Eurosurveillance - Volume 30, Issue 19, 15 May 2025

Zoonotic influenza, including infections with avian and swine influenza A viruses (swIAV), is a notifiable disease in the Netherlands. Human cases infected with swIAV have previously been rarely detected in the Netherlands.

We aimed to describe detection and characterisation of Eurasian avian-like swIAV infections in humans in the Netherlands 2020–2023.

The Dutch National Influenza Center coordinates different activities to monitor respiratory infections and circulating human influenza viruses. This monitoring includes sentinel surveillance in general practitioner practices, community participatory surveillance and characterisation of influenza viruses received from diagnostic laboratories. A subset of the specimens positive for influenza A virus from the monitoring activities are sent for further characterisation. We characterised swIAV from human patients using whole genome sequencing, tested the viruses for antiviral susceptibility and in haemagglutination inhibition assays for antigenic characterisation and compared them with previous detections from humans and pigs.

Avian-like swine influenza virus was detected in three persons presenting with mild respiratory symptoms, and all recovered fully. Only one patient had close contact with pigs shortly before the start of symptoms. Sequence analyses of the viruses showed clustering with swAIV from pigs in a recently initiated surveillance system on pig farms.

These human cases show that swIAV viruses with zoonotic potential are enzootic in the Netherlands. Finding them by coincidence suggests human infections might occur more frequently than noticed.

Evidence-informed public health decision-making (EIDM) is a complex process that must consider multiple factors.

We aimed to identify and describe existing frameworks supporting evidence-informed public health decision-making and their application to infectious disease.

We conducted a scoping review to describe current EIDM framework use in public health. We included decision-making frameworks in public health and examples of their use in infectious diseases. We searched MEDLINE and Health Systems Evidence from inception to December 2022. We also hand searched websites of relevant organisations and conducted a forward citation search of the included frameworks. Two reviewers selected studies independently, one reviewer extracted data and one cross-checked for accuracy. We presented the results narratively.

We included 15 frameworks. Seven had a generic scope and eight were focused on specific topics (immunisation, COVID-19 or other, non-infectious diseases). From the included frameworks, we identified a total of 18 criteria with each framework assessing a median of eight, the most frequent being ‘desirable effects’, ‘resources considerations’ and ‘feasibility’. We identified infectious disease examples for four frameworks: ‘Grading of Recommendations, Assessment, Development, and Evaluation’ (GRADE), WHO-INTEGRATe Evidence (WHO-INTEGRATE), ‘Ethics, Equity, Feasibility, and Acceptability’ (EEFA) and ‘Community Preventive Services Task Force’ (CPSTF) evidence-to-decision frameworks.

Although several EIDM frameworks exist for public health decision-making, most have not been widely applied to infectious diseases. Current EIDM frameworks inconsistently address factors for public health decision-making. Further application and evaluation, and possibly adaptation of existing frameworks, is required to optimise decision-making in public health and infectious diseases.

Evidence-informed decision-making in public health (PH) is a complex process requiring the consideration of multiple perspectives and contextual factors. Evidence-to-decision (EtD) frameworks are structured approaches aiming to improve decision-making by considering critical criteria, but users’ experience has not been systematically synthesised.

We aim to summarise users’ experiences of EtD frameworks used for PH.

As part of a broader scoping review, we identified 15 EtD frameworks for PH decision-making. We searched MEDLINE and Health Systems Evidence, conducted a hand search and citation search strategy for documents reporting users’ experience of EtD frameworks and surveyed key stakeholders. We conducted a descriptive thematic synthesis, identifying main barriers and facilitators, complementing with surveys to relevant stakeholders.

We identified 12 studies reporting users’ experience of two EtD frameworks: Grading of Recommendations Assessment, Development and Evaluation (n = 9) and World Health Organization INTEGRATe Evidence (n = 3). Both were perceived as structured approaches that enhanced the use of evidence while including contextual factors and facilitating consensus-building processes. Main barriers were lack of high-quality evidence for the effectiveness of PH interventions, limitations of the terminology or unclear boundaries between specific criteria, perceptions of missing criteria and the need for more guidance. Survey responses (n = 13) were consistent with these findings.

Users of the two frameworks had an overall positive perception of the approaches, but several barriers remain. These experiences may change over time as the frameworks evolve. There is an evidence gap regarding users’ experience for other EtD frameworks.