bluuebunny/crossref_metadata_2025 huggingface dataset:
Update on the new variant of Chlamydia trachomatis: Prevalence and diagnostics
Authors: Herrmann B
Published: March 2021

In 2006, a new variant of Chlamydia trachomatis (nvCT) was discovered in Sweden [1]. Due to a deletion in the target sequence for PCR amplification, nvCT has escaped detection by the nucleic acid amplification tests Abbott m2000 (Abbott Laboratories) and Cobas Amplicor/TaqMan48 (Roche Diagnostics) which together were used for 65% of all chlamydia tests in Sweden. The third test commonly used in Sweden, ProbeTec ET (Becton Dickinson [BD]), does detect the new variant because it uses a different DNA target sequence in the cryptic plasmid. The nvCT is spread all over Sweden and in early 2007, it accounted for between 20% and 65% of all chlamydia cases in Swedish counties where Abbott/Roche test systems were used [2]. In the four counties that used the BD system, the proportion of nvCT was only between 7% and 20% in the same time period. Ongoing studies are now following the spread of the nvCT in several counties.
Publication of report on chlamydia control activities in Europe
Authors: Low N ,   Screening for Chlamydia Review in Europe (SCREen) project team
Published: March 2021

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2008 European Football Championship - ECDC epidemic intelligence support
Authors: Kreidl P , Buxbaum P , Santos-O’Connor F , Payne L , Strauss R , Hrabcik H , Matter H. C. , Dreyfus A , Arias P
Published: March 2021

Mass gathering events may pose an increased risk for outbreak of infectious diseases, and a potential for rapid international spread [1,2]. Even events not considered relevant from the public health point of view can have a big media impact. The European Centre for Disease Prevention and Control (ECDC) has on several occasions given support to the European Union Member States (EU MS) during sporting events such as the Olympic Games and football championships to ensure the rapid detection of possible public health risks [3-6].
Assays for the detection of recent infections with human immunodeficiency virus type 1
Authors: Murphy G , Parry J.  V.
Published: March 2021

The Serological Testing Algorithm for Recent HIV Seroconversion (STARHS) is a generic term for several laboratory techniques that can be used to differentiate recent from long standing infections with human immunodeficiency virus-1 (HIV-1). There are several other approaches that identify acute seroconverters, but STARHS methods are distinguished by their ability to identify infections that occurred during an extended period of 4-6 months prior to sampling. While the STARHS techniques have been employed on an individual basis, their main usefulness lies in the potential of estimating the rate of acquisition of new HIV infection, or incidence, in a population by application to cross-sectional sero-surveys. This is substantially simpler and less expensive than cohort studies. As such, STARHS techniques facilitate the timely monitoring of the impact on HIV incidence of factors such as interventions, demographic factors and behavioural patterns. The major STARHS techniques currently available are described. Furthermore, the principles behind the methods used are discussed and the limitations of the current assays and the confounding factors that may affect assay specificity are described. A model algorithm for the application of a STARHS assay is shown. Finally, we outline recommendations for laboratory quality systems that will improve the efficiency of STARHS testing, reproducibility of results and reliability of incidence estimates.
Monitoring HIV epidemiology using assays for recent infection: where are we?
Authors: Barin F , Nardone A
Published: March 2021

Although all the assays for recent infections have shown limitations, they have been already used in many circumstances to estimate either HIV incidence or, at least, the proportion of recent infection in various populations. Even if they cannot be recommended for routine use worldwide because of insufficient data on their performance to provide precise incidence in different populations, a few studies have already illustrated their usefulness.
Principles and uses of HIV incidence estimation from recent infection testing - a review
Authors: Le Vu S , Pillonel J , Semaille C , Bernillon P , Le Strat Y , Meyer L , Desenclos J  C
Published: March 2021

Since the 1990s, the development of laboratory-based methods has allowed to estimate incidence of human immunodeficiency virus (HIV) infections on single samples. The tests aim to differentiate recent from established HIV infection. Incidence estimates are obtained by using the relationship between prevalence, incidence and duration of recent infection. We describe the principle of the methods and typical uses of these tests to characterise recent infection and derive incidence. We discuss the challenges in interpreting estimates and we consider the implications for surveillance systems. Overall, these methods can add remarkable value to surveillance systems based on prevalence surveys as well as HIV case reporting. The assumptions that must be fulfilled to correctly interpret the estimates are mostly similar to those required in prevalence measurement. However, further research on the specific aspect of window period estimation is needed in order to generalise these methods in various population settings.
Increase in VTEC cases in the south of Ireland: link to private wells?
Authors: O’Sullivan M B , Garvey P , O’Riordan M , Coughlan H , McKeown P , Brennan A , McNamara E
Published: March 2021

High levels of verotoxigenic Escherichia coli (VTEC) have been recorded to date in 2008 in the Republic of Ireland. One hundred and forty-eight VTEC cases were notified up to the end of August 2008 (Figure 1), compared to 70-90 confirmed cases reported in the equivalent time period in 2006 and 2007. Thirty three percent of cases notified in Ireland in 2008 indicated that their usual drinking water supply was a private well.
Measures taken to reduce the risk of West Nile virus transmission by transplantation in Italy
Authors: Nanni Costa A , Grossi P , Porta E , Venettoni S , Fehily D
Published: March 2021

For the first time in Italy, two patients with meningoencephalitis were diagnosed with West Nile virus (WNV) infection in September 2008 [1]. The patients live in the Bologna and Ferrara provinces of Emilia Romagna where WNV infections had previously been noted in horses, crows and magpies [2]. The Italian National Transplant Centre (CNT), which is responsible for the procurement, processing and distribution of organs and tissues in Italy, has now reviewed the risks of transmission of WNV by organ, tissue and cell transplantation and, taking into account the advice and recommendations of the relevant authorities in other countries, issued guidance to the transplant community.
Report on the measles situation in Portugal
Authors: Gíria M , Rebelo-de-Andrade H , Fernandes T , Pedro S , Freitas G
Published: March 2021

A measles case, imported from the United Kingdom (UK), was reported in Portugal in late August 2008. Previously, measles cases imported from Romania, and import-related cases, were reported in 2005. There was no transmission to the autochthonous Portuguese population.
Mapping the future dynamics of disease transmission: risk analysis in the United Kingdom Foresight Programme on the detection and identification of infectious diseases
Authors: Suk J E , Lyall C , Tait J
Published: March 2021

This paper reflects on the qualitative risk analysis framework developed for a Foresight study on the Detection and Identification of Infectious Diseases, which was coordinated in 2005 by the United Kingdom (UK) under what is now the Government Office for Science, Department for Innovation, Universities and Skills. The risk assessment covered human, plant and animal diseases in the UK and Africa in the years 2015 and 2030. Through engaging a diverse pool of experts, we developed a model conceptualising disease spread as the outcome of interactions among sources, pathways and drivers. We then used this model to conduct a Delphi survey of experts. The factors perceived most likely to contribute to infectious disease spread in 2015 and 2030 included geographic extension of existing pathogens (partially due to climate change), over-use of antibiotics/antivirals/pesticides leading to drug resistance, and zoonoses. Our methodology provides a framework for those who need to integrate a wide range of perspectives and factors into their planning and analyses.
Import of norovirus infections in the Netherlands and Ireland following pilgrimages to Lourdes, 2008 – preliminary report
Authors: Verhoef L , Duizer E , Vennema H , Siebenga J , Swaan C , Isken L , Koopmans M , Balay K , Pothier P , McKeown P , van Dijk G , Capdepon P , Delmas G
Published: March 2021

Between mid-September and 19 October 2008, nine clusters of norovirus infection involving around 90 primary cases and over a hundred secondary cases were identified in patients from the Netherlands, Ireland, Italy and France, linked to pilgrimage to Lourdes, France.
A swimming pool-associated outbreak of cryptosporidiosis in Staffordshire, England, October to December 2007
Authors: Coetzee N , Edeghere O , Orendi J M , Chalmers R , Morgan L
Published: March 2021

In October 2007 an increase in laboratory-confirmed cryptosporidiosis cases in Staffordshire, England prompted an outbreak investigation. Case ascertainment included interviewing suspected cases and contacts and obtaining faecal specimens from those with diarrhoea for laboratory identification. Over a three-month period we identified 57 cases of cryptosporidiosis (39 confirmed) distributed across 36 households. The majority of cases (69%) were younger than 20 years. The most plausible exposure was multiple swimming episodes (56% of cases) in 13 local public swimming pools. One large swimming pool was most frequently visited by swimmers and considered a significant contributor to transmission because of substandard filtration and maintenance systems. Control measures focused on inspecting and improving operating standards at swimming pools, hygiene information to swimmers, and early detection and exclusion of cases. The rapid case investigation described in this paper provided adequate information for the early detection and control of a typical seasonal swimming pool related cryptosporidiosis outbreak. Ensuring adequate filtration standards at public swimming pools particularly before the high use periods of late summer and autumn remains a priority.
Developing the Community reporting system for foodborne outbreaks
Authors: Gervelmeyer A , Hempen M , Nebel U , Weber C , Bronzwaer S , Ammon A , Makela P
Published: March 2021

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Invasive meningococcal disease with fatal outcome in a Swiss student visiting Berlin
Authors: Zuschneid I , Witschi A , Quaback L , Hellenbrand W , Kleinkauf N , Koch D , Krause G
Published: March 2021

Following the fatal invasive meningococcal disease in a Swiss student who had been visiting Berlin, several public health institutions on local, regional and national level cooperated to ensure that the appropriate measures such as contact tracing and post exposure prophylaxis were taken to prevent further cases. The incidence highlighted the importance of early disease notification and showed that if an infectious disease requiring public health action occurs in an international context, it is vital that relevant information is communicated to all levels of the public health systems of the countries involved.
Achievements of the Belgian Antibiotic Policy Coordination Committee (BAPCOC)
Authors: Goossens H , Coenen S , Costers M , De Corte S , De Sutter A , Gordts B , Laurier L , Struelens M J
Published: March 2021

A Belgian Antibiotic Policy Coordination Committee (BAPCOC) was officially established in 1999 by Royal Decree. The overall objective of BAPCOC is to promote judicious use of antibiotics in humans and animals and to promote infection control and hospital hygiene, with the overall aim to reduce antibiotic resistance. BAPCOC fostered strong and interdisciplinary public health, scientific and political leadership, which led to many evidence-based interventions such as multimedia campaigns to promote the prudent use of antibiotics in the community, national campaigns to promote hand hygiene in hospitals, publication of clinical practice guidelines, staffing and technical support for establishment of antibiotic management teams in all Belgian hospitals, surveillance programmes on antibiotic use and resistance in humans and animals and the promotion of research. These activities and interventions resulted in a measurable decrease in antibiotic use and resistance in the community and hospitals.
Experiences with the Dutch Working Party on Antibiotic Policy (SWAB)
Authors: Prins J M , Degener J E , de Neeling A  J , Gyssens I C , the SWAB board Collective
Published: March 2021

The Dutch Working Party on Antibiotic Policy (Stichting Werkgroep AntibioticaBeleid, SWAB) was founded in 1996 as an initiative of the Society for Infectious Diseases, the Dutch Society for Medical Microbiology, and the Dutch Association of Hospital Pharmacists. Its primary goal is to contribute to the containment of antimicrobial resistance and the expanding costs incurred for the use of antibiotics. SWAB is the Intersectoral Coordinating Mechanism (ICM) for the Netherlands, and it is at present the National Antimicrobial Resistance (AMR) Focal Point. It coordinates the national surveillance of antibiotic resistance, in collaboration with the National Institute for Public Health and the Environment (RIVM), coordinates the surveillance of the use of antibiotics, and runs a guideline development programme. Information about consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria is presented annually in NethMap. Over the past decade, outpatient consumption of antibiotics has risen only slightly, but in the hospital setting there was an overall significant increase in antibiotic use, due mainly to the steady reduction in the average length of patient hospital stays. In 2006 we introduced our electronic national antibiotic guide 'SWAB-ID' for the antibiotic treatment and prophylaxis of common infectious diseases in hospitals.
The Russian influenza in Sweden in 1889-90: an example of Geographic Information System analysis
Authors: Skog L , Hauska H , Linde A
Published: March 2021

Using data from a study of the 1889-90 Russian flu in Sweden, this article describes how the application of Geographic Information System (GIS) may improve analyses and presentation of surveillance data. In 1890, immediately after the outbreak, all Swedish doctors were asked to provide information about the start and the peak of the epidemic, and the total number of cases in their region and to fill in a questionnaire on the number, sex and age of infected persons in the households they visited. General answers on the epidemic were received from 398 physicians and data on individual patients were available for more than 32,600 persons. These historic data were reanalysed with the use of GIS, in map documents and in animated video sequences, to depict the onset, the intensity and the spread of the disease over time. A stack diagram with the observations grouped into one week intervals was produced to depict the spread in one figure only. To better understand how the influenza was disseminated, Thiessen polygons were created around 70 places reported on by the doctors. Having prepared GIS layers of the population (divided into parishes), estimations could be made for all the Swedish parishes on the number of infected persons for each of the 15 weeks studied. The described models may be useful in current epidemiological investigations, as well.
Increased number of Clostridium difficile infections and prevalence of Clostridium difficile PCR ribotype 001 in southern Germany
Authors: Borgmann S , Kist M , Jakobiak T , Reil M , Scholz E , von Eichel-Streiber C , Gruber H , Brazier J  S , Schulte B
Published: March 2021

In recent years, Clostridium difficile infection (CDI) has emerged as an increasing problem, both in in- and outpatients. In a rural region of southern Germany, the annual number of C. difficile toxin (Tcd)-positive patients has increased from 95 to 796 in the period from 2000 to 2007. Simultaneously, the proportion of positive tests among all Tcd examinations has risen from 7.0% to 12.8%, indicating that the higher number of affected patients was not solely due to an increase in the number of assays. Elevated numbers of CDI have recently been associated with outbreaks of the ribotype 027 strain, particularly in North America. This strain has also been isolated in Europe, including in Germany. Ribotyping and PCR testing for binary toxin genes of C. difficile strains isolated from in- and outpatients demonstrate a predominance (59%) of C. difficile ribotype 001, which exhibits antibiotic resistance to erythromycin, ciprofloxacin, and moxifloxacin, but lacks binary toxin genes. In summary, in our region of Germany, the number of patients affected by CDI has increased, probably due to spread of C. difficile ribotype 001.
A food-borne outbreak of cryptosporidiosis among guests and staff at a hotel restaurant in Stockholm county, Sweden, September 2008
Authors: Insulander M , de Jong B , Svenungsson B
Published: March 2021

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Denmark: Botulism in an infant or infant botulism?
Authors: Pærregaard A , Angen Ø , Lisby M , Mølbak K , Clausen M E , Christensen J J
Published: March 2021

A 4.5 months old, previously healthy Danish girl was admitted to a paediatric department after six days of passive behaviour and weak suck. Over the next days she became increasingly weak, developed bilateral ptosis, the muscle stretch reflexes were lost, and mydriasis with slow pupillary responses was noted. Botulism was suspected and confirmed by testing of patient serum in a bioassay. The condition of the patient improved following administration of botulism antiserum. The clinical picture was suggestive of intestinal (infant) botulism. However, botulism acquired from consumption of food with preformed neurotoxin could not be excluded. The food history revealed consumption of a commercially produced banana/peach puree which was suspected as a possible source, and based on a precautionary principle this product was recalled. The case description illustrates a risk-management dilemma between suspected foodborne versus intestinal botulism. Taking the potentially very serious consequences of foodborne botulism into consideration, the measures taken were justified.
Investigations and control measures following a case of inhalation anthrax in East London in a drum maker and drummer, October 2008
Authors: Anaraki S , Addiman S , Nixon G , Krahé D , Ghosh R , Brooks T , Lloyd G , Spencer R , Walsh A , McCloskey B , Lightfoot N
Published: March 2021

We discuss the investigations and control measures undertaken following the notification of a fatal case of inhalation anthrax in East London. The patient is believed to have acquired the infection from making animal hide drums. Environmental investigations identified one drum and two pieces of animal skins contaminated with anthrax spores.
Eurosurveillance achievements in 2008 and challenges for 2009
Authors: Eurosurveillance editorial team
Published: March 2021

2008 was yet another year of major innovations for Eurosurveillance. Since January 2008, Eurosurveillance has been published once a week online with short, rapid communications as well as longer papers on the surveillance, prevention and control of communicable diseases.
Increase in hepatitis A cases in the Czech Republic in 2008 – an update
Authors: Cástková J , Beneš C
Published: March 2021

In 2008, 1,616 cases of hepatitis A were reported in the Czech Republic, more than a 10-fold increase compared with the annual number of cases registered in 2003-2007. The infection was initially associated with injecting drug users, most probably by person-to-person contact or parenteral transmission, and in the second half of the year continued to spread among the general population with increased susceptibility.
Cluster of cases of hepatitis A with a travel history to Egypt, September-November 2008, France
Authors: Couturier E , Roque-Afonso A M , Letort M J , Dussaix E , Vaillant V , de Valk H
Published: March 2021

Since September 2008, 26 cases of hepatitis A with a history of travel to Egypt have been reported in France. Investigations indicate that a common source of contamination linked to Nile river cruises is the most likely explanation of the increase in the number of cases reported in France as well as in several other European Union countries.
Start of the influenza season 2008-9 in Europe - increasing influenza activity moving from West to East dominated by A(H3N2)
Authors: Goddard N , Zucs P , Ciancio B , Plata F , Hungnes O , Mazick A , Meijer A , Hay A , Daniels R , Nicoll A , Zambon M
Published: March 2021

The influenza season 2008-9 started in week 49 of 2008 and is so far characterised by influenza virus type A subtype H3N2. Isolates of this subtype that were tested proved susceptible to neuraminidase inhibitors, but resistant to M2 inhibitors. The circulating A(H3N2) viruses are antigenically similar to the component in the current northern hemisphere influenza vaccine.
First identification of metallo-beta-lactamase-producing Pseudomonas aeruginosa in the Czech Republic
Authors: Hrabák J , Fridrichová M , Štolbová M , Bergerová T , Zemlickova H , Urbaskova P
Published: March 2021

Since 2005, invasive isolates of Pseudomonas aeruginosa have been collected in the Czech Republic as part of the European Antibiotic Resistance Surveillance System (EARSS). Forty-eight microbiology laboratories throughout the country including approximately 81% of the population provide consecutive isolates from blood and cerebrospinal fluid. Surprisingly, no metallo-beta-lactamase (MBL) was found in 1,259 invasive isolates tested over the past three years until the detection of two MBL-producing strains in mid-2008. Both strains were isolated from patients hospitalised in one regional hospital. The MBL was identified as IMP-7, which had been seen previously in Canada, Japan, Malaysia and Slovakia.
International travels and fever screening during epidemics: a literature review on the effectiveness and potential use of non-contact infrared thermometers
Authors: Bitar D , Goubar A , Desenclos J  C
Published: March 2021

Several countries plan to introduce non-contact infrared thermometers (NCIT) at international airports in order to detect febrile passengers, thus to delay the introduction of a novel influenza strain. We reviewed the existing studies on fever screening by NCIT to estimate their efficacy under the hypothesis of pandemic influenza. Three Severe Acute Respiratory Syndrome (SARS) or dengue fever interventions in airports were excluded because of insufficient information. Six fever screening studies in other gathering areas, mainly hospitals, were included (N= 176 to 72,327 persons; fever prevalence= 1.2% to 16.9%). Sensitivity varied from 4.0% to 89.6%, specificity from 75.4% to 99.6%, positive predictive value (PPV) from 0.9% to 76.0% and negative predictive value (NPV) from 86.1% to 99.7%. When we fixed fever prevalence at 1% in all studies to allow comparisons, the derived PPV varied from 3.5% to 65.4% and NPV was >=99%. The low PPV suggests limited efficacy of NCIT to detect symptomatic passengers at the early stages of a pandemic influenza, when fever prevalence among passengers would be =<1%. External factors can also impair the screening strategy: passengers can hide their symptoms or cross borders before symptoms occur. These limits should be considered when setting up border control measures to delay the pandemic progression.
Factors affecting the adherence to an antenatal screening programme: an experience with toxoplasmosis screening in France
Authors: Cornu C , Bissery A , Malbos C , Garwig R , Cocherel C , Ecochard R , Peyron F , Wallon M
Published: March 2021

Monthly serological testing is mandatory in France for pregnant women not immune to toxoplasmosis. We assessed for the first time the adherence to this national programme, using data from antenatal tests for Toxoplasma antibodies collected by the Union of Health Insurance Services in the French Rhone-Alpes region. Data from 34,290 pregnancies was analysed. The first test was done late in 25% of women (8,430). Women had on average 5.7 tests during pregnancy, only 40 percent (13,774) were tested seven or more times as recommended. Young women were more likely to have a late first test, but age did not significantly influence regularity and number of tests. Free medical coverage favoured a late first test, fewer tests and longer between-test intervals. An early first test did not affect test numbers or between-test intervals. A re-useable prescription for several tests was associated with better adherence. Prescription by general practitioners was associated with an earlier first test, but fewer tests and longer between-test intervals. When prescribing physician(s) included a gynaecologist, the first test was more likely to be behind schedule, but the overall number of tests was higher and between-test intervals shorter. Because data was collected through private laboratories, our conclusions apply to the majority of French patients who need to schedule a separate visit for blood testing after prescription.
An oyster-associated hepatitis A outbreak in France in 2007
Authors: Guillois-Bécel Y , Couturier E , Le Saux J C , Roque-Afonso A M , Le Guyader F S , Le Goas A , Pernès J , Le Bechec S , Briand A , Robert C , Dussaix E , Pommepuy M , Vaillant V
Published: March 2021

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Tuberculosis in the European Union – ongoing commitment needed to control the disease
Authors: Jakab Z
Published: March 2021

World TB day on 24 March commemorates this event and is an opportunity for a critical appraisal of the TB situation, for raising awareness and for joining forces in order to control the disease.
First identification of class A carbapenemase-producing Klebsiella pneumoniae in the Republic of Ireland
Authors: Roche C , Cotter M , O’Connell N , Crowley B
Published: March 2021

The Klebsiella pneumoniae carbapenemase (KPC) was detected in a carbapenem-resistant respiratory isolate of Klebsiella pneumoniae in an Irish hospital. This is the first report of a KPC-producing isolate in the Republic of Ireland. The isolate was resistant to all β-lactams. Furthermore, it had reduced susceptibility to three other classes of non-β-lactam antibiotics. The isolate was not associated with travel abroad. Detection of KPC-producing bacteria has important infection control and public health implications.
The emergence of Clostridium difficile PCR ribotype 027 in Denmark – a possible link with the increased consumption of fluoroquinolones and cephalosporins?
Authors: Søes L , Mølbak K , Strøbæk S , Truberg Jensen K , Torpdahl M , Persson S , Kemp M , Olsen K E
Published: March 2021

Increasing rates of Clostridium difficile infection (CDI) with an unusual, severe course have been reported in several countries; this rise has partly been ascribed to the emergence of a virulent strain, C. difficile PCR ribotype 027 (CD027). An intriguing question is whether this could be related to increasing consumption of broadspectrum antibiotics. From 1997 to 2007, the number of hospital discharges in Denmark with the diagnosis enterocolitis caused by C. difficile increased from eight to 23 per 100,000 hospital discharges. This increase was proportional to a concomitant rise in the consumption of fluoroquinolones and cephalosporins. The first outbreak of CD027 in Denmark occurred from October 2006 to August 2007 and included 13 patients, most of them elderly, admitted to three hospitals in the same region. Most of the patients had overlapping periods of admission. All patients had been treated with broadspectrum antibiotics, in particular cephalosporins and fluoroquinolones, prior to positive culture of CD027. Thirty days after confirmation of diagnosis, three of the 13 patients had died. Taken together, the data support the hypothesis that the increasing use of certain broadspectrum antibiotics may be related to a possible increase of C. difficile infection, and show that the specific contribution by CD027 in its emergence needs to be determined.
Mumps epidemiology in the Mid-West of Ireland 2004-2008: increasing disease burden in the university/college setting
Authors: Whyte D , O’Dea F , McDonnell C , O’Connell N H , Callinan S , Brosnan E , Powell J , Monahan R , FitzGerald R , Mannix M , Greally T , Dee A , O’Sullivan P
Published: March 2021

Mumps is a contagious vaccine-preventable viral disease that is experiencing a revival in students attending second and third level colleges. Large mumps outbreaks have been reported in several countries despite the presence of childhood immunisation programmes over many years, including measles, mumps, and rubella (MMR) vaccination. In 2008, 1,377 cases of mumps were notified in Ireland and 1,734 in the first three months of 2009 (provisional data). This paper reviews the recent epidemiology of mumps in the Mid-West region of Ireland and highlights preventive measures. A substantial proportion of cases were not laboratory-confirmed and it is important that doctors continue to notify suspected cases. In the Irish Mid-West, data from enhanced surveillance shows a high proportion of mumps in the age group 15-24 years. Complications were uncommon and rarely severe. Where data were available, over half of the cases did not recall having received two doses of MMR, but most recalled one dose. Parents should continue to ensure children receive both MMR vaccinations so that uptake is optimal for protection. Steps were taken to increase awareness of the disease in the school, college and university settings. Preventive measures implemented to limit mumps transmission in the school/college setting over recent years included vaccination of close contacts, isolation for five days and hand hygiene.
Ongoing rubella outbreak in Austria, 2008-2009
Authors: Schmid D , Kasper S , Kuo HW , Aberle S , Holzmann H , Daghofer E , Wassermann-Neuhold M , Feenstra O , Krischka C , Allerberger F
Published: March 2021

Since October 2008, a total of 143 cases of rubella have affected the two Austrian provinces Styria and Burgenland. The index case occurred in mid-October 2008, but was not notified to the public health authorities until February 2009, when the Austrian Agency for Health and Food Safety was asked to investigate a cluster of 32 rubella cases (24 laboratory-confirmed and eight clinically suspected cases). No case of rubella had been reported in the two affected provinces between February 2007 - when statutory notification for rubella was implemented - and mid-October 2008. 113 of the 143 cases (79%) were confirmed: 101 (89.3% of the 113 cases) clinical-laboratory confirmed and 12 clinical-epidemiological confirmed. Thirty cases fulfilled the criteria of a probable outbreak case only (laboratory results or data on epidemiological link are pending). For 140 outbreak cases data on age was known; the median age was 19 years (range: 2-60 years). 20 cases occurred in soldiers in seven military camps in the area. 55 cases (38.5 %) were female. One case of a laboratory-confirmed rubella infection, affecting an unvaccinated pregnant 18-years old native Austrian in the early first trimenon of pregnancy, led to voluntary abortion.
Pandemic phase level 4: human cases of the novel influenza A/H1N1 strain confirmed in Scotland and Spain
Authors: Editorial team Collective
Published: March 2021

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An ongoing measles outbreak in Bulgaria, 2009
Authors: Marinova L , Kojouharova M , Mihneva Z
Published: March 2021

After seven years without indigenous transmission of measles in Bulgaria, an increasing number of cases have been reported since 15 April 2009. By 19 June, the total number of notifications reached 84. To date, 64 were confirmed as measles cases and 15 cases, for whom laboratory results are pending, have been classified as probable. The present measles outbreak affects mostly the Roma population living in the north-eastern part of the country. The most affected age groups are young children below 1 year of age and children 1 to 9 years of age. An immunisation campaign was started in the affected administrative regions, targeting all persons from 13 months to 30 years of age who had not received the complete two-dose MMR vaccination.
Epidemiological and transmissibility analysis of influenza A(H1N1)v in a southern hemisphere setting: Peru
Authors: Munayco C V , Gómez J , Laguna-Torres V A , Arrasco J , Kochel T J , Fiestas V , Garcia J , Perez J , Torres I , Condori F , Nishiura H , Chowell G
Published: March 2021

We present a preliminary analysis of 1,771 confirmed cases of influenza A(H1N1)v reported in Peru by 17 July including the frequency of the clinical characteristics, the spatial and age distribution of the cases and the estimate of the transmission potential. Age-specific frequency of cases was highest among school age children and young adults, with the lowest frequency of cases among seniors, a pattern that is consistent with reports from other countries. Estimates of the reproduction number lie in the range of 1.2 to 1.7, which is broadly consistent with previous estimates for this pandemic in other regions. Validation of these estimates will be possible as additional data become available.
What will the next influenza season bring about: seasonal influenza or the new A(H1N1)v? An analysis of German influenza surveillance data
Authors: Uphoff H , Geis S , Grüber A , Hauri A M
Published: March 2021

For the next influenza season (winter 2009-10) the relative contributions to virus circulation and influenza-associated morbidity of the seasonal influenza viruses A(H3N2), A(H1N1) and B, and the new influenza A(H1N1)v are still unknown. We estimated the chances of seasonal influenza to circulate during the upcoming season using data of the German influenza sentinel scheme from 1992 to 2009. We calculated type and subtype-specific indices for past exposure and the corresponding morbidity indices for each season. For the upcoming season 2009-10 our model suggests that it is unlikely that influenza A(H3N2) will circulate with more than a low intensity, seasonal A(H1N1) with more than a low to moderate intensity, and influenza B with more than a low to median intensity. The probability of a competitive circulation of seasonal influenza A with the new A(H1N1)v is low, increasing the chance for the latter to dominate the next influenza season in Germany.
Cases of influenza A(H1N1)v reported in Turkey, May-July 2009
Authors: Ciblak M A , Albayrak N , Odabas Y , Basak Altas A , Kanturvardar M , Hasoksuz M , Sucaklı B , Korukluoglu G , Bal E , Ertek M , Badur S
Published: March 2021

Following the declaration by the World Health Organization (WHO) of human cases of infection with a new influenza A(H1N1)v virus of swine origin, the Turkish Ministry of Health launched a case-based reporting of influenza A(H1N1)v throughout the country on 27 April 2009. The index case was detected on 15 May 2009. As of 17 July 2009 the number of laboratory-confirmed cases of influenza A(H1N1)v totaled 128 of whom 38 were indigenous cases.
Epidemiological analysis of the influenza A(H1N1)v outbreak in Bolivia, May-August 2009
Authors: Gianella A , Walter A , Revollo R , Loayza R , Vargas J , Roca Y
Published: March 2021

The outbreak of pandemic influenza (H1N1) began in Bolivia on 25 May 2009. Between May and August, the National Center of Tropical Disease (CENETROP) analysed by RT-PCR 7,060 samples of which 12.7% were positive. A preliminary analysis of the 895 confirmed cases identified between May and August 2009 describes epidemiological and clinical characteristics. After the first imported cases from the United States and Peru, the locally acquired infections predominated (90%). The number of cases was highest in the age group of 10 to 29 year-olds, and 89.6% of cases were observed in people under the age of 40 years. Fever, cough, nasal discharge and headache remained the main symptoms.
Imported human African trypanosomiasis in Europe, 2005-2009
Authors: Gautret P , Clerinx J , Caumes E , Simon F , Jensenius M , Loutan L , Schlagenhauf P , Castelli F , Freedman D , Miller A , Bronner U , Parola P , for EuroTravNet Collective
Published: March 2021

Physicians in Europe are likely to see more African trypanosomiasis cases because of the increasing popularity of travel to Africa. In this paper the literature on imported cases in Europe, since 2005 is reviewed. Because of the high mortality risk associated with acute Rhodesian trypanosomiasis, travellers should be informed about preventive measures and the early disease manifestations.
Resistance of turkeys to experimental infection with an early 2009 Italian human influenza A(H1N1)v virus isolate
Authors: Terregino C , De Nardi R , Nisi R , Cilloni F , Salviato A , Fasolato M , Capua I
Published: March 2021

We performed an experimental infection of 21- and 70-day-old meat turkeys with an early human isolate of the 2009 pandemic H1N1 influenza virus exhibiting an α-2,3 receptor binding profile. Virus was not recovered by molecular or conventional methods from blood, tracheal and cloacal swabs, lungs, intestine or muscle tissue. Seroconversion was detected in a limited number of birds with the homologous antigen only. Our findings suggest that in its present form, the pandemic H1N1 influenza virus is not likely to be transmitted to meat turkeys and does therefore not represent an animal health or food safety issue for this species.
Estimating diagnostic accuracy of tests for latent tuberculosis infection without a gold standard among healthcare workers
Authors: Girardi E , Angeletti C , Puro V , Sorrentino R , Magnavita N , Vincenti D , Carrara S , Butera O , Ciufoli A M , Squarcione S , Ippolito G , Goletti D
Published: March 2021

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Differences and Commonalities of National Field Epidemiology Training Programmes in Europe
Authors: Krause G , Aavitsland P , Alpers K , Barrasa A , Bremer V , Helynck B , Perra A
Published: March 2021

From 1994 to 2009, national field epidemiology training programmes (FETP) have been installed in Spain, Germany, Italy, France and Norway. During their two year duration, different components of the FETP are devised as follows: 63-79 weeks are spent on projects in hosting institutes, 2-26 weeks in outside projects, 9-30 weeks in courses and modules, and 1-2 weeks in scientific conferences. A considerable proportion of the Spanish FETP has is provided conventional ‘class room training’. The content of the modules is very similar for all programmes. Except from the Italian programme, all focus on infectious disease epidemiology. The German and Norwegian programmes are so called EPIET-associated programmesas their participants are integrated in the modules and the supervision offered by EPIET, but salaries, facilitators, and training sites are provided by the national programme. These EPIET-associated programmes require strong communications skills in English. Alumni of all five FETP are generally working within the public health work force in their respective countries or at international level, many of them in leading functions. Although three new FETP have been installed since the last published ‘Euroroundup’ in Eurosurveillance on European FETP in 2001, the progress with respect to the establishment of national FETP or EPIET-associated programmes has been slow. Member States should be aware of how much support EPIET can offer for the establishment of national FETP or EPIET-associated programmes. However, they also need to be ready to provide the necessary resources, the administrative environment and long-term dedication to make field epidemiology training work.
“I-MOVE” towards monitoring seasonal and pandemic influenza vaccine effectiveness: lessons learnt from a pilot multi-centric case-control study in Europe, 2008-9
Authors: Kissling E , Valenciano M , Falcão J  M , Larrauri A , Widgren K , Pitigoi D , Oroszi B , Nunes B , Savulescu C , Mazick A , Lupulescu E , Ciancio B , Moren A
Published: March 2021

Within I-MOVE (European programme to monitor seasonal and pandemic influenza vaccine effectiveness (IVE)) five countries conducted IVE pilot case-control studies in 2008-9. One hundred and sixty sentinel general practitioners (GP) swabbed all elderly consulting for influenza-like illness (ILI). Influenza confirmed cases were compared to influenza negative controls. We conducted a pooled analysis to obtain a summary IVE in the age group of ≥65 years.
We measured IVE in each study and assessed heterogeneity between studies qualitatively and using the I2 index. We used a one-stage pooled model with study as a fixed effect. We adjusted estimates for age-group, sex, chronic diseases, smoking, functional status, previous influenza vaccinations and previous hospitalisations.
The pooled analysis included 138 cases and 189 test-negative controls. There was no statistical heterogeneity (I2=0) between studies but ILI case definition, previous hospitalisations and functional status were slightly different. The adjusted IVE was 59.1% (95% CI: 15.3-80.3%). IVE was 65.4% (95% CI: 15.6-85.8%) in the 65-74, 59.6% (95% CI: -72.6 -90.6%) in the age group of ≥75 and 56.4% (95% CI: -0.2-81.3%) for A(H3). Pooled analysis is feasible among European studies. The variables definitions need further standardisation. Larger sample sizes are needed to achieve greater precision for subgroup analysis. For 2009-10, I-MOVE will extend the study to obtain early IVE estimates in groups targeted for pandemic H1N1 influenza vaccination.
Surveillance of the first 205 confirmed hospitalised cases of pandemic H1N1 influenza in Ireland, 28 April – 3 October 2009
Authors: Cullen G , Martin J , O’Donnell J , Boland M , Canny M , Keane E , McNamara A , O’Hora A , Fitzgerald M , Jackson S , Igoe D , O’Flanagan D
Published: March 2021

From 28 April 2009 to 3 October 2009, 205 cases of confirmed pandemic H1N1 influenza were hospitalised in Ireland. Detailed case-based epidemiological information was gathered on all hospitalised cases. Age-specific hospitalisation rates were highest in the age group of 15 to 19 year-olds and lowest in those aged 65 years and over. Nineteen hospitalised cases (9%) were admitted to intensive care units (ICU) where the median length of stay was 24 days. Four hospitalised cases (2%) died. Fifty-one percent of hospitalised cases and 42% of ICU cases were not in a recognised risk group. Asthma was the most common risk factor among cases; however, people with haemoglobinopathies and immunosuppression were the most over-represented groups.
Introduction of human papillomavirus (HPV) vaccination in Belgium, 2007-2008
Authors: Simoens C , Sabbe M , Van Damme P , Beutels P , Arbyn M
Published: March 2021

This paper documents the progress of human papillomavirus (HPV) vaccine introduction in Belgium. Information on vaccine use is based on sales statistics and reimbursement claims. From November 2007 to November 2008, the National Institute for Health and Disability Insurance reimbursed the HPV vaccine for girls aged between 12-15 years. In December 2008, the age limit was extended to include girls up to the age of 18. In November 2008, the total number of HPV vaccines sold exceeded 530,000 doses. The number of vaccines reimbursed in Belgium, for the period November 2007-November 2008, corresponds to the amount required to fully vaccinate 44% of all girls aged between 12-15 years. However, the trend was decreasing over the last 10 months. By the current reimbursement policy, we can expect that maximum half of the target population can be reached. In Flanders (one of the three Communities in Belgium), the intention is to start, from September 2010, with a free school-based HPV immunisation for girls in the first year of secondary school (12 years of age), complemented with vaccination by a physician of choice. This strategy ensures a higher HPV vaccine coverage which is expected to be as high as the current coverage in the hepatitis B vaccination programme (approximately 80%) offered to boys and girls in the same age group and under the same circumstances.
Oseltamivir-resistant influenza A(H1N1) viruses detected in Europe during season 2007-8 had epidemiologic and clinical characteristics similar to co-circulating susceptible A(H1N1) viruses
Authors: Ciancio B  C , Meerhoff T J , Kramarz P , Bonmarin I , Borgen K , Boucher C A , Buchholz U , Buda S , Dijkstra F , Dudman S , Duwe S , Hauge S H , Hungnes O , Meijer A , Mossong J , Paget W  J , Phin N , van der Sande M , Schweiger B , Nicoll A
Published: March 2021

During the 2007-08 influenza season, high levels of oseltamivir resistance were detected among influenza A(H1N1) viruses in a number of European countries. We used surveillance data to describe influenza A(H1N1) cases for whom antiviral resistance testing was performed. We pooled data from national studies to identify possible risk factors for infection with a resistant virus and to ascertain whether such infections led to influenza illness of different severity. Information on demographic and clinical variables was obtained from patients or their physicians. Odds ratios for infection with an oseltamivir resistant virus and relative risks for developing certain clinical outcomes were computed and adjusted through multivariable analysis. Overall, 727 (24.3%) of 2,992 tested influenza A(H1N1) viruses from 22 of 30 European countries were oseltamivir-resistant. Levels of resistance ranged from 1% in Italy to 67% in Norway. Five countries provided detailed case-based data on 373 oseltamivir resistant and 796 susceptible cases. By multivariable analysis, none of the analysed factors was significantly associated with an increased risk of infection with an oseltamivir-resistant virus. Similarly, infection with an oseltamivir-resistant virus was not significantly associated with a different risk of pneumonia, hospitalisation or any clinical complication. The large-scale emergence of oseltamivir-resistant viruses in Europe calls for a review of guidelines for influenza treatment.
Behaviour of the pandemic H1N1 influenza virus in Andalusia, Spain, at the onset of the 2009-10 season
Authors: Mayoral Cortés J M , Puell Gómez L , Pérez Morilla E , Gallardo García V , Duran Pla E , Fernandez Merino J C , Guillén Enriquez J , Carmona J C , Andérica G , Mateos I , Navarro Marí J M , Pérez Ruiz M , Daponte A
Published: March 2021

In Andalusia, Spain, the pandemic influenza A(H1N1)v virus has spread throughout the community, being the dominant influenza strain in the season so far. The current objective of the Andalusia Health Service is focussed on the mitigation of the health and social impact by appropriate care of the patients at home or in health centres. The 2009-10 seasonal influenza epidemic started early compared with to previous seasons. This article analyses the influenza A(H1N1)v situation in Andalusia until the week 39/2009.
Detection of human norovirus from frozen raspberries in a cluster of gastroenteritis outbreaks
Authors: Maunula L , Roivainen M , Keränen M , Mäkelä S , Söderberg K , Summa M , von Bonsdorff C H , Lappalainen M , Korhonen T , Kuusi M , Niskanen T
Published: March 2021

We describe a cluster of norovirus outbreaks affecting about 200 people in Southern Finland in September and October 2009. All outbreaks occurred after consumption of imported raspberries from the same batch intended for the catering sector. Human norovirus genotype GI.4 was found in frozen raspberries. The berries were served in toppings of cakes in separate catering settings or mixed in curd cheese as a snack for children in a daycare center. The relative risk for consumption of the berry dish was 3.0 (p ≤ 0.05) at the daycare centre. Human norovirus GI.4 was also detected in samples from two patients, and in berries. Both shared identical partial capsid sequences. Based on the results of epidemiological, trace-back and laboratory investigations it was concluded that one particular batch of frozen raspberries was the source of all outbreaks.