bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of a large outbreak of Clostridium difficile PCR-ribotype 027 infections in northern France, 2006-2007 and associated clusters in 2008-2009
Authors: Birgand G , Blanckaert K , Carbonne A , Coignard B , Barbut F , Eckert C , Grandbastien B , Kadi Z , Astagneau P
Published: October 2017

In 2006 and 2007, a large outbreak of Clostridium difficile infections (CDIs) with PCR-ribotype 027 was identified in northern France. Overall, 38 healthcare facilities notified 529 CDIs over a 22-month period, including 281 laboratory-confirmed CDI 027 and 248 non-confirmed CDI 027 cases (incidence rate per 10,000 elective bed days: 1.63, range: 0.07 to 7.94). The cases occurred mainly in long-term care hospital facilities and nursing homes, near the border between France and Belgium. An active surveillance and prevention campaign was launched at the first epidemic peak including hygiene precautions for healthcare professionals, which supported healthcare facilities to improve care organisation. The outbreak was controlled at the end of 2007, but sporadic cases were identified until the end of 2009. A bundle of appropriate control measures may halt the spread of such outbreaks, provided that substantial human resources and financial support are available.
2009 pandemic influenza A(H1N1) outbreak in a complex of schools in Paris, France, June 2009
Authors: Carrillo-Santisteve P , Renard-Dubois S , Cheron G , Csaszar-Goutchkoff M , Lecuit M , Lortholary O , Bello P Y
Published: October 2017

An outbreak of 2009 pandemic influenza A(H1N1), involving 81 cases with symptoms of influenza-like illness, was confirmed in June 2009 in a complex of schools in Paris, France. At that time, there was no community transmission in France. The index case, a 10-year-old girl, had travelled to the United Kingdom with her school class. Of the 81 symptomatic cases, 35 were confirmed and 46 were probable; 48 of the cases were female. Three were adults and 78 were children (median age of the children was 7.9 years, range: 6 months to 12 years). Control measures were implemented as soon as a new case was confirmed in a school, which included active case finding among the pupils in the same class as the index case, setting up a dedicated influenza outpatient clinic that families were recommended to consult if necessary, prophylactic treatment of contacts and school closure. A retrospective study was conducted on all confirmed cases and all symptomatic cases who had consulted the dedicated outpatient clinic from 17 to 27 June 2009. Further work is needed to better define conditions under which the pandemic virus can be transmitted in schools and in households.
Assessing the risk of a community outbreak of hepatitis A on blood safety in Latvia, 2008
Authors: Perevoščikovs J , Lenglet A , Lucenko I , Šteinerte A , Payne Hallström L , Coulombier D
Published: October 2017

Post-transfusion hepatitis A virus (HAV) infection worldwide is considered a sporadic event. An outbreak of HAV infection occurred in Latvia between the end of 2007 and throughout 2008 with more than 2,800 confirmed cases reported over a 13-month period (incidence of 123 per 100,000 population). The majority of reported HAV infection cases were in people over 18 years of age and in people living in the capital city, Riga. We estimated that the crude risk for HAV contamination of whole blood supplies in Riga between February and October 2008 ranged from 1.4 to 10.6per 10,000 donated units. In people under 40 years of age, the risk of receiving an infectious blood transfusion was more than 3.0 per 10,000 recipients between August and October 2008 during the peak of the outbreak. We conclude that there is a previously under-recognised impact of HAV on blood safety during widespread outbreaks of this disease. Estimating the risk of contamination of blood supplies during an infectious disease outbreak scenario is important for fine tuning risk assessments and potentially improving public health practices.
Case report: West-Nile virus infection in two Dutch travellers returning from Israel
Authors: Aboutaleb N , Beersma M F , Wunderink H F , Vossen A CTM , Visser L G
Published: October 2017

We report about West Nile virus (WNV) infections in a symptomatic traveller returning from Israel and in her asymptomatic travel companion. Knowledge of the current epidemiological situation in Israel from where WNV cases were reported recently enabled a rapid diagnosis. The described cases serve as a reminder for physicians to consider WNV in the diagnosis of patients returning from areas with potential circulation of the virus.
Fatal and mild primary dengue virus infections imported to Norway from Africa and south-east Asia, 2008-2010
Authors: Vainio K , Noraas S , Holmberg M , Fremstad H , Wahlstrøm M , Ånestad G , Dudman S
Published: October 2017

Between 2008 and 2010, eight cases of viraemic dengue fever in travellers were diagnosed in Norway. They had returned from Eritrea, Thailand and Indonesia. All cases were primary dengue infections, seven non-complicated dengue fever and one dengue shock syndrome with a fatal outcome. Four patients were infected with dengue virus serotype 1, one with type 2 and three with type 3. Two cases from Thailand, the fatal case and the two imported from Eritrea were infected with type 1.
Public health advice based on routine mumps surveillance in England and Wales
Authors: Yung C , Bukasa A , Brown K , Pebody R
Published: October 2017

In view of the increase in the number of mumps cases in 2009 and of the reports of mumps outbreaks in 2010, we report on the most recently available mumps surveillance data in England and Wales.
Differences in national influenza vaccination policies across the European Union, Norway and Iceland 2008-2009
Authors: Mereckiene J , Cotter S , D'Ancona F , Giambi C , Nicoll A , Lévy-Bruhl D , Lopalco P L , Weber J T , Johansen K , Dematte L , Salmaso S , Stefanoff P , Greco D , Dorleans F , Polkowska A , O’Flanagan D , on behalf of the VENICE project gatekeepers group
Published: October 2017

In 2009 the second cross-sectional web-based survey was undertaken by the Vaccine European New Integrated Collaboration Effort (VENICE) project across 27 European Union (EU) member states (MS), Norway and Iceland (n=29) to determine changes in official national seasonal influenza vaccination policies since a survey undertaken in 2008 and to compare the estimates of vaccination coverage between countries using data obtained from both surveys. Of 27 responding countries, all recommended vaccination against seasonal influenza to the older adult population. Six countries recommended vaccination of children aged between six months and <18 years old. Most countries recommended influenza vaccination for those individuals with chronic medical conditions. Recommendations for vaccination of healthcare workers (HCW) in various settings existed in most, but not all countries. Staff in hospitals and long-term care facilities were recommended vaccination in 23 countries, and staff in out-patient clinics in 22 countries. In the 2009 survey, the reported national estimates on vaccine coverage varied by country and risk group, ranging from 1.1% - 82.6% for the older adult population; to between 32.9% -71.7% for clinical risk groups; and from 13.4% -89.4% for HCW. Many countries that recommend the influenza vaccination do not monitor the coverage in risk groups. In 2008 and 2009 most countries recommended influenza vaccination for the main risk groups. Hovewer, despite general consensus and recommendations for vaccination of high risk groups many countries do not achieve high coverage in these groups. The reported vaccination coverage still needs to be improved in order to achieve EU and World Health Organization goals.
Geographical clustering of cases of infection with moxifloxacin-resistant Clostridium difficile PCR-ribotypes 012, 017 and 046 in Sweden, 2008 and 2009
Authors: Åkerlund T , Alefjord I , Dohnhammar U , Struwe J , Norén T , Tegmark-Wisell K , the Swedish C. difficile Study Group Collective
Published: October 2017

We report the results of two nationwide surveillance studies of Clostridium difficile infection conducted during 2008 and 2009 in Sweden. The first study aimed to identify and quantify the proportion of C. difficile isolates with decreased susceptibility to moxifloxacin, particularly those of PCR-ribotype 027. From December 2007 to September 2008, 20 of 28 regional laboratories sent 585 isolates to the Swedish Institute for Infectious Disease Control for typing. A majority of the isolates (454 of 585; 78%) belonged to four PCR ribotypes (012, SE37, 017 and 046), all clustered in geographical regions. Only two type 027 isolates were found, both from the same patient. In the second study, involving all 28 regional laboratories, all consecutive C. difficile isolates collected during two time periods in 2009 (n=364) were typed and tested for susceptibility to clindamycin, erythromycin, moxifloxacin, metronidazole and vancomycin. The three most common PCR ribotypes were SE21, 001 and 020 (22% of all isolates). Types 012, 017, and 046 were geographically clustered and associated with decreased susceptibility to moxifloxacin, clindamycin and erythromcin. The extent of moxifloxacin prescription was highly variable among counties, indicating a need for careful monitoring of prescription rates to follow its role in C. difficile epidemiology.
Intestinal parasites isolated in a large teaching hospital, Italy, 1 May 2006 to 31 December 2008
Authors: Masucci L , Graffeo R , Bani S , Bugli F , Boccia S , Nicolotti N , Fiori B , Fadda G , Spanu T
Published: October 2017

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Rapidly controlled outbreak of Serratia marcescens infection/colonisations in a neonatal intensive care unit, Pescara General Hospital, Pescara, Italy, April 2011
Authors: Polilli E , Parruti G , Fazii P , D’Antonio D , Palmieri D , D’Incecco C , Mangifesta A , Garofalo G , Del Duca L , D’Amario C , Scimia M , Cortesi V , Fortunato V
Published: October 2017

In April 2011, an outbreak of Serratia marcescens infection/colonisations occurred in the neonatal intensive care unit of Pescara General Hospital. Rapid microbiological investigations lead to identification of five cases of likely cross-transmission from a neonate hospitalised for S. marcescens sepsis: four infections and one neonate colonised post-mortem. Two low birth weight neonates died. The environmental investigation detected S. marcescens from two soap dispensers. Strict hygiene measures lead to early interruption of the outbreak, without recurrences to date.
Enhanced surveillance during a large outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/verotoxin-producing Escherichia coli in Germany, May to June 2011
Authors: Wadl M , Rieck T , Nachtnebel M , Greutélaers B , an der Heiden M , Altmann D , Hellenbrand W , Faber M , Frank C , Schweickert B , Krause G , Benzler J , Eckmanns T , on behalf of the HUS surveillance and laboratory team Collective
Published: October 2017

Germany has a well established broad statutory surveillance system for infectious diseases. In the context of the current outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/verotoxin-producing Escherichia coli in Germany it became clear that the provisions of the routine surveillance system were not sufficient for an adequate response. This article describes the timeline and concepts of the enhanced surveillance implemented during this public health emergency.
Suspected transmission of tuberculosis in a maternity ward from a smear-positive nurse: preliminary results of clinical evaluations and testing of neonates potentially exposed, Rome, Italy, 1 January to 28 July 2011
Authors: Borgia P , Cambieri A , Chini F , Coltella L , Delogu G , Di Rosa E , Fadda G , Giorgi Rossi P , Girardi E , Goletti D , Guasticchi G , Morrone A , Pezzotti P , Romagnoli C , Sacerdote M T , Russo C , Villani A , Zarelli L
Published: October 2017

We report preventive measures adopted after tuberculosis (TB) transmission from a nurse to a newborn assessed in late July 2011. All exposed neonates born between January and July 2011 were clinically evaluated and tested by QuantiFERON TB gold in-tube; newborns testing positive were referred for prophylaxis. Of 1,340 newborns, 118 (9%) tested positive and no other active cases of TB were found. Active surveillance for TB will be continued over the next three years for all those exposed.
Public health implications of an outbreak of rabies in arctic foxes and reindeer in the Svalbard archipelago, Norway, September 2011
Authors: MacDonald E , Handeland K , Blystad H , Bergsaker M , Fladberg M , Gjerset B , Nilsen O , Os H , Sandbu S , Stokke E , Vold L , Ørpetveit I , Gaup Åmot H , Tveiten O
Published: October 2017

Between 16 September and 5 October 2011 rabies was diagnosed in two arctic foxes and eight reindeer in the Svalbard archipelago, in Norway. This outbreak occurs at the end of the reindeer hunting season and poses an increased risk to many people that were involved in the hunt. As of 28 September 2011, 280 people had received post-exposure prophylaxis. No human cases of rabies have occurred.
Influenza A(H1N1)pdm09 vaccination policies and coverage in Europe
Authors: Mereckiene J , Cotter S , Weber J T , Nicoll A , D'Ancona F , Lopalco P L , Johansen K , Wasley A M , Jorgensen P , Lévy-Bruhl D , Giambi C , Stefanoff P , Dematte L , O’Flanagan D , the VENICE project gatekeepers group Collective
Published: October 2017

In August 2010 the Vaccine European New Integrated Collaboration Effort (VENICE) project conducted a survey to collect information on influenza A(H1N1)pdm09 vaccination policies and vaccination coverage in the European Union (EU), Norway and Iceland. Of 29 responding countries, 26 organised national pandemic influenza vaccination and one country had recommendations for vaccination but did not have a specific programme. Of the 27 countries with vaccine recommendations, all recommended it for healthcare workers and pregnant women. Twelve countries recommended vaccine for all ages. Six and three countries had recommendations for specific age groups in children and in adults, countries for specific adult age groups. Most countries recommended vaccine for those in new risk groups identified early in the pandemic such as morbid obese and people with neurologic diseases. Two thirds of countries started their vaccination campaigns within a four week period after week 40/2009. The reported vaccination coverage varied between countries from 0.4% to 59% for the entire population (22 countries); 3% to 68% for healthcare workers (13 countries); 0% to 58% for pregnant women (12 countries); 0.2% to 74% for children (12 countries). Most countries identified similar target groups for pandemic vaccine, but substantial variability in vaccination coverage was seen. The recommendations were in accordance with policy advice from the EU Health Security Committee and the World Health Organization.
Two invasive mosquito species, Aedes albopictus and Aedes japonicus japonicus, trapped in south-west Germany, July to August 2011
Authors: Werner D , Kronefeld M , Schaffner F , Kampen H
Published: October 2017

Adult females of two invasive species, Aedes albopictus and Aedes japonicus japonicus, were collected for the first time in July and August 2011 in Germany. Previously, only immature stages of these species had been found in the country. Repeated detection of these species reveals the Upper Rhine Valley in south-west Germany to be a particularly sensitive region for the introduction and establishment of exotic mosquito species that needs careful observation.
The Danish vaccination register
Authors: Grove Krause T , Jakobsen S , Haarh M , Mølbak K
Published: October 2017

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Psittacosis outbreak in Tayside, Scotland, December 2011 to February 2012
Authors: McGuigan C C , McIntyre P G , Templeton K
Published: October 2017

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The need for ethical reflection on the use of molecular microbial characterisation in outbreak management
Authors: Rump B , Cornelis C , Woonink F , Verweij M
Published: October 2017

Current thinking on the development of molecular microbial characterisation techniques in public health focuses mainly on operational issues that need to be resolved before incorporation into daily practice can take place. Notwithstanding the importance of these operational challenges, it is also essential to formulate conditions under which such microbial characterisation methods can be used from an ethical perspective. The potential ability of molecular techniques to show relational patterns between individuals with more certainty brings a new sense of urgency to already difficult ethical issues associated with privacy, consent and a moral obligation to avoid spreading a disease. It is therefore important that professionals reflect on the ethical implications of using these techniques in outbreak management, in order to be able to formulate the conditions under which they may be applied in public health practice.
Capacities, practices and perceptions of evidence-based public health in Europe
Authors: Latham J , Murajda L , Forland F , Jansen A
Published: October 2017

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Outbreaks associated to large open air festivals, including music festivals, 1980 to 2012
Authors: Botelho-Nevers E , Gautret P
Published: October 2017

In the minds of many, large scale open air festivals have become associated with spring and summer, attracting many people, and in the case of music festivals, thousands of music fans. These festivals share the usual health risks associated with large mass gatherings, including transmission of communicable diseases and risk of outbreaks. Large scale open air festivals have however specific characteristics, including outdoor settings, on-site housing and food supply and the generally young age of the participants. Outbreaks at large scale open air festivals have been caused by Cryptosporium parvum, Campylobacter spp., Escherichia coli, Salmonella enterica, Shigella sonnei, Staphylococcus aureus, hepatitis A virus, influenza virus, measles virus, mumps virus and norovirus. Faecal-oral and respiratory transmissions of pathogens result from non-compliance with hygiene rules, inadequate sanitation and insufficient vaccination coverage. Sexual transmission of infectious diseases may also occur and is likely to be underestimated and underreported. Enhanced surveillance during and after festivals is essential. Preventive measures such as immunisations of participants and advice on-site and via social networks should be considered to reduce outbreaks at these large scale open air festivals.
Describing readmissions to an Ebola case management centre (CMC), Sierra Leone, 2014
Authors: Fitzpatrick G , Vogt F , Moi Gbabai O B , Black B , Santantonio M , Folkesson E , Decroo T , Van Herp M
Published: October 2017

Case management centres (CMCs) are part of the outbreak control plan for Ebola virus disease (EVD). A CMC in Sierra Leone had 33% (138/419) of primary admissions discharged as EVD negative (not a case). Fifteen of these were readmitted within 21 days, nine of which were EVD positive. All readmissions had contact with an Ebola case in the community in the previous 21 days indicating that the infection was likely acquired outside the CMC.
A psittacosis outbreak in Belgian customs officers
Authors: De Schrijver K
Published: October 2017

In March 1994, health authorities in Antwerp, Belgium, were informed that a member of a team of 15 customs officers had developed psittacosis. The customs officer concerned had been admitted to hospital with pneumonia 10 days after exposure to parakeets t
Outbreak of Escherichia coli O157 in Sweden
Authors: Ziese T , Anderson Y , de Jong B , Löfdahl S , Ramberg M
Published: October 2017

The Swedish Institute for Infectious Disease Control (Smittskyddsinstitutet - SMI) received no more than three reports of enterohaemorrhagic E. coli O157 infections (EHEC) each year from 1988 to 1994. About half of these were due to E. coli O157. In July
The tuberculosis situation in Portugal : a historical perspective to 1994
Authors: Antunes M L , Fonseca-Antunes A
Published: October 2017

Portugal built its first tuberculosis (TB) hospital in Funchal, Madeira, in 1862. In 1899, Queen Amelia proposed and sponsored a private foundation, with clinics, hospitals, sanatoriums and preventoria, where relatives and other contacts of TB patients we
HELICS: a European project to standardise the surveillance of hospital acquired infection, 1994-1995
Authors: Mertens R , van den Berg J. M.J , Fabry J , Jepsen O. B
Published: October 2017

During the 1990s several European countries began to set up national or regional networks for the surveillance of hospital acquired infections. Most of these networks were based on the US Centers for Disease Control and Prevention (CDC) National Nosocomia
Value of influenza vaccine during an outbreak of influenza A in a nursing home, Pyrénées Atlantiques, France, November-December 1995
Authors: Infuso A , Baron S , Fauveau H , Melon M , Fleury H , Desenclos J C
Published: October 2017

A public health officer of the Direction Départementale de l'Action Sanitaire et Sociale des Pyrénées Atlantiques in France was notified of an outbreak of acute respiratory illness among residents of a nursing home on 4 December, 1995. Over 50 of the 69 r
An outbreak of hepatitis A in Puglia, Italy, 1996
Authors:   P Malfait,   PL Lopalco,   S Salmaso,   C Germinario,   G Salamina,   M Quarto,   S Barbuti,   R Cipriati,   A Mundo,   G Pesone
Published: October 2017

In the region of Puglia, in the south east of Italy (population: 4 million), the number of notifications of hepatitis A virus (HAV) infection increases in a two yearly cycle. In 1992 a very large outbreak was observed, but no epidemiological investigation
Urban outbreak of Q fever, Briançon, France, March to June 1996
Authors: Armengaud A , Kessalis N , Desenclos J C , Maillot E , Brousse P , Brouqui P , Tixier-Dupont H , Raoult D , Provensal P , Obadia Y
Published: October 2017

Q fever is an ubiquitous zoonosis caused by the rickettsial organism Coxiella burnetii. Both sporadic cases and epidemics occur in areas where sheep and goats are bred. The main route of transmission is by inhalation of aerosols from the environment (soil
The European Sero-Epidemiology Network
Authors: Osborne K , Weinberg J , Miller E
Published: October 2017

The purpose of serological surveillance is to monitor levels of immunity to particular diseases within a population in order to enhance the quality of information on which public health measures, such as vaccination programmes, are based. Serological surv
Polio outbreak in Albania, 1996
Authors: Ciofi Degli Atti M L , Prevots R , Sallabanda A , Malfait P , Diamantil E , Aylward B , Greco D , Wassilak S
Published: October 2017

Between April and November 1996, a large outbreak of polio occurred in Albania, which had reported to be free of polio since 1985. Although Albania had not reported polio in that interval, the risk of introduction and circulation of wild poliovirus had in
Development of a European electronic network on communicable diseases: the IDA-HSSCD programme
Authors: Weinberg J , Nohynek H , Giesecke J
Published: October 2017

The European Commission (EC) has stated that setting up disease surveillance and health monitoring systems that cover the EU is a priority, and has proposed the development of a Community wide network, relying on electronic, computer based communications
Changes in age specific immunity to diphtheria in Poland in the past 40 years
Authors: Zakrzewska A , Galazka A , Rymkiewicz D
Published: October 2017

In recent years people in Poland have acquired diphtheria from eastern neighbours. It was considered important therefore to study the age specific immunity against diphtheria and to compare it with the results of seroepidemiological studies conducted in t
Increasing incidence of resistance to trimethoprim and ciprofloxacin in epidemic Salmonella typhimurium DT104 in England and Wales
Authors: Threlfall E J , Ward L. R. , Rowe B
Published: October 2017

Salmonella typhimurium definitive phage type (DT) 104 (= DT104) with chromosomally-encoded resistance to ampicillin, chloramphenicol, streptomycin, sulphonamides, and tetracyclines (= R-type ACSSuT) has become increasingly common in humans in England and
An outbreak of Salmonella enteritidis food poisoning in a psychiatric hospital in Dublin, Ireland
Authors: Grein T , O’Flanagan D , McCarthy T , Prendergast T
Published: October 2017

On 29 August 1996 Ireland's Eastern Health Board (EHB) was informed of an outbreak of gastrointestinal illness in a psychiatric hospital in Dublin. Fifty people among 240 members of staff and 183 patients had reportedly fallen ill since 27 August and new
Is murine typhus re-emerging in Portugal ?
Authors: Bacellar F , Lencastre I , Filipe A R
Published: October 2017

Murine typhus or endemic typhus is an infectious disease, clinically very similar to epidemic typhus, and caused by Rickettsia typhi(sometimes referred to as R. mooseri). Murine typhus was fairly common in Portugal until the 1940s, when several cases diag
Underreporting of legionnaires’ disease in France : the case for more active surveillance
Authors: Infuso A , Hubert B , Etienne J
Published: October 2017

In France, surveillance of legionnaires’ disease started in 1987 with a mandatory clinician-based notification system. An average of 54 cases were reported yearly between 1988 and 1995 and six non-nosocomial clusters were identified. In 1995 the surveilla
Surveillance of sexually transmitted infections in England and Wales
Authors: Hughes G , Catchpole M
Published: October 2017

Owing to the unique link between the epidemiology of sexually transmitted infections (STIs) and human behaviour, the surveillance of STIs requires the collection of more demographic and behavioural data than for other infectious diseases. In order to supp
Surveillance of sexually transmitted infections in Scotland
Authors: Noone A , Chalmers J , Young H
Published: October 2017

Applications of the surveillance of sexually transmitted infections (STIs) include setting priorities for and planning preventive and treatment services, evaluating interventions, and shaping research hypotheses. In Scotland routine data on STIs, (other t
Establishing a European network for the diagnosis of "imported" viral diseases (ENIVD)
Authors: Niedrig M , Niklasson B , Lloyd G , Schmitz H , LeGuenno B
Published: October 2017

The epidemics in recent years of Ebola haemorrhagic fever in Zaire and Gabon acted as a reminder that dangerous infections can be imported very quickly into Europe. Meetings on emerging and re-emerging pathogens organised by the World Health Organization
Vaccination campaign for meningococcal disease in a rural area in the Netherlands - January 1998
Authors: van Steenbergen J. E. , Kraayeveld A. G. , Spanjaard L
Published: October 2017

Neisseria meningitidis group C regularly causes epidemics in schools, universities, and army units, and in the past decade community outbreaks have been reported. Since a safe and effective polysaccharide vaccine is available the issue arises repeatedly
European Antimicrobial Resistance Surveillance System (EARSS): susceptibility testing of invasive Staphylococcus aureus
Authors: Veldhuijzen I , Bronzwaer S , Degener J , Kool J , les participants de EARSS / EARSS participants Collective
Published: October 2017

Over 400 laboratories participate in EARSS (European Antimicrobial Resistance Surveillance System) and send data to the National Institute of Public Health and the Environment (RIVM) in The Netherlands. Data on about 14 000 isolates of Staphylococcus aure
Two outbreaks of mumps in children vaccinated with the Rubini strain in Spain indicate low vaccine efficacy
Authors: Pons C , Pelayo T , Pachon I , Galmes A , González L , Sánchez C , Martinez F
Published: October 2017

This paper reports a descriptive study of two outbreaks of mumps in Spanish towns in 1998 and an assessment of the efficacy of the vaccine used. It provides evidence of the low level of protection against the mumps virus that has been observed previously
BSE : the European regulatory context
Authors: Chalus T , Peutz I
Published: October 2017

The Bovine Spongiform Encephalopathy crisis provoked a fundamental re-appraisal of the way in which the European Community approaches matters of food safety. Between 28 July 1989, when restrictions on the dispatch of certain live cattle from the UK starte
FiRe works – the Finnish Study Group for Antimicrobial Resistance (FiRe)
Authors: Nissinen A , Huovinen P
Published: October 2017

The Finnish Study Group for Antimicrobial Resistance (FiRe), a network founded in 1991, has established a standard routine susceptibility testing method that yields reliable and comparable results for both diagnostic and epidemiological purposes. Results
International surveillance of antimicrobial resistance in Europe: now we also need to monitor antibiotic use
Authors: Bronzwaer S  L A M , Buchholz U , Kool J. L.
Published: October 2017

With travel and trade within the European Union (EU) increasing over the years, the risk of dissemination of (resistant) pathogens grows. Many studies have shown that there is a growing problem with antimicrobial resistance. For example, methicillin resistant Staphylococcus aureus (MRSA) was initially largely a problem of hospitals, but it is now increasingly reported as a community acquired infection. Certain strains have been shown to spread between European countries. Antimicrobial resistance may result in prolonged hospital stay, higher costs, and higher morbidity or even mortality.
Minced beef and human salmonellosis: review of the investigation of three outbreaks in France
Authors: Haeghebaert S , Duché L , Gilles C , Masini B , Dubreuil M , Minet J- C , Bouvet P , Grimont F , Delarocque Astagneau E , Vaillant V
Published: October 2017

The synthesis of investigations of three salmonellosis outbreaks which occured in France between 1998 and 2000 confirms the role of the consumption of minced beef and highlights the importance of prevention measures.
Travel associated legionnaires’ disease in Europe in 1999
Authors:   F Lever,   C Joseph, on behalf of the European Working Group for Legionella Infections (EWGLI)
Published: October 2017

The European Surveillance Scheme for Travel Associated Legionnaires’ Disease was notified of the highest number of cases in travellers in 1999 since the scheme began in 1987. This reflects enhanced surveillance activities and an increase in the use of urinary antigen detection for Legionella pneumophila serogroup 1. The scheme's extensive reporting and investigation activities are complemented in some countries by the activities of tour operators, who have been legally responsible for the health and safety of their clients since the 1996 European Commission’s Package Travel Directive came into force. In recent years, the work conducted by the collaborators has helped establish good surveillance and control in sites used by travellers.
Malaria in the WHO European Region (1971–1999)
Authors: Sabatinelli G , Ejov M , Joergensen P
Published: October 2017

The number of autochthonous reported cases of malaria fell from 90 506 to 37 170 between 1996 and 1999 in the WHO European Region. There has been, however, an eight-fold increase in imported cases since the 1970s: 1500 cases were reported in 1972, 13 000 cases in 1999. France, Germany, Italy, and the United Kingdom are the west European countries with the largest numbers of cases.
Europe-wide surveillance for sexually transmitted infections: a timely and appropriate intervention
Authors: Fenton K. A. , Giesecke J , Hamers F F
Published: October 2017

Sexually transmitted infections (STIs), including HIV, pose a significant threat to the health and wellbeing of Europeans and require concerted and sustained intervention. Over the past decade, the number of reported cases of STIs, including antimicrobial resistant Neisseria gonorrhoeae, has increased appreciably (1), and outbreaks of syphilis have recently been reported in many Member states of the European Union (EU) (2, 3). Young people, homosexual men, and those with poor access to health care (including preventive and educational services) seem to be particularly affected, with increased travel and migration, high risk sexual behaviours, and a deterioration of public health responses to STI control (for example, partner notification) being key driving factors. Many of these demographic and behavioural trends are similar across EU states, as is the desire to develop and implement effective STI prevention and control programmes.
An outbreak of legionnaires’ disease in a municipality in northern Portugal
Authors: Correia A M , Gonçalves G , Reis J , Cruz J M , Castro e Freitas J A
Published: October 2017

Eleven cases of legionnaires´ disease, all patients living in the same municipality, were admitted to a district hospital in northern Portugal. Preliminary investigations suggested an association with the events of the annual festivities in that municipality. Legionella pneumophila was not isolated from any of the suspected sources, but evidence from a case control study suggested that an aerosol produced by a decorative fountain in the main square during the night of a rock concert was the likely vehicle of infection. The prevalence of smoking was higher among cases than controls.
Occurrence of Salmonella enterica serovar Dublin in Austria
Authors: Allerberger F , Liesegang A , Grif K , Prager R , Danzl J , Höck F , Ottl J , Dierich M P , Berghold C , Neckstaller I , Tschäpe H , Fisher I. S.T.
Published: October 2017

In Austria, Salmonella enterica subsp. enterica serovar Dublin, a bovine-adapted serovar, rarely causes infections in humans. In 2000, Austria was within the European mean with an incidence of 0.1 per million inhabitants. Our data show that the vast majority of all serovar Dublin infections (human and non-human) can be traced epidemiologically to two districts in the Tyrol. This concentration of cases can be explained by a particularly traditional aspect of cattle farming in this area, the alpine pasture. There is an increased risk of cross infection due to the communal keeping of animals from various farms. Infected cattle are a source of infection for humans, and transmission usually occurs from eating beef and drinking cows’ milk. Using pulsed field gel electrophoresis and automated ribotyping, three out of five isolates from human infections could be traced to characteristic Tyrolean Dublin clones. Bacteriological screening for faecal carriage before the transfer of cattle from risk-herds to the alpine pastures and before the return from risk-pastures to the farms would be a possible starting point to prevent cross-contamination of large mixed herds and contamination of pasture through latently infected cattle. Appropriate research is necessary.
An outbreak of diarrhoeic shellfish poisoning in Antwerp, Belgium
Authors: De Schrijver K , Maes I , De Man L , Michelet J
Published: October 2017

In Antwerp, Belgium, 403 cases of diarrhoeic shellfish poisoning were reported after consumption of blue mussels. Symptoms included diarrhoea, vomiting, abdominal pain, and nausea. The analysis of faecal specimens from patients allowed diagnosis exclusions for bacteria and viruses. Mouse-assays revealed the presence of biotoxins specific of dinoflagellates, which were identified and quantified by LC-MS. The mussels were imported from Denmark, and were part of a batch presenting high concentrations of okadaic acid above the regulatory limits.
Spanish flu epidemic in 1918 in Geneva, Switzerland
Authors: Ammon C  E
Published: October 2017

In Geneva, Switzerland, the Spanish flu epidemic affected more than 50% of the population. The mortality was higher among those aged between 20–49 years and among men. The socioeconomic impact was very important, as the outbreak led to severe dysfunctions, including in health services. This epidemic shows the socio-economical burden that may be associated with influenza and highlights the need for pandemic preparedness.
Salmonella - "old" organism, continued challenges !
Authors: O’Brien S , de Valk H
Published: October 2017

Following the events of 11 September 2001, the ensuing spectre of bioterrorism and considerable efforts planning for the unthinkable (1), this Eurosurveillance issue reminds us of the continuing threat to public health from well-recognised pathogens, sometimes mistakenly judged to be controlled. Recently the incidence of salmonellosis has decreased substantially across the European Union, the number of cases reported to Enternet (2) declining from 100 267 in the peak year of 1997 to 73 006 in 2001 (I.S.T. Fisher - personal communication). However, recent events and the following articles illustrate continued challenges in salmonella control.
Influenza vaccination in Europe: an inventory of strategies to reach target populations and optimise vaccination uptake
Authors:   M Kroneman,   W J Paget,   G A van Essen
Published: October 2017

A study was undertaken to assess influenza vaccine
uptake in risk groups and to get insight into vaccination
practices in European countries. Questionnaires were
completed by national influenza experts from 26 coun-tries.
Only 14 were able to provide uptake rates for the elderly.
For the other risk groups, even fewer could
provide data. Vaccines are usually administred by GPs.
Financial incentives for physicians and patients might
work as a strategy to increase uptake rates, but due to
the small amount of data, it was not possible to carry out
thorough multivariate analyses. The development of a
uniform influenza vaccination monitoring method was
recommended to allow for comparision of uptake data
in Europe.
The internet, a simple and convenient tool in Chlamydia trachomatis screening of young people
Authors: Novak D , Edman A C , Jonsson M. , Karlsson R B
Published: October 2017

The objective of this study was to evaluate a new C. trachomatis screening method based on a home sampling strategy and using the internet as a facility for the participants to obtain their test results. A population based screening study was designed in primary care setting in Umeå, Sweden. It included all males aged 22 years (n=1074), living in Umeå, a city with 100 000 inhabitants. The participation rate was 38.5%. In the study group, 1.1% were infected with C. trachomatis. Participants obtained their results on the internet and three quarters of males infected with C. trachomatis sought medical treatment independently. The number of times the internet was visited exceeded the number of urine samples tested. The internet C. trachomatis screening strategy achieved the highest male participation rate yet published, and also reached young males outside the high risk groups.
Waterborne outbreak among Spanish tourists in a holiday resort in the Dominican Republic, August 2002
Authors: Paez Jimenez A , Pimentel R , Martinez de Aragon M V , Hernández Pezzi G , Mateo S , Martinez Navarro J. F.
Published: October 2017

On 3 September 2002, the Spanish national centre of epidemiology (Centro Nacional de Epidemiología - CNE) was alerted to a high number of gastroenteritis cases in Spanish tourists who had travelled to a hotel in Punta Cana on different days during august 2002. Entamoeba hystolitica cysts have been visualised by microscopy in the stools of several patients that sought medical attention in the Dominican Republic.
The CNE informed the health authorities in the Dominican Republic and conducted in conjunction an epidemiological investigation.
A descriptive study of the 76 initial cases estimated a mean illness duration of 5.1+2.9 days and a exposure period of 3.6+2.2 days. Following a retrospective cohort study, the attack rate was found to be 32.4%. Consequently, 216 (95% CI=114.75-317.25) spanish tourists had probably developed the illness.
Stool samples were collected in Spain from untreated patients who still felt unwell. None of the samples were positive for E.hystolitica.
On 10 September, a hygiene inspection was undertaken at the hotel. Samples of the ice and meals served at the buffet that day, yielded coliform bacteria.
Consumption of water from the resort water system was the only risk factor associated with the symptoms (RR= 3.55; 95% CI =1.13-10.99).
To avoid similar outbreaks occurring again at the hotel, it is essential to regularly monitor the water quality and to improve food handling hygiene standards. Basic food hygiene training for food handlers should be mandatory.
An international guideline for the management foodborne and waterborne outbreaks among tourists in holiday resorts should be drawn up, involving all competent authorities of both destination and tourist origin countries.
An outbreak of Adenovirus type 8 Keratoconjunctivitis in a nursing home in Madrid
Authors: Sendra Gutierrez J M , Martin Rios D , Casas I , Sáez P , Tovar A , Moreno C
Published: October 2017

This work describes and analyses an outbreak of epidemic keratoconjunctivitis which occurred in 2001 and 2002 in a nursing home for the elderly in Leganes (an area of Madrid). This is the first such published case in Spain with these characteristics and this serotype identification.
Sociodemographic characteristics, epidemic curve and attack rates are described. Comparisons of the data were carried out using a chi2 test for qualitative variable and t-test for quantitative. Factors associated with the illness are explored by means of contingency tables and logistic regression models.
One hundred and two cases were detected, with an attack rate of 36.4% for residents, and 12.9% for workers, not considering spatial or professional differences. The epidemic curve showed an interpersonal transmission pattern. Multivariate analysis identified the following risk factors in the residents: able to wander freely through the building, urinary incontinence and use of shared bathroom. In 34.6% of the conjunctival samples, adenovirus serotype 8 was detected with identical genomic sequence.
Establishment of hygienic sanitary guidance adapted for the cleaning of such establishments and contact with residents as well as early diagnosis and good coordination of human and material resources are key factors in the prevention and control of these outbreaks in closed communities.
Impact of the meningococcal C conjugate vaccine in Spain: an epidemiological and microbiological decision
Authors: Cano R , Larrauri A , Mateo S , Alcalá B , Salcedo C , Vázquez J A
Published: October 2017

The new meningococcal C conjugate vaccine became available in Spain and was included in the infant vaccination schedule in 2000. A catch-up campaign was carried out in children under six years of age. As a consequence, the incidence of meningococcal disease caused by serogroup C has fallen sharply during the last three epidemiological years in Spain. The risk of contracting serogroup C disease in 2002/2003 fell by 58% when compared with the season before the conjugate vaccine was introduced. There was also an important decrease in mortality. Three deaths due to serogroup C occurred in the age groups targeted for vaccination in 2002/2003, compared with 30 deaths in the same age groups in the season before the launch of the vaccine campaign. In the catch-up campaign the vaccine coverage reached values above 92%. For the 2001, 2002 and 2003 routine childhood immunisation programme coverage values ranged from 90% to 95%. During the past three years a total of 111 cases of serogroup C disease have been reported in patients in the vaccine target group. Most of the vaccination failures occurred during the epidemiological year 2002/2003. Eight (53%) vaccine failures occurred in children who had been routinely immunised in infancy, and could be related to a lost of protection with time since vaccination. The isolation of several B:2a:P1.5 strains (ST-11 lineage) is noteworthy. These may have their origin in C:2a:P1.5 strains which, after undergoing genetic recombination at the capsular operon level, express serogroup B. These strains could have relevant epidemic potential.
Panton-Valentine leukocidin positive MRSA in 2003: the Dutch situation
Authors: Wannet W J B , Heck M E , Pluister G N , Spalburg E , Van Santen M G , Huijsdans X W , Tiemersma E , de Neeling A J
Published: October 2017

Analysis of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the Netherlands in 2003 revealed that 8% of the hospital isolates carried the loci for Panton-Valentine leukocidin (PVL). Molecular subtyping showed that most Dutch PVL-MRSA genotypes corresponded to well-documented global epidemic types. The most common PVL-MRSA genotypes were sequence type ST8, ST22, ST30, ST59 and ST80. MRSA with ST8 increased in the Netherlands from 1% in 2002 to 17% in 2003. It is emphasised that PVL-MRSA might not only emerge in the community, but also in the hospital environment.
Syphilis surveillance and trends of the syphilis epidemic in Germany since the mid-90s
Authors: Marcus U , Bremer V , Hamouda O
Published: October 2017

Recent surveillance reports from Europe and the United States show an increase in syphilis cases. Accurate epidemiological information about the distribution of syphilis is important for targeting screening and intervention programmes. The German syphilis notification system changed in 2001 from physician to laboratory-based reporting, which is complemented by a newly introduced sexually transmitted infection (STI) sentinel system. After reaching an all time low during the 1990s, syphilis notifications have increased significantly since 2001, coinciding with the introduction of the new reporting system. However, the increased reported incidence is reflecting a true rise in the number of cases and is not predominantly determined by more underreporting through the previous reporting system. The increase reflects syphilis outbreaks among men who have sex with men (MSM). The first of these outbreaks was observed in Hamburg in 1997. In 2003, incidence in men was ten times higher than in women. An estimated 75% of syphilis cases are currently diagnosed among MSM. A high proportion (according to sentinel data, up to 50%) of MSM diagnosed with syphilis are HIV positive. The continuously high number of syphilis cases diagnosed among heterosexuals in Germany in recent years compared with other western European countries may reflect the higher population movement between Germany and syphilis high incidence regions in south-east and eastern Europe.
Bichat guidelines for the clinical management of tularaemia and bioterrorism-related tularaemia
Authors: Bossi P , Tegnell A , Baka A , van Loock F , Werner A , Hendriks J , Maidhof H , Gouvras G
Published: October 2017

Francisella tularensis is one of the most infectious pathogenic bacteria known, requiring inoculation or inhalation of as few as 10 organisms to initiate human infection. Inhalational tularaemia following intentional release of a virulent strain of F. tularensis would have great impact and cause high morbidity and mortality. Another route of contamination in a deliberate release could be contamination of water. Seven clinical forms, according to route of inoculation (skin, mucous membranes, gastrointestinal tract, eyes, respiratory tract), dose of the inoculum and virulence of the organism (types A or B) are identified. The pneumonic form of the disease is the most likely form of the disease should this bacterium be used as a bioterrorism agent. Streptomycin and gentamicin are currently considered the treatment of choice for tularemia. Quinolone is an effective alternative drug. No isolation measures for patients with pneumonia are necessary. Streptomycin, gentamicin, doxycycline or ciprofloxacin are recommended for post-exposure prophylaxis.