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Article ; Online: Iatrogenic botulism.

Hagberg, Guri / Skytøen, Emilie Ranheim / Nakstad, Ingvild / O' Sullivan, Kristin / Koht, Jeanette / Johansen, Tone Kristin Bjordal / Feruglio, Siri L / Frøyshov, Sten

Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke

2024 Volume 144, Issue 2

Abstract: This case study describes severe iatrogenic botulism following treatment with a botulinum toxin injection at a private clinic abroad. ...

Title translation	Iatrogen botulisme.
Abstract	This case study describes severe iatrogenic botulism following treatment with a botulinum toxin injection at a private clinic abroad.
MeSH term(s)	Humans ; Botulism/diagnosis ; Botulism/etiology ; Botulism/therapy ; Botulinum Toxins, Type A ; Ambulatory Care Facilities ; Iatrogenic Disease ; Clostridium botulinum
Chemical Substances	Botulinum Toxins, Type A (EC 3.4.24.69)
Language	Norwegian
Publishing date	2024-02-12
Publishing country	Norway
Document type	Journal Article
ZDB-ID	603504-8
ISSN	0807-7096 ; 0029-2001
ISSN (online)	0807-7096
ISSN	0029-2001
DOI	10.4045/tidsskr.23.0625
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Article ; Online: Transmission of SARS-CoV-2 in Norwegian schools during academic year 2020-21: population wide, register based cohort study.

Rotevatn, T A / Bergstad Larsen, Vilde / Bjordal Johansen, Tone / Astrup, Elisabeth / Surén, Pål / Greve-Isdahl, Margrethe / Telle, Kjetil Elias

BMJ medicine

2022 Volume 1, Issue 1, Page(s) e000026

Abstract: Objective: To assess the risk of transmission of SARS-CoV-2 in schools in Norway mainly kept open during the covid-19 pandemic in the academic year 2020-21.: Design: Population wide, register based cohort study.: Setting: Primary and lower ... ...

Abstract	Objective: To assess the risk of transmission of SARS-CoV-2 in schools in Norway mainly kept open during the covid-19 pandemic in the academic year 2020-21. Design: Population wide, register based cohort study. Setting: Primary and lower secondary schools in Norway open during the academic year 2020-21, with strict infection prevention and control measures in place, such as organisation of students into smaller cohorts. Contact tracing, quarantine, and isolation were also implemented, and testing of students and staff identified as close contacts. Participants: All students and educational staff in primary and lower secondary schools in Norway, from August 2020 to June 2021. Main outcome measures: Overall attack rate of SARS-CoV-2 transmission (AR14) was defined as the number of individuals (among students, staff, or both) in the school with covid-19, detected within 14 days of the index case, divided by the number of students and staff members in the school. AR14 to students (attack rates from all index cases to students only) and AR14 to school staff (attack rates from all index cases to staff members only) were also calculated. These measures for student and school staff index cases were also calculated separately to explore variation in AR14 based on the characteristics of the index case. Results: From August 2020 to June 2021, 4078 index cases were identified; 3220 (79%) students and 858 (21%) school staff. In most (2230 (55%)) schools with an index case, no subsequent individuals with covid-19 were found within 14 days; in 631 (16%) schools, only one more individual with covid-19 within 14 days was found. Overall, AR14 was 0.33% (95% confidence interval 0.32% to 0.33%). When restricting index cases and subsequent individuals with covid-19 to students born in the same year, AR14 to students (0.56-0.78%) was slightly higher. Conclusions: Regarding the number of people infected with SARS-CoV-2 among students and staff, these results suggest that schools were not an important setting for transmission of the virus in Norway during the covid-19 pandemic in the academic year 2020-21.
Language	English
Publishing date	2022-08-05
Publishing country	England
Document type	Journal Article
ISSN	2754-0413
ISSN (online)	2754-0413
DOI	10.1136/bmjmed-2021-000026
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Article ; Online: Experience with open schools and preschools in periods of high community transmission of COVID-19 in Norway during the academic year of 2020/2021

Sara Stebbings / Torill Alise Rotevatn / Vilde Bergstad Larsen / Pål Surén / Petter Elstrøm / Margrethe Greve-Isdahl / Tone Bjordal Johansen / Elisabeth Astrup

BMC Public Health, Vol 22, Iss 1, Pp 1-

2022 Volume 9

Abstract: Abstract Background Schools and preschools have largely remained open in Norway throughout the pandemic, with flexible mitigation measures in place. This contrasts with many other high-income countries that closed schools for long periods of time. Here ... ...

Abstract	Abstract Background Schools and preschools have largely remained open in Norway throughout the pandemic, with flexible mitigation measures in place. This contrasts with many other high-income countries that closed schools for long periods of time. Here we describe cases and outbreaks of COVID-19 in schools and preschools during the academic year 2020/2021, to evaluate the strategy of keeping these open with infection prevention control measures in place. Methods In this descriptive study, the Norwegian Institute of Public Health initiated systematic surveillance for COVID-19 cases and outbreaks in schools and preschools in October 2020. Data was compiled from the national outbreak alert system VESUV, municipality websites, and media scanning combined with the national emergency preparedness register Beredt C-19. An outbreak was defined as ≥ 2 cases among pupils or staff within 14 days at the same educational setting. Settings were categorized as preschool (1–5-years), primary school (6–12-years), lower secondary school (13–15-years) and upper secondary school (16–18- years). We reported the incidence rate among preschool and school-aged pupils and gave a descriptive overview of outbreaks and included cases per educational setting. Results During the whole academic year, a total of 1203 outbreaks in preschools and school settings were identified, out of a total of 8311 preschools and schools nationwide. The incidence of COVID-19 in preschool- and school-aged children and the rates of outbreaks in these settings largely followed the community trend. Most of the outbreaks occurred in primary schools (40%) and preschools (25%). Outbreaks across all settings were mostly small (median 3 cases, range 2 to 72), however, 40 outbreaks (3% of total) included 20 or more cases. The larger outbreaks were predominantly seen in primary schools (43%). Conclusions We observed few large outbreaks in open schools and preschools in Norway during the academic year of 2020/2021, also when the Alpha variant was predominant. This ...
Keywords	SARS-Cov 2 ; COVID-19 ; Schools ; Preschools ; Children ; Pupils ; Public aspects of medicine ; RA1-1270
Subject code	370
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: School Closure Versus Targeted Control Measures for SARS-CoV-2 Infection.

Rotevatn, Torill A / Elstrøm, Petter / Greve-Isdahl, Margrethe / Surén, Pål / Johansen, Tone Kristin Bjordal / Astrup, Elisabeth

Pediatrics

2022 Volume 149, Issue 5

Abstract: Objectives: To compare effects of school closures with effects of targeted infection prevention and control (IPC) measures in open schools on SARS-CoV-2 infection rates in students.: Methods: We conducted interrupted time-series analyses to compare ... ...

Abstract	Objectives: To compare effects of school closures with effects of targeted infection prevention and control (IPC) measures in open schools on SARS-CoV-2 infection rates in students. Methods: We conducted interrupted time-series analyses to compare trends in infection rates in grades 1-10 in 7 boroughs in Oslo, Norway, between February 15 and April 18, 2021. All schools at all levels had implemented strict IPC measures. While grades 1-4 attended school throughout the study period, school closures were implemented for grades 5-10 from March 17. We obtained individual level data from nationwide registries. Results: A total of 616, 452, and 446 students in grades 1-4, 5-7 and 8-10, respectively, were registered with a positive SARS-CoV-2 test during the study period, when the α-variant dominated. A statistically significant reduction in postintervention trends was observed for grades 1-4 (coefficient -1.26; 95% confidence interval (CI), -2.44 to -0.09). We did not observe any statistically significant between-group differences in postintervention trends between grades 1-4 and 5-7 (coefficient 0.66; 95% CI, -1.25 to 2.58) nor between grades 1-4 and 8-10 (coefficient -0.63; 95% CI, -2.30 to 1.04). Findings indicate that keeping schools open with strict IPC measures was equally effective as school closures on reducing student infection rates. Conclusions: School closure was not more effective than targeted IPC measures in open schools in reducing student infection rates. Our findings suggest that keeping schools open with appropriate IPC measures should be preferred over school closures, considering the negative consequences closures have on students.
MeSH term(s)	COVID-19/prevention & control ; Humans ; Norway/epidemiology ; SARS-CoV-2 ; Schools ; Students
Language	English
Publishing date	2022-03-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2021-055071
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Article ; Online: Experience with open schools and preschools in periods of high community transmission of COVID-19 in Norway during the academic year of 2020/2021.

Stebbings, Sara / Rotevatn, Torill Alise / Larsen, Vilde Bergstad / Surén, Pål / Elstrøm, Petter / Greve-Isdahl, Margrethe / Johansen, Tone Bjordal / Astrup, Elisabeth

BMC public health

2022 Volume 22, Issue 1, Page(s) 1454

Abstract: Background: Schools and preschools have largely remained open in Norway throughout the pandemic, with flexible mitigation measures in place. This contrasts with many other high-income countries that closed schools for long periods of time. Here we ... ...

Abstract	Background: Schools and preschools have largely remained open in Norway throughout the pandemic, with flexible mitigation measures in place. This contrasts with many other high-income countries that closed schools for long periods of time. Here we describe cases and outbreaks of COVID-19 in schools and preschools during the academic year 2020/2021, to evaluate the strategy of keeping these open with infection prevention control measures in place. Methods: In this descriptive study, the Norwegian Institute of Public Health initiated systematic surveillance for COVID-19 cases and outbreaks in schools and preschools in October 2020. Data was compiled from the national outbreak alert system VESUV, municipality websites, and media scanning combined with the national emergency preparedness register Beredt C-19. An outbreak was defined as ≥ 2 cases among pupils or staff within 14 days at the same educational setting. Settings were categorized as preschool (1-5-years), primary school (6-12-years), lower secondary school (13-15-years) and upper secondary school (16-18- years). We reported the incidence rate among preschool and school-aged pupils and gave a descriptive overview of outbreaks and included cases per educational setting. Results: During the whole academic year, a total of 1203 outbreaks in preschools and school settings were identified, out of a total of 8311 preschools and schools nationwide. The incidence of COVID-19 in preschool- and school-aged children and the rates of outbreaks in these settings largely followed the community trend. Most of the outbreaks occurred in primary schools (40%) and preschools (25%). Outbreaks across all settings were mostly small (median 3 cases, range 2 to 72), however, 40 outbreaks (3% of total) included 20 or more cases. The larger outbreaks were predominantly seen in primary schools (43%). Conclusions: We observed few large outbreaks in open schools and preschools in Norway during the academic year of 2020/2021, also when the Alpha variant was predominant. This illustrates that it is possible to keep schools and preschools open even during periods of high community transmission of COVID-19. Adherence to targeted IPC measures adaptable to the local situation has been essential to keep educational settings open, and thus reduce the total burden on children and adolescents.
MeSH term(s)	Adolescent ; COVID-19/epidemiology ; Child ; Child, Preschool ; Humans ; Norway/epidemiology ; SARS-CoV-2 ; Schools
Language	English
Publishing date	2022-07-30
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-022-13868-5
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Article ; Online: When schools were open for in-person teaching during the COVID-19 pandemic - the nordic experience on control measures and transmission in schools during the delta wave.

Rotevatn, Torill Alise / Nygård, Karin / Espenhain, Laura / Legarth, Rebecca / Møller, Karina Lauenborg / Sarvikivi, Emmi / Helve, Otto / Aspelund, Guðrún / Ersson, Annika / Nordahl, Marie / Greve-Isdahl, Margrethe / Astrup, Elisabeth / Johansen, Tone Bjordal

BMC public health

2023 Volume 23, Issue 1, Page(s) 62

Abstract: Background: Extensive measures to control spread of SARS-CoV-2 have led to limited access to education for millions of children and adolescents during the COVID-19 pandemic. Education and access to schools is vital for children and adolescents' learning, ...

Abstract	Background: Extensive measures to control spread of SARS-CoV-2 have led to limited access to education for millions of children and adolescents during the COVID-19 pandemic. Education and access to schools is vital for children and adolescents' learning, health, and wellbeing. Based on high vaccine uptake and low incidence levels, the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) decided to start the academic year 2021/22 with schools open for in-person teaching and moderate mitigation measures. We describe trends in SARS-CoV-2 infections and vaccination coverage among students during the first 12 weeks of the fall semester. Methods: In this multinational, retrospective, observational study, we have used surveillance and registry data from each of the Nordic countries to describe vaccine uptake (≥12 years), infection incidence (whole population) and transmission of SARS-CoV-2 among students. The study period, week 30 to 41 (Jul 26th - Oct 17th), represents the autumn semester from immediately before school started until fall break. In addition, we collected information on mitigation measures applied by the respective countries. Results: There were slight variations between the countries regarding existing infection prevention and control (IPC) measures, testing strategies and vaccination start-up among adolescents. All countries had high vaccine uptake in the adult population, while uptake varied more in the younger age groups. Incidence in the school-aged population differed between countries and seemed to be influenced by both vaccine uptake and test activity. Infection clusters among school-aged children were described for Denmark and Norway, and the number of clusters per week reflected the incidence trend of the country. Most events consisted of only 1-2 cases. Larger clusters appeared more frequently in the higher grades in Norway and in lower grades in Denmark. Conclusion: Data from the Nordic countries indicate that vaccination of adults and adolescents, in addition to mitigation measures, enabled full in-person learning. As SARS-CoV-2 infection does not represent a severe medical risk for most children as previously thought, measures targeting this group should be carefully adjusted and kept at a minimum. Our data add to the evidence on incidence and transmission of SARS-CoV-2 among students in schools open for in-person teaching, and may be valuable for decision makers worldwide.
MeSH term(s)	Adolescent ; Adult ; Child ; Humans ; COVID-19/epidemiology ; COVID-19/prevention & control ; Pandemics/prevention & control ; Retrospective Studies ; SARS-CoV-2 ; Schools
Language	English
Publishing date	2023-01-09
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-022-14906-y
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Article ; Online: Exotic dried fruits caused

Johansen, Tone Bjordal / Brandal, Lin T / MacDonald, Emily / Naseer, Umaer / Stefanoff, Pawel / Røed, Margrethe Hovda / Berglund, Turid M / Johannessen, Gro S / Bergsjø, Bjarne / Vold, Line / Lange, Heidi

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin

2021 Volume 26, Issue 14

Abstract: We describe an outbreak ... ...

Abstract	We describe an outbreak of
MeSH term(s)	Case-Control Studies ; Disease Outbreaks ; Europe ; Female ; Fruit ; Humans ; Italy ; Male ; Middle Aged ; Norway/epidemiology ; Salmonella/genetics ; Salmonella Food Poisoning/diagnosis ; Salmonella Food Poisoning/epidemiology
Language	English
Publishing date	2021-04-09
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	1338803-4
ISSN	1560-7917 ; 1025-496X
ISSN (online)	1560-7917
ISSN	1025-496X
DOI	10.2807/1560-7917.ES.2021.26.14.2000221
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Article ; Online: Infection prevention guidelines and considerations for paediatric risk groups when reopening primary schools during COVID-19 pandemic, Norway, April 2020.

Johansen, Tone Bjordal / Astrup, Elisabeth / Jore, Solveig / Nilssen, Hege / Dahlberg, Bente Barton / Klingenberg, Claus / Berg, Are Stuwitz / Greve-Isdahl, Margrethe

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin

2020 Volume 25, Issue 22

Abstract: In response to the coronavirus disease (COVID-19) pandemic, most countries implemented school closures. In Norway, schools closed on 13 March 2020. The evidence of effect on disease transmission was limited, while negative consequences were evident. ... ...

Abstract	In response to the coronavirus disease (COVID-19) pandemic, most countries implemented school closures. In Norway, schools closed on 13 March 2020. The evidence of effect on disease transmission was limited, while negative consequences were evident. Before reopening, risk-assessment for paediatric risk groups was performed, concluding that most children can attend school with few conditions requiring preventative homeschooling. We here present infection prevention and control guidelines for primary schools and recommendations for paediatric risk groups.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Child ; Coronavirus ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Guidelines as Topic ; Humans ; Norway/epidemiology ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Risk Assessment ; Risk Factors ; SARS-CoV-2 ; Schools/organization & administration
Keywords	covid19
Language	English
Publishing date	2020-06-09
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	1338803-4
ISSN	1560-7917 ; 1025-496X
ISSN (online)	1560-7917
ISSN	1025-496X
DOI	10.2807/1560-7917.ES.2020.25.22.2000921
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Article ; Online: Experience with open schools and preschools in periods of high community transmission of COVID-19 in Norway during the academic year of 2020/2021.

Stebbings, Sara / Rotevatn, Torill Alise / Larsen, Vilde Bergstad / Surén, Pål / Elstrøm, Petter / Greve-Isdahl, Margrethe / Bjordal Johansen, Tone / Astrup, Elisabeth

medRxiv

Abstract: ... Background ... Schools and preschools have largely remained open in Norway throughout the pandemic, with flexible mitigation measures in place. This contrasts with many other high-income countries that closed schools for long periods of time. Here we ... ...

Abstract	Background Schools and preschools have largely remained open in Norway throughout the pandemic, with flexible mitigation measures in place. This contrasts with many other high-income countries that closed schools for long periods of time. Here we describe cases and outbreaks of COVID-19 in schools and preschools during the academic year 2020/2021, to evaluate the strategy of keeping these open with infection prevention control measures in place. Methods In this descriptive study, the Norwegian Institute of Public Health initiated systematic surveillance for COVID-19 cases and outbreaks in schools and preschools in October 2020. Data was compiled from the national outbreak alert system VESUV, municipality websites, and media scanning combined with the national emergency preparedness register Beredt C-19. An outbreak was defined as ≥2 cases among pupils or staff within 14 days at the same educational setting. Settings were categorized as preschool (1-5-years), primary school (6-12-years), lower secondary school (13-15-years) and upper secondary school (16-18- years). We reported the incidence rate among preschool and school-aged pupils and gave a descriptive overview of outbreaks and included cases per educational setting. Results During the whole academic year, a total of 1203 outbreaks in preschools and school settings were identified, out of a total of 8311 preschools and schools nationwide. The incidence of COVID-19 in preschool- and school-aged children and the rates of outbreaks in these settings largely followed the community trend. Most of the outbreaks occurred in primary schools (40%) and preschools (25%). Outbreaks across all settings were mostly small (median 3 cases, range 2 to 72), however, 40 outbreaks (3% of total) included 20 or more cases. The larger outbreaks were predominantly seen in primary schools (43%). Conclusions We observed few large outbreaks in open schools and preschools in Norway during the academic year of 2020/2021, also when the Alpha variant was predominant. This illustrates that it is possible to keep schools and preschools open even during periods of high community transmission of COVID-19. Adherence to targeted IPC measures adaptable to the local situation has been essential to keep educational settings open, and thus reduce the total burden on children and adolescents.
Keywords	covid19
Language	English
Publishing date	2021-11-17
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2021.11.16.21265186
Database	COVID19

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Article ; Online: Transmission of SARS-CoV-2 in Norwegian schools: A population-wide register-based cohort study on characteristics of the index case and secondary attack rates

Rotevatn, Torill Alise / Larsen, Vilde Bergstad / Johansen, Tone Bjordal / Astrup, Elisabeth / Suren, Paal / Greve-Isdahl, Margrethe / Telle, Kjetil Elias

medRxiv

Abstract: Objectives: To assess transmission of SARS-CoV-2 in schools mainly kept open during the COVID-19 pandemic. Design: Population-wide register-based cohort study. Setting: Primary and lower secondary schools in Norway have been open during the academic year ...

Abstract	Objectives: To assess transmission of SARS-CoV-2 in schools mainly kept open during the COVID-19 pandemic. Design: Population-wide register-based cohort study. Setting: Primary and lower secondary schools in Norway have been open during the academic year 2020/2021 with strict infection prevention and control (IPC) measures in place. All identified contacts including student and staff members were urged to get tested following a positive SARS-CoV-2 case in a school. Participants: All students and educational staff in Norwegian primary and lower secondary schools from August 2020 to June 2021. Main outcome measures: Overall secondary attack rate (SAR14) was operationalized as the number of secondary cases (among students and/or staff) in the school by 14 days after the index case, divided by the number of students and staff members in the school. Moreover, we calculated SAR14-to-students, denoting transmission from all index cases to students only, SAR14-to-school staff, denoting transmission from all index cases to staff members only. We also calculated these measures in stratified samples consisting of student index cases or school staff index cases. Results: From August 2020 to June 2021 there were 4,078 index cases, 79% were students and 21% were school staff. In the majority (55%) of schools with an index case, no secondary cases were observed by 14 days, and in 16% of the schools there were only one secondary case within 14 days. Overall SAR14 was found to be 0.33% (95%CI 0.32-0.33). Staff-to-staff transmission (SAR14 0.45%, 95%CI 0.40-0.52) was found to be slightly more common than student-to-student (SAR14 0.33%, 95%CI 0.32-0.34) and student-to-staff (SAR14 0.28%, 95%CI 0.25-0.30) transmission. Conclusions: Our results confirm that schools have not been an important arena of transmission of SARS-CoV-2 in Norway and therefore support that schools can be kept open with IPC measures in place.
Keywords	covid19
Language	English
Publishing date	2021-10-07
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2021.10.04.21264496
Database	COVID19

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