bluuebunny/crossref_metadata_2025 huggingface dataset:
Mandatory disease reporting by German laboratories: a survey of attitudes, practices and needs
Authors: Zucs A  P , Benzler J , Krause G
Published: October 2017

In 2000, the new German infectious disease control act replaced aggregate with individual case reporting. The process was facilitated by the simultaneous introduction of electronic data transfer within the public health system. Reporting laboratories have not been electronically connected to this network. A survey by means of a postal questionnaire was conducted in 2003 among 537 German medical microbiology laboratories to explore their reporting habits, preference for electronic reporting formats, and relevant software equipment. Almost 90% of the respondents indicated a reporting delay of no more than 24 hours and 45% were still manually filling in paper forms for reporting purposes. The introduction of electronic reporting formats was favoured by 74% of the laboratories although 33% were not using any microbiology-specific software and the remaining 67% listed 62 different products. Pilot projects with selected software manufacturers might help to pave the way for the implementation of a standardised electronic infectious disease reporting format in Germany.
Electronic reporting improves timeliness and completeness of infectious disease notification, The Netherlands, 2003
Authors: Ward M , Brandsema P , van Straten E , Bosman A
Published: October 2017

In 2002, the internet based reporting system OSIRIS was introduced in the Netherlands and by the end of that year had fully replaced the paper-based reporting system. The objectives of OSIRIS were to improve timeliness and completeness of surveillance data on infectious diseases reported from regional to national level. We compared the timeliness of infectious diseases reported by the conventional paper-based system in 2001 with those reported by OSIRIS in 2003. Two distinct types of delay were compared: total delay: defined as time between sympton onset and reporting at national level and central delay: defined as time between regional and national reporting. Median delays between both systems were compared using the Wilcoxon Rank Sum-Test. We also compared electronic reports received via OSIRIS in 2003 to those received through the conventional system for 2001 for completeness of specific data fields. The Fisher exact test and the Mantel-Haenzel test with Yates correction were used to determine the significance of proportions of completed data fields in each system.
Evaluation of tickborne encephalitis case classification in Poland
Authors: Stefanoff P , Eidson M , Morse D L , Zielinski A
Published: October 2017

Central European tickborne encephalitis (TBE) is a viral disease of the central nervous system. Despite a surveillance system for TBE existing in Poland since 1970, there are no standardised case definitions and different diagnostic tests are used in various regions. The purpose of this study was to summarise four years of surveillance data using standardised case definitions. From 1999 to 2002, 607 cases of TBE were reported to Poland’s national surveillance system: 386 (63.6%) were males, 331 (54.5%) lived in rural areas, and 186 (30.6%) were between 30 and 50 years old. Of 606 diagnosed cases, 453 (74.7%) had aseptic meningitis, 109 (18.0%) had meningoencephalitis, and 44 (7.3%) had meningoencephalomyelitis. Of the 607 reported cases, 602 (99.2%) could be classified: 153 (25.4%) as confirmed, 343 (57.0%) as probable, and 106 (17.6%) as possible cases. There was a significant difference in classified cases by gender: 28.6% of male cases were classified as confirmed, compared with 19.7% of female cases (chi2= 10.48, p=0.0053). There was a significant difference in case classification by clinical diagnosis: 32.4% of cases with meningoencephalitis were classified as confirmed cases, compared with 24.7% of cases with aseptic meningitis (chi2=11.79, p=0.019). There were also significant differences in the distribution by case definition group across geographical regions. For appropriate monitoring of TBE, a uniform and valid case definition should be used in European countries. With only 25% of reported cases meeting the definition for confirmed cases, there is a need for more complete follow-up and standardised testing of suspect cases.
Blood safety and nucleic acid testing in Europe
Authors: Laperche S
Published: October 2017

Over the past two decades, a long series of specific and non-specific measures have been introduced into the screening of blood donations in order to reduce the residual risk of transmission of bloodborne viruses. The latest specific measure has been viral nucleic acid testing (NAT), introduced by the European plasma industry in 1995, and subsequently introduced for blood donations in several countries in Europe and elsewhere. NAT was implemented to reinforce the safety of the blood supply; it can detect acute viral infections during the ‘window period’, that were not being detected by the serological screening methods used at that time. To assess the impact of NAT on the safety of the blood supply, it is essential to estimate the residual risk of viral transmission. In this issue, six European countries (France, Germany, Italy, Spain, Switzerland and the United Kingdom) that have recently implemented NAT describe their experiences and the results of the evaluation of the residual risk of viral transmission in their blood supply [1-6].
Communicable disease control in a migrant seasonal workers population: A case study in Norway
Authors: Guérin P J , Vold L , Aavitsland P
Published: October 2017

Reliable data on the health status of migrant seasonal workers in Europe is scarce. Access to public health care for this population depends on national regulations, and their legal status in host countries. In this manuscript we describe a case study of a salmonellosis outbreak that occurred in Norway, and highlight the difficulties encountered in applying control measures in a population of seasonal migrant farm workers. Surveillance and control of infectious diseases need to be supported by legislation which makes implementation of control measures possible. Efforts have been made to improve the rights for migrants in Europe with regard to healthcare, but seasonal migrant workers still remain largely outsiders where these measures are concerned. Special attention should be given to this disadvantaged group in terms of social rights and healthcare. Preparedness plans should be improved to deal with contagious pathogens involving the seasonal migrant population.
Surveillance of Lyme borreliosis in Germany, 2002 and 2003
Authors: Mehnert W H , Krause G
Published: October 2017

Lyme borreliosis is a potentially serious infection common in Germany, but little data about its incidence, distribution, and clinical manifestations are available. Lyme borreliosis is not a notifiable disease in Germany, but six of Germany’s 16 states – Berlin, Brandenburg, Mecklenburg-Vorpommern, Sachsen, Sachsen-Anhalt and Thüringen, have enhanced notification systems, which do include Lyme borreliosis. The efforts made in these states to monitor confirmed cases through notification are therefore an important contribution to understanding the epidemiology of Lyme borreliosis in Germany. This report summarises the analysis of Lyme borreliosis cases submitted to the Robert Koch-Institut during 2002-2003. The average incidence of Lyme borreliosis of the six East German states was 17.8 cases per 100 000 population in 2002 and increased by 31% to 23.3 cases in 2003, respectively. Patient ages were bimodally distributed, with incidence peaks among children aged 5- 9 and elderly patients, aged 60- 64 in 2002, and 65- 69 in 2003. For both years, 55% of patients were female. Around 86% of notified cases occurred from May to October. Erythema migrans affected 2697 patients (89.3%) in 2002 and 3442 (86.7%) in 2003. For a vector-borne disease, like Lyme borreliosis, the risk of infection depends on the degree and duration of contact between humans and ticks harbouring Borrelia burgdorferi. As infectious ticks probably occur throughout Germany, it is likely that the situation in the remaining 10 German states is similar to that of the states in this study.
Community acquired MRSA infections in a paediatric population in Greece
Authors: Vourli S , Perimeni D , Makri A , Polemis M , Voyiatzi A , Vatopoulos A
Published: October 2017

We investigated the characteristics of 20 community acquired methicillin resistant Staphylococcus aureus (MRSA) strains isolated in a paediatric hospital in Athens. Eighteen of these, all isolated from skin and soft tissue infections, carried the Panton-Valentine leukocidin (PVL) determinants. They all were found resistant to fusidic acid, tetracycline and kanamycin, and displayed a PFGE pattern identical to that of the well-described ST80 CA-MRSA clone circulating in various European countries.
The 2003 European heat waves
Authors: Kosatsky T
Published: October 2017

The current issue of Eurosurveillance updates and provides additional context to the report in early 2004 of an estimated 22 080 excess deaths in England and Wales, France, Italy and Portugal during and immediately after the heat waves of the summer of 2003 [1]. While estimates for England and Wales [2], France [3], and Portugal [4], are largely unchanged from those reported earlier, to these should be added 6595-8648 excess deaths in Spain [5], of which approximately 54% or 3574-4687 occurred in August, and 1400-2200 in the Netherlands [6], of which an estimated 500 occurred during the heat wave of 31 July-13 August. Data for Italy, provided here for the cities of Bologna, Milan, Rome, and Turin, are compatible with the earlier estimate that 3134 excess deaths occurred in the 21 Italian regional capitals during the period 1 June-15 August [1,7]; the Italian National Institute of Statistics however, reported an excess of 19 780 deaths country-wide during June-September 2003 as compared to 2002 [8]. Reports elsewhere indicate that approximately 1250 heat-related deaths occurred in Belgium during the summer of 2003 [9], that there were 975 excess deaths during June-August in Switzerland [10] and 1410 during the period August 1-24 in Baden-Württemberg, Germany [11]. At this point, it seems reasonable to speculate that with evidence of heat wave-associated deaths beyond England and Wales, France, Italy, and Portugal, the previously published estimate of 22 080 early August excess deaths should be revised upward by at least 50% for all of western Europe, and by 100% or more if heat events that occurred during June and July 2003 are also taken into account.
The effect of the summer 2003 heat wave on mortality in the Netherlands
Authors: Garssen J , Harmsen C , De Beer J
Published: October 2017

In the Netherlands, between 1400 and 2200 deaths in the summer of 2003 may have been heat-related. The fact that the maximum temperatures were lower than in some other European countries, and occurred in less heavily populated areas, may have led to mortality figures that were relatively less dramatic. The temporarily increased death rates are only partly due to a forward shift of mortality. Heat-related mortality was most pronounced among the elderly in nursing homes.
An outbreak of mumps in Sweden, February-April 2004
Authors: Sartorius B , Penttinen P , Nilsson J , Johansen K , Jönsson K , Arneborn M , Löfdahl M , Giesecke J
Published: October 2017

Between 24 February and 26 April 2004, Västra Götaland county in Sweden reported 42 cases of suspected mumps. A descriptive study of the cases was undertaken. A questionnaire was administered by telephone and vaccine effectiveness was calculated using the screening method. Seventy four per cent (31/42) of the suspected cases were interviewed by telephone. Eight out of the 42 serum samples were positive or equivocal for mumps IgM by ELISA. Mumps virus genome was identified in 21/42 (50%) saliva samples. Eleven were selected for sequencing and all were confirmed to be mumps virus. Cases were predominantly from 2 small towns. Eighteen out of 19 cases that developed bilateral swelling could be linked to one small town. The median age of interviewed cases was 43 years (range 5 to 88). Six cases were admitted to hospital, 5 of which were older than 30 years. The highest incidence occurred in the 35 to 44 years age group. Vaccine effectiveness was estimated to be 65% for 1 dose and 91% for 2 doses.
This descriptive study shows the increasing age of mumps cases with increasing vaccine coverage. Vaccine effectiveness was particularly high for 2 doses. Second-dose uptake must be ensured, as primary vaccine failure is well documented in mumps. Stronger precautions must be taken to avoid pools of susceptible older individuals accumulating due to the increased risk of complications.
Real or media-mediated outbreak of coxsackie infections in 2002 in Greece?
Authors: Exindari M , Gioula G , Raptis D , Mavroidi V , Bouzia E , Kyriazopoulou V
Published: October 2017

The purpose of this study was to provide evidence about the existence of a coxsackie B outbreak in Greece in 2002 by comparing data of laboratory confirmed coxsackie B recent infections in northern Greece between 1998-2001 with data from 2002.
The infections were confirmed serologically, using the indirect immunofluorescence method detecting IgM antibodies for coxsackie B1-B6 viruses. Sera from 2701 patients residents of northern Greece who were suspected to be suffering from coxsackie B virus infections were examined: 2056 between 1998 and 2001, and 645 in 2002.
The comparison between the results of laboratory confirmed cases and data available at the laboratory between the two periods showed that:
- The total number of patients examined per year was higher in 2002 (645 versus an annual average of 514 in 1998-2001).
- The proportion of laboratory confirmed recent infections was lower in 2002 (27.8% versus 32.7%) and the estimated incidence was 0.66/10 000 for 2002 and 0.32-0.84/10 000 for 1998-2001.
- The age distribution differed: the proportions of cases in children versus cases in adults were reversed in 2002 compared with 1998-2001, with a higher proportion among children in 2002. The difference between the two periods was statistically significant. Children aged 3-5 years were the age group most affected in 2002.
- Seasonal distribution remained the same for both periods (peaks in spring and autumn). In 2002, three fatal cases occurred in April, but no deaths were reported in 1998-2001.
- The clinical syndromes involved also differed: cases of respiratory infections, mainly pneumonia, rose from 5.75% to 24.3% in children in 2002 and cases of myopericarditis rose in adults from 13% in 1998-2001 to 29.5% in 2002.
The last finding, combined with the involvement of the media (because of the three fatal cases) and the panic in the general public that followed suggested that an outbreak had occurred, but we conclude that there was no outbreak.
Wound botulism in injectors of drugs: upsurge in cases in England during 2004
Authors: Akbulut D , Dennis J , Gent M , Grant K A , Hope V , Ohai C , McLauchlin J , Mithani V , Mpamugo O , Ncube F , De Souza-Thomas L
Published: October 2017

Wound infections due to Clostridium botulinum were not recognised in the UK and Republic of Ireland before 2000. C. botulinum produces a potent neurotoxin which can cause paralysis and death. In 2000 and 2001, ten cases were clinically recognised, with a further 23 in 2002, 15 in 2003 and 40 cases in 2004. All cases occurred in heroin injectors. Seventy cases occurred in England; the remainder occurred in Scotland (12 cases), Wales (2 cases) and the Republic of Ireland (4 cases). Overall, 40 (45%) of the 88 cases were laboratory confirmed by the detection of botulinum neurotoxin in serum, or by the isolation of C. botulinum from wounds. Of the 40 cases in 2004, 36 occurred in England, and of the 12 that were laboratory confirmed, 10 were due to type A. There was some geographical clustering of the cases during 2004, with most cases occurring in London and in the Yorkshire and Humberside region of northeast England.
Disseminated and chronic Lyme borreliosis in Norway, 1995 – 2004
Authors: Nygård K , Brantsaeter A B , Mehl R
Published: October 2017

Lyme borreliosis is the most common tickborne infection in Norway. All clinical manifestations of Lyme borreliosis other than erythema migrans are notifiable to Folkehelseinstituttet, the Norwegian Institute of Public Health. During the period 1995-2004 a total of 1506 cases of disseminated and chronic Lyme borreliosis were reported. Serological tests were the basis for laboratory diagnosis in almost all cases. The annual numbers of cases showed no clear trend over the period, but varied each year between 120 and 253 cases, with the highest number of cases reported in 2004. Seventy five per cent of cases with information on time of onset were in patients who fell ill during the months of June to October. There was marked geographical variation in reported incidence rates, with the highest rates reported from coastal counties in southern and central Norway. Fifty six per cent of the cases were in males and 44% in females. The highest incidence rate was found in children aged between 5 and 9 years. Neuroborreliosis was the most common clinical manifestation (71%), followed by arthritis/arthralgia (22%) and acrodermatitis chronica atrophicans (5%). Forty six per cent of patients were admitted to hospital. Prevention of borreliosis in Norway relies on measures to prevent tick bites, such as use of protective clothing and insect repellents, and early detection and removal of ticks. Antibiotics are generally not recommended for prophylaxis after tick bites in Norway.
An imported case of canine rabies in Aquitaine: Investigation and management of the contacts at risk, August 2004-March 2005
Authors: Servas V , Mailles A , Neau D , Castor C , Manetti A , Fouquet E , Ragnaud J M , Bourhy H , Paty M C , Melik N , Astoul J , Cliquet F , Moiton M P , François C , Coustillas M , Minet J- C , Parriaud P , Capek I , Filleul L
Published: October 2017

In August 2004, a case of rabies was diagnosed in a puppy that had been illegally imported from Morocco to Bordeaux (France). Because a great number of people and animals were thought to have come into contact with the puppy, extensive tracing measures were implemented, and an international alert was launched to trace and treat the contacts at risk. One hundred and eighty seven people received post-exposure treatment, eight of whom also received serovaccination, and 57 animals known to have been exposed to the puppy were tested. Six months after the death of the rabid animal, none of the people treated showed any signs of rabies, nor was any secondary animal case reported. The management of this crisis highlights the importance of the role of a rapid alert system at European level. Strict application of sanitary control regulations is essential for animals introduced into EU countries, and all necessary information must be made available to EU residents travelling to rabies enzootic areas.
'Did you have flu last week?’ A telephone survey to estimate a point prevalence of influenza in the Swedish population
Authors: Payne L , Kühlmann-Berenzon S , Ekdahl K , Giesecke J , Högberg L , Penttinen P
Published: October 2017

Sentinel surveillance usually underestimates the true burden of influenza in a population, as individuals must present to medical establishments to be included in the surveillance system. We carried out a telephone survey to estimate the national burden of influenza in the Swedish population for one week during the 2004/05 influenza season. Fixed-line telephone numbers were randomly sampled and households interviewed concerning influenza illness between 14-20 February 2005 (Week 7 of 2005). Questions regarding seasonal influenza vaccination status, symptoms and the impact of illness on daily life were also included. A self-defined influenza prevalence of 7.7% in week 7 of 2005 was estimated. On applying a case definition of ‘cough and fever and muscle pain’ for influenza like illness, the prevalence decreased to 3.6%. The survey provided insight into the burden of illness in the population further to that estimated through the sentinel surveillance system.
Absence of infection in asymptomatic contacts of index SARS case in France
Authors: Le Vu S , Yazdanpanah Y , Bitar D , Emmanuelli J , Bonmarin I , Desenclos J C
Published: October 2017

The first case of severe acute respiratory syndrome (SARS) in France was diagnosed in March 2003. We conducted a serological survey to assess whether or not asymptomatic persons who had been in contact with this patient during his infectious stage had been infected. They were interviewed and asked to provide a blood sample for SARS coronavirus immunoglobulin G antibody testing. Despite the likely high infectivity of the SARS patient, no asymptomatic SARS infection was found in any of the 37 contacts included. These findings support a SARS case definition that is essentially based on clinical and epidemiological assessment, should SARS re-emerge.
Epidemiology and response to the growing problem of tuberculosis in London
Authors: Antoine D , Maguire H , Story A
Published: October 2017

As in other countries with low tuberculosis incidence, tuberculosis in England and Wales tends to be concentrated in some subgroups of the population, and is mainly a problem in large cities. In 2003, almost half of all tuberculosis cases reported in England and Wales were from London, where the incidence was almost five times higher than in the rest of England and Wales. While the highest proportion of cases occur in foreign born patients, evidence from a large outbreak of drug resistant tuberculosis points to ongoing active transmission among marginalised groups including homeless people, hard drug users, and prisoners. Increasing rates of disease and levels of drug resistance, combined with a concentration of disease in hard-to-reach risk groups now present a major challenge to tuberculosis control in the city. To respond to the changing epidemiology observed in recent years, treatment and control services are being reconfigured, surveillance has been improved with the implementation of the London TB register, and the utility of mobile digital x ray screening for at risk populations such as homeless people and prisoners is being evaluated. However, tuberculosis in London is not yet under control and more needs to be done. Services must adapt to the needs of those groups now most affected. This will require continued improvements to surveillance and monitoring, combined with improved access to care, better case detection, rapid diagnosis and active social support for people undergoing treatment.
Infection risks from water in natural and man-made environments
Authors: Nichols G
Published: October 2017

People can catch diarrhoeal diseases from contamination of both natural and man-made environments with human or animal faeces. Young children are more likely to be susceptible to the agents and to be exposed. While some diarrhoeal diseases acquired in childhood can be relatively mild and give some protection as an adult, others are more severe. The two papers presented in this issue of Eurosurveillance describe, on the face of it, unremarkable small outbreaks; one, from Chikwe Ihekweazu et al, linked to exposure to a stream contaminated with Escherichia coli from animal faeces [1]; the other, from Melanie Jones et al, to exposure to a water feature contaminated with Cryptosporidium parvum from either animal or human faeces [2].
Cryptosporidium outbreak linked to interactive water feature, UK: importance of guidelines
Authors: Jones M , Boccia D , Kealy M , Salkin B , Ferrero A , Nichols G , Stuart J M
Published: October 2017

A need for national guidelines relating to interactive water features was highlighted following three outbreaks of cryptosporidiosis in the United Kingdom, all of which were related to public water features. In August 2003 the Health Protection Agency South West of England was notified of an outbreak of cryptosporidiosis associated with an interactive water feature designed for water play within an adventure park. The water feature was implicated following samples with a high coliform count and the presence of faecal coliforms.
A case was defined as any child (younger than 16 years of age) who had visited the park during August and who subsequently had gastrointestinal symptoms and a faecal sample positive for cryptosporidium. Seventy one children were identified in the cohort.
This outbreak of cryptosporidiosis was characterised by a very high attack rate (89%), relatively severe in duration (median 8 days) and had a relatively high hospital admission (16% of cases). The epidemic curve was consistent with a point source of infection, which corresponded to the date 80% of the cohort visited the park. This outbreak has similarities to two other cryptosporidiosis outbreaks reported in England in 2003 that involved public water features. These outbreaks raise issues about the operation and maintenance of water-based recreational attractions that very often involve children. The paper reflects on the basic control measures that can be taken and highlights the need for guidelines, especially since such attractions are becoming increasingly common. The Pool Water Treatment Advisory Group in United Kingdom has now produced guidelines.
Outbreak of E. coli O157 infection in the south west of the UK: risks from streams crossing seaside beaches
Authors: Ihekweazu C , Barlow M , Roberts S , Christensen H , Guttridge B , Lewis D A , Painter S
Published: October 2017

In August 2004 seven cases of Escherichia coli O157 infection were identified in children on holiday in Cornwall, southwest England, all of whom had stayed at different sites in the area. Isolates from all seven cases were confirmed as E. coli serogroup O157 phage type 21/28. We carried out a case-control study among holidaymakers who visited the beach. A standardised questionnaire was administered by telephone to parents. They were asked where on the beach the children had played, whether they had had contact with the stream that flowed across the beach, and about their use of food outlets and sources of food eaten. Cases were more likely to have played in the stream than controls (OR [1.72- undefined]). The time spent in the stream by cases was twice spent there by controls. Cases and controls were equally exposed to other suspected risk factors. PFGE profiles for all the cases were indistinguishable. Increased numbers of coliforms were found in the stream prior to the outbreak. Cattle were found grazing upstream. We suggest that the vehicle of infection for an outbreak of acute gastrointestinal illness caused by E. coli O157 was a contaminated freshwater stream flowing across a seaside beach. The onset dates were consistent with a point source. Heavy rainfall in the days preceding the outbreak might have lead to faeces from the cattle potentially contaminated by E. coli O157 contaminating the stream, thereby leading to the outbreak. Control measures included fencing off the part of the stream in which children played, and putting up warning signs around the beach.
Human H5N1 infections: so many cases – why so little knowledge?
Authors: Nicoll A
Published: October 2017

This month edition contains an account of clusters of H5N1 infection in humans in Azerbaijan [1]. The account is doubly rare: It describes the first occasion where the source is seemingly wild birds. Reading what happened is reassuring as the people infected had probably killed and defeathered infected swans. I.e. this was not casual exposure to wild birds but rather qualitatively similar to when humans are intimately exposed to sick domestic poultry, which remains the most potent risk factor (one recent analytic study came up with an odds ratio of 29 [2]).
Two clusters of human infection with influenza A/H5N1 virus in the Republic of Azerbaijan, February–March 2006
Authors: Gilsdorf A , Boxall N , Gasimov V , Agayev I , Mammadzade F , Ursu P , Gasimov E , Brown C , Mardel S , Jankovic D , Pimentel G , Amir Ayoub I , Maher Labib Elassal E , Salvi C , Legros D , Pessoa da Silva C , Hay A , Andraghetti R , Rodier G , Ganter B
Published: October 2017

Following the appearance of influenza A/H5 virus infection in several wild and domestic bird species in the Republic of Azerbaijan in February 2006, two clusters of potential human avian influenza due to A/H5N1 (HAI) cases were detected and reported by the Ministry of Health (MoH) to the World Health Organization (WHO) Regional Office for Europe during the first two weeks of March 2006. On 15 March 2006, WHO led an international team, including infection control, clinical management, epidemiology, laboratory, and communications experts, to support the MoH in investigation and response activities.
As a result of active surveillance, 22 individuals, including six deaths, were evaluated for HAI and associated risk infections in six districts. The investigations revealed eight cases with influenza A/H5N1 virus infection confirmed by a WHO Collaborating Centre for Influenza and one probable case for which samples were not available. The cases were in two unrelated clusters in Salyan (seven laboratory confirmed cases, including four deaths) and Tarter districts (one confirmed case and one probable case, both fatal). Close contact with and de-feathering of infected wild swans was considered to be the most plausible source of exposure to influenza A/H5N1 virus in the Salyan cluster, although difficulties in eliciting information were encountered during the investigation, because of the illegality of some of the activities that might have led to the exposures (hunting and trading in wild birds and their products). These cases constitute the first outbreak worldwide where wild birds were the most likely source of influenza A/H5N1 virus infection in humans.
The rapid mobilisation of resources to contain the spread of influenza A/H5 in the two districts was achieved through collaboration between the MoH, WHO and its international partners. Control activities were supported by the establishment of a field laboratory with real-time polymerase chain reaction (RT-PCR) capacity to detect influenza A/H5 virus. Daily door-to-door surveillance undertaken in the two affected districts made it unlikely that human cases of influenza A/H5N1 virus infection remained undetected.
Surveillance of human salmonellosis in Bulgaria, 1999-2004: trends, shifts and resistance to antimicrobial agents
Authors: Asseva G , Petrov P , Ivanov I , Kantardjiev T
Published: October 2017

This article analyses the distribution of resistant salmonella and resistance mechanisms among the most frequently encountered serotypes in Bulgaria. Culture, biochemical tests and serotyping were used for identification. Screening for resistance to 14 antimicrobial agents with the standard Bauer-Kirbi disk-diffusion method. The double disk synergy method was used to determine production of extended-spectrum â-lactamases (ESBL). Transfer of genes coding for ESBLs with experimental conjugation. Specific primers were used for PCR detection of bla-CTX-M, bla-SHV and bla-TEM. 245 resistant salmonella strains were determined in our study; the majority originated from sporadic cases of human illness or asymptomatic infection and the remaining 23 were isolated from outbreaks. 79 producers of ESBL were detected: 5 S. Enteritidis, 1 S. Typhimurium, 9 S. Isangi and 62 S. Corvallis with types of enzymes: CTX-M3, TEM and SHV. Gene coding for extended-spectrum â- lactamases were successfully transferred into a recipient Escherichia coli C1A strain simultaneously with genes coding for resistance to aminoglycosides and sulphonamides (for bla-CTX-M3) and gene coding for resistance to aminoglycosides and chloramphenicol (for bla-SHVand bla-TEM). PCR amplification revealed bla-CTX-M3 genes in S. Enteritidis, and bla-SHV and bla-TEM in S. Corvallis. Salmonellae have revealed increasing resistance to all clinically important groups of antimicrobial agents. Bulgaria is the first country in the world where ESBL in serotype Corvallis has been reported.
A wide diversity of resistance genes is found among the leading serotypes of salmonella causing human disease in Bulgaria.
SmiNet-2: Description of an internet-based surveillance system for communicable diseases in Sweden
Authors: Rolfhamre P , Janson A , Arneborn M , Ekdahl K
Published: October 2017

Electronic systems for communicable diseases surveillance enhance quality by simplifying reporting, improving completeness, and increasing timeliness.
In this article we outline the ideas and technologies behind SmiNet-2, a new comprehensive regional/national system for communicable disease surveillance in Sweden. The system allows for reporting from physicians (web form) and laboratories (direct from lab data system) over the internet. Using a unique personal identification number, SmiNet-2 automatically merges clinical and laboratory notifications to case records. Privileged users, at national and county level, work against a common central server containing all notifications and case records. In addition, SmiNet-2 has separate county servers with tools for outbreak investigations, contact tracing and case management.
SmiNet-2 was first used in September 2004. Individual counties receive up to 90% of all notifications electronically. In its first year, SmiNet-2 received 54 980 clinical notifications and 32 765 laboratory notifications, which generated 58 891 case records.
Since most clinicians in Sweden have easy access to the internet, a general web-based reporting has been feasible, and it is anticipated that within a few years all reporting to SmiNet-2 will be over the internet. In this context, some of the major advantages of SmiNet-2 when compared with other systems are timeliness in the dataflow (up to national level), the full integration of clinical and laboratory notifications, and the capability to handle more than 50 diseases with tailor-made notification forms within one single system.
Significant increase of listeriosis in Germany - Epidemiological patterns 2001-2005
Authors: Koch J , Stark K
Published: October 2017

Listeriosis has been a mandatorily notifiable disease in Germany since January 2001. Clinical cases with isolation of Listeria monocytogenes from sterile specimens or neonates are reported to the Robert Koch-Institut. Listeriosis incidence significantly increased from 0.26 per 100 000 inhabitants (217 cases) in 2001 to 0.62 per 100 000 (519 cases) in 2005.
Prolonged outbreak of B meningococcal disease in the Seine-Maritime department, France, January 2003 to June 2005
Authors: Rouaud Pascale , Perrocheau A , Taha M K , Sesboué C , Forgues A M , Parent du Châtelet I , Lévy-Bruhl D
Published: October 2017

Between January 2003 and June 2005, an outbreak of meningococcal disease occured in the department of Seine-Maritime in northern France. Eighty six cases were notified, giving an average annual incidence of 2.7 cases per 100 000 inhabitants, compared with 1.6 in France. An especially affected area was defined as the city of Dieppe and its surrounding area (26 cases, giving an annual incidence of 12 cases per 100 000). This outbreak was due to N. meningitidis phenotype B:14:P1.7,16 belonging to the clonal complex ST-32/ET-5. Over the 31 B14:P1.7,16 cases confirmed by phenotyping methods at the national reference centre for meningococci (CNR, Centre National de Référence des méningocoques) the case-fatality rate (19%) and the proportion of purpura fulminans (42%) were especially high. Teenagers aged between 15 and 19 years and children aged 1 to 9 years were the most affected. In 2003, health authorities put in place enhanced epidemiological surveillance and informed practitioners and population about the disease. In 2004, the national vaccination advisory board studied the opportunity of using a non licensed outer membrane vesicle vaccine developed in Norway which may be effective against the B14:P1.7,16 strain. The Ministry of health decided in 2006 to offer vaccination with this vaccine to people aged 1 to 19 years in Seine- Maritime.
Healthcare associated infections in university hospitals in Latvia, Lithuania and Sweden: a simple protocol for quality assessment
Authors: Struwe J , Dumpis U , Gulbinovic J , Lagergren Å , Bergman U
Published: October 2017

Surveillance of healthcare associated infections is an overlooked parameter of good clinical practice in most healthcare institutions, due to the workload demanded in the absence of adequate IT-systems. The aim of the present study was to investigate whether a simple protocol could be used to estimate the burden of healthcare associated infections in three university hospitals in Huddinge in Sweden, Riga in Latvia and Vilnius in Lithuania and form the basis for initiating a long term follow up system.
The medical records of all patients receiving antibiotics were reviewed according to a standardised protocol, focusing on the indications for the drugs and on the frequency of hospital acquired infection (HAI) in a point-prevalence survey. Only comparable specialities were included.
The proportion of patients treated with antibiotics (prophylaxis not included) were 63/280 (22%) in Huddinge, 73/649 (11%) in Riga and 99/682 (15%) in Vilnius. The proportion of admitted patients treated for a HAI were 15%, 3% and 4%, respectively, (both comparisons Huddinge versus other centres P<0.001). Surgical site infections were most common, followed by infections with an onset more than 2 days after admission without any of the other registered risk factors present. Our inexpensive and simple method showed that healthcare associated infections were a significant problem among patients admitted to Huddinge. The figures obtained can be used for further discussion and form a baseline for follow up at the local level. The comparison of figures between centres was far less relevant than the process the study created.
A slow epidemic of LGV in the Netherlands in 2004 and 2005
Authors: van de Laar M J W , Koedijk F. D.H. , Götz H , de Vries H JC
Published: October 2017

In 2004, an outbreak of LGV was detected in MSM in the Netherlands. By January 2006, 179 confirmed cases of LGV had been reported; 65 (retrospectively) in 2002/2003, 76 in 2004 and 38 in 2005.
The evolution of the LGV outbreak appears to have slowed down and only a few cases were found in the first months of 2006.
Improvement of a national public health surveillance system through use of a quality circle
Authors: Krause G , Benzler J , Reiprich G , Görgen R
Published: October 2017

Surveillance systems for infectious diseases build the basis for effective public health measures in the prevention and control of infectious diseases. Assessing and improving the quality of such national surveillance systems is a challenge, as many different administrations and professions contribute to a complex system in which sensitive information must be exchanged in a reliable and timely fashion. We conducted a multidisciplinary quality circle on the national public health surveillance system in Germany which included clinicians, laboratory physicians, and staff from local and state health departments as well as from the Robert Koch-Institut. The recommendations resulting from the quality circle included proposals to change the federal law for the control of infectious diseases as well as practical activities such as the change of notification forms and the mailing of faxed information letters to clinicians. A number of recommendations have since been implemented, and some have resulted in measurable improvements. This demonstrates that the applied method of quality circle is a useful tool to improve the quality of national public health surveillance systems.
The Early Warning and Response System for communicable diseases in the EU: an overview from 1999 to 2005
Authors: Guglielmetti P , Coulombier D , G Thinus G , Van Loock F , Schreck S
Published: October 2017

Under Decision 2119/98/EC of the European Parliament and of the Council, a network for epidemiological surveillance and control of communicable diseases in the Community was set up in 1998. One pillar of Decision 2119/98/EC is the early warning and response system (EWRS). The main objective of the network is to establish permanent communication between European Union (EU) Member States’ public health authorities, which are responsible for determining the measures required to control communicable disease-related events. Since 1998, a web based informatics tool has been developed in order to allow information to be shared between the relevant public health authorities. Between 1998 and December 2005, a total of 583 messages were circulated through the EWRS, notifying 396 events. The information shared through the system helped to coordinate public health measures in the EU. However, only few events prompted specific measures at Community level and most of them were controlled with public health measures applied at national level. Major events (such as the Severe Acute Respiratory Syndrome) and the results of simulation exercises prompted the Commission to upgrade the informatics system on the basis of user needs. Since 1 May 2004 the 10 newest Member States have provided information under the current legislation and since April 2005 the European Centre for Disease Prevention and Control (ECDC) is part of the system. Future developments will include a link between the existing EWRS and the communication platform currently developed by the ECDC.
Hepatitis and HIV in Northern Ireland prisons: a cross-sectional study
Authors: Danis K , Doherty L , McCartney M , McCarrol J , Kennedy H
Published: October 2017

A study was undertaken in Northern Ireland (NI) prisons to (i) determine prevalence of bloodborne viruses among inmates, (ii) estimate the extent of self-reported risk behaviours. All three prisons in NI were included in the study. Outcome measures included (i) antibodies to hepatitis C (HCV), hepatitis B (HBV) core antigen, HIV, (ii) self-reported risk behaviour. Five prisoners (0.75 %) tested positive for HBV, seven (1.1%) for HCV and none for HIV. Eleven per cent reported ever having injected drugs. Of these, 20% had started injecting while in prison, and 12% shared injecting equipment in prison. Two per cent had completed HBV immunisation. Injecting drugs was associated with HCV (adjusted prevalence ratio=5.2; 95% CI 0.9-16) and HBV infection (adjusted prevalence ratio=4.1; 95% CI 0.7-23). The low prevalence of bloodborne viruses within NI prisons is not consistent with findings of studies in other countries, possibly reflecting the unique sociopolitical situation in NI. In spite of knowledge of the risks of transmission of bloodborne viruses in prison, high-risk practices are occurring. Preventing risk behaviours and transmission of infection in prisons now poses a challenge for health services in the United Kingdom.
Stagnating influenza vaccine coverage rates among high-risk groups in Poland and Sweden in 2003/4 and 2004/5
Authors: Kroneman M , van Essen G A
Published: October 2017

This paper examines influenza vaccine coverage rates (VCR) in Poland and Sweden during the 2003/4 and 2004/5 influenza seasons. An average sample of 2,500 persons was interviewed in each country and each season. Questions regarded age and possible chronic diseases, as well as information on whether they had had an influenza vaccination in the given season. Those who had not received the vaccine were also asked to give reasons for non-vaccination. About one in four (Sweden) to one in three (Poland) of the persons surveyed belonged to high-risk groups (>=65 years of age or suffering from chronic diseases). In the 2004/5 season, 17% (CI 12-19%) of the Polish elderly and 45% (CI 39-50%) of the Swedish elderly were vaccinated. In Poland, 9% (CI 7-12%) of respondents younger than 65 years of age with a chronic condition were vaccinated, whereas in Sweden the corresponding rate was 12% (CI 9-16%). In both countries, the VCR did not change significantly from the previous season. Personal invitations resulted in a higher VCR. In Sweden, the most frequently mentioned reasons for not being vaccinated were the assumption of not qualifying for a vaccination and perceived resistance. In Poland in both years, perceived resistance to flu and the cost of the vaccination were the most often mentioned reasons. The influenza vaccination rates in Poland and Sweden remain far below World Health Organization (WHO) recommendations for the high-risk population. No increase in VCR as demonstrated in this study may indicate that these two countries will not be able to meet the 2010 WHO target, if no further action is taken concerning vaccine uptake.
Outbreaks of influenza and influenza-like illness in schools in England and Wales, 2005/06
Authors: Zhao H , Joseph C A , Phin N
Published: October 2017

In England and Wales, clinical reports from primary care showed that influenza activity for the season 2005/06 only rose above the base line for four weeks during February 2006. However, outbreaks of influenza-like illness and/or gastrointestinal infection in schools began to be reported to the Health Protection Agency, Centre for Infections in early January 2006. To quantify the type, size and the spread of these outbreaks a reporting form was distributed to local Health Protection Units in England and to Wales for retrospective and prospective weekly completion. Between weeks 48/05 and 11/06, a total of 688 school outbreaks were reported, including 658 outbreaks of influenza-like illness with or without other symptoms. The remaining 30 outbreaks listed as gastrointestinal only were excluded from the present analysis. Influenza B was confirmed in 70 outbreaks where testing took place. 61% of the outbreaks were reported from primary schools for children aged 4-11 years. This large scale outbreak in school children with flu-like illness across England and Wales was not picked up by most of the routine surveillance schemes, therefore, we believe that a school absentee monitoring and reporting system may be needed to give an early warning of increased influenza activity, especially for the mild form of the disease caused by influenza B virus
Community-acquired pneumonia and influenza hospitalisations in northern Portugal, 2000-2005
Authors: Dias J , Correia A M , Queirós Laurinda
Published: October 2017

Binary file ES_Abstracts_Final_ECDC.txt matches
Pertussis: An old disease in new clothes
Authors: Wirsing von König C H , Riffelman Marion
Published: October 2017

In this issue of Eurosurveillance, two articles report data about pertussis.
Chlamydia: a major challenge for public health
Authors: Van de Laar M JW , Morré S A
Published: October 2017

Chlamydia trachomatis is the most commonly reported bacterial sexually transmitted infection (STI) in Europe. Genital chlamydial infection causes cervicitis and salpingitis in women and urethritis and conjunctivitis in both men and women.