sick individuals, including field hospitals, had been established. To aid the most vulnerable, public and private organisations had organized fundraising drives. Results Despite the use of mitigation techniques, the pandemic in Cabo Verde has caused severe socioeconomic harm. It is crucial to preserve and strengthen active surveillance, infection control, and risk communication methods. Social protection policies and economic incentives have the potential to boost infection control strategies.