Since the beginning of the Covid-19 pandemic, the scientific community has explored determinants of Covid 19 disease severity. However, the majority of studies are based on in-hospital patients with high risk of collider- or selection bias. The present investigation details risk factors associated with overall mortality, hospitalization and intensive care unit (ICU) admission in Covid-19 infections, with complete population coverage and high-resolution data on patient characteristics and comorbid conditions This population-based observational study comprises all residents 18 years and older in Stockholm Region—1.8 million inhabitants—using the real-time Covid-19 monitoring framework. The observation period lasted between March 1 to December 31, 2020. Hazard ratios (HR) for risk factors of Covid-19 disease severity were assessed using Cox proportional hazard models. In total, 3322 deaths, 11,508 hospitalizations and 1423 ICU-admissions related to Covid-19 occurred during the study period. Kidney failure, diabetes and obesity increased risk of mortality and so did heart failure and ischemic heart disease. However, atrial fibrillation and hypertension did not. Risk of hospitalization follow a similar pattern, whereas admission to intensive care differs; triage processes where clearly present as certain co-morbid conditions were associated with lower ICU admission. Observed differences in risk of mortality and hospitalization among patients with Covid 19 raise important questions about potentially protective comedication which will be further addressed using the real-time Covid-19 monitoring framework.

INTRODUCTION The WHO End TB Strategy emphasises early diagnosis and screening of TB in high-risk groups, including migrants. We analysed TB yield data from four large migrant TB screening programmes to inform TB policy.METHODS We pooled routinely collected individual TB screening episode data from Italy, the Netherlands, Sweden and the United Kingdom under the European Union Commission E-DETECT.TB grant, described characteristics of the screened population, and analysed TB case yield.RESULTS We collected data on 2,302,260 screening episodes among 2,107,016 migrants, mostly young adults aged 18–44 years (77.8%) from Asia (78%) and Africa (18%). There were 1,658 TB cases detected through screening, with substantial yield variation (per 100,000): 201.1 for Sweden (95% confidence intervals CI 111.4–362.7), 68.9 (95% CI 65.4–72.7) for the United Kingdom, 83.2 (95% CI 73.3–94.4) for the Netherlands and 653.6 (95% CI 445.4–958.2) in Italy. Most TB cases were notified among migrants from Asia (n = 1,206, 75/100,000) or Africa (n = 370, 76.4/100,000), and among asylum seekers (n = 174, 131.5/100,000), migrants to the Netherlands (n = 101, 61.9/100,000) and settlement visa migrants to the United Kingdom (n = 590, 120.3/100,000).CONCLUSIONS We found considerable variations in yield across programmes, types of migrants and country of origin. These variations may be partly explained by differences in migration patterns and programmatic characteristics.

IntroductionThe WHO End-TB Strategy emphasises screening for early diagnosis of tuberculosis (TB) in high-risk groups, including migrants. We analysed key drivers of TB yield differences in four large migrant TB screening programmes to inform TB control planning and feasibility of a European approach.MethodsWe pooled individual TB screening episode data from Italy, the Netherlands, Sweden, and the UK and analysed predictors and interactions for TB case yield using multivariable logistic regression models.ResultsBetween 2005–2018 in 2,302,260 screening episodes among 2,107,016 migrants to four countries; the programmes identified 1,658 TB cases (yield 72.0 per 100,000; 95% confidence interval, CI68.6–75.6). In logistic regression analysis, we found associations between TB screening yield and age (>55 years odds ratio, OR2.91, CI2.24–3.78), being an asylum seeker (OR3.19, CI1.03–9.83) or on a settlement visa (OR1.78, CI1.57–2.01), close TB contact (OR12.25, 11.73–12.79), and higher TB incidence in the country of origin (CoO). We demonstrated interactions between migrant typology and age, as well as CoO. For asylum seekers, the elevated TB risk remained similar above CoO incidence thresholds of 100 per 100,000.ConclusionsKey determinants of TB yield included close contact, increasing age, incidence in CoO and specific migrant groups including asylum seekers and refugees. For most migrants such as UK students and workers, TB yield significantly increased with levels of incidence in CoO. The high, CoO-independent TB risk in asylum seekers above a 100 per 100,000 threshold could reflect higher transmission and reactivation risk of migration routes; with implications for selecting populations for TB screening.

During an outbreak of acute gastroenteritis in Sweden when laboratory routine diagnostics failed to detect a causative agent, Sapporo virus was detected in stool specimens using electron microscopy (M.-P. Hergens, J. Nederby Öhd, E. Alm, H. Hervius Askling, S. Helgesson, M. Insulander, N. Lagerkvist, B. Svennungsson, M. Tihane, T. Tolfvenstam, P. Follin, unpublished data). Whole-genome sequencing revealed a Sapporo virus variant clustering with genogroup V.