Between weeks 40 2020 and 8 2021, the World Health Organization European Region experienced a 99.8% reduction in sentinel influenza virus positive detections (33/25,606 tested; 0.1%) relative to an average of 14,966/39,407 (38.0%; p < 0.001) over the same time in the previous six seasons. COVID-19 pandemic public health and physical distancing measures may have extinguished the 2020/21 European seasonal influenza epidemic with just a few sporadic detections of all viral subtypes. This might possibly continue during the remainder of the influenza season.

This article presents and compares coronavirus disease 2019 attack rates for infection, hospitalization, intensive care unit (ICU) admission and death in healthcare workers (HCWs) and non-HCWs in nine European countries from 31 st January 2020 to 13 th January 2021. Adjusted attack rate ratios in HCWs (compared with non-HCWs) were 3.0 [95% confidence interval (CI) 2.2–4.0] for infection, 1.8 (95% CI 1.2–2.7) for hospitalization, 1.9 (95% CI 1.1–3.2) for ICU admission and 0.9 (95% CI 0.4–2.0) for death. Among hospitalized cases, the case-fatality ratio was 1.8% in HCWs and 8.2% in non-HCWs. Differences may be due to better/earlier access to treatment, differential underascertainment and the healthy worker effect.

Epidemiology capacity in state health departments is suboptimal and has decreased, as assessed by states' ability to carry out the ESPHs, by their ability to use newer surveillance technologies, and by the number of epidemiologists employed. Federal emergency preparedness funding, which supported more than 20% of state-based epidemiologists in 2006, has decreased. The 2009 Epidemiology Capacity Assessment demonstrates the negative impact of this decrease on states' epidemiology capacity.

Decisions on school closures and on safe schooling during the COVID-19 pandemic should be evidence-based. We conducted a systematic literature review to assess child-to-child and child-to-adult SARS-CoV-2 transmission and to characterise the potential role of school closures on community transmission. 1337 peer-reviewed articles published through August 31, 2020 were screened; 22 were included in this review. The literature appraised provides sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in community, household and school settings. Transmission by children was most frequently documented in household settings, while examples of children as index cases in school settings were rare. Included studies suggested that school closures may help to reduce SARS- CoV-2 transmission, but the societal, economic, and educational impacts of prolonged school closures must be considered. In-school mitigation measures, alongside continuous surveillance and assessment of emerging evidence, will promote the protection and educational attainment of students and support the educational workforce.

Although most nationally notifiable conditions were explicitly reportable, we found that many of these conditions have implicit reporting authority in states. As notifiable condition surveillance moves toward an informatics-driven approach, automated electronic case-detection systems will need explicit information about what conditions are reportable. Future work should address the feasibility of standardizing the format of reportable disease lists and nomenclature used to facilitate data aggregation and interpretation across states.