bluuebunny/crossref_metadata_2025 huggingface dataset:
Fox rabies in France
Authors: Toma B
Published: October 2017

Fox rabies was first recorded in France in March 1968, and remained a problem until 1998. In the course of the first two decades and despite the control measures applied, rabies expanded both in terms of the enzootic surface area and number of cases.
The measures applied consisted of actions aimed at reducing fox population density, the mandatory vaccination of domestic carnivores in the officially infected areas, and use of human prophylaxis.
Following the large scale implementation of oral vaccination of foxes, starting 1989-1990, the rabies front was pushed back and yearly incidence decreased until rabies was eliminated at the end of 1998. The comparison of results obtained during both periods of applying various strategies is spectacular. France remains exposed to the risk from bat rabies on one hand, and from accidental cases of canine rabies imported from enzootic countries, on the other.
Knowledge of zoology can help to clarify problems in epidemiology
Authors: Moutou F
Published: October 2017

Recent animal rabies data from Lithuania are of great concern, as cases are increasing. To gain insight into the risk for public health, we can investigate the number of people who have visited a rabies control centre since 1996 after contact with an animal suspected to be infected with rabies
Epidemiology of invasive meningococcal disease in France in 2003
Authors: Perrocheau A , Taha M  K , Lévy-Bruhl D
Published: October 2017

National surveillance of invasive meningococcal disease (IMD) is based on mandatory reporting. The case definition for surveillance notification was changed in mid-2002 to include cases without microbiological confirmation. The IMD alert detection system was enhanced in 2003 with daily reporting and weekly analysis by district, serogroup, and age. Evaluation of the exhaustivity of the surveillance with capture-recapture analysis allowed correcting for underreporting.
In 2003, 803 cases were reported. After correction for under-reporting, the estimated incidence was 1.78 / 100 000. After excluding ‘new’ cases reported with new definition criteria, the 2002-2003 increase was 4%. Incidence decreased with age, with the highest values in infants less than 1 year (20/100 000), children aged between 1 and 2 years (11/100 000) and in teenagers of 17 years old(7/100 000). The overall case fatality rate was 12%. Fifty nine per cent of cases were due to serogroup B, 32% to C, 5% to W135, and 4% to Y and non-groupable meningococci. Patients with purpura fulminans treated with intravenous antibiotics before admission to hospital were shown to have lower fatality rates than those not treated.
In 2001-2003, 5 situations required particular attention: two clusters of serogroup B IMD had set off mass prophylaxis, one outbreak due to a specific B IMD clonal complex with high case fatality rate, and two districts crossed the alert threshold for serogroup C IMD, 2/100 000, and mass vaccination was recommended.
Legionnaires' disease in Europe 2003-2004
Authors: Ricketts K D , Joseph C
Published: October 2017

Once a year, countries that collaborate in the European Surveillance Scheme for Travel Associated Legionnaires’ Disease (EWGLINET) are requested to submit a dataset that provides epidemiological and microbiological information on cases of legionnaires’ disease (nosocomial (hospital-acquired), community and travel related) detected in their country for that year. This paper presents the data collected for 2003 and 2004. For this period, 9166 cases were reported to the dataset by 35 countries, of which 941 cases were associated with outbreaks. Fourteen countries reported a total of 218 detected outbreaks. National infection rates varied between countries from 28.7 to less than one case per million population. This information is valuable in that it allows countries to assess the effectiveness of their national surveillance schemes in detecting cases.
Over the two year period, 748 cases were reported to have died, giving a case fatality rate of 8.2%. The lack of detailed epidemiological information on deaths from legionnaires’ disease is highlighted. The establishment of the European Centre for Disease Prevention and Control is seen as an opportunity to develop European collaborations more fully, and to increase further the protection of Europeans from outbreaks of legionnaires’ disease.
Emergence of MRSA infections in horses in a veterinary hospital: strain characterisation and comparison with MRSA from humans
Authors: Cuny C , Kuemmerle J , Stanek C , Willey B , Strommenger B , Witte W
Published: October 2017

Methicillin-resistant Staphylococcus aureus has become an emerging public health problem worldwide, no longer only associated with healthcare-associated infections. With the exception of some recent reports concerning infections in cats, dogs and horses, infections with MRSA in companion animals have been infrequently reported. Here we submit findings for MRSA infections in horses in a central European university hospital.
Tuberculosis outcome monitoring – is it time to update European recommendations?
Authors: Falzon D , Scholten J , Infuso A
Published: October 2017

We discuss tuberculosis treatment outcome monitoring and the adherence of countries in the WHO European Region to modifications introduced in 2001 to enhance inter-country comparability.
Outcomes for definite pulmonary tuberculosis cases were compared for cases reported in 2001 and 2000. Reporting was considered complete if 98% or more of cases originally notified had outcome reported. In both years, maximal period of observation was 12 months from start of treatment. In 2000, countries reported outcome as ‘cured’, ‘completed’, ‘died’, ‘failed’, ‘defaulted’, ‘transferred’ and ‘other, not evaluated’ for cohorts of new and retreated cases. In 2001, following changes, countries were also requested to monitor cases with unknown treatment history and two outcome categories were added – ‘still on treatment’ and ‘unknown’.
Of 42 countries reporting outcomes in 2001, 74% (31) had nationwide, complete data, up from 50% (19/38) in 2000. Twelve of 21 countries that reported on observation period complied with that recommended. ‘Defaulted’ and ‘transferred’ were applied interchangeably with ‘unknown’. Among new cases, ‘still on treatment’ was used by 15/31 countries (range: 1%-15%). ‘Failed’ was rarely recorded in western European countries (<1%).
European tuberculosis outcome monitoring should include all definite pulmonary cases, applying the standard period of observation and revised categories, and preferably reported using individual data.
An outbreak of Campylobacter jejuni associated with consumption of chicken, Copenhagen, 2005
Authors: Mazick A , Ethelberg S , Møller Nielsen E , Mølbak K , Lisby M
Published: October 2017

In May/June 2005 an outbreak of diarrhoeal illness occurred among company employees in Copenhagen. Cases were reported from seven of eight companies that received food from the same catering kitchen. Stool specimens from three patients from two companies were positive for Campylobacter jejuni. We performed a retrospective cohort study among employees exposed to canteen food in the three largest companies to identify the source of the outbreak and to prevent further spread. Using self-administered questionnaires we collected information on disease, days of canteen food eaten and food items consumed. The catering kitchen was inspected and food samples were taken. Questionnaires were returned by 295/348 (85%) employees. Of 247 employees who ate canteen food, 79 were cases, and the attack rate (AR) was 32%. Consuming canteen food on 25 May was associated with illness (AR 75/204, RR=3.2, 95%CI 1.3-8.2). Consumption of chicken salad on this day, but not other types of food, was associated with illness (AR=43/97, RR=2.3, 95%CI 1.3-4.1). Interviews with kitchen staff indicated the likelihood of cross-contamination from raw chicken to the chicken salad during storage.
This is the first recognised major Campylobacter outbreak associated with contaminated chicken documented in Denmark. It is plausible that food handling practices contributed to transmission, and awareness of safe food handling and storage has since been raised among kitchen staff. The low number of positive specimens accrued in this outbreak suggests a general underascertainment of adult cases in the laboratory reporting system by a factor of 20.
A case of myiasis due to Hypoderma bovis, Lithuania, 2004
Authors: Zygutiene M , Narkeviciute I , Mudeniene V , Ziliukiene J
Published: October 2017

This paper describes the first diagnosis of myiasis with identification of the Hypoderma bovis larvae in Lithuania, in 2004.
Surveillance of listeriosis in Finland during 1995-2004
Authors: Lyytikäinen O , Nakari U M , Lukinmaa S , Kela E , Nguyen Tran Minh N , Siitonen A
Published: October 2017

We analysed the surveillance data from listeriosis cases notified to the Finnish National Infectious Diseases Register between 1995 and 2004 and describe our recent experience in investigating clusters of listeriosis cases. The number of annual cases varied between 18 and 53 but no trends in incidence were identified (average annual incidence was 7 cases per million inhabitants).
Listeria outbreak associated with sandwich consumption from a hospital retail shop, United Kingdom
Authors: Dawson S J , Evans M R , Willby D , Bardwell J , Chamberlain N , Lewis D A
Published: October 2017

An outbreak of listeriosis occurred in the Swindon area of the UK in autumn 2003. Five cases were detected in pregnant women. Four of these women were thought to have eaten prepacked sandwiches from a retail outlet in one particular hospital. Sampling at the supplier detected Listeria monocytogenes, which was indistinguishable on molecular testing from the patients’ isolates. Recent changes in UK food legislation should help diminish the risk of further outbreaks/cases such as ours occurring.
HIV incidence increasing in MSM in Germany: factors influencing infection dynamics
Authors: Marcus U , Voss L , Kollan C , Hamouda O
Published: October 2017

After an initial peak in the mid-1980s, HIV incidence in men who have sex with men (MSM) declined in most western industrialised countries and then levelled off during the 1990s. Since the late 1990s, increasing numbers of newly diagnosed HIV infections in MSM have been observed in the majority of countries with large and visible MSM communities.
Based on a review of national and international behavioural surveillance studies of MSM and national HIV surveillance data, we propose a model for the HIV epidemic in MSM in Germany.
The model includes aspects such as individuals’ increasing numbers of sexual partners and increasing frequency of unprotected anal intercourse, conditional condom use based on real or perceived HIV status of sexual partners (HIV ‘serosorting’) and sexual role assignments (insertive versus receptive based on HIV status (HIV ‘seropositioning’), selection of partners and formation of sexual networks through seeking sexual partners on the internet, the introduction of HAART and changing HAART treatment strategies. All these aspects have been shown or are suspected to increase or decrease HIV transmission risk in MSM.
We conclude that increasing HIV incidence in MSM in recent years has been fuelled by a spread of HIV in high-risk sexual networks with an increasing proportion of infections transmitted during highly infective early HIV infection, acquired mostly from casual sexual partners.
Rectal lymphogranuloma venereum surveillance in France 2004-2005
Authors: Herida M , de Barbeyrac B , Sednaoui P , Scieux C , Lemarchand N , Kreplak G , Clerc M , Timsit J , Goulet V , Desenclos J C , Semaille C
Published: October 2017

Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis strains belonging to the L1, L2 or L3 genotype.
An alert about an outbreak of LGV among MSM in the Netherlands was published in January 2004. The first cases of rectal LGV in France were retrospectively diagnosed in March 2004 and sentinel surveillance for LGV was implemented in April 2004.
Most of the participating centres were located in the cities of Paris and Bordeaux. Only confirmed rectal LGV cases were included in the surveillance. Rectal specimens from men that were found to be positive for C trachomatis by PCR were sent to the National Reference Centre for Chlamydia infection for genotyping. Simple epidemiological data provided by clinicians and genotyping results were sent to the Institut de Veille Sanitaire (InVS) where data were anonymously recorded.
A total of 328 C. trachomatis rectal strains isolated in men were genotyped by the end of December 2005. Of these, 244 (74%) were LGV strains belonging to the L2 genotype. No L1 or L3 C. trachomatis genotype was found.
Diagnosis was made retrospectively for 46 cases. The median age of patients with LGV was 39 years. HIV status was known for 96 patients: 82/96 (85%) were HIV-infected. Most LGV cases were diagnosed in the Paris area (92%). Among the remaining 26% C. trachomatis strains, genotypes Da and G were the most frequent.
As with syphilis in recent years, the emergence of LGV in Europe is mainly affecting HIV-infected MSM. The screening and treatment of STIs should be included in the clinical follow-up of all HIV-infected MSM.
A measles outbreak in children under 15 months of age in La Rioja, Spain, 2005-2006
Authors: Perucha M , Ramalle-Gómara E , Lezaun M E , Blanco A , Quiñones C , Blasco M , Gonzalez M A , Cuesta C , Echevarria J E , Mosquera M M , de Ory F
Published: October 2017

This paper describes a measles outbreak in La Rioja, Spain, which began in December 2005 and mainly affected children under 15 months of age who were not yet immunised with MMR vaccine. The measles cases were detected by the mandatory reporting system, under which laboratories must report every confirmed measles case. Cases were classified in accordance with the National Measles Elimination Plan: suspected and laboratory-confirmed. In the period 14 December 2005 to 19 February 2006, 29 suspected cases of measles were investigated, and 18 were confirmed. The mean incubation period was 13.8 days (range: 9 to 18). Of the 18 confirmed cases, only two were in adults. MMR vaccination was recommended for all household contacts, as well as for children aged 6 to 14 months who attended the daycare centres where the cases had appeared. At these centres, the second dose of MMR was administered ahead of schedule for children under three years of age. It was recommended that the first dose of MMR vaccine be administered ahead of schedule for all children aged 9 to 14 months. During an outbreak of measles, children aged 6 months or older, who have not previously been vaccinated against measles, mumps and rubella, should receive a first dose as soon as possible, and those who have had a first dose should receive a second dose as soon as possible, provided that a minimum of one month has elapsed between the two doses
Respiratory viruses and influenza-like illness: a survey in the area of Rome, winter 2004-2005
Authors: Rezza G , Valdarchi C , Puzelli S , Ciotti M , Farchi F , Fabiani C , Calzoletti L , Donatelli I , Perno C F
Published: October 2017

Limited information is available on the viral aetiology of influenza-like illness (ILI) in Southern European countries. Hereby we report the main findings of a survey conducted in the area of Rome during the 2004-2005 winter season.
ILI cases were defined as individuals with fever >37.5°C and at least one constitutional symptom and one respiratory symptom, recruited during the survey period. Influenza and other respiratory viruses were identified using polymerase chain reaction (PCR) on throat swabs. Basic individual information was collected through a standard form.
Of 173 ILI cases enrolled, 74 tested positive for one virus, and two tested positive for two viruses. Overall, 33.5% of the cases were positive for influenza viruses, 5.2% for adenoviruses, 3.5% for parainfluenza viruses, 1.7% for coronaviruses, and 1.2% for the respiratory syncitial virus. The proportion of influenza virus detection was higher in the ‘high influenza activity’ period. The distribution of viral agents varied across age groups, influenza viruses being more likely to be detected in younger patients.
Viral pathogens were identified in less than 50% of ILI cases occurred during a high activity influenza season. The detection of other than influenza viruses was sporadic, without evidence of large outbreaks due to specific agents.
Case-control study for risk factors for Q Fever in southwest England and Northern Ireland
Authors: Orr H J , Christensen H , Smyth B , Dance D AB , Carrington D , Paul I , Stuart J M ,   on behalf of the South West Q Fever Project Group
Published: October 2017

Q fever (Coxiella burnetti) is thought to account for 1% (700 cases) of community acquired pneumonia in the United Kingdom each year, and can result in serious complications such as endocarditis. Although outbreaks have frequently been reported worldwide, the causes are often not clearly identified and there have been few studies of risk factors in sporadic cases.
We conducted a matched case-control study. Cases of acute Q fever in people aged over 15 years in southwest England and Northern Ireland were identified from January 2002 to December 2004. Controls were matched for age, sex and the general practice at which they were registered. Questionnaires asking about contact with animals, and leisure and work activities, were posted to cases and controls.
Questionnaires were completed by 39/50 (78%) of the cases and 90/180 (50%) of the controls. In the single variable analysis, occupational exposure to animals or animal products was the only risk factor associated with cases at the 5% level (P=0.05, odds ratio (OR) 3.4). Long term illness appeared to be significantly protective (P=0.03, OR 0.3). In multivariable analysis the strength of association between occupational exposure and illness remained high (OR 3.6, 95% confidence interval (CI) 0.9 to 14.8) and smoking emerged as a possible risk factor.
This is the first case-control study to identify occupational exposure to animals or animal products as the most likely route of infection in sporadic cases as opposed to outbreaks.
From evaluation to continuous quality assurance of surveillance systems
Authors: Krause G
Published: October 2017

Surveillance systems have been described as the nerve cells of public health with afferent arms receiving information, cell bodies analysing the information and efferent arms initiating appropriate action or further distribution of information [1]. Increasing numbers of scientific publications on the methodology and evaluation of surveillance systems seem to underline the importance of surveillance systems in public health. The most often cited references in these publications appear to be the definition of public health surveillance by Thacker and Berkelman [2] and variations thereof, and the recommendations for evaluating surveillance systems from 1988 [3] and its update from 2002 written by working groups at the Centers for Disease Control and Prevention (CDC) in the United States[4].
A pseudo-outbreak of human A/H5N1 infections in Greece and its public health implications
Authors: Spala G , Panagiotopoulos T , Mavroidi N , Dedoukou X , Baka A , Tsonou P , Triantafyllou E , Mentis A , Kyriazopoulou V , Melidou A , Tsiodras S
Published: October 2017

The recent wide geographic spread of the highly pathogenic avian influenza A/H5N1 virus has important public health implications. Several wild migratory birds were confirmed to be infected with avian influenza A/H5N1 in Greece in February and March 2006. The aim of this paper is to report data from potential H5N1 human cases that presented to local hospitals during this period with a respiratory infection and expressing concern about exposure to avian influenza.
A case-control investigation was conducted that included case identification with the use of a structured definition, review of epidemiological and clinical characteristics and molecular testing for avian influenza A/H5N1. The setting was the entire country of Greece during February and March 2006. The main outcomes were rates of possible cases (meeting both a clinical and an epidemiological criterion) and clinical or epidemiological characteristics differentiating them from potential cases that met either one of the criteria of a possible case, but not both.
Twenty six potential patients (81% of whom met a clinical criterion, and 39% of whom met an epidemiological criterion) presented and most (85%) were admitted in local hospitals during the period of interest. The majority of cases (85%) were observed in northern Greece where most of the confirmed A/H5N1 avian cases were documented. Five of the 26 evaluated patients met the definition of a possible case. These clustered within the early period of confirmed A/H5N1 cases in wild migratory birds (P=0.05). Molecular testing was negative for all possible cases. Application of a revised case definition constructed according to newer European Union guidance resulted in the exclusion of two possible cases.
Several potential A/H5N1 human cases were recently identified in Greece. Both the timing of identification and the geographical location of potential cases suggest an increased awareness on the part of the general public, as well as poor interpretation of the case definition by the clinicians.
Letter on Pneumococcal disease surveillance in Europe
Authors: Pachon I , Santa Olalla Patricia
Published: October 2017

Letter to the Editor
A national syndromic surveillance system for England and Wales using calls to a telephone helpline
Authors: Smith G E , Cooper D L , Loveridge P , Chinemana F , Gerard E , Verlander N
Published: October 2017

Routine primary care data provide the means to monitor a variety of syndromes which could give early warning of health protection issues. In the United Kingdom, a national syndromic surveillance system, operated jointly by the UK Health Protection Agency (HPA) and NHS Direct (a national telephone health helpline), examines symptoms reported to NHS Direct. The aim of the system is to identify an increase in syndromes indicative of common infections and diseases, or the early stages of illness caused by the deliberate release of a biological or chemical agent. Data relating to 11 key symptoms/syndromes are received electronically from all 22 NHS Direct call centres covering England and Wales and analysed by the HPA on a daily basis. Statistically significant excesses in calls are automatically highlighted and assessed by a multi-disciplinary team. Although the surveillance system has characterised many sudden rises in syndromes reported to NHS Direct, no evidence of a biological or chemical attack has been detected. Benefits of this work, however, are early warning and tracking of rises in community morbidity (e.g. influenza-like illness, heatstroke); providing reassurance during times of perceived high risk (e.g. after the 7 July 2005 London bombs and December 2005 Buncefield oil depot fire); and timely surveillance data for influenza pandemic planning and epidemic modeling.
Prisons: health hazards, but also health opportunities
Authors: Weilandt C , Radun D
Published: October 2017

“Prisons are among the most unhealthy places in our societies. In them, people are not only deprived of their freedom but they are also exposed to threats such as violence, addiction and infectious diseases, while at the same time their own capacity to manage these risks is severely constrained” [1].
Hepatitis A antibody prevalence among people with an intellectual disability in Ireland
Authors: Sayers G , Dooley S , Staines A , Lane J , Thornton L , Staines M , Brennan S , Kelly P , Finlay F
Published: October 2017

This manuscript aims to determine the prevalence of antibody to and risk factors for hepatitis A virus (HAV) in individuals attending three intellectual disability services through a cross-sectional survey held in Dublin, Ireland. Participants were 636 individuals aged four to 78 years attending three intellectual disability services. The main outcome measure was the measurement of anti-HAV (IgG antibody) in oral fluid swabs using an antibody capture enzyme immunoassay (EIA) technique. Risk factor information was obtained by questionnaire from the individual’s medical record.
Eurosurveillance comes of age and moves to ECDC
Authors: Therre H , Desenclos J  C , Hoile E , Gill N , Brunet J B
Published: October 2017

Eurosurveillance was created in 1995 to support exchange and dissemination of authoritative scientific information within the part of public health community involved in the field of infectious disease surveillance and control, at a time when European surveillance networks were at an early stage of growth. Now part of a large network, the publication is entering a new stage: the editorial function will now be hosted at the European Centre for Disease Prevention and Control (ECDC) in Stockholm. This will strengthen the platform for the next stage in Eurosurveillance’s development as the major home of peer-reviewed European information on infectious disease surveillance and control.
Outbreak of domestically acquired typhoid fever in Leipzig, Germany, June 2004
Authors: Muehlen M , Frank C , Rabsch W , Fruth A , Suckau M , Moeller I , Gronemann B , Prager R , Ruf B R , Grünewald T , Ammon A , Stark K , Alpers K
Published: October 2017

In June 2004, three confirmed cases of typhoid fever were reported to the health authorities in Leipzig, Germany. The patients had been admitted to hospital with unexplained fever and otherwise mild symptoms. All were members of the same pony club, none had been abroad. A retrospective cohort study among pony club members was performed to identify the source of infection. A suspected case was defined as unexplained fever >=38.5°C over three or more days since 1 May 2004. Additional positive serology defined a probable case and Salmonella Typhi isolation from blood or stool cultures a confirmed case. All hospitals, paediatricians and general practitioners in Leipzig and surroundings were contacted to identify additional cases.
In total, six cases were identified, all among pony club members: four confirmed, including the three originally reported cases, one probable and one suspected. The only exposure common to all cases during the probable time of infection was consumption of sandwiches with herb dressing from a snack bar on 25 or 26 May (May 25: RR=5.7; 95% CI 0.9-37.9; both days: RR=, P=0.007). Foods and workers from the snack bar tested negative. However, one worker, not previously registered with the health authorities, was identified during a site visit. It cannot be excluded that further unregistered individuals worked at the snack bar between May and June 2004. Despite intense case-finding activities, no further cases were identified among the population.
The most likely vehicle in this outbreak was sandwiches with herb dressing, though the source of contamination remains unknown. Even without history of travel to endemic countries, physicians should consider typhoid fever when managing patients with unexplained fever.
Rotavirus in Spain (2000-2004): a predictive model for a surveillance system
Authors: Luquero F J , Eiros J M , Sanchez-Padilla E , Castrodeza J , Simón-Soria F , Ortiz de Lejarazu R
Published: October 2017

Rotavirus infection is one of the main causes of acute gastroenteritis and has an important impact on hospitalisation. There is no homogeneous surveillance system for rotavirus infections in Europe. The aim of this study is to develop a predictive model in order to estimate the expected rotavirus infections in the population covered by a hospital. A five year study (2000-2004) was developed in a Spanish university hospital. A correlation test between the notifications reported to the Microbiological Information System (SIM) and hospitalisations was carried out, as well as a time series analysis, obtaining the trend and the cyclical components. The predictive model was adjusted using the least squares method. A direct relationship between the microbiological isolations and the hospitalisations was established (=0.925; p<0.001). A significant annual cycle was observed, with the peak of cases occurring in February. The two principal outbreaks that occurred in the study period would have been detected with the predictive model. Expected rotavirus cases and hospitalisations for 2005 and 2006 were obtained. The notifications of rotavirus infections reported to SIM are adequate in order to establish a hospital surveillance system, but a predictive model which provides expected cases is also necessary. Therefore, this tool will be useful to evaluate preventive measures such as rotavirus vaccines, which will soon be available in Europe.
Short summary of Swedres 2005, a report on Swedish antibiotic utilisation and resistance
Authors: Cars O , Olsson-Liljequist B , Lundh K
Published: October 2017

""Swedres 2005"", the fifth report on Swedish antibiotic utilisation and resistance in human medicine, was presented in May 2006. Compared with the rest of Europe, antibiotic consumption and resistance levels in Sweden are relatively low. However, global travel and trade facilitate the spread of bacteria between countries and continents. As a consequence, also in Sweden, increasing resistance trends are seen for some pathogens, notably ESBL-producing enterobacteriaceae.
Successful transfer of Eurosurveillance to ECDC
Authors: Jakab Z
Published: October 2017

One of the first things the new European Centre for Disease Prevention and Control (ECDC) had to address in 2005 when the Centre was just being set up and operational was the requirement in its Work Plan 2005-2006 to issue a “weekly epidemiological report”.
Influenza antiviral susceptibility monitoring activities in relation to national antiviral stockpiles in Europe during the winter 2006/2007 season
Authors: Meijer A , Lackenby A , Hay A , Zambon M
Published: October 2017

Due to the influenza pandemic threat, many countries are stockpiling antivirals in the hope of limiting the impact of a future pandemic virus. Since resistance to antiviral drugs would probably significantly alter the effectiveness of antivirals, surveillance programmes to monitor the emergence of resistance are of considerable importance. During the 2006/2007 influenza season, an inventory was conducted by the European Surveillance Network for Vigilance against Viral Resistance (VIRGIL) in collaboration with the European Influenza Surveillance Scheme (EISS) to evaluate antiviral susceptibility testing by the National Influenza Reference Laboratories (NIRL) in relation to the national antiviral stockpile in 30 European countries that are members of EISS. All countries except Ukraine had a stockpile of the neuraminidase inhibitor (NAI) oseltamivir. Additionally, four countries had a stockpile of the NAI zanamivir and three of the M2 ion channel inhibitor rimantadine. Of 29 countries with a NAI stockpile, six countries'; NIRLs could determine virus susceptibility by 50% inhibitory concentration (IC50) and in 13 countries it could be done by sequencing. Only in one of the three countries with a rimantadine stockpile could the NIRL determine virus susceptibility, by sequencing only. However, including the 18 countries that had plans to introduce or extend antiviral susceptibility testing, the NIRLs of 21 of the 29 countries with a stockpile would be capable of susceptibility testing appropriate to the stockpiled drug by the end of the 2007/2008 influenza season. Although most European countries in this study have stockpiles of influenza antivirals, susceptibility surveillance capability by the NIRLs appropriate to the stockpiled antivirals is limited.
Cross-border investigation of a Shigella sonnei outbreak in a group of Norwegian tourists after a trip to Russia
Authors: Schimmer B , Meldal H , Perederij N G , Vold L , Petukhova M A , Grahek-Ogden D , Nygård K
Published: October 2017

In early September 2006, the Norwegian Institute of Public Health was alerted to an outbreak of Shigella sonnei infections (shigellosis) among 23 Norwegian passengers who had taken a bus tour from Kirkenes, Norway to Murmansk, Russia. The trip lasted from 27 to 31 August, and the group stayed in various hotels and visited several restaurants in both Kirkenes and Murmansk during this period. Stool samples from three ill passengers yielded S. sonnei; an additional 10 passengers had gastrointestinal symptoms with diarrhoea or loose stools with abdominal pain. An investigation was initiated in collaboration with the department of epidemiological surveillance in Murmansk. We sent a questionnaire to the work e-mail addresses of all passengers asking about symptoms and exposures. Two restaurants and a hotel visited by the Norwegian tourists in Murmansk were inspected and sampled. Of all the food and beverage items mentioned in the questionnaire, only cured meat consumed in restaurant A in Murmansk on 28 August was associated with the risk of developing illness. Inspections of the restaurants in Murmansk identified some hygienic shortcomings and inadequate routines. However, S. sonnei could not be isolated from food samples or the personnel. Improved routines were implemented.
Sentinel Surveillance: an option for surveillance of infectious intestinal disease
Authors: Gauci C , Melillo Fenech T , Gilles H , O'Brien S , Stabile I , Calleja N , Ruggeri F , Cuschieri L , Mamo J
Published: October 2017

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New eyes: improving Europe’s infectious disease surveillance
Authors: O’Flanagan D
Published: October 2017

This edition of Eurosurveillance contains reports of infectious disease surveillance systems from all corners of Europe. In some instances, routinely collected notifiable data coupled with microbiological data can provide sufficient information to allow appropriate public health intervention.
Epidemiology of meningococcal meningitis and changes in the surveillance system in Poland, 1970-2006
Authors: Gryniewicz O , Kolbusz J , Rosinska M , Zielinski A , Stefanoff P
Published: October 2017

The objective of this study was to describe the general features of meningococcal meningitis epidemiology in 1970-2006 in Poland, in the context of changes made in surveillance system methods. Because of limited availability of case-based data, a more detailed analysis was performed only for the period 1994-2006 with special focus on case-fatality and diagnostic certainty. The reported annual number of meningococcal meningitis cases reached its peak of 416 (incidence 1.2 per 100,000) in 1981, after which it decreased to 76 cases in 2003 (incidence 0.2), and then increased to 151 cases in 2006 (incidence 0.4 per 100,000). The observed decrease was consistent with the decline in the number of live births and the drop in mortality from meningococcal disease observed using an independent reporting of death certificates. In 1994-2006, 1,677 cases of meningococcal meningitis were registered, with annual incidence varying between 0.2 and 0.5 per 100,000 inhabitants. Median age of patients was 4 years and 73% of cases were under 18 years of age. The majority of cases were caused by group B meningococci, but a trend towards increasing proportion of serogroup C has been identified. Meningococcal meningitis only was reported in 79% of cases, and meningitis with concomitant septicaemia in 21%. The overall case fatality was 3.7% - 4.5% in cases of meningitis only, and 7.1% in cases of meningitis with septicaemia. Based on the case definition introduced in 2005, 88.1% of the cases would be classified as confirmed and 4.8% as probable, whereas 7.1% would not fulfil the criteria of the case definition >Although diagnostic certainty of reported cases has improved in recent years, it is still problematic. Further efforts are needed to increase the proportion of serogrouped cases and assess the burden of meningococcal disease in Poland.
Pertussis outbreak detected by active surveillance in Cyprus in 2003
Authors: Theodoridou M , Hadjipanagis A , Persianis N , Makri S , Hadjichristodoulou C
Published: October 2017

Pertussis is a disease of substantial public health importance that still lacks an efficient surveillance system. It has been a notifiable disease in Cyprus since 1930, and has had an incidence rate of 1 per 100,000 persons during the last 10 years. In 2001, the Greece-Cyprus Paediatric Surveillance Unit (GCPSU) was established with the aim of active surveillance for rare paediatric diseases, including weekly data reporting, zero reporting, and obligatory laboratory tests. From November 2002, pertussis has been included in the active surveillance scheme of GCPSU, resulting in a very early detection of an outbreak in June 2003 that led to immediate and successful action.
Incidence of Beijing genotype of Mycobacterium tuberculosis in Elche, Spain: A 13-year surveillance study
Authors: Garcia-Pachon E , Escribano I , Rodriguez J C , Ruiz M , Ramos J M , Navarro J F , Royo G
Published: October 2017

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Helicobacter pylori: primary antimicrobial resistance and first-line treatment strategies
Authors: Kist M
Published: October 2017

Knowledge of primary antimicrobial resistance of Helicobacter pylori is important for the clinical management of infection-related gastroduodenal diseases.
Robustness of measles immunity in parturient women in Gipuzkoa, Basque Country, Spain, in the post-vaccination era
Authors: Cilla G , Serrano-Bengoechea E , Vicente D , Montes M , Pérez-Trallero E
Published: October 2017

The infants of mothers with vaccine-induced immunity lose passive acquired measles antibodies earlier than infants of naturally infected mothers. This study included two cohorts of parturient women: one composed of women who gave birth in 1990 (end of the epidemic period), and another comprising women who gave birth in 2006 (after eight years without virus circulation). Immunoglobulin G (IgG) antibodies against measles (IgG-AM) were investigated by enzyme immunoassay in stored serum samples (-40°C). Measles-IgG titres of >400 mIU/mL were found in all 185 parturient women who gave birth in 1990, all with natural immunity. Of 185 women who gave birth in 2006, most of whom had vaccine-induced protection, measles-IgG were undetectable in 4.9% (
Epidemiological and virological assessment of influenza activity in Europe during the winter 2005-2006
Authors: Meijer A , Meerhoff T J , Meuwissen L. E. , Van Der Velden J , Paget W J , European Influenza Surveillance Scheme (EISS)
Published: October 2017

Influenza activity in Europe during the winter 2005-2006 started late January - early February 2006 and first occurred in the Netherlands, France, Greece and England. Subsequently, countries were affected in a random pattern across Europe and the period of influenza activity lasted till the end of April. In contrast to the winter seasons in the period 2001-2005, no west-east pattern was detected. In 12 out of 23 countries, the consultation rates for influenza-like illness or acute respiratory infection in the winter 2005-2006 were similar or higher than in the winter 2004-2005, despite a dominance of influenza B viruses that normally cause milder disease than influenza A viruses. In the remaining 11 countries the consultation rates were lower to much lower than in the winter 2004-2005. The highest consultation rates were usually observed among children aged 0-14. The circulating influenza virus types and subtypes were distributed heterogeneously across Europe. Although the figures for total virus detections in Europe indicated a predominance of influenza B virus (58% of all virus detections), in many countries influenza B virus was predominant only early in the winter, whilst later there was a marked increase in influenza A virus detections. Among the countries where influenza A viruses were co-dominant with B viruses (9/29) or were predominant (4/29), the dominant influenza A subtype was H3 in seven countries and H1 in four countries. The vast majority of characterised influenza B viruses (90%) were similar to the B/Victoria/2/87 lineage of influenza B viruses that re-emerged in Europe in the winter 2004-2005 but were not included in the vaccine for the influenza season 2005-2006. This might help to explain the dominance of influenza B viruses in many countries in Europe during the winter 2005-2006. The influenza A(H3) and A(H1) viruses were similar to the reference strains included in the 2005-2006 vaccine, A/California/7/2004 (H3N2) and A/New Caledonia/20/99 (H1N1), respectively. In conclusion, the 2005-2006 influenza epidemic in Europe was characterised by moderate clinical activity, a heterogeneous spread pattern across Europe, and a variable virus dominance by country, although an overall dominance of influenza B viruses that did not match the virus strain included in the vaccine was observed.
Results of a Europe-wide investigation to assess the presence of a new variant of Chlamydia trachomatis
Authors: Savage E J , Ison C , Van de Laar M JW ,   European Surveillance of Sexually Transmitted Infections (ESSTI)
Published: October 2017

In 2006, a new variant of Chlamydia trachomatis was reported in Sweden. Three countries – Ireland, Norway, and Denmark – have detected the variant to date, but very few cases in total have occurred. The European network for STI surveillance (ESSTI) and the European Centre for Disease Prevention and Control (ECDC) assessed the potential spread of the variant in other European countries, and concluded that there is currently no evidence that the variant has spread widely across Europe. However, the variant strain has been reported in between 10% and 65% of infected patients in Sweden. It is too early to tell whether the variant will remain confined to Sweden or whether the number of cases will significantly increase. Enhanced surveillance will need to be continued to address these concerns.
Reasons for the sharp increase of genital chlamydia infections reported in the first months of 2007 in Sweden
Authors: Velicko I , Kühlmann-Berenzon S , Blaxhult A
Published: October 2017

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Mutant Chlamydia trachomatis in Denmark
Authors: Hoffmann S , Jensen J S
Published: October 2017

A mutant Chlamydia trachomatis variant was detected in Sweden in 2006 and has since also been diagnosed in Norway, but not in Ireland or the Netherlands. This paper describes a study aimed at assessing the presence of the new variant in Denmark. Between November 2006 and April 2007 we tested 3,770 specimens using methods capable of detecting the new variant and distinguishing it from the wild type. In late March 2007 we found one case of the new variant in a 19-year old Danish woman without any known relationship to Sweden. It is surprising that the spread of this sexually transmitted pathogen into Denmark and within Denmark has been so low in view of its rapid and substantial spread within Sweden.
French situation concerning the Swedish Chlamydia trachomatis variant
Authors: de Barbeyrac B , Raherison S , Cado S , Normandin F , Clerc M , Clairet V , Goulet V , Bébéar C
Published: October 2017

In 2006, a plasmid deletion mutant of Chlamydia trachomatis was identified in Sweden that can not be detected with those commercial tests targeting the deleted area. In order to study the spread of this strain in France, a laboratory-based surveillance system was set up by the National Reference Centre for Chlamydiae and the Institut de Veille Sanitaire. Among 1,141 C. trachomatis-positive specimens from all over France, the new variant was only detected in one case. This case was a non-French resident consulting a sexually transmitted infections clinic. Although the new variant does not seem to be established in France as yet, surveillance based on the testing of C. trachomatis-positive samples from all over France continues.
Managing Legionnaires' disease in Europe: the need for international collaboration
Authors: Joseph C
Published: October 2017

Travel and tourism is an increasingly important economic activity throughout Europe and the rest of the world.
Results of a 12-month long enhanced surveillance of listeriosis in Italy
Authors: Gianfranceschi M , Gattuso A , D'Ottavio M C , Fokas S , Aureli P
Published: October 2017

Since 1993, the reporting of listeriosis has been mandatory in Italy. The surveillance system based on case notifications from physicians is managed by the Ministry of Health. The information collected includes only gender, age and case distribution by region. To gather more information, an active surveillance was conducted for 12 months (2002-2003). All hospital microbiological laboratories in Italy (n=103) were given clinical and food questionnaires and were requested to report positive cases and send strains for testing. A higher number of cases of listeriosis were reported by this active surveillance compared to the mandatory notifications. In addition, information on risk factors, clinical symptoms and outcomes of 77 reported cases were analysed. In one case it was possible to trace the source of infection. Of the 77 cases of listeriosis, 41 Listeria monocytogenes isolates were characterised by serotype and pulsotype. More than 95% of the strains belonged to serotypes 1/2a, 4b and 1/2b; molecular analysis revealed 23 different AscI pulsotypes. The information collected is very important for understanding the real situation of listeriosis in Italy. It can be used to take effective actions in improving food safety and to provide dietary advice to individuals at greater risk of infection.
Rubella immunity and vaccination coverage of the population of northern Greece in 2006
Authors: Gioula G , Fylaktou A , Exindari M , Atmatzidis G , Chatzidimitriou D , Melidou A , Kyriazopoulou-Dalaina V
Published: October 2017

This study was prompted by two rubella outbreaks that occurred in northern Greece in the last decade (1993 and 1999) and by periodic changes to the immunisation strategy. It was designed to determine the current status of rubella immunity and vaccination coverage in this region, eight years after the last outbreak in 1999 and seven years after the last epidemiological study in the area. Among the 685 subjects studied the seroprevalence was 83.7% and the total vaccination rate was 31.3%. In people born before the introduction in 1989 of the measles/mumps/rubella (MMR) vaccine into the national immunisation programme, higher rates of rubella seropositivity (88.1%) were observed compared to those born after 1989 (77.1%). The vaccination rates for these age groups were 14.8% and 58.1%, respectively. The reason for this difference is the lack of vaccination at the time these people were children, and it underlines the need for a vaccination strategy targeting older people as well. Among women of reproductive age (16-40 years), who represented 44.8% of the study population, 13.9% were susceptible to rubella and only 18.5% were vaccinated. These results indicate that there is a great need for a comprehensive policy designed to protect mostly young adults and women of childbearing age in order to prevent congenital rubella infections. This policy should also include competent surveillance systems for rubella and congenital rubella syndrome and an evaluation of existing immunisation programmes.