Background Tuberculosis (TB), a communicable disease, is the leading cause of death from a single infectious agent and one of the top 10 causes of death worldwide. Its burden varies among different countries. In the 31 European Economic Area member states, in 2017, the TB notification rate was 10.7/100,000 population; in Portugal, this rate was 17.5/100,000 population and the majority of the notified cases occurred in two districts: Lisbon and Oporto. The aim of this study is to analyse TB's notifications in a group of primary healthcare centres of Loures-Odivelas (ACES LO), between 2015 and 2019. Methods An observational, descriptive, retrospective, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included were: age, sex, TB's presentation, antimicrobial susceptibility testing, HIV testing. Descriptive analysis was performed for all variables. Results In ACES LO, notified cases of TB dropped 18.0% between 2015 and 2017, having since increased by 54.8% (n = 113), a notification rate of 32.3/100,000 population in 2019. The male to female ratio was 1.7 and the most affected age group was the 30-40 year old group (n = 25). Notified cases in children <10 years old have increased from 0 in 2016 to 7 in 2019. Pulmonary TB was reported in 73.5% (n = 83) of the notified cases; in 56.6% (n = 64), antimicrobial susceptibility testing revealed that first-line treatment would be effective; HIV testing was positive in 10.6% (n = 12). Conclusions Surveillance is the first step towards taking action to control and eliminate TB. ACES LO has a high notification rate of TB, therefore effort should be made in order to reduce TB's incidence. More investigation should be performed in order to evaluate the possibility of reintroduction of Bacille Calmette-Guérin (BCG) vaccine to the general population, instead of only risk groups, as it happens in ACES LO since 2016. Key messages Surveillance is one of the ten essential Public Health operations, allowing us to measure and analyse health problems in a certain population. Tuberculosis’ incidence is still high in some populations; it is a critical issue to raise awareness about.

Background In the WHO European Region, in 2018, there were 16.2 newly diagnosed HIV infections per 100,000. In Portugal, there were 9.5 new cases per 100,000 population. The aim of this study is to analyse HIV/AIDS's notifications in the group of primary healthcare centres of Loures-Odivelas (ACES LO), with 340,000 inhabitants, between 2015 and 2019. Methods An observational, descriptive, retrospective, quantitative study was performed. Data was collected in March 2020, from the National System of Epidemiological Surveillance Database. Variables included were age, sex, HIV's presentation, country of probable origin of infection, probable form of transmission, partner characteristics, pregnancy at diagnosis, reason for testing/consultation, anti-retroviral therapy (ART) before diagnostic of AIDS. Descriptive analysis was performed for all variables. Results In ACES LO, there were 83 notified cases of HIV infection/AIDS between 2015 and 2019, with 36.1% of cases notified in 2019. The male to female ratio was 1.4. The average age was 41.7 years old. At time of notification, 56.6% of cases were asymptomatic and 25.3% had clinical criteria for AIDS. Guinea-Bissau was the probable origin of infection in 43.0% of cases (n = 23). Men having sex with men (MSM) was the probable form of transmission in 19.3% of cases. In 19.6% of cases of heterosexual contact, the partner was known to have HIV infection. Six women were pregnant at time of diagnosis. Testing was done on a routine basis in 22.2% of cases (n = 54). Among those with clinical criteria for AIDS (n = 21), 5 cases had previously taken ART. Conclusions There was an increase in notified cases of HIV infection/AIDS from 2015 to 2019 in ACES LO. The male to female ratio was lower than for Portugal in 2018.The proportion of cases with AIDS at time of notification was higher than for Portugal in 2018. Preventive strategies should be reinforced for people with partners diagnosed with HIV infection and perhaps for people. Key messages More than one third of cases were notified in 2019. Preventive strategies should be reinforced for people with partners diagnosed with HIV infection.

Issue Adenoviral conjunctivitis is the most common cause of conjunctivitis. Its most severe form is epidemic keratoconjunctivitis (EKC). This highly contagious disease is the only form to significantly involve the cornea and may cause visual impairing sequelae that persist for years. Description On January 2020, staff members at a childcare facility (CCF) alerted the Public Health Unit of Loures-Odivelas to a suspected conjunctivitis outbreak. The CCF was responsible for 57 children, separated in different rooms: a nursery (4-12 months), a pre-school (1-3 years) and a kindergarten (4-5 years). At the initial assessment, 4 cases of active disease were identified, all of which were at home and under treatment. CCF staff had previously identified 33 cases. Symptom onset of the index case had occurred more than 5 weeks before the alert. Infection control and epidemiological investigation were initiated. CCF staff was instructed to implement preventive measures, including careful disinfection of surfaces and toys, as well as frequent handwashing. Information about the disease and recommendations were sent to the children's caretakers. Results A total of 87 cases distributed in 8 weeks were identified: 28 at the CCF (25 children and 3 workers) and 59 close contacts (50 adults and 9 children). Average duration of disease was 14.1 days. In total, 43.9% of the children attending the CFF were affected. The highest attack rate was observed at the pre-school (69.2%, against 38.9% and 17.6% at the nursery and the kindergarten, respectively). 88.0% of the CCF children's households were affected. The average number of affected close contacts per affected child attending the CCF was 2.63. Corneal involvement was observed in 17,4% of cases. Lessons EKC outbreaks may go unnoticed by public health services, despite its high contagiousness and impact. Improvement of communication with organizations in the community is essential to secure future early detection and intervention. Key messages Epidemic keratoconjunctivitis is a highly contagious disease with potential long-term consequences. Early detection and intervention by public health services are essential to mitigate the impact of outbreaks and depend on well-established communication lines with institutions in the community.

Background Sexually transmitted infections (STIs) are a major public health problem in Europe and in Portugal, their incidence has been increasing since the 90s. Although STIs are among the most frequently reported infections globally, they still go often underdiagnosed. Their under notification is also a problem in Portugal. The aim of this study is to describe STIs' notifications in the area of the groups of primary healthcare centers of Loures-Odivelas (ACES LO), between 2015-2019. Methods An observational, descriptive, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included for each STIs notification were age and sex. Univariate descriptive analysis and evolution trends were performed for each variable. Results A total of 638 cases of STIs were reported from 2015 to 2019. The number of reported cases increased from 87 to 197 cases (126.4%). The annual mean incidence of HBV and HCV notifications were 8 and 4, respectively. There was an increase in reported cases of syphilis (33 to 57), HIV (13 to 29), chlamydia (13 to 46) and gonorrhea (18 to 51). In 2019, 30.9% of the notified cases were syphilis infections, 23.5% gonorrhea infections, 22.1% chlamydia infections and 13.2% HIV infections.Males comprised 460 cases (72.1%), and, in patients aged between 15 and 44 years old, 484 cases (75.9%) were reported. From 2015 to 2019, the co-infections of gonorrhea and chlamydia increased from 2 to 10 cases (25.0%). In 2019, 17.5% of the notified cases of gonorrhea were co-infections. Conclusions The modification of risk behaviors and the appropriate treatment of infected people, including infected partners, are determinant to prevent recurrent infections and to interrupt the transmission cycle. Increasing notification should facilitate the monitoring of STIs' trends, contributing to the implementation of appropriate interventions and for better decision-making in public health. Key messages Campaigns about sexual health promotion are important to increase safer sexual health practices. More notifications contribute to better data quality and more robust decision-making.

Background Travel from Portugal to other countries has increased in the past 5 years. A pre-travel health consultation is advised to all travellers to raise awareness and reduce travel-related risk. We describe the experience of a pre-travel consultation centre in the public health service. Methods A retrospective observational study about consultations in an international vaccination centre between 2014-2018. Variables included were: sex, age, destination, purpose, referral, and prescriptions. Descriptive analyses were performed for all variables. Results Between 2014 and 2018, there were 1,546 consultations. Regarding individual characteristics, 54% were female, and 80% had between 15 and 64 years of age. There was no referral in 66% of the consultations, followed by 16% from general practitioners in the Primary Care Centres Group. The leading destination was Africa (54%), in a downward trend (74% in 2015 and 32% in 2018) followed by Asia (18%) with an upward trend (12% to 28% in the same period). The primary purpose was tourism (83%), followed by work (9%). In total, 3,287 vaccines were prescribed with typhoid fever vaccine accounting for 26%, hepatitis A vaccine 22%, and yellow fever vaccine 15%. Mefloquine was the primary therapeutic drug prescribed for destinations with risk for malaria (41%). Regarding destinations with low risk for malaria, in 42% of the consultations, personal protective measures were the only recommendation. Conclusions Our data show that pre-travel consultations seem to be valued and actively asked for by travellers, but medical referral is still insufficient. Regarding health promotion and prevention of diseases, tracking trends in the most common destinations allows to optimize the information provided in the consultation, effectively capacitating the traveller to recognize and act on the most common travel-related health risks. In further studies, a post-travel follow-up should be carried out to determine the impact of the consultation. Key messages Pre-travel consultation is an actively sought-after service by the community, but awareness should be promoted in the medical community. Pre-travel consultation can have an important role in the health literacy of travellers.