bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of nosocomial infections in two Latvian hospitals.
Authors: Dumpis U , Balode A , Vīgante D , Narbute I , Valinteliene R , Pïrags V , Martinsons A , Vingre I
Published: October 2017

The first point prevalence survey of the nosocomial infection (NI) rate was conducted in two Latvian hospitals. At the time of the survey 17.5% (226/1291) patients had symptoms or were being treated for infection. The overall prevalence rate was 5.6% (72/1291) for NI and 12.7% for community acquired infections (164/1291). Surgical site infection (SSI) was the most common NI (62%) followed by respiratory tract infection (RTI) (7.5%), and urinary tract infection (UTI) (6.4%). NI rate was higher with increasing age of patients, in intensive care units and surgical wards, and among those who had an intravenous device or urinary catheter. Microbiological investigation yielded positive results in 29% (21/72) of patients with NIs. Antibacterial treatment was given to 22.3% (288/1291) of hospitalised patients and in 62% (182/288) of these, cefazolin was prescribed. Results from this study will be used to plan a national prevalence survey.
Surveillance of screening for hepatitis C through the laboratory network RENA-VHC, France, 2000-2001
Authors: Meffre C , Larsen C , Perin A , Bouraoui L , Delarocque Astagneau E
Published: October 2017

Over the period 2000-2001, 189 private or hospital laboratories scattered throughout France participated to the laboratory network RENA-VHC. A total of 759 591 serologies (screening tests and validation of screening
tests) were performed, revealing an increase of 10% between 2000 and 2001. The rate of the amount of tests
to validate screening found positive over the overall amount of tests performed was 1.2% in 2000 and 1.0%
in 2001. This suggests that screening covered more people with little risk of acquiring HCV infection. The per-sons
confirmed HCV positive were predominantly men (sex ratio 1.5) of which 31% were30 to 39 years of age.
WHO European Region's strategy for elimination of measles and congenital rubella infection
Authors: Hanon F X , Spika John J. , Wassilak Steven S. , Emiroglu N
Published: October 2017

The WHO strategy for measles elimination in Europe includes the strengthening of surveillance and immunisation programmes in collaboration with European specific networks (EUVAC.NET and CCEE-Baltic) and Member States.
Vaccine coverage of pre-school age children in France in 2000
Authors: Antona D , Bussière E , Guignon N. , Badeyan G , Lévy-Bruhl D
Published: October 2017

This article presents results of the main measures on
vaccine coverage carried out in France in children up
to six years of age. Vaccine coverage is very high for
diphtheria, tetanus, pertussis, and poliomyelitis, and
satisfactory for vaccination against Haemophilus influen-zae
b invasive infections. It will be necessary, however,
to increase vaccine coverage against measles, mumps
and rubella in infants and to ensure efficient catch up.
Hepatitis B vaccine coverage is deficient in infants and
could be improved when the vaccine is available in a
combined form.
Two outbreaks of Salmonella Enteritidis phage type 8 linked to the consumption of Cantal cheese made with raw milk, France, 2001
Authors: Haeghebaert S , Sulem P , Deroudille L , Vanneroy-Adenot E. , Bagnis O , Bouvet P , Grimont F , Brisabois A , Hervy C. , Espié E , de Valk H ,   F Le Querrec,   V Vaillant
Published: October 2017

Salmonelloses are one are the main causes of foodborne infections in industrialised countries. In France, the incidence of human salmonellosis recorded by the National Reference Centre for Salmonella and Shigella (CNRSS) in 2001 was 21 cases per 100 000 inhabitants, and Salmonella serotype Enteritidis represented 39% of cases (1).
This article reports the investigation results of two community outbreaks of salmonellosis that occurred simultaneously in the south west of France, and which were linked to the consumption of cheese made from raw milk.
Incidence of AIDS cases in Spanish penal facilities through the capture-recapture method, 2000
Authors: Acin E , Gomez P. , Hernando P. , Corella I
Published: October 2017

Three available sources of information used in the surveillance of AIDS in Spanish prisons were used to carry out a capture-recapture study. Results showed the register of AIDS cases (RCS) considerably underestimates the incidence of this disease in prisons as it covers only 50% of cases. This study highlights the need to use additional sources to the RCS to evaluate the real incidence of AIDS in prisons in Spain.
Nosocomial outbreak of scabies in a hospital in Spain
Authors: Larrosa A. , Cortés-Blanco M , Martinez S. , Clerencia C , Urdaniz L  J , Urban J , Garcia J
Published: October 2017

An outbreak of scabies occurred in a ward of a local hospital in Barbastro (Huesca, Spain), between November 2002 and January 2003. The outbreak was linked to a patient infested with mites when he was admitted to the ward on 1 November 2002. The first case had onset of symptoms on 5 November and the last one on 5 January 2003. Seventeen cases were reported: 11 healthcare workers (HCWs) and six patients.The outbreak was attributed to a delay in diagnosis, and lack of individual protection measures by caregivers. The use of short-sleeved coats is an habitual risk practice in this ward. Contact with fomites, animals, infested clothes or intimate contact with people other than their usual partners were dismissed as risk factors for the infestation. The different groups of caregivers in this ward presented a similar risk of becoming infested, and the mechanism of transmission was probably person to person contact. The implementation of specific guidelines for scabies prevention and treatment, as well as an active surveillance system, were fundamental to the control of this outbreak.
Surveillance of human Campylobacter infections in France - Part 2 - Implementation of national surveillance
Authors: Gallay A , Simon F , Mégraud F.
Published: October 2017

In 2001, one year after the study of microbiological laboratories that showed the feasibility of a surveillance of Campylobacter infections, 1389 private laboratories were asked whether they would be willing to participate. The high proportion of positive responses (48%, 661) allowed the implementation on 1 April 2002 of surveillance of human Campylobacter infections.
The 11th International Workshop on Campylobacter, Helicobacter and related Organisms (CHRO), 2001
Authors: Takkinen J , Ammon A
Published: October 2017

Over 700 participants from 54 countries attended the eleventh Campylobacter, Helicobacter and Related Organisms (CHRO) meeting in September 2001. This meeting was an opportunity to update and better understand the microbiological and epidemiological complexities of Campylobacter. The mechanism of pathogenesis of this bacteria is not yet fully understood and important progress was made in the microbiological characterisation. The availibility of over 100 different strain characteristics from various locations all over Europe, brought together by Campynet, is an invaluable tool for achieving this aim.
There is increasing evidence to suggest that different risk factors exist for different species of Campylobacter. The link between antibiotic use in farm animals and increased resistance to some antimicrobials for humans still needs to be proved and some contradictory results reported on this issue.
Early influenza in Europe and SARS escaping from high security laboratories !
Authors: Desenclos J C
Published: October 2017

In this issue, Radun et al report a retrospective investigation of SARS in 21 German guests who stayed at Hotel 'M' in Hong Kong between 21 February and 3 March 2003 (1). They were able to identify retrospectively an unrecognized case of SARS in a patient who stayed on the ninth floor on the night of 21-22 February (the same floor as the symptomatic physician who had acquired SARS in Guangdong province, China).
How Europe is facing up to antibiotic resistance
Authors: Struelens M J
Published: October 2017

In this issue, Witte and colleagues report on the emergence, since 2002, of cases in Germany of infection with community-acquired methicillin-resistant Staphylococcus aureus (c-MRSA) producing the Panton-Valentine leukocidin. This report adds evidence to the rapid geographical dissemination of this emerging, hyper-virulent variant of an 'old pathogen' across Europe. First reported in the early 1990s among aboriginal populations in Western Australia, outbreaks of c-MRSA infections have more recently been described in population groups such as prison inmates, injecting drug users, sports teams and schoolchildren, in the United States and Europe. Current evidence from molecular studies points to the spread in each continent of a limited number of PVL-producing MRSA clones that are genetically distinct from epidemic nosocomial strains. This represents a public health threat, because these strains are associated with severe soft tissue and pulmonary infection and the outcome of MRSA infection is worse than with infection caused by beta-lactam susceptible S. aureus, especially if inappropriately treated with beta-lactams that are usually prescribed for these infections. We must, therefore, upgrade the diagnostic work-up for this kind of infection in the outpatient setting and adapt empirical therapy accordingly. Moreover, surveillance should be intensified to monitor the incidence of MRSA and detect and control outbreaks in the community. In this respect, the report by Witte et al underscores the important early warning role that reference laboratories can play by using high resolution molecular markers based on routine typing and susceptibility data.
Methods for sentinel virological surveillance of influenza in Europe - an 18-country survey
Authors: Meerhoff T J , Meijer A , Paget W J ,   on behalf of EISS
Published: October 2017

The European Influenza Surveillance Scheme (EISS) is based on an integrated clinical and virological surveillance model. To assess the comparability of virological data, a questionnaire was sent to participants in June 2002 enquiring about specimen collection, laboratory diagnosis of influenza and tests for other respiratory infections. The results showed differences, but also uniformity in virological data collection methods. Similarities were reported for the specimen collection procedures; the type of swab and the transport conditions were comparable. The diagnostic methods were diverse; differences were seen in the (sub)typing methods, with PCR used most often in western countries. The findings will be helpful for the interpretation of virological data collected by sentinel physicians and for the creation of a Community Network of Reference Laboratories for Human Influenza in Europe. Important objectives of the Community Network include the harmonisation of virological methods and the application of quality assurance assessments for the national reference laboratories.
European Surveillance of Travel Associated Legionnaires' Disease
Authors: Joseph C
Published: October 2017

Disease acquired in one country but diagnosed and reported in another, necessitates international cooperation if it is to be controlled, investigated and further cases prevented. The European surveillance scheme for travel associated legionnaires' disease (EWGLINET) was established in 1987 to operate in this type of context and has been highly active in sharing information and coordinating its actions since then. In July 2002 European guidelines were introduced by EWGLINET that have standardised the response to clusters across most countries in Europe. Three papers presented in this special issue show how the guidelines have been successfully adopted in France (1), Italy (1) and Spain (2), despite the additional workload associated with their implementation. The paper from the coordinating centre in London provides an overview of EWGLINET results in 2002.
Legionnaires´ disease clusters associated with travel to Spain during the period January 2001 to July 2003
Authors: Cano R , Prieto N , Martin C , Pelaz C , Mateo S
Published: October 2017

Epidemiological surveillance and control of travel associated cases of legionnaires´ disease are necessary tasks for public health and collaboration between countries is necessary to do this. Within the framework of the European Surveillance Scheme for Travel Associated Legionnaires' Disease (EWGLINET), European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease have been produced . This has established the reporting and response criteria when cases or clusters appear. In this paper the analysis of the information corresponding to the 46 reported clusters related to Spain is presented. Data corresponds to the period January 2001 to July 2003.
Gastrointestinal illnesses in tourists: whose responsibility?
Authors: Cartwright R
Published: October 2017

Improvements in public health and the control of communicable diseases throughout Europe have been achieved due to the multidisciplinary approach and not only as a result of efforts of public health physicians. The conclusions of the Spanish team that studied the outbreak of gastroenteritis in tourists visiting the Dominican Republic provides a good example of the need for both cross discipline and international cooperation. Tourism is one of the top three global economic forces, with an increasing number of tourists each year. It is estimated that there are over 70 million package holidays sold in Europe annually with destinations worldwide. The tourists are exposed to a wide range of conditions and pathogenic organisms.
Foodborne outbreaks in northern Portugal, 2002
Authors: Correia A  M , Gonçalves G , Saraiva Margarida
Published: October 2017

In October 2001, foodborne outbreaks (FBO) were included in the Portuguese alert and response surveillance system. Accordingly, the northern regional health authority (Delegado Regional de Saúde do Norte - DRSN) began a surveillance programme of foodborne outbreaks. This report is a brief description of data generated from this programme in 2002. For each foodborne outbreak the local health authority (Delegado de Saúde Concelhio - DSC) produced a written report. Fifty-nine percent of the 27 FBOs studied by DSCs during 2002 were reported within 72 hours after the date of onset. Five hundred and seventy seven people became ill, 9.6% of the patients were admitted to hospital, and no deaths were reported. The aetiological agent was identified from patients in 63% of FBOs, and in food items in 18.5% of the situations. Salmonella enterica was responsible for 73.7% of the outbreaks in which the agent was laboratory confirmed. Meals implicated in the outbreak were mainly prepared in restaurants and private homes (75.0% of FBO). Inadequate processing, preparing or handling of foods were the contributing factors more often reported by the DSC. We believe that epidemiological surveillance and control of FBO must be reinforced in Portugal as part of a wider strategy to promote food safety.
Prevention of congenital rubella infection: a challenge for every country in Europe
Authors: Crowcroft N , Pebody R G
Published: October 2017

The current issue of Eurosurveillance provides the common theme of the epidemiology and control of congenital rubella infection (CRI) across Europe. It provides a stark reminder that despite the availability of a safe and effective vaccine for many years, CRI - the consequence of rubella infection during pregnancy, remains an important public health problem both in the European Union and the wider WHO European Region. The following articles outline the various operational challenges facing national immunisation programmes in Europe. They vividly illustrate large differences in disease burden and inequalities in access to preventive health services both between and within countries. Four groups of countries can be distinguished.
Rubella in England, Scotland and Wales
Authors: Tookey P
Published: October 2017

Rubella vaccine was offered to schoolgirls in the United Kingdom (UK) from 1970, with antenatal testing and postpartum vaccination for susceptible women introduced during the 1970s. Mass vaccination with MMR of children aged 12-15 months was introduced in 1988; schoolgirl vaccination was discontinued in 1996 and replaced by a second dose of MMR for pre-school children; postpartum vaccination of susceptible women identified through antenatal testing continues. Rubella was made a notifiable disease in 1988, and is monitored through clinical and laboratory reports; data are available on rubella associated terminations and congenital rubella syndrome(CRS) births, rubella susceptibility in population subgroups, and vaccine uptake. Reported cases of CRS declined from about 50 a year 1971-75 to just over 20 a year 1986-90, and rubella associated terminations from an average of 750 to 50 a year. About 40 infants with CRS have been reported since 1991; about a third of their mothers were infected abroad, most in their country of origin (imported infections), a third were born abroad but acquired infection in the UK, and a third were UK-born. Women living in the UK who were born abroad have much higher rubella susceptibility rates than UK-born women. Although there is currently very little rubella infection circulating, uptake of MMR has dropped by over 10% since 1995. If rubella starts to circulate again, immigrant women will be at increased risk of acquiring infection in pregnancy.
Strengthening early warning function of surveillance in the Republic of Serbia: lessons learned after a year of implementation
Authors: Valenciano M , Bergeri I , Jankovic D , Milic N , Parlic M , Coulombier D
Published: October 2017

The Republic of Serbia, with WHO support, has implemented an early warning system (ALERT) for priority communicable diseases, to complement the routine surveillance system which notifies individual confirmed cases.
The results of its evaluation, conducted one year after implementation is presented here. ALERT relies on notification of 11 syndromes by primary care facilities. Data is analysed weekly at district level and transmitted to national epidemiologists. ALERT is perceived to be a simple and flexible tool. Acceptability is higher at national level than at district level. Some districts perceive ALERT as a parallel system poorly connected to control measures. Sensitivity of ALERT in detecting cases of meningitis is 93%, and 37% for cases of hepatitis. Retrospective analysis of ALERT data identified 9 outbreaks, 5 of which had been recognized by epidemiologists. ALERT was the timeliest system for detecting 4 outbreaks identified by both systems. ALERT was useful for triggering timely investigation and control of outbreaks of hantavirus and salmonellosis and for detecting the start of the influenza season.
However, ALERT did not detect clusters of brucellosis and tularaemia targeted by the unexplained fever syndrome. This evaluation underlined the need for a global review of surveillance activities when implementing new components such as ALERT. While control measures based on notification of individual confirmed cases are well understood and implemented, the investigation and verification process that should result from an increase in ALERT syndromes is not fully understood.
Field epidemiology training programmes, such as the EPIET programme, are best suited to bring about this change of perspective.
Outbreak of Clostridium histolyticum infections in injecting drug users in England and Scotland
Authors: Brazier J  S , Gal M , Hall V , Morris T E
Published: October 2017

Clostridial infections in injecting drug users in the United Kingdom are a relatively new phenomenon that came to light in 2000 when cases of serious illness and deaths due to Clostridium novyi were recorded. In the period December 2003 to April 2004, the Anaerobe Reference Laboratory received twelve referrals of an extremely rare isolate, Clostridium histolyticum, from cases of infection in injecting drug users submitted from nine different hospitals in England and Scotland. Molecular typing of these isolates by two different methods of pulsed-field gel electrophoresis and PCR ribotyping revealed they are all indistinguishable, indicating a common source of the infections, most probably a batch of heroin that was recently distributed across the UK.
Travellers returning to Sweden as sentinels for comparative disease incidence in other European countries, campylobacter and giardia infection as examples
Authors: Ekdahl K , Giesecke J
Published: October 2017

Comparable figures on disease incidence between countries are difficult to attain. We therefore compared risk of infection for Swedes going to other European countries. We took as the numerator the number of imported cases from European countries of campylobacter and giardia infection in the national Swedish surveillance database, and as the denominator, the number of visitors to each country from a commercial database on foreign travel. Risk of infection in tourists was also compared to national incidence figures for a selection of countries.
The European Centre for Disease Prevention and Control
Authors: Gouvras G
Published: October 2017

The start-up event for the European Centre for Disease Prevention and Control took place in Stockholm on 27 September 2004. In terms of surveillance and control of communicable disease in the European Union, it marked the beginning of a new era.
Perspectives for a European Centre for Disease Prevention and Control
Authors: Kokki M , Haigh R
Published: October 2017

On 30 March the Council finally put its seal on the Regulation setting up a new European Centre for Disease Prevention and Control. Negotiations, from the Commission's proposal in July 2003 to final agreement by both the European Parliament and the Council took just eight months. This might not be a record for agreeing new EU legislation, but in terms of the type of legislation involved - setting up a new Community body with all that entails for permanent funding and obligatory participation by Member States - it probably is. Now comes the next phase - the practical implementation of the Regulation. First amongst the priorities will be the choice of Director and the site in Stockholm. The Regulation sets out an ambitious series of requirements to make the Centre operational by May 2005 - making arrangements for the Management Board, organising the work programme for 2005, and putting in place many organisational requirements.
Travel Associated Legionnaires' Disease in Europe : 2003
Authors: Ricketts K D , Joseph C ,   on behalf of the European Working Group for Legionella Infections
Published: October 2017

Six hundred and thirty two cases of travel-associated legionnaires' disease with onset in 2003 were reported to the EWGLINET surveillance scheme by 24 countries. Eighty nine clusters were detected, 35 (39%) of which would not have been detected without the EWGLINET scheme. One hundred and seven accommodation sites were investigated and 22 sites were published on the EWGLI website. The proportion of cases diagnosed primarily by the urinary antigen test was 81.2%, and 48 positive cultures were obtained. Thirty eight deaths were reported to the EWGLINET scheme, giving a crude fatality rate of 6%. Countries are encouraged to inform the coordinating centre of cases that fall ill after travelling within their own country of residence ('internal travel'), and are also encouraged to obtain patient isolates for culture where at all possible.
Dramatic shift in the epidemiology of Salmonella enterica serotype Enteritidis phage types in western Europe, 1998-2003 - results from the Enter-net international salmonella database
Authors: Fisher I. S.T.
Published: October 2017

Salmonella enterica serotype Enteritidis is the predominant salmonella serovar identified by the Enter-net national reference laboratories in western Europe. As it is the most commonly recognised serotype, it is important that phage typing is carried out so that outbreaks can be recognised and confirmed, and trends in infections identifed. Data from the Enter-net salmonella database show that there has been a dramatic shift between phage types identified in Europe from 1998-2003. In 1998, the proportion of phage type (PT) 4 was 61.8%, making it the most frequently identified phage type in humans (21 630 cases), whereas by 2003 the proportion of PT4 had fallen to 32.1% (8794 cases) with other strains increasing, both in proportion and numbers. This paper identifies the emerging strains that are becoming more relevant in public health terms.
ECDC and WHO: a common mission for better health in Europe
Authors: Danzon M
Published: October 2017

With the opening of the European Centre for Disease Prevention and Control (ECDC) in Stockholm in May, 2005 will be an important year for public health in Europe. The idea of a European CDC has been in the air for many years, following the successful and interesting results obtained by the United States CDC in Atlanta.
A multilevel approach to understanding the resurgence and evolution of infectious syphilis in Western Europe
Authors: Fenton K
Published: October 2017

Nearly eight years after an outbreak of infectious syphilis was first reported in Bristol, England, successive outbreaks have occurred in most western European countries. In this issue of Eurosurveillance we take a look at the recent resurgence and evolution of infectious syphilis in seven European countries in order to critically review our understanding of its epidemiology, and to examine opportunities for directing interventions in the near future. The papers also provide some insight into the multilevel, multifactorial causation of syphilis epidemics, and how this may be changing over time in the presence of preventive interventions.
Recent syphilis trends in Belgium and enhancement of STI surveillance systems
Authors: Sasse A , Defraye A , Ducoffre G
Published: October 2017

Over the past five years, a series of syphilis outbreaks mainly occurring among gay men have been observed in Europe. One of these outbreaks was reported in the city of Antwerp, Belgium, during the first quarter of 2001. This outbreak is still ongoing in 2004. Furthermore, active syphilis diagnoses reported by the Sentinel Laboratory Network rose by 89% in the country during the fourth quarter of 2003. An increase in Brussels was also observed during the same quarter (+300%; 24 cases reported). Overall, the sentinel network of clinicians reported that 93.4% of patients were male; among them, 79.9% were men having sex with men (MSM). The overall proportion of patients co-infected with HIV was 50.5% (MSM: 58.6%; male heterosexuals: 23.8%; females: 8.3%); 76.1% of co-infected patients were already aware of their HIV infection at the time they were diagnosed with syphilis.
Syphilis and gonorrhoea in the Czech Republic
Authors: Zákoucká H , Polanecký V , Kaštánková V
Published: October 2017

Syphilis remains a public health problem in the Czech Republic and worldwide. The Czech Republic - until 1993 a part of Czechoslovakia - has a long tradition in public health activities, and STI surveillance is mainly focused on the infections traditionally called venereal diseases - syphilis, gonorrhoea, chancroid, and lymphogranuloma venereum. Campaigns from the early 1950s, were successful in controlling syphilis and gonorrhoea; and chancroid and lymphogranuloma venereum infections are extremely rare. In late 1980s, a low incidence of newly reported syphilis cases was achieved (100-200 cases annually), while around 6500 cases of gonorrhoea were recorded annually during the same period. Health care and prevention of STI diseases in the Czech Republic are based on close cooperation between clinical departments and laboratory and epidemiological services of Environmental Health Offices. Annual statistics showing data on reported cases of ’venereal diseases’, based on ICD-10 codes, are available from 1959. Separate statistical data on other STIs are not available, and aggregated numbers only for Chlamydia trachomatis infections have been presented annually since 2000. Following the political and social changes in the Czech community in 1989, a distinct increase of syphilis was recorded. Between 50% and 60% of notified cases were classified as late latent or of unknown duration. The continuing annual occurrence of congenital syphilis (7-18 cases per year) reported during the 1990s has also been a very serious phenomenon. Cases have been concentrated in large urban areas with a high level of commercial sex activity, and a high proportion of cases is also noted in refugees. While the annual incidence of gonorrhoea gradually decreased from 1994 to 2001 (from 28.5 to 8.9 per 100 000 population), the incidence of syphilis increased in this period from 3.6 to 9.6 per 100 000 population (the highest value was 13.4 in 2001) and in 2000, for the first time in many years, it exceeded the incidence of gonorrhoea.
Syphilis in Denmark–Outbreak among MSM in Copenhagen, 2003-2004
Authors: Cowan S  A
Published: October 2017

Denmark is currently experiencing an outbreak of syphilis that began in 2003 and has continued in 2004. Data from the national surveillance system show that most cases are in men who have sex with men (MSM), and that a large proportion of these patients are also HIV positive. The proportion of known HIV positive cases in MSM notified with syphilis during the outbreak has, however, not been significantly different from previous years. The majority of cases were reported from Copenhagen municipality, and 70% of the cases were acquired domestically. The outbreak does not seem to be affecting the age group under 20 years. We speculate that most of the MSM found with both syphilis and HIV were already HIV positive when they acquired syphilis infection.
Varicella zoster virus vaccination policies and surveillance strategies in Europe
Authors: Pinot de Moira A , Nardone A ,   On behalf of the ESEN2 group
Published: October 2017

The incorporation of varicella zoster virus (ZVV) vaccination in childhood immunisation schedules is becoming an increasingly common option in Europe. The current study forms part of the European Sero-Epidemiology Network 2 (ESEN2) organisational analysis for VZV and describes current passive immunisation policies, as well as current and proposed active immunisation strategies, and existing surveillance systems for diseases caused by the varicella zoster virus in ESEN countries.
Epidemiological and virological assessment of influenza activity in Europe during the 2003-2004 season
Authors: Paget W J , Meerhoff T J , Meijer A ,   on behalf of the EISS
Published: October 2017

The 2003-2004 influenza season in Europe was dominated by the spread of the new drift variant A/Fujian/411/2002 (H3N2)-like virus which was not perfectly matched with the A(H3N2) component of the influenza vaccine. Sporadic cases of this virus were detected in Europe at the end of the 2002-2003 season and influenza activity associated with this virus began relatively early during the 2003-2004 season. Generally, influenza activity first occurred in the west of Europe (Ireland, the United Kingdom and the Iberian Peninsula) in October/November and gradually moved east across Europe, affecting Latvia, Lithuania and Poland during the months of January and February 2004. In general, the intensity of clinical activity was higher than during the 2002-2003 season (in 13 out of 20 networks) and, in countries reporting age specific data, the highest consultation incidences were observed among children aged 0-14. However, despite the emergence of the A(H3N2) drift variant, clinical incidences were not especially high compared with historical data. The composition of the 2004-2005 influenza vaccine has been modified compared with the 2003-2004 season and includes an A/Fujian/411/2002 (H3N2)-like virus strain and a new B virus strain (a B/Shanghai/361/2002-like virus).
Infectious diseases surveillance activities in the North of Portugal, during the EURO 2004 football tournament
Authors: Gonçalves G , Castro L , Correia A  M , Queirós Laurinda
Published: October 2017

A European football tournament (EURO 2004) took place in Portugal, from the 12 June to the 4 July 2004. Portugal’s Northern Regional Health Authority serves a population of 3.2 million people. This region hosted 12 matches, more than any other region. We describe the communicable disease surveillance activities in the region, during EURO 2004. Ten foodborne outbreaks, seven cases of meningococcal disease and one case of legionnaires’ disease, were detected. Visitors were not affected, furthermore, cases among residents seemed not to be influenced by the presence of thousands of visitors. A similar pattern has been observed at other mass gatherings where special surveillance activities were implemented. This does not reduce the importance of public health surveillance during such mass gatherings. Furthermore, evaluation of this special activities should be an opportunity to put, issues of communicable disease surveillance resources, priorities, organisation and training back on the agenda.
Hepatitis A outbreak among MSM linked to casual sex and gay saunas in Copenhagen, Denmark
Authors: Mazick A , Howitz M , Rex S , Jensen I  P , Weis N , Katzenstein T L , Haff J , Mølbak K
Published: October 2017

During an outbreak of hepatitis A predominantly among men who have sex with men (MSM) in Copenhagen, Denmark, in 2004, we did a case-control study to determine risk factors for infection. A case was an MSM >17 years, living in Copenhagen, with IgM positive hepatitis A infection diagnosed between June and August 2004, and without a household contact with a hepatitis A case before onset of illness. Controls were selected at the Copenhagen Pride Festival. The study included 18 cases and 64 controls. Sixteen of 18 cases and 36/63 controls had sex with casual partners (ORMH 5.6, 95% CI 1.2-26.9). Eleven of 18 cases and 14/62 controls had sex in gay saunas (ORMH 4.2, 95% CI 1.5-11.5). Sex at private homes appeared to be protective (ORMH 0.2, 95% CI 0.1-0.7). Casual sex including sex in gay saunas was an important risk factor for the spread of HAV among MSM in Copenhagen. The results are in accordance with findings in other European outbreaks. As the general immunity to hepatitis A decreases and the outbreak potential increases, we recommend health education and hepatitis A vaccination to all MSM not living in monogamous relationships, especially if they visit gay saunas or other places with frequent partner change. To stop spread of hepatitis A among MSM in Europe, a European consensus on prevention and control measures may be required.
Quality assurance for the diagnostics of viral diseases to enhance the emergency preparedness in Europe
Authors: Donoso-Mantke O , Schmitz H , Zeller H , Heyman P , Papa A , Niedrig M
Published: October 2017

The threat posed by emerging and re-emerging communicable diseases and, more recently, by the intentional release of infectious agents in a susceptible population, has been receiving considerable attention at the national and international levels. Public health efforts to strengthen disease detection, surveillance and control have been intensified. However, clinicians and clinical microbiology laboratories play an important role in the early detection of disease, the identification of the putative agent, and notification of the appropriate authorities. To be effective in this role, laboratories must be specially prepared to handle viral agents safely, and need, among other things, the appropriate rapid and sensitive diagnostic tests. In 1998 the European Network for Diagnostics of “Imported” Viral Diseases (ENIVD) was established. ENIVD presently comprises, as permanent members, 44 expert laboratories in 21 European Union (EU) member states and 4 non-EU countries and is one of the networks on infectious diseases funded by the European Commission. ENIVD fulfils many of the important tasks required for the surveillance and control of imported, rare and emerging viral infections such as the exchange of expertise and the organisation of external quality assurance (EQA) programmes, both of which are needed to improve diagnostics. Here, we summarise the data generated by recent EQA activities focussed on the diagnostics of infections with hantavirus, dengue virus, filovirus, Lassa virus, orthopox virus and the SARS-coronavirus (SARS-CoV). These were carried out between 1999 and 2004 and involved 93 laboratories from 41 countries, including laboratories from additional countries outside of Europe. Particularly the EU-candidate countries and Eastern neighbouring countries will be invited to join the network in the near future. A public website is available at http://www.enivd.de.
High sensitivity for tuberculosis in a national integrated surveillance system in Finland
Authors: Kokki M , Holmström P , Ruutu P
Published: October 2017

Little is known about the sensitivity of surveillance for tuberculosis after integration of formerly dedicated tuberculosis surveillance and control into the general health care system, an integration which took place in Finland in 1987. We compared routine laboratory notifications to the National Infectious Disease Register (NIDR) for Mycobacterium tuberculosis from January 1, 1995, to December 31, 1996, with data collected independently from all laboratories offering M. tuberculosis culture, and with data from patient records. 1059 culture-positive cases were found. The overall sensitivity of the NIDR was 93 % (984/1059). The positive predictive value of a culture-positive case in the NIDR to be a true culture-confirmed case was 99%. For the culture-confirmed cases in the NIDR, one or more physician notification forms had been submitted for 89%. A highly sensitive notification system for culture-positive tuberculosis can be achieved in an integrated national infectious disease surveillance system based on laboratory notification.
Surveillance of antimicrobial resistance in Bulgaria - a synopsis from BulSTAR 2003
Authors: Petrov M , Hadjieva N , Kantardjiev T , Velinov Tz , Bachvarova A
Published: October 2017

We introduce Bulgarian Surveillance Tracking Antimicrobial Resistance (BulSTAR) and make the first report on surveillance data for 2003. This longitudinal surveillance programme monitors the isolation and antimicrobial susceptibility of all clinically significant microorganisms isolated from blood cultures, cerebrospinal fluid, upper and lower respiratory tract, urine and wound samples in the participating microbiology laboratories. Twenty eight public, 45 hospital and 6 private laboratories from all 28 counties of the Republic of Bulgaria participated in BulSTAR 2003. The total number of isolates from monitored sources during the surveillance period was 98 929. Seven microorganisms represented 72% of all isolated bacteria in BulSTAR 2003: Escherichia coli, Staphylococcus aureus, Proteus-Providencia-Morganella group, Klebsiella spp., Pseudomonas spp, Streptococcus pneumoniae and Streptococcus pyogenes. Generally the resistance of clinically significant Gram positive and Gram negative bacteria in Bulgaria was estimated to be at a medium level when compared with many other surveillance sources worldwide. A unique 32-year experiment on the population by treating all severe infections with an ampicillin/gentamicin combination resulted in twofold higher levels of resistance to amynoglycosides compared with other countries worldwide. This is due to the extremely conservative treatment schemes used in the former socialist countries, based on national directives and cheap domestic production of gentamicin and ampicillin. The forthcoming introduction of a computer network and improvements in detecting mistakes are expected to increase the sensitivity and the significance of BulSTAR surveillance system - an indispensable tool in the combat against increasing worldwide antibiotic resistance.
Human trichinellosis due to Trichinella britovi in southern France after consumption of frozen wild boar meat
Authors: Gari-Toussaint M , Tieulié N , Baldin J  L , Dupouy-Camet J , Delaunay P , Fuzibet J G , Le Fichoux Y , Pozio E , Marty P
Published: October 2017

Six patients were infected with Trichinella britovi in southern France following consumption of frozen wild boar meat, which had been frozen at -35°C for 7 days. Microscopic examination of a sample of frozen wild boar muscle revealed the presence of rare encapsulated Trichinella larvae, identified as T. britovi. People eating wild boar must follow individual prophylactic rules such as efficient cooking of meat (at least 65°C at the core for 1 minute) as recommended by the International Commission on Trichinellosis, or freezing exceeding four weeks at -20°C.
Mortality in Portugal associated with the heat wave of August 2003: Early estimation of effect, using a rapid method
Authors: Nogueira P J , Falcão J M , Contreiras M T , Paixão E , Brandão J , Batista I
Published: October 2017

During the first two weeks of August 2003, Portugal was affected by a severe heat wave.
Following the identification in Portugal of the influence of heat waves on mortality in 1981 and 1991 (estimated excess of about 1900 and 1000 deaths respectively), the Observatório Nacional de Saúde (ONSA) - Instituto Nacional de Saúde Dr. Ricardo Jorge, together with the Vigilância Previsão e Informação - Instituto de Meteorologia, created a surveillance system called ÍCARO, which has been in operation since 1999. ÍCARO identifies heat waves with potential influence on mortality [1].

Before the end of the 2003 heat wave, ONSA had produced a preliminary estimate of its effect on mortality. The results based on daily number of deaths from 1 June to 12 August 2003 were presented within 4 working days. Data was gathered from 31 National Civil registrars, covering the district capitals of all 18 districts of mainland Portugal, and representing approximately 40% of the mainland’s mortality.

The number of deaths registered in the period 30 July to 12 August was compared with the ones registered during 3 comparison periods: (in July): 1-14 July, 1-28 July, and 15-28 July). 15-28 July, the period best resembling the heat wave in time and characteristics, produced an estimation of 37.7% higher mortality rate then the value expected under normal temperature conditions. From this value, an estimate of 1316 death excess was obtained for mainland Portugal.

The main purpose of this article is to present the method used to identify and assess the occurrence of an effect (excess mortality) during the heat wave of summer 2003.
Summary of the mortality impact assessment of the 2003 heat wave in France
Authors: Pirard P , Vandentorren S , Pascal M , Laaidi K , Le Tertre A , Cassadou S , Ledrans M
Published: October 2017

France experienced a record-breaking heat wave between 2 and 15 August 2003. All the French regions were affected by this heat wave, which resulted in an excess of 14 800 deaths between 1 and 20 August. The increase in the number of excess deaths followed the same pattern as the increase in temperatures. No deviance from the normal death rate was observed in the month of August during the last third of the month, nor during the following three months. There was a clear discrepancy in the impact of the heat wave from city to city. If the effect of duration of consecutive days with high minimal temperatures and deviance with the seasonal normal temperature was patent, this could not explain all of the observed variability of the death incidence. The victims were mainly elderly women older than 75 years. In terms of relative risk and contribution to the global toll, deaths linked to heat were the most important. Based on these results, the French government developed a Heat Health Watch Warning System and set up a preventive action plan for each region in 2004.
Mortality in Spain during the heat waves of summer 2003
Authors: Simon F , Lopez-Abente G , Ballester E , Martinez F
Published: October 2017

The effect of the elevated temperatures on mortality experienced in Europe during the summer of 2003 was observed in several countries. This study, carried out in Spain, describes mortality between 1 June and 31 August and evaluates the effect of the heat wave on mortality.
Observed deaths were obtained from official death registers from 50 provincial capitals. Observed deaths were compared with the expected number, estimated by applying a Poisson regression model to historical mortality series and adjusting for the upward trend and seasonality observed. Meteorological information was provided by the Instituto Nacional de Meteorología (National Institute of Meteorology).
Spain experienced three heat waves in 2003. The total associated excess deaths were 8% (43 212 observed deaths compared with 40 046 expected deaths). Excess deaths were only observed in those aged 75 years and over (15% more deaths than expected for the age group 75 to 84 and 29% for those aged 85 or over). This phenomenon (heat-associated excess mortality) is an emerging public health problem because of its increasing attributable risk, the aging of the Spanish population and its forecasted increasing frequency due to global warming. The implementation of alert and response systems based on monitoring of climate-related risks, emergency room activity and mortality, and strengthening the response capacity of the social and health services should be considered.
Reply to Letter: Outbreaks caused by parvovirus B19
Authors: Gonçalves G , Correia A M , Palminha P , Rebelo-Andrade Helena , Alves A
Published: October 2017

We are grateful for the comments provided by Kelly and Leydon, and Bernard J Cohen. They seem to share our previously expressed opinion that ’in the context of measles and rubella elimination programs, study protocols should include data collection procedures and laboratory tests able to confirm or discard the diagnosis of B19 infections.’ [1]. They have provided a useful commentary with relevant information and references.
Surveillance of listeria infections in Europe
Authors: de Valk H , Jacquet C , Goulet V , Vaillant V , Perra A , Simon F , Desenclos J C , Martin P
Published: October 2017

In addition to the economic consequences and threats associated with outbreaks, listeriosis remains of great public health concern, as it has one of the highest case fatality rates of all the foodborne infections (20%-30%), and has common source epidemic potential. Changes in the way food is produced, distributed and stored have created the potential for diffuse and widespread outbreaks involving many countries.
In 2002, a survey was carried out to assess the need for and the feasibility of a European network on listeria infections in humans. Data on surveillance systems and laboratory methods were collected through two postal surveys sent to the national Centres for communicable disease surveillance and to the listeria reference laboratories. Surveillance systems for listeria infections were in operation in 16 out of the 17 countries surveyed, and 16 countries had a national reference laboratory (NRL). All countries based their case definition of listeriosis on the isolation of Listeria monocytogenes. Fourteen NRLs performed at least one typing method on human strains. At least 13 countries already carried out or expressed willingness to carry out characterisation of isolates by pulsed field gel electrophoresis (PFGE) of L. monocytogenes strains isolated from human cases following a standard protocol. The participants concluded that there was a clear added value to having a European surveillance network for listeria infections, particularly for outbreak detection and investigation, and that a surveillance network based on the existing national surveillance systems was feasible.