bluuebunny/crossref_metadata_2025 huggingface dataset:
European Immunization Week 2008 - time for reflection
Authors: Kreidl P , Gomes H , Lopalco P L , Hagmaier K , Pastore Celentano L , Vasconcelos P , Yilmaz C
Published: March 2021

This week’s edition of Eurosurveillance is dedicated to European Immunization Week 2008, which will take place from 21 to 27 April. In 2005, the World Health Organization (WHO) organised the first European Immunization Week (http://www.euro.who.int/vaccine/eiw/20050608_1) to increase vaccination coverage by raising awareness about the importance of immunisation, with a special focus on reaching vulnerable and hard-to-reach population groups. During the week, each participating country implements activities to inform and engage key target groups using the slogan “prevent-protect-immunise” and focuses on critical challenges regarding immunisation in their country.
European Immunization Week 2008: Progress towards regional goals
Authors: WHO Collective
Published: March 2021

The World Health Organization (WHO) Regional Office for Europe established the European Immunization Week (EIW, http://www.euro.who.int/vaccine) in 2005 for three reasons:
1) to raise public awareness of the benefits of immunisation,
2) to support national immunisation systems, and
3) to provide a framework for mobilising public and political support for governmental efforts to protect the public through universal childhood immunisation.
Measles is still a cause for concern in Europe
Authors: Muscat M , Bang H , Glismann S
Published: March 2021

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Measles and mumps immunity in Northern Greece, 2004-2007
Authors: Fylaktou A , Haidopoulou K , Goutaki M , Papadimitriou E , Kalamitsiou S , Papaventsis D
Published: March 2021

A cross-sectional study was conducted in order to determine the prevalence of mumps and measles antibodies in a representative sample of the general population in Northern Greece between January 2004 and May 2007. Overall, 900 healthy individuals participated in the study. The great majority were found to be protected against measles. The total protection rate against mumps was significantly less (87% versus 72%, respectively; p<0.01). Compared to all other age groups, statistically significantly lower protection rates were found in children younger than 1.5 years (p<0.01). The lowest rates of all adult groups were found in the age group of 21 to 30 years (86% and 68% for measles and mumps, accordingly). In conclusion, protection rates against both measles and mumps seem to be lower than expected in certain age groups, such as infants and young adults.
Probable cases of Crimean-Congo-haemorrhagic fever in Bulgaria: a preliminary report
Authors: Kunchev A , Kojouharova M
Published: March 2021

Between 20 January and 10 April 2008, six probable Crimean-Congo-haemorrhagic fever (CCHF) cases were reported in the municipality of Gotse Delchev, in Blagoevgrad district.
An increase in reported cases of haemorrhagic fever with renal syndrome in Slovenia in early 2008
Authors: Koren N , Grilc E , Blaško M , Avsic T , Kraigher A
Published: March 2021

Haemorrhagic fever with renal syndrome (HFRS) is an acute zoonotic viral disease, caused by hantaviruses. Hantaviruses infect rodents worldwide. They are transmitted to humans by aerosol from rodent excreta. Several hantaviruses are known to infect humans with varying severity.
The measles situation in Austria: a rapid risk assessment by an ECDC team and the outcome of an international meeting in Vienna, Austria
Authors: Strauss R , Kreidl P , Muscat M , Coulombier D , Mulders M , Gijsens A , König C , Stirling J , El Belazi G , Muchl R , Feierabend P , Holzmann H , Mutz I , Hrabcik H
Published: March 2021

For the last three years, Austria has been considered a low-moderate incidence country (< 1/100,000/year) for measles [1] and the last significant measles outbreak occurred in 2003 involving 64 cases [2].
HARMONY – the International Union of Microbiology Societies’ European Staphylococcal Typing Network
Authors: Cookson B , the HARMONY participants Collective
Published: March 2021

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On-line Global/WHO-European Regional Measles Nucleotide Surveillance
Authors: Gnaneshan S , Brown K E , Green J , Brown D  W
Published: March 2021

Measles virus causes an acute infection characterised by rash and fever. Measles infection is preventable by vaccination, but remains a significant cause of childhood mortality in the developing world with an estimated number of approximately 242,000 deaths by measles in 2006 [1].
A European laboratory network for sequence-based typing of methicillin-resistant Staphylococcus aureus (MRSA) as a communication platform between human and veterinary medicine – an update on SeqNet.org
Authors: Friedrich A W , Witte W , de Lencastre H , Hryniewicz W , Scheres J , Westh H , SeqNet.org participants Collective
Published: March 2021

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MLVA-NET – a standardised web database for bacterial genotyping and surveillance
Authors: Guigon G , Cheval J , Cahuzac R , Brisse S
Published: March 2021

Strain typing is an important aid to surveillance networks and outbreak investigations of infectious diseases [1]. MLVA (Multilocus VNTR Analysis, with VNTR standing for Variable Number of Tandem Repeats) has emerged as a highly discriminatory and widely applicable genotyping method that is now being applied for strain tracking in a growing number of bacterial pathogens [2,3]. The genomic loci containing tandem repeats are often maintained among strains of a bacterial species, while individual strains harbour different copy numbers that can be determined simply by PCR amplification. Similar to sequence-based methods such as Multilocus Sequence Typing (MLST), the MLVA method indexes genetic variation at well defined genomic loci and produces reproducible allelic profiles that can be coded in a simple digital format. Hence, they represent an attractive alternative to banding profile-based methods such as pulsed-field gel electrophoresis (PFGE), which requires dedicated efforts (e.g. http://www.cdc.gov/pulsenet) in order to produce fingerprinting data that are comparable across laboratories. Indeed, to be useful to surveillance networks and for global epidemiology, a genotyping method has to be technically accessible, reproducible and to yield easily portable data. In addition, electronic databases that are made accessible through the Internet can render exchange and comparison of data among laboratories very effective for local, national, and international surveillance. Existing databases of MLST data accessible through web portals (http://www.pubmlst.org,http://www.mlst.net, http://www.pasteur.fr/mlst) represent a common language for strain typing that has proven extremely useful for collaborative research and global epidemiology of bacterial and fungal pathogens [4]. However, given the much faster evolutionary rate of tandem repeats compared to nucleotide sequences, MLVA markers provide much improved resolution compared to MLST, thus representing a subtyping tool that is especially useful for strain discrimination in genetically homogeneous pathogens, such as M. tuberculosis [5], Bacillus anthracis [6] or Salmonella enterica serotype Typhimurium [7]. Web-accessible MLVA databases are not yet widely used for international collaboration [8], but the development in this area is very active (http://mlva.u-psud.fr/, http://www.mlva.eu/, http://www.miru-vntrplus.org).
HepSEQ – an Integrated Hepatitis B Epidemiology and Sequence Analysis Platform
Authors: Myers R , Gnaneshan S , Ijaz S , Tedder R , Ramsay M , Green J , HepSEQ Steering Committee Collective
Published: March 2021

Hepatitis B virus (HBV) is a major human pathogen. The outcome of acute hepatitis B is variable but usually followed by a complete recovery. A small proportion of infections in adults and a higher proportion of infections in early childhood continue in a chronically infected state in which the virus persists in the liver. Patients with chronic hepatitis B usually have no initial symptoms of infection, but over time the major disease sequelae, cirrhosis and hepatocellular carcinoma, can develop. It is estimated that some 350 million people worldwide are currently chronically infected with HBV, but many more will have been infected and recovered.
Imported rabies in a quarantine centre in the United Kingdom
Authors: Catchpole M , Thomas L , Morgan D , Brown K , Turbitt D , Kirkbride H
Published: March 2021

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Increase in hepatitis A cases in Latvia, in 2008, including an ongoing outbreak associated with a restaurant in Riga – preliminary report
Authors: Perevoščikovs J , Lucenko I , Magone S , Brila A
Published: March 2021

The Latvian Public Health Agency (PHA) is currently investigating an outbreak of at least 44 hepatitis A cases (as of 8 May) associated with a restaurant X in Riga, Latvia. Seven of the infected people were employees of the restaurant; 37 were customers, mostly employees from the nearby office buildings who had lunch at this restaurant.
First cases of Clostridium difficile PCR ribotype 027 acquired in Austria
Authors: Indra A , Huhulescu S , Kernbichler S , Kuo HW , Feierl G , Holler A , Skrabal F , Tucek G , Allerberger F
Published: March 2021

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WHO publishes the third edition of guidelines for the prevention and control of air-travel-associated tuberculosis
Authors: Abubakar I , Fernandez de la Hoz K
Published: March 2021

Air travel has increased over the last few decades resulting in greater risk of the spread of infectious diseases carried by infectious travellers. The risk of transmission of pathogens is particularly important for airborne organisms raising concern among public health agencies and the public. Despite limited research on the risk of tuberculosis associated with air travel, several reports have published evidence of the transmission of tuberculosis infection, including multidrug-resistant tuberculosis (MDR-TB) [1, 2].
Salmonella infections associated with reptiles: the current situation in Europe
Authors: Editorial team Collective , Bertrand S , Rimhanen-Finne R , Weill F  X , Rabsch W , Thornton L , Perevoščikovs J , van Pelt W , Heck M
Published: March 2021

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Validation of a syndromic surveillance system using a general practitioner house calls network, Bordeaux, France
Authors: Flamand C , Larrieu S , Couvy F , Jouves B , Josseran L , Filleul L
Published: March 2021

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Mumps Vaccination in the Czech Republic
Authors: Kubínyiová M , Beneš C , Príkazský V , Roubalová K , Cástková J
Published: March 2021

I would like to take this opportunity to present a more complete picture of Czech mumps vaccine history.
Situation of hantavirus infections and haemorrhagic fever with renal syndrome in European countries as of December 2006
Authors: Heyman P , Vaheri A ,   ENIVD members
Published: March 2021

Hantavirus infections are widely distributed in Europe with the exception of the far north and the Mediterranean regions. The underlying causes of varying epidemiological patterns differ among regions: in western and central Europe epidemics of haemorrhagic fever with renal syndrome (HFRS) caused by hantavirus infections follow mast years with increased seed production by oak and beech trees followed by increased rodent reproduction. In the northern regions, hantavirus infections and HFRS epidemics occur in three to four year cycles and are thought to be driven by prey - predator interactions. Hantavirus infections and HFRS seem to be on the increase in Europe, partly because of better diagnostics, partly perhaps due to environmental changes. Unfortunately, hantavirus infections are still heavily under-diagnosed in many European countries. Here we report the results of a survey conducted in 2007 amongst the member laboratories of the European Network for diagnostics of Imported Viral Diseases (ENIVD).
Measles resurges in Italy: preliminary data from September 2007 to May 2008
Authors: Filia A , De Crescenzo M , Seyler T , Bella A , Ciofi Degli Atti M L , Nicoletti L , Magurano F , Salmaso S
Published: March 2021

Following an incidence rate of 1/100,000 inhabitants in 2006 [1], Italy has been facing an upsurge of measles cases since September 2007, with outbreaks being reported in various regions. In Italy, measles vaccination is currently offered free of charge as combined measles-mumps-rubella (MMR) vaccine. The current national vaccination schedule recommends two doses of MMR vaccine, given respectively at 11-12 months and 5-6 years of age. Although childhood vaccination coverage has increased in recent years, reaching the national average of 88% in 2006 (source: Ministry of Health), with some regional variability (Figure 1), it is still below the target of 95% set by the National Measles Elimination Plan (MEP) launched in 2003 [2], and outbreaks continue to occur.
Travel-associated Legionnaires’ disease in Europe: 2006
Authors: Ricketts K D , Yadav R , Joseph C A
Published: March 2021

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Extensively drug-resistant tuberculosis: first report of a case in Ireland
Authors: Kennedy B , Lyons O , McLoughlin A-M , Gibbons N , O'Flanagan D , Keane J
Published: March 2021

Extensively drug-resistant tuberculosis (XDR-TB) is an emerging global threat. Between 2002 and 2007 sixteen countries in the European Union (EU) reported at least one case of XDR-TB [1]. Infection is characterised by alarming mortality rates in both HIV and non-HIV populations.
Effective control measures limited measles outbreak after extensive nosocomial exposures in January-February 2008 in Gothenburg, Sweden
Authors: Follin P , Dotevall L , Jertborn M , Khalid Y , Liljeqvist J Å , Muntz S , Qvarfordt I , Söderström A , Wiman Å , Åhrén C , Österberg P , Johansen K
Published: March 2021

In January-February 2008, one imported case of measles initiated a series of exposures with around 380 nosocomial secondary contacts. Susceptible individuals were traced early and control measures were initiated that managed to limit the consequences considerably. Only four secondary cases were identified by the end of March. This minor outbreak illustrates the importance and efficiency of early control measures as well as the fact that the risk of measles outbreaks still exists in a country that has high measles, mumps, rubella vaccination coverage among children.
Laboratory investigation of the first suspected human cases of infection with avian influenza A(H5N1) virus in Bulgaria
Authors: Hadzhiolova T , Pavlova S , Kotseva R
Published: March 2021

Reports of human cases of infection with avian influenza A(H5N1) virus have received increased public attention because of the potential for the emergence of a pandemic strain. In the end of 2005 and the beginning of 2006, avian influenza A(H5N1) virus caused outbreaks among domestic poultry and was isolated from wild swans in many European countries, including Bulgaria. Between January and March 2006, samples were collected from 26 patients who had been in close contact with ill or dead birds and developed a subsequent respiratory illness. The testing took place at the National Laboratory of Influenza in Sofia. Specific ?(H5N1) assays were applied for screening (Sacace RT-PCR and real-time kit). Avian flu ?(H5N1) virus was not detected in any of the patients tested. In three patients, human subtype ?(H1N1) influenza virus, identifiable by RT-PCR was isolated and further characterized by hemagglutination inhibition test (HIT). The reliability of the molecular assays used in this investigation was demonstrated in an International Quality Control for Human and Avian ?(H5N1) Influenza performed later in 2006 by INSTAND (Society for Promotion of Quality Assurance in the Medical Laboratories), Germany.
Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008
Authors: Kuijper E  J , Barbut F , Brazier J  S , Kleinkauf N , Eckmanns T , Lambert M L , Drudy D , Fitzpatrick F , Wiuff C , Brown D  J , Coia J  E , Pituch H , Reichert P , Even J , Mossong J , Widmer A F , Olsen K E , Allerberger F , Notermans D  W , Delmée M , Coignard B , Wilcox M , Patel B , Frei R , Nagy E , Bouza E , Marin M , Åkerlund T , Virolainen-Julkunen A , Lyytikäinen O , Kotila S , Ingebretsen A , Smyth B , Rooney P , Poxton I R , Monnet D. L.
Published: March 2021

Outbreaks of Clostridium difficile infections (CDI) with increased severity, high relapse rate and significant mortality have been related to the emergence of a new, hypervirulent C. difficile strain in North America and Europe. This emerging strain is referred to as PCR ribotype 027 (Type 027). Since 2005, individual countries have developed surveillance studies about the spread of type 027. C. difficile Type 027 has been reported in 16 European countries. It has been responsible for outbreaks in Belgium, Germany, Finland, France, Ireland, Luxembourg, The Netherlands, Switzerland and the United Kingdom (England, Wales, Northern Ireland and Scotland). It has also been detected in Austria, Denmark, Sweden, Norway, Hungary, Poland and Spain. Three countries experienced imported patients with CDI due to Type 027 who acquired the infection abroad. The antimicrobial resistance pattern is changing, and outbreaks due to clindamycin-resistant ermB positive Type 027 strains have occurred in three European countries. Ongoing epidemiological surveillance of cases of CDI, with periodic characterisation of the strains involved, is required to detect clustering of cases in time and space and to monitor the emergence of new, highly virulent clones.
Clostridium difficile: summary of actions in the European Union
Authors: Suetens C
Published: March 2021

Since 2006, the European Centre for Disease Prevention and Control (ECDC) has been addressing the new CDI situation. Considering the worrying evolution of CDI in Northern America, reports of Type 027 CDI outbreaks in Belgium, The Netherlands and the UK in 2005, and the preliminary results of an EU-wide study conducted in 2005 by the ESCMID Study Group for C. difficile (ESGCD), ECDC convened a group of experts consisting of members of ESGCD, epidemiologists from healthcare-associated surveillance networks from the European Union (EU) and from the US Centers for Disease Control and Prevention (CDC). This ECDC working group recognised the emergence of a new CDI problem in some EU Member States and the potential for spread to other countries and decided to act.
Measles outbreak in an anthroposophic community in The Hague, The Netherlands, June-July 2008
Authors: van Velzen E , de Coster E , van Binnendijk R , Hahné S
Published: March 2021

An ongoing outbreak of measles linked to anthroposophic communities in The Hague, The Netherlands has been identified since mid-June 2008. Thirty-four cases have been reported until 25 July. In addition, two cases have been reported in other cities (Leiderdorp and Utrecht). Both are epidemiologically linked to the cluster in The Hague.
Country-wide HIV incidence study complementing HIV surveillance in Germany
Authors: Bätzing-Feigenbaum J , Loschen S , Gohlke-Micknis S , Zimmermann R , Herrmann A , Kamga Wambo O , Kücherer C , Hamouda O
Published: March 2021

Serological methods exist that allow differentiating between recent and long-standing infections in persons infected with HIV. During a pilot study in Berlin between 2005 and 2007 methodologies have been evaluated. In a cross-sectional study blood samples, demographic, laboratory, clinical and behavioural data based on a KABP survey were collected from patients with newly diagnosed HIV infections. The BED-CEIA was used to determine recency of infection. Recent HIV infections contributed 54% (CI [95%]: 45; 64) in MSM and 16% (CI [95%]: 0; 39) in patients with other transmission risks (p=0.041). Proportions of recent infections were significantly higher in MSM ≤30 years (p=0.019). The mean age was 33.9 (median 34 years) in recent compared with 38.6 years (median: 38 years) in long-standing infections (p=0.011). High-risk behaviour indicated through very low condom use in recently HIV infected MSM could be identified. The results of the pilot study support expectations that the modified application of the method may contribute to improving HIV prevention efforts in Germany. On this basis the Robert Koch Institute implemented a countrywide HIV incidence study to complement HIV surveillance in early 2008. The study is funded by the German Ministry of Health. Data on recent HIV infections and current HIV transmission risks are collected. Design, methods and impact are described in detail.
Settings for identifying recent HIV infections: the Portuguese experience
Authors: Cortes Martins H , Paixão M T
Published: March 2021

Portugal has been the western European country with the highest rate of notified acquired immunodeficiency syndrome (AIDS) cases since 1999 and human immunodeficiency virus (HIV) infection cases since 2000. Nonetheless, exact information on the magnitude and trends of recently acquired infections is missing. In a cross-sectional study we aimed to determine HIV prevalence, the proportion of recently acquired infections and the incidence among patients attending a Sexually Transmitted Infections (STI) clinic and among HIV positive cases tested at the AIDS Reference Laboratory (ARL), by using the Avidity Index (AI) of antibodies to identify recent HIV-1 seroconversions. Demographic and behavioural data were collected. At the STI clinic 253 patients were enrolled, 16 were found to be HIV infected (14 HIV-1, 2 HIV-2) and a prevalence of 6.3% was obtained. Four recent HIV-1 infections were identified and the HIV-1 incidence was 3.3% per year. At the ARL, 332 newly diagnosed cases of HIV-1 infection were studied, 59 (17.8%) were recent infections and an annual incidence of 4.1% was estimated. These findings support STI clinics as key sentinel sites for recently acquired HIV infections and illustrate the viability of testing for recent HIV infections in these settings and reinforce the value of this method in the surveillance for better monitoring current trends of the HIV/AIDS epidemic in Portugal.
Survey on legislation regarding wet cooling systems in European countries
Authors: Ricketts K D , Joseph C , Lee J , Wewalka G ,   European Working Group for Legionella Infections
Published: March 2021

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Changes in prevention and outbreak management of Legionnaires’ disease in the Netherlands between two large outbreaks in 1999 and 2006
Authors: Sonder G J , van den Hoek J A , Bovée L P , Aanhane F E , Worp J , Du Ry van Beest Holle M , van Steenbergen J E , den Boer J W , Ijzerman E P , Coutinho R  A
Published: March 2021

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'Chlamydia Monday' in Sweden
Authors: Hansdotter F , Blaxhult A
Published: March 2021

The number of reported cases of Chlamydia trachomatis infections has increased in Sweden in the last decade, as in many other European countries [1]. After a temporary fall in the number of cases reported in Sweden in 2006, due to the spread of a new variant that was not detectable with some of the test methods used at the time, 2007 showed a record high of over 47,000 reported cases [2].
Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) case reporting in the World Health Organization European Region in 2006
Authors: Devaux I , Alix J , Likatavicius G , Herida M , Nielsen S , Hamers F  F , Nardone A
Published: March 2021

This article presents information on HIV and AIDS case reporting systems as part of a survey on HIV/AIDS surveillance practices in the World Health Organization (WHO) European Region. A standardised questionnaire was sent to the 53 national correspondents of the European Centre for the Epidemiological Monitoring of AIDS (EuroHIV). The HIV and AIDS case reporting section of the questionnaire comprised four parts: data collection system, HIV/AIDS case definition for surveillance, variables collected, and evaluation of surveillance systems). Individual-based data collection systems for HIV case reports have been implemented in 43 of 44 countries in the WHO European Region and for AIDS case reports in all the countries. For HIV case reports, a coded identifier is used in 28 countries, and full names are used in 11 countries. The European AIDS case definition has been adopted in 35 countries (80%). Information on molecular epidemiology is available in 30 countries, and HIV drug resistance is monitored in 11 countries. HIV/AIDS case reporting systems have been evaluated for under-reporting in 17 countries and for completeness in 11 countries. This article outlines the future needs for HIV/AIDS surveillance and presents recommendations on how to improve data comparability across European countries in the WHO region
Tuberculosis in a shopping centre, Portugal, 2004-5
Authors: Duarte R , Miranda A , Braga R , Carvalho A , Rola J , Marques A , Barros H
Published: March 2021

Genotyping enables to confirm or exclude a tuberculosis (TB) cluster. Excluding the link between cases is particularly important in countries with intermediate/high incidence of TB where the emergence of several TB cases in a particular location in space or time (higher than the expected) could be explained by chance alone. During 2004 and 2005, five TB cases occurred in five shops of a Portuguese shopping centre which employed a total of about 1000 workers. After an epidemiological survey, 52 close contacts were identified and screened. Latent tuberculosis infection was diagnosed in 10 contacts (eight family members and two work colleagues of cases). Genotyping of the Mycobacterium tuberculosis isolates revealed no link between the cases. For this reason no screening of all staff of the shopping centre was carried out. However, close contacts (52) and all fellow workers (1000) were kept under surveillance for two years, and no additional cases were diagnosed. The present analysis demonstrates that the exclusion of a chain of ongoing transmission by genotyping for the investigation of a cluster is cost-effective from the perspective of the public health service, because it allows to avoid unnecessary large scale screening operation and instead to direct resources to more effective measures of TB control.
Unknown disease in South Africa identified as arenavirus infection
Authors: Zeller H , Leitmeyer K , Varela Santos C , Coulombier D
Published: March 2021

On 12 September 2008, a tourist guide organising safari trips, residing in Lusaka, Zambia, was evacuated in a critical condition to Johannesburg, South Africa. She was admitted to a clinic where she died on 14 September about 10 days after the onset of symptoms. The symptoms included a prodromal phase with fever, myalgia, vomiting, diarrhoea, followed by rash, liver dysfunction and convulsions [1]. Cerebral oedema was detected on scan examination. No laboratory specimen was available for investigation. The paramedic who had cared for the index case during her evacuation to Johannesburg developed prodromal symptoms similar to the index case. He was hospitalised on 27 September. His condition deteriorated and he died on 2 October. An intensive care unit nurse who cared for the index case in Johannesburg developed similar flu-like symptoms and was hospitalised on 1 October. Her condition deteriorated on 4 October and she died on 5 October of acute respiratory distress syndrome. In both cases, the incubation period is estimated to have been about one week. On 13 October, the World Health Organization (WHO) posted a website update informing about a fourth case affecting a nurse who had been in contact with the paramedic [2]. On 12 October 2008, the National Institute for Communicable Diseases (NICD) in South Africa provided preliminary evidence that the causative agent of the disease was a virus from the Arenaviridae family [3]. Specimens were shipped to the United States Centers for Disease Control and Prevention (CDC) in Atlanta for additional investigations.
Outbreak of Salmonella enterica serovar Typhimurium in Switzerland, May – June 2008, implications for production and control of meat preparations
Authors: Schmid H , Hächler H , Stephan R , Baumgartner A , Boubaker K
Published: March 2021

An increased number of Salmonella Typhimurium cases were reported in Switzerland between May and June 2008. Investigations involved 72 cases. Results of PFGE typing identified several outbreak strains, the dominating one present in 43 of the 72 isolates. Strains affecting one third of the cases were also found in animal samples, in particular pork. However, no specific food source could be identified. Outbreaks described in this paper highlight the importance of food safety regulations such as those on minced meat and meat preparations issued by the European Commission and adopted by Switzerland into the national law.
Salmonella Typhimurium outbreaks in the Netherlands in 2008
Authors: Doorduyn Y , Hofhuis A , de Jager C  M , van der Zwaluw W  K , Notermans D  W , van Pelt W
Published: March 2021

A large, countrywide outbreak due to multi-resistant Salmonella Typhimurium phage type DT104 is ongoing in the Netherlands, with 152 cases as of 20 October. Pilot interviews did not suggest any specific source of infection but a hypothesis pointing to pork products has been formulated and a large case-control study is under way. Earlier this year two other oubtreaks due to S. Typhimurium were detected and investigated, the first (DT15A) linked to a particular brand of cream cheese, the other (Dutch phage type ft507) to a local butcher.
Increasing multidrug resistance and limited treatment options: situation and initiatives in Europe
Authors: Kristinsson K G , Monnet D L
Published: March 2021

Antimicrobial resistance due to the continuous selective pressure from widespread use of antimicrobials in humans, animals and agriculture has been a growing problem for decades. In 2001, European Union Ministers of Health adopted Council Recommendations on the prudent use of antimicrobial agents in human medicine. This issue of Eurosurveillance is the second one this month dedicated to antimicrobial resistance, in connection with the first-ever European Antibiotic Awareness Day - a European Union (EU) health initiative involving all key players to increase awareness of Europeans about antimicrobial resistance and prudent use of antibiotics.
Increasing prevalence of ESBL-producing Enterobacteriaceae in Europe
Authors: Coque T M , Baquero F , Cantón R
Published: March 2021

Extended-spectrum beta-lactamases (ESBLs) have been increasingly reported in Europe since their first description in 1983. During the 1990s, they were described mainly as members of the TEM- and SHV-beta-lactamase families in Klebsiella pneumoniae causing nosocomial outbreaks. Nowadays, they are mostly found in Escherichia coli that cause community-acquired infections and with increasing frequency contain CTX-M enzymes. Dissemination of specific clones or clonal groups and epidemic plasmids in community and nosocomial settings has been the main reason for the increase in most of the widespread ESBLs belonging to the TEM (TEM-24, TEM-4, TEM-52), SHV (SHV-5, SHV-12) and CTX-M (CTX-M-9, CTX-M-3, CTX-M-14 or CTX-M-15) families in Europe. Co-selection with other resistances, especially to fluoroquinolones, aminoglycosides and sulfonamides, seems to have contributed to the problem. The emergence of epidemic clones harbouring several beta-lactamases simultaneously (ESBLs, metallo-beta-lactamases or cephamycinases) and of new mechanisms of resistance to fluoroquinolones and aminoglycosides warrants future surveillance studies.
Emergence of extensively drug-resistant and pandrug-resistant Gram-negative bacilli in Europe
Authors: Souli M , Galani I , Giamarellou H
Published: March 2021

International and local surveillance networks as well as numerous reports in the biomedical literature provide evidence that the prevalence of antibiotic resistant Gram-negative bacteria is escalating in many European countries. Furthermore, isolates characterised as multidrug-resistant (i.e. resistant to three or more classes of antimicrobials), extensively drug resistant (i.e. resistant to all but one or two classes) or pandrug-resistant (i.e. resistant to all available classes) are increasingly frequently isolated in hospitalised patients causing infections for which no adequate therapeutic options exist. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae are specifically addressed in this review as the most problematic and often extensively or pandrug-resistant pathogens. According to the available multicentre surveillance studies, the proportion of imipenem-resistant A. baumannii strains is reported to be as high as 85% in bloodstream isolates from intensive care unit patients in Greece and 48% in clinical isolates from hospitalised patients in Spain and Turkey. Among 33 European countries participating in the European Antimicrobial Resistance Surveillance System (EARSS) in 2007, six countries reported carbapenem resistance rates of more than 25% among P. aeruginosa isolates, the highest rate reported from Greece (51%). According to EARSS, Greece has also the highest resistance rates among K. pneumoniae; 46% to carbapenems, 58% to quinolones and 63% to third generation cephalosporins. This review describes the magnitude of antimicrobial resistance in Gram-negative bacteria in Europe highlighting where the efforts of the scientific communities, the academia, the industry and the government should focus in order to confront this threat.
A persistent problem with scabies in and outside a nursing home in Amsterdam: indications for resistance to lindane and ivermectin
Authors: van den Hoek J A , van de Weerd J A , Baayen T D , Molenaar P M , Sonder G J , van Ouwerkerk I M , de Vries H JC
Published: March 2021

An ongoing outbreak of scabies in and outside a nursing home in Amsterdam is described. Despite standard treatment with lindane and ivermectin, many recurrences were observed which suggested resistance to these drugs. After treatment with 5% permethrine, the patients were finally cured.
Cluster of imported malaria from Gambia in Finland – travellers do not listen to given advice
Authors: Valve K , Ruotsalainen E , Kärki T , Pekkanen E , Siikamäki H
Published: March 2021

Twelve Finnish tourists contracted falciparum malaria from Gambia in the period between 3 and 27 November 2008. The travellers came from different parts of Finland and all except one had booked the trip from the same travel agency. Ten of them had received information about the risk of malaria in Gambia and protection from mosquito bites but none of them had used adequate malaria chemoprophylaxis.
Cohort study of an outbreak of viral gastroenteritis in a nursing home for elderly, Majorca, Spain, February 2008
Authors: Luque Fernández M A , Galmés Truyols A , Herrera Guibert D , Arbona Cerdá G , Sancho Gayá F
Published: March 2021

An outbreak of acute gastroenteritis occurred in a nursing home for elderly in Majorca between 4 and 23 February 2008. To know its aetiology and mechanism of transmission a retrospective cohort study was conducted with a fixed cohort including 146 people (96 residents and 50 employees). The data were collected from clinical histories and through a survey by questionnaire. In total 71 cases were identified (53 residents, 18 employees), corresponding to an overall attack rate (AR) of 48.6%. The consumption of tap water, adjusted by age, sex and consumption of meals provided at the nursing home, presented a relative risk (RR) of 4.03 (95%CI, 1.4-11.4). The microbiological analyses confirmed the presence of norovirus and/or rotavirus in five of the seven stool samples submitted. The slow appearance of cases at the beginning of the outbreak is characteristic of a person to person transmission, while the sudden peak in the middle of the month suggests a common source such as the tap water. We therefore concluded that the outbreak likely originated from two sources: an infected employee of the nursing home and the tap water. The high number of dependent residents most probably facilitated the spread of the outbreak.
Influenza vaccination coverage in England, 2000-2008
Authors: Pebody R  G , Begum F , Gates P , Noakes K , Salisbury D
Published: March 2021

For several years, the Health Protection Agency on behalf of Department of Health has undertaken routine annual uptake monitoring of the seasonal influenza vaccination programme in England in order to provide an annual estimate of uptake in targeted groups. In 2007-8, 95% of 8,375 GP practices in England took part in data collection. The national mean uptake in those 65 years and above in England was 74%, approaching the WHO target of 75%.
Hepatitis A outbreak in a Roma village in eastern Slovakia, August-November 2008
Authors: Hrivniaková L , Sláčiková M , Kolcunová S
Published: March 2021

We describe an outbreak of hepatitis A in Lomnička, a village in the eastern part of Slovakia. The outbreak was limited to the village and did not spread either to other districts of Slovakia or to the neighbouring countries. The number of cases reported from 28 August to 30 November 2008 was 298. All cases but one occurred in the Roma population. The outbreak was associated with low socio-economic conditions which facilitated person-to-person transmission. No common source of the outbreak was verified.
Cluster of hepatitis A cases among travellers returning from Egypt, Belgium, September through November 2008
Authors: Robesyn E , Micalessi M I , Quoilin S , Naranjo M , Thomas I
Published: March 2021

Following a European alert by France, we detected a hepatitis A cluster in Belgian travellers returning from Egypt. Our investigation supports the hypothesis of a common source outbreak, linked to Nile river cruises. The outbreak also suggests the need to consider an intensification of the vaccination policy for travellers to hepatitis A endemic countries.
Antiviral resistance of influenza A (H3N2) strains isolated in northern Greece between 2004 and 2007
Authors: Melidou A , Kyriazopoulou V , Diza E , Alexiou S , Pierroutsakos Y
Published: March 2021

The prevention and control of influenza with vaccines and antiviral drugs is of great importance. M2 inhibitors, amantadine and rimantadine have been extensively used in some countries. The next generation of antiviral drugs, neuraminidase (NA) inhibitors oseltamivir and zanamivir, are being stockpiled for a potential influenza pandemic. The emergence of resistant strains is thus an important issue. The purpose of this study was to examine the sensitivity to M2 and NA inhibitors of Greek influenza A(H3N2) strains isolated during three influenza seasons between 2004 and 2008 and to determine the phylogenetic clades of those strains. M2 and NA sequences of 34 patient isolates were checked for known resistance mutations. In addition, haemagglutinin (HA) sequences were used to determine the phylogenetic relationship between resistant and sensitive strains. All influenza A(H3N2) strains isolated during the season 2004-5 were found susceptible to adamantanes, bearing the S31N mutation, compared to 88% of the strains isolated in 2005-6 and 75% of the strains isolated in 2006-7. Molecular analysis of the HA gene showed a correlation of the mutants with specific phylogenetic clades. No known mutations in the NA or HA gene that have been implicated in resistance to NA inhibitors were found in the A(H3N2) strains isolated in the three influenza seasons. Despite the fact that amantadine is the only drug approved for prophylaxis in Greece, it has not been extensively used. So it seems that resistant strains circulating in the area after 2005 followed the global trend of replacement of susceptible strains by resistant ones. Oseltamivir and zanamivir are currently approved only for therapeutic use in Greece and has not been extensively used either.
Measles resurgence in France in 2008, a preliminary report
Authors: Parent du Châtelet I , Floret D , Antona D , Lévy-Bruhl D
Published: March 2021

Since the beginning of 2008, France has been experiencing a resurgence of measles. It started in a religious traditionalist group with low coverage and secondarily spread to the general population. This situation is the consequence of the insufficient vaccine coverage (less than 90 % at 24 months of age) which had led to the accumulation of susceptibles over the last years. More than 550 cases have been notified in 2008, the vast majority being unvaccinated. One measles-related death has occurred early 2009. Efforts to enhance communication to the general public and the health professionals on measles vaccination and control measures around cases are ongoing.
Mumps outbreak among the military in Luxembourg in 2008: epidemiology and evaluation of control measures
Authors: Mossong J , Bonert Ch , Weicherding P , Opp M , Reichert P , Even J , Schneider F
Published: March 2021

In the last quarter of 2008, an outbreak of mumps occurred in Luxembourg affecting initially 10 young adults at a military centre. Following a mass vaccination campaign, no further clinical cases were observed. 90% of 136 vaccine recipients were IgG positive one month after vaccination compared to 54% before vaccination. Until 31 December 2008, 19 mumps cases were also reported from the community. The outbreak strain belonged to genogroup G.
Treatment failure in case of typhoid fever imported from India to Czech Republic, December 2008 - January 2009
Authors: Lukáčová L , Orságová I , Zjevíková A , Chmelařová E
Published: March 2021

In this report we describe a case of typhoid fever in a Czech patient with history of travel to India and discuss antibiotic treatment failure which led to the relapse of fever.
Nationwide outbreak of STEC O157 infection in the Netherlands, December 2008-January 2009: continuous risk of consuming raw beef products
Authors: Greenland K , de Jager C , Heuvelink A , van der Zwaluw K , Heck M , Notermans D , van Pelt W , Friesema I
Published: March 2021

The Netherlands experienced a nationwide outbreak of Shiga toxin-producing Escherichia coli (STEC) O157 with onset of symptoms from the end of December 2008 until the end of January 2009. A total of 20 laboratory-confirmed cases were linked to the outbreak strain, serotype O157: H-, stx1, stx2, eae and e-hly positive. The investigation into the source of this outbreak is still ongoing, but evidence so far suggests that infection occurred as a result of consuming contaminated raw meat (steak tartare).
Salmonellosis cases caused by a rare Salmonella Enteritidis PT6c associated with travel to Bulgaria, June-July 2008
Authors: Petrov P , Parmakova K , Siitonen A , Asseva G , Kauko T , Kojouharova M , Kantardjiev T
Published: March 2021

In June 2008 an outbreak of gastroenteritis was registered in Sunny Beach resort situated on the Black Sea coast in Bulgaria, affecting 14 employees of a hotel, five of whom tested positive for Salmonella Enteritidis. During June-July 2008 four sporadic S. Enteritidis cases were also reported and two of them were foreign tourists. In the same period S. Enteritidis cases connected with travel to Bulgaria were reported to the European Centre for Disease Prevention and Control (ECDC) from Finland, United Kingdom, Sweden, Germany and Norway. We describe a study performed to find out relatedness between Bulgarian and Finnish S. Enteritidis isolates using phage typing (PT) and pulse-field gel electrophoresis (PFGE). Fifteen S. Enteritidis isolates from Bulgaria and 195 from Finland (including 28 from travellers to Bulgaria) were phage typed. Within Bulgarian isolates four different PTs were found and PT6c with eight strains was predominant. Nineteen out of 28 strains isolated from the Finns visiting Bulgaria belonged also to PT6c. PFGE typing (with one enzyme) of all S. Enteritidis PT6c strains (8 Bulgarian and 19 Finnish isolates) showed indistinguishable PFGE profile. The typing results thus demonstrated a link between Bulgarian and Finnish S. Enteritidis isolates. We conclude that S. Enteritidis PT6c was the cause of a salmonellosis outbreak in Sunny Beach and was exported to Finland, and likely to the United Kingdom, Norway, Sweden and Germany.
Prevention of congenital rubella and congenital varicella in Europe
Authors: Pandolfi E , Chiaradia G , Moncada M , Rava L , Tozzi A  E
Published: March 2021

Rubella and varicella zoster virus (VZV) infections during pregnancy can cause severe adverse outcomes in the embryo or foetus. Despite the availability of safe and efficacious vaccines, cases of congenital rubella and varicella syndrome still occur in Europe. As of 2004, several countries had high proportions of women of childbearing age that were susceptible to rubella and varicella virus infection. Effective immunisation strategies to enhance prevention should include an active role of different medical specialists in order to include all medical consultations a person may have at different points in their lives as an opportunity to immunise susceptibles. Linkage of data on infectious diseases with those from congenital defects registries may be helpful to monitor the epidemiology of congenital rubella and varicella.
Where is West Nile fever? Lessons learnt from recent human cases in northern Italy
Authors: Gobbi F , Napoletano G , Piovesan C , Russo F , Angheben A , Rossanese A , Cattelan A M , Gallo L , Valsecchi M , Piazza A , Venturi G , Bisoffi Z
Published: March 2021

West Nile disease in humans has been detected for the first time in Italy in two regions, Emilia-Romagna and Veneto. Surveillance subsequently set up in Veneto detected a case of West Nile neuroinvasive disease and a few asymptomatic infections, but no case of West Nile fever. We conclude that also West Nile fever cases should be specifically targeted by surveillance.
The first case of Lassa fever imported from Mali to the United Kingdom, February 2009
Authors: Atkin S , Anaraki S , Gothard P , Walsh A , Brown D , Gopal R , Hand J , Morgan D
Published: March 2021

This is the first case of Lassa fever to be imported from Mali to the United Kingdom. This paper discusses the investigations, the virological analysis, the surveillance and management of contacts undertaken following a case of Lassa fever.
Substantial underreporting of tuberculosis in West Greece - implications for local and national surveillance
Authors: Jelastopulu E , Alexopoulos E C , Venieri D , Tsiros G , Komninou G , Constantinidis T C , Chrysanthopoulos K
Published: March 2021

In order to estimate the reliability of the officially reported national tuberculosis (TB) incidence rates we performed a retrospective review of data collected in regional and national public health framework. TB notifications for the period 2000-2003 were obtained from two major hospitals and three relevant Public Health Departments (PHDs) in the region of West Greece, and subsequently compared with the data reported to the Hellenic Centre for Diseases Control (KEELPNO).
During the four-year study period a total of 161 cases of TB were reported to the PHDs in West Greece; 70% of these cases were reported to the KEELPNO. Furthermore only 72 (38.7%) out of the 186 cases of TB identified in the two hospitals were notified to the PHDs. Assuming that the degree of undernotification observed for the two hospitals is the same throughout the region, we estimated that the case detection rate was 14 cases per 100,000 persons per year, i.e. 3.7 times higher than the rate officially reported for the period 2000-2003. Male predominance (2.1, male/female ratio) and an increased incidence in the elders (older than 60 years) and adolescents (10-14 years old) were also evident. The study demonstrated a substantial underestimation of TB burden in West Greece. In the face of the massive influx of immigrants and refugees coming from regions with high TB incidence and the increase of the number of drug-resistant cases a reliable and complete notification of TB is crucial in the planning of programs and development of appropriate control policies.