Background: The Project on a Framework for Rating Evidence in Public Health (PRECEPT) is a collaboration between European public health agencies and academic institutions. It aims at defining a framework for evaluating and grading evidence in the field of infectious disease prevention and control. PRECEPT proposes a 4-step approach for the conduct of evidence assessments, comprising question framing (step 1), conduct of systematic reviews (step 2), evidence assessment (step 3) and preparation of evidence summaries (step 4).

Objectives: To test the PRECEPT framework in 2 systematic reviews/evidence assessments in the field of infectious disease prevention.

Methods: We used two case studies to test PRECEPT: 1) Prognostic value of screening for colonisation by gram-negative bacteria for the prediction of neonatal sepsis; and, 2) Effectiveness and safety of influenza vaccination during pregnancy. Following the PRECEPT work flow, we performed systematic reviews, assessed risk of bias and applied GRADE (Grading of Recommendations Assessment, Development and Evaluation).

Results: For case study 1, the systematic review identified 9 studies on sensitivity/specificity of screening for neonatal colonisation. We used QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) to assess risk of bias which was high in all studies. For case study 2, we tested the use existing systematic reviews for the development of new evidence assessments. We identified 4 systematic reviews on the effectiveness and safety of influenza vaccination during pregnancy. AMSTAR (Assessment of multiple systematic reviews) was used to assess their methodological quality, resulting in summary scores of 9-11. GRADE certainty in the evidence was high for efficacy of influenza vaccination during pregnancy against laboratory-confirmed influenza.

Conclusions: Testing PRECEPT showed the suitability of the framework for the development of evidence assessment in infectious disease prevention. However, we also identified areas for further refinement, including the need for detailed guidance on the use of existing systematic reviews and guidance on the how to proceed with prognostic studies.