bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of the 2003 heat wave on daily mortality in England and Wales and the use of rapid weekly mortality estimates
Authors: Johnson H , Kovats S , McGregor G , Stedman J , Gibbs M , Walton H
Published: October 2017

This paper describes a retrospective analysis of the impact of the 2003 heat wave on mortality in England and Wales, and compares this with rapid estimates based on the Office for National Statistics routine weekly deaths reporting system. Daily mortality data for 4 to 13 August 2003, when temperatures were much hotter than normally seen in England, were compared with averages for the same period in years 1998 to 2002. The August 2003 heat wave was associated with a large short-term increase in mortality, particularly in London. Ozone and particulate matter concentrations were also elevated during the heat wave. Overall, there were 2139 (16%) excess deaths in England and Wales. Worst affected were people over the age of 75 years. The impact was greatest in the London region where deaths in those over the age of 75 increased by 59%. Estimated excess mortality was greater than for other recent heat waves in the United Kingdom.
The estimated number of deaths registered each week is reported by the Office for National Statistics. The first clear indication of a substantial increase in deaths was published on 21 August 2003. This provided a quick first estimate of the number of deaths attributable to the heat wave and reflected the pattern of daily deaths in relation to the hottest days, but underestimated the excess when compared with the later analysis.
Outbreak of tinea corporis gladiatorum, a fungal skin infection due to Trichophyton tonsurans, in a French high level judo team
Authors: Poisson D. M. , Rousseau Didier , Defo D , Estève E
Published: October 2017

An outbreak of 49 cases of tinea corporis gladiatorum due to Trichophyton tonsurans infection occurred in a high level judo team of 131 members in Orléans, central France, between October 2004 and April 2005. The team was divided into 5 groups: cadet-junior boys (n=44), cadet-junior girls (n=33), male university students (n= 15), female university students (n=21), and a group called ‘pôle technique’ made up of high level judokas who have finished academic study (n=18). The outbreak involved 86% of the cadet-junior boys, but only 6 men in the ‘pôle technique’ (33%) and only 5 of the 69 other team members (7%) (cadet-junior girls and university students). We describe the outbreak and the results of a survey that found a known risk factor for the ‘pôle technique’: sharing an electric hair shaver. Personal hygiene practices were found to be very good among the cadet-junior boys. The high attack rate in this group may be linked to the poor shower facilities in the gymnasium where they practiced that led them to have their showers several hours after the end of daily practice.
The epidemiology of severe Streptococcus pyogenes associated disease in Europe
Authors: Lamagni T  L , Efstratiou A , Vuopio-Varkila J , Jasir A , Schalén C ,   Strep-EURO
Published: October 2017

Several European countries reported outbreaks of severe disease caused by Streptococcus pyogenes in the late 1980s. This marked a departure from the previous decades, where very few such outbreaks were noted. These changes in disease occurrence formed part of a global phenomenon, the reasons for which have yet to be explained. Results of surveillance activities for invasive S. pyogenes infection within Europe over the past fifteen years identified further increases in many countries. However, variations in surveillance methods between countries preclude robust comparisons being made, illustrating the need for a unified surveillance strategy across Europe. This was finally embodied in the Strep-EURO programme, introduced in 2002.
Pneumococcal vaccination policy in Europe
Authors: Pebody R G , Leino T , Nohynek H , Hellenbrand W , Salmaso S , Ruutu P
Published: October 2017

Infection due to Streptococcus pneumoniae (Pneumococcus) (Pnc) is an important cause of invasive clinical manifestations such as meningitis, septicaemia and pneumonia, particularly in young children and the elderly. A 23-valent polysaccharide Pnc vaccine (PPV) has been available for many years and a 7-valent conjugate Pnc vaccine (PCV) has been licensed since 2001 in Europe. As part of a European Union (EU) funded project on pneumococcal disease (Pnc-EURO), a questionnaire was distributed to all 15 EU member states, Switzerland, Norway and the 10 accession countries in 2003 to ascertain current pneumococcal vaccination policy. Twenty three of the 27 target countries, constituting the current European Union (plus Norway and Switzerland), completed the questionnaire.
PPV was licensed in 22 of the 23 responding countries and was in the official recommendations of 21. In all the 20/21 countries for which information was available, risk groups at higher risk of infection were targeted. The number of risk groups targeted ranged from one to 12. At least 17 countries recommend that PPV be administered to all those >65 years of age (in three countries, to those over 60 years of age).
Thirteen countries had developed national recommendations for PCV in 2003. No country recommended mass infant immunisation at that time, but rather targeted specific risk groups (between 1 and 11), particularly children with asplenia (n=13) and HIV infection (n=12). PCV use was restricted to children under two years of age in seven countries, and in four countries to children under five years of age.
Future decisions on use of pneumococcal vaccines in Europe will be decided on the basis of several factors including: local disease burden; the predicted impact of any universal programme, particularly the importance of serotype replacement and herd immunity (indirect protection to the unvaccinated population); the effectiveness of reduced dose schedules, and vaccine cost. Indeed, at least one country, Luxembourg, has since implemented a universal infant PCV immunisation policy.
Letter to the Editor: Outbreaks caused by parvovirus B19
Authors: Kelly H , Leydon J
Published: October 2017

In a recent edition of Eurosurveillance Monthly, Gonçalves and colleagues reported that outbreaks of a rash illness in a kindergarten, primary and secondary school in the local health area of Braga in northern Portugal were due to human parvovirus B19 [1]. Although human parvovirus was suspected clinically, laboratory investigations were undertaken to exclude both measles and rubella as the cause of the outbreak, given that Portugal is approaching measles elimination. The authors noted that human parvovirus has been reported as a cause of rash illness, potentially as a differential diagnosis for measles and rubella, in developing and developed countries [1].
Completeness of malaria notification in the Netherlands 1995-2003 assessed by capture-recapture method
Authors: Klein S , Bosman A
Published: October 2017

In 1999 in the Netherlands, the duty to notify malaria was transferred from physicians to laboratories by the new Infectious Diseases Law. To evaluate the effect of this change, we aimed to estimate completeness of malaria notification in the Netherlands from 1995-2003. We calculated it relative to sentinel laboratory and hospital admission data. Using the two-source capture-recapture method (CRM), we estimated the total number of cases to assess the completeness relative to this number.
The completeness of notification relative to sentinel data was 18.2 % (95% CI of 15.7-20.7) from 1995-1998 and 56.4 % (95% CI of 47.0-65.8) for 2000-2003. The completeness relative to the number of malaria cases admitted to the hospital was 35.1 % for the period 1995-2003. The estimated numbers of cases of malaria between 1995 and 1998 were 3123 (95% CI of 2796-3449) and 5043 (95% CI of 4343-5742) between 2000 and 2003. The completeness relative to this numbers changed from 35.5 % (95% CI of 32.1-39.7) in 1995-1998 to 36.1 % (95% CI of 31.7-41.9) for the years 2000-2003.
Laboratory-based notification has significantly increased the absolute number of malaria notifications, but there was no change in completeness relative to hospital admissions. The increase in estimated malaria cases may be artificial, due to the extent of violation of CRM requirements over the study period.
European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus
Authors: Puro V , De Carli G , Cicalini S , Soldani F , Balslev U , Begovac J , Boaventura L , Campins Marti M , Hernández Navarrete M J , Kammerlander R , Larsen C , Lot F , Lunding S , Marcus U , Payne L , Pereira A A , Thomas T , Ippolito G
Published: October 2017

Exposure prevention is the primary strategy to reduce the risk of occupational bloodborne pathogen infections in healthcare workers (HCW). HCWs should be made aware of the medicolegal and clinical relevance of reporting an exposure, and have ready access to expert consultants to receive appropriate counselling, treatment and follow-up.
Vaccination against hepatitis B virus (HBV), and demonstration of immunisation before employment are strongly recommended. HCWs with postvaccinal anti-HBs levels, 1-2 months after vaccine completion, >10 mIU/mL are considered as responders. Responders are protected against HBV infection: booster doses of vaccine or periodic antibody concentration testing are not recommended. Alternative strategies to overcome non-response should be adopted.
Isolated anti-HBc positive HCWs should be tested for anti-HBc IgM and HBV-DNA: if negative, anti-HBs response to vaccination can distinguish between infection (anti-HBs >50 mUI/ml 30 days after 1st vaccination: anamnestic response) and false positive results(anti-HBs >10 mUI/ml 30 days after 3rd vaccination: primary response); true positive subjects have resistance to re-infection. and do not need vaccination
The management of an occupational exposure to HBV differs according to the susceptibility of the exposed HCW and the serostatus of the source. When indicated, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible (within 1-7 days).
In the absence of prophylaxis against hepatitis C virus (HCV) infection, follow-up management of HCV exposures depends on whether antiviral treatment during the acute phase is chosen. Test the HCW for HCV-Ab at baseline and after 6 months; up to 12 for HIV-HCV co-infected sources. If treatment is recommended, perform ALT (amino alanine transferase) activity at baseline and monthly for 4 months after exposure, and qualitative HCV-RNA when an increase is detected.
Rabies remains a ‘neglected disease’
Authors: Fooks A. R.
Published: October 2017

Europe continually encounters the serious threat posed from zoonotic diseases including ancient bacterial agents such as Mycobacterium tuberculosis. The largest threat, however, is from RNA viruses such as the SARS-CoV, the Heninipah viruses, avian influenza viruses and emerging lyssaviruses.
Rabies in Europe in 2005
Authors: Bourhy H , Dacheux L , Strady C , Mailles A
Published: October 2017

Rabies is still present in Europe in 2005. Its incidence in humans remains limited (fewer than 5 human cases per year) through the application of strict prophylactic measures (anti-rabies treatment) and by means of veterinary rabies control measures in the domesticated and wild animal populations. The main indigenous animal reservoirs are: the dog in eastern European countries and on the borders with the Middle East; the fox in central and eastern Europe; the racoon dog in northeastern Europe; and the insectivorous bat throughout the entire territory. Finally, each year, cases of animals with rabies imported from enzootic areas are reported, showing the permeability of borders and traveller’s lack of consideration of the rabies risk. These importations constantly threaten the rabies-free status of terrestrial animals in western European countries and complicate the therapeutic decisions taken by physicians in the absence of information regarding the biting animal.
Human-to-human transmission of avian influenza A/H7N7, The Netherlands, 2003
Authors: Du Ry van Beest Holle M , Meijer A , Koopmans M , de Jager C M
Published: October 2017

An outbreak of highly pathogenic avian influenza A virus subtype H7N7 began in poultry farms in the Netherlands in 2003. Virus infection was detected by RT-PCR in 86 poultry workers and three household contacts of PCR-positive poultry workers, mainly associated with conjunctivitis. To determine the magnitude of and risk factors for human-to-human transmission of influenza A/H7N7 in the Netherlands, a retrospective cohort study among household members of infected poultry workers was undertaken. In total, 33 (58.9%) of 56 (among 62) participants who provided blood samples had positive H7 serology, using single convalescent serum samples obtained at least 3 weeks after onset of symptoms of the index case. Eight household members (12.9%) reported symptoms (conjunctivitis and/or ILI), of which four of five (80.0%) tested seropositive. On univariate analysis, significant risk factors for seropositivity included having at least two toilets, a pet bird, and using cloth handkerchiefs. It was not possible to obtain a stable model for binomial regression for the outcome of A/H7N7 infection. Further seroprevalence studies among contacts of asymptomatic H7 cases should be conducted.
Ascertainment of meningococcal disease in Europe
Authors: Trotter C , Samuelsson S , Perrocheau A , de Greeff S , de Melker H , Heuberger S , Ramsay M
Published: October 2017

Meningococcal disease surveillance in most countries is based upon a combination of statutory notification systems and laboratory reporting, both of which are recognised to underestimate the true burden of disease. The incidence of meningococcal disease varies throughout Europe, and although there are many reasons for this, it is important to quantify the degree of under-ascertainment in order to validate international comparisons. Here, we review the literature on the ascertainment of meningococcal disease in Europe and the available methods for estimating the degree of under-reporting. We found that the sensitivity of surveillance varies between countries and over time, with estimates ranging from 40% to 96%. We identified five methods suitable for conducting ascertainment studies, from simple comparative studies to more complicated capture-recapture and regression analyses. Studies of ascertainment may be used to identify weaknesses and biases in surveillance data, and facilitate the improvement of these systems. These findings are relevant to the surveillance of other infectious diseases, particularly those with lower mortality and a lower public profile than meningococcal disease, for which ascertainment may be worse.
Trichinellosis: still a concern for Europe
Authors: Dupouy-Camet J
Published: October 2017

Trichinellosis is a zoonotic disease caused by the ingestion of raw meat containing larvae of the nematode Trichinella. Four species of Trichinella are found in Europe : Trichinella spiralis (cosmopolitan), T. britovi (in wildlife from mountainous areas), T. nativa (in wildlife from colder and northern regions) and T. pseudospiralis (a cosmopolitan nonencapsulating species). Human trichinellosis causes high fever, facial oedema, myositis and eosinophilia. It can be a serious disease, particularly in elderly patients in whom neurological or cardiovascular complications can lead to death.
Tattooing, permanent makeup and piercing in Amsterdam; guidelines, legislation and monitoring
Authors: Worp J , Boonstra A , Coutinho R A , van den Hoek J A R
Published: October 2017

Tattooing, body piercing and permanent makeup are increasing in popularity. Here, we describe the procedures involved in these practices, their risks, the content of guidelines developed by the Municipal Health Service in Amsterdam (the Netherlands) to reduce infection risks, the legislation in the city of Amsterdam, and results of monitoring in tattoo and piercing studios.
Hepatitis A vaccination policy for travellers to Egypt in eight European countries, 2004
Authors: Ward M , Borgen K , Mazick A , Muehlen M
Published: October 2017

In 2004, an outbreak of hepatitis A occurred in European tourists returning from Egypt. The reported hepatitis A attack rates varied considerably between tourists from different European countries. To determine the reason for this divergence in attack rates, a survey was undertaken with the following objectives: (a) documentation of national hepatitis A prevention policies for people travelling to Egypt and (b) documentation of hepatitis A reporting practices in these countries. A questionnaire was compiled and distributed to 13 European countries. All eight of the countries that responded had produced guidelines for the prevention of travel-associated hepatitis A. Between 2001-2003, 40% (range 4-51) of hepatitis A cases reported annually were associated with travel abroad. This occurred despite the fact that all countries recommended active vaccination with hepatitis A vaccine for people travelling to Egypt for holidays. There was no standard case definition for reporting confirmed cases in the countries that reported hepatitis A cases. As it is likely that travel-associated infections will increase as more people take overseas holidays, innovative ways to increase the number of travellers who seek and adhere to appropriate medical advice prior to travel must be explored. In addition, we recommend the use of the European Commission case definition for notification of confirmed cases of hepatitis A.
An outbreak of airborne tularaemia in France, August 2004
Authors: Siret V , Barataud D , Prat M , Vaillant V , Ansart S , Le Coustumier A , Vaissaire J , Raffi F , Garré M , Capek I
Published: October 2017

Fifteen tularaemia cases were identified after a holiday spent at a converted mill in the Vendee region in France, between 9 and 12 August 2004.
The mill was visited, and descriptive, retrospective cohort and environmental investigations were conducted. The 39 people who had stayed at the mill between 24 July and 11 August were asked about symptoms, exposure to food and animals, and leisure activities.
A case was defined as a person with evidence of fever and a positive serology (seroconversion or significant rise in antibody titre, or a single titre) = 40. Culture for Francisella tularensis and polymerase chain reaction (PCR) diagnosis was carried out for drinking water, firewood, and domestic animals at the mill.
Fifteen cases of tularaemia (38%) were confirmed. Twelve of the cases (80%) had the pulmonary form. None of the patients was admitted to hospital.
There was a strong association between infection and participation in a dinner at the mill on 4 August (p<10-8). One of the three dogs present in the dining room was serologically positive for F. tularensis.
Results of analysis of environmental samples were negative.
These investigations confirmed the occurrence of a cluster of 15 tularaemia cases, in patients who were infected on the evening of 4 August, in a mill in Vend¨¦e, an endemic area for tularaemia. The investigations highlight the existence of nonspecific and benign pulmonary forms of the illness in France.
The pulmonary form of infection in the human cases and the positive serology of the dog suggest contamination by inhalation of contaminated particles from the dog¡¯s fur disseminated by the dog shaking itself.
Emerging Salmonella Enteritidis anaerogenic phage type 14b: Outbreak in Norwegian, Swedish and Finnish travellers returning from Greece
Authors: Guérin P J , Nygård K , Siitonen A , Vold L , Kuusi M , de Jong B , Rottingen J A , Alvseike O , Olsson A , Lassen J , Andersson Y , Aavitsland P
Published: October 2017

In July 2001, the Norwegian Institute of Public Health (Folkehelseinstituttet, FHI) reported a cluster of Salmonella Enteritidis of phage type 14b infections in Norwegian travellers returning from Greece. An increase in the same uncommon phage type was also registered in Sweden and Finland at the same time. Cases of S. Enteritidis PT 14b in patients returning from Greece were reported in these three Nordic countries in 2001 (303 cases), 2002 (164 cases) and 2003 (199 cases). Case-control studies performed in 2001 in Norway and Sweden indicated that consumption of chicken was associated with illness. In 2002 and 2003, continuing case reports indicated that this uncommon phage type had probably become established in the Greek food chain. Tour operators were informed and contacts were made with Greek public health authorities. Because place of infection is not systematically included in most Salmonella notification systems, the S. Enteritidis phage type 14b outbreak reported here may represent only part of a larger outbreak among travellers visiting Greece. Infections are often reported only in the tourists’ home countries and public health authorities in the tourist destinations may not be aware of the problem. Further collaboration between national institutes of public health in Europe is needed to detect outbreaks occurring among tourists.
Salmonella Enteritidis phage type 21 outbreak in Austria, 2005
Authors: Schmid D , Schandl S , Pichler A M , Kornschober C. , Berghold C , Beranek A , Neubauer G , Neuhold-Wassermann M , Schwender W , Klauber A , Deutz A , Pless P , Allerberger F
Published: October 2017

We report an outbreak of gastroenteritis due to Salmonella Enteritidis PT 21 associated with attending an annual traditional fair in a small Austrian village on 4 May 2005. The outbreak lasted from 4 to 8 May. Descriptive and analytical epidemiological investigations were conducted in order to determine the extent of the outbreak and to identify outbreak risk factors. Of the 115 persons who visited the fair, 85 persons fulfilled the criteria of an outbreak case (attack rate=73.9%). Stool specimens from 52 patients, including two kitchen staff, were tested for salmonella, and 20 specimens were positive for Salmonella Enteritidis PT 21. The cohort study revealed mixed salad (which included potatoes) as the likely cause of the outbreak (RR: 10.4, 95%CI 2.8 – 39.1; P=<0.001). The causative agent of the outbreak was cultured from the stock of eggs used at the fair and from all three drag swabs and one barn dust sample collected from the responsible egg laying flock. Molecular subtyping by pulsed-field gel electrophoresis of genomic DNA after XbaI digestion showed that isolates from eggs, from the flock and from humans were indistinguishable. We hypothesise that cross contamination from eggs to boiled potatoes occurred in the kitchen area, where raw eggs were handled by village residents preparing a traditional Viennese egg dressing. Unrefrigerated storage of peeled potatoes may have favoured bacterial growth. Eggs from small rural flocks of laying hens kept in a traditional ‘natural’ way should not be assumed to be salmonella-free.
Tuberculosis and BCG in Europe
Authors: Watson J  M
Published: October 2017

BCG (Bacillus Calmette-Guerin) vaccine was developed from an attenuated strain of Mycobacterium bovis at the beginning of the twentieth century. Its widespread use as a vaccine against tuberculosis spread in Europe, and subsequently globally, over the next 50 years. It remains one of the most frequently administered vaccines in the world. It has also been one of the most controversial. Widely differing estimates of the effectiveness of BCG at protecting against different forms of tuberculosis in different population subgroups in different settings have been published [1]. Some countries, with a low incidence of tuberculosis, did not adopt the use of BCG vaccine at all and some others abandoned its use at a later stage. In addition, great variation developed in national programmes for the administration of BCG including the age(s) at which it should be given, whether or not its administration should be preceded by tuberculin sensitivity testing, and whether repeat vaccinations with BCG should be given.
European survey of BCG vaccination policies and surveillance in children, 2005
Authors: Infuso A , Falzon D ,   on behalf of the Euro-TB network
Published: October 2017

In 2005, all 25 EU countries, as well as Andorra, Bulgaria, Norway, Romania and Switzerland, participated in a survey on BCG vaccination in children. BCG was recommended nationally for children under 12 months in 12 countries, in older children in five countries and in children at risk (from origin, contact or travel) in 10 countries. Seven countries did not use BCG systematically. Revaccination was practised in four countries. In countries with universal vaccination, BCG coverage was high (83.0% to 99.8%). TB cases commonly occurred in vaccinated children (at least 30%-98% in five countries using universal or high-risk approach). Disseminated infection due to BCG was rarely reported in recent years (0-1/100 000 vaccinated). There is a wide variation among BCG recommendations in Europe, and nearly half the countries surveyed were considering revisions, at a time when the European Centre for Disease Prevention and Control (ECDC) is advocating for harmonised vaccine strategies. Data on monitoring of BCG coverage in target groups is important but often lacking in Europe. Information on BCG status and eligibility should be collected routinely through TB case notification. The incidence of severe adverse effects of BCG in children should be monitored. Given lack of evidence to its efficacy, revaccination should be discontinued.
A regional outbreak of S. Typhimurium in Denmark and identification of the source using MLVA typing
Authors: Torpdahl M , Sørensen G , Ethelberg S , Sandø G , Gammelgard K , Jannok Porsbo L
Published: October 2017

In Denmark, as part of the national laboratory-based surveillance system of human enteric infections, all S. Typhimurium isolates are currently sub-typed using phage typing, antibiogram typing, and pulsed-field gel electrophoresis (PFGE). However, the discriminatory ability of PFGE is not always high enough to discriminate within certain phage types, and it is not always possible to separate unrelated and related isolates. We have therefore applied multiple locus variable number of tandem repeats analysis (MLVA) for surveillance typing of S. Typhimurium since 2004. In May and June 2005, an outbreak with 26 cases of S. Typhimurium infection was identified by MLVA. The isolates were fully sensitive and had one of the most frequently occurring Danish phage types (DT12) and PFGE types. S. Typhimurium DT12 isolates from routine surveillance of animals and food were typed using MLVA and PFGE for comparison with the human isolates. The typing results revealed that an isolate from a pig herd and its corresponding slaughterhouse located in the same geographic region as the outbreak had the same PFGE and MLVA type as the human isolates. In contrast, all other DT12 isolates investigated, which had the same PFGE profile, had different MLVA types. The conclusion that the pig herd was the source of the human infections was supported by patient information, and pork from the herd stopped entering the market on 29 June. MLVA may contribute significantly to both surveillance and outbreak investigations of S. Typhimurium, as without MLVA typing this outbreak would not have been found nor its origin traced.
Epidemiological and virological assessment of influenza activity in Europe, during the 2004-2005 winter
Authors: Meijer A , Paget W J , Meerhoff T J , Brown C S , Meuwissen L. E. , Van Der Velden J , European Influenza Surveillance Scheme (EISS) Collective
Published: October 2017

The 2004-2005 influenza season in Europe started in late December 2004 and the first influenza activity occurred in the west and southwest (Spain, United Kingdom and Ireland). Influenza activity then moved gradually east across Europe during January and early February 2005, and from late February until late March, most movement was south to north. The intensity of clinical influenza activity in ten out of 23 countries was higher than during the 2003-2004 season, and lower or equal to the 2003-2004 season in the other 13 countries. The highest consultation rates were generally observed among children aged 0-14 years. However, the peak consultation rates due to influenza-like illness or acute respiratory infection were not especially high when compared with historical data. The predominant virus strain was influenza A (83% of total detections) of the H3 subtype (85% of H-subtyped A viruses), with fewer influenza B (17% of total detections) or A(H1) viruses (15 % of H-subtyped A viruses) detected. The vast majority of A(H3) viruses were similar to the reference strains A/Wellington/1/2004 (H3N2) and, subsequently, A/California/7/2004 (H3N2) that are closely related drift variants of the A/Fujian/411/2002 (H3N2) prototype vaccine strain. The B viruses co-circulated with A viruses during the whole influenza season in 11 out of 24 countries.
Seven of these were located in the northeast of Europe and in these countries the proportion of B viruses was higher (range: 31-60%) than in the rest of Europe (range: 6-26%). In 13 out of 24 countries the B viruses circulated relatively late in the season. About 43% of all antigenically characterised B viruses were B/Hong Kong/330/2001-like (B/Victoria/2/87 lineage), a strain that is distinguishable from the vaccine influenza B strain, which was a B/Yamagata/16/88 lineage virus. Based on the viruses detected worldwide until February 2005, the World Health Organization modified the composition of the 2005-2006 influenza vaccine from the 2004-2005 season vaccine to include a new A(H3N2) component: an A/California/7/2004 (H3N2)-like virus.
Outbreak of human listeriosis associated with tomme cheese in northwest Switzerland, 2005
Authors: Bille J , Blanc D S , Schmid H , Boubaker K , Baumgartner A , Siegrist H H , Tritten M L , Lienhard R , Berner D , Anderau R , Treboux M , Ducommun J M , Malinverni R , Genné D , Erard P , Waespi U
Published: October 2017

During an eight week period in spring 2005, 10 cases of listeriosis were reported in a small area of northwest Switzerland (150 000 inhabitants). Eight cases were in older immunocompromised patients who became ill with bacteraemia (three deaths), and two cases were in pregnant women who had septic abortion.
Shiga toxin-producing Escherichia coli (STEC) O157 outbreak, The Netherlands, September – October 2005
Authors: Doorduyn Y , de Jager C M , van der Zwaluw W K , Friesema I H , Heuvelink A E , de Boer E , Wannet W J B , van Duynhoven Y T H P
Published: October 2017

In September 2005, the first national food-related outbreak of Shiga toxin (Stx)-producing Escherichia coli (STEC) O157 was investigated in the Netherlands. A total of 21 laboratory-confirmed cases (including one secondary case), and another 11 probable cases (two primary and nine secondary cases) were reported in patients who became ill between 11 September and 10 October 2005. Preliminary investigation suggested consumption of a raw beef product, steak tartare (in the Netherlands also known as 'filet américain'), and contact with other symptomatic persons as possible risk factors. A subsequent case-control study supported the hypothesis that steak tartare was the source of the outbreak (matched odds ratio (OR) 272, 95% confidence interval (CI) 3 - 23211). Consumption of ready-to-eat vegetables was also associated with STEC O157 infection (matched OR 24, 95% CI 1.1 – 528), but was considered a less likely source, as only 40% of the cases were exposed. Samples of steak tartare collected from one chain of supermarkets where it is likely that most patients (67%) bought steak tartare, all tested negative for STEC O157. However, sampling was done three days after the date of symptom onset of the last reported case. Since 88% of the cases became ill within a two week period, point source contamination may explain these negative results. It is concluded that steak tartare was the most likely cause of the first national food-related outbreak of STEC O157 in the Netherlands.
Epidemic conjunctivitis in Germany, 2004
Authors: Schrauder A , Altmann D , Laude G , Claus H , Wegner K , Köhler R , Habicht-Thomas H , Krause G
Published: October 2017

Epidemic conjunctivitis can be associated with viral or bacterial pathogens, whereas epidemic keratoconjunctivitis is caused mainly by adenoviruses type 8,19 and 37. In Germany, the incidence of adenovirus conjunctivitis cases increased from 0.2 per 100 000 inhabitants (in 2001 and 2002) eventually to 0.5 in 2003 and 0.8 in 2004. The detection of adenovirus in conjunctival swabs is notifiable to the local health departments. Data about cases with positive conjunctival swabs are then transmitted to the Robert Koch-Institut. Quality control of data takes place and national surveillance data of confirmed cases with adenovirus conjunctivitis are published. From January to April 2004 the national surveillance system captured an outbreak with 1024 cases (131 laboratory confirmed). Analysis of the national surveillance data showed that in March 2004 the group primarily affected by epidemic keratoconjunctivitis was young men between 18 -29 years old followed by an increased number of notifications from women in the same age group. Meanwhile the German Armed Forces experienced an outbreak of conjunctivitis, almost exclusively without laboratory confirmation, affecting 6378 soldiers.
Despite the small number of laboratory confirmed cases it became clear from the analysis of the national surveillance data that person-to-person transmission between young men and similar age groups of the population did occur. Whether the outbreak started within the garrisons of the German Armed Forces or whether it was triggered within these accommodations, there is clearly a need for the national and the military public health institutions to work together on guidelines to handle future challenges.
Pneumococcal disease surveillance in Europe
Authors: Pebody R  G , Hellenbrand W , D'Ancona F , Ruutu P ,   on behalf of the European Union funded Pnc-EURO contributing group
Published: October 2017

Pneumococcal disease (Pnc) is responsible for invasive pneumococcal disease (IPD) – mainly meningitis and septicaemia - and is an infection of public health importance in Europe. Following the licensure of an effective conjugate vaccine (PCV) in Europe, several European countries, including France, Germany, the Netherlands, Norway, Spain and the United Kingdom, are introducing universal Pnc childhood immunisation programmes. As part of a European Union (EU) funded project on pneumococcal disease (Pnc-EURO), a questionnaire was distributed in late 2003 to each of the current 25 European Union member states as well as Norway and Switzerland to get a clearer picture of national surveillance for invasive pneumococcal disease (IPD) in Europe. All respondents were contacted in 2006 and asked to provide an update to the questionnaire.
Twenty two of the 27 countries targeted completed and returned the questionnaire. Four of the 22 responding countries have no reporting requirement for IPD. Eighteen countries reported a total of 27 national surveillance systems. Case definitions employed in these systems differed. Fourteen of the 18 countries reported collection of IPD strains to a single reference lab for serotyping and in 12 countries to a single laboratory for susceptibility testing. Thirteen countries undertook laboratory quality assurance. Information on age and sex were widely collected, but only 11/27 systems collected information on pneumococcal polysaccharide vaccine status, while 5/27 systems collected information on pneumococcal conjugate vaccine status. The incidence of IPD reported in each of the 18 countries ranged from 0.4 to 20/100 000 in the general population, with a total of 23 470 IPD cases reported over a 12 month period.
Surveillance for IPD in Europe is very heterogeneous. Several countries lack surveillance systems. Large differences in reported disease incidence may reflect both true differences, and also variations in patient and healthcare factors, including surveillance. If IPD surveillance in Europe can be strengthened, countries will be able to make informed decisions regarding the introduction of new pneumococcal vaccines and also to monitor and compare the impact and effectiveness of new programmes.
Surveillance of influenza-like illness in England and Wales during 1966-2006
Authors: Elliot A J , Fleming D M
Published: October 2017

We report surveillance data collected since 1966 from a general practice database in England and Wales. Incidence rates of influenza-like illness (ILI) peaked during the winter of 1969/70, and were then followed by a decade of heightened activity. There has since been a gradual downward trend of ILI, interspersed with winters of heightened activity; since 1999/2000, the incidence of ILI has been at its lowest for 40 years. We argue that the decade following the herald waves of the pandemic could be equally important for the planning of healthcare services in the community.
Using sentinel surveillance to monitor effectiveness of influenza vaccine is feasible: A pilot study in Denmark
Authors: Mazick A , Christiansen A H , Samuelsson S , Mølbak K
Published: October 2017

The influenza vaccine for the season 2003/04 did not contain the circulating A(H3N2)/Fujian virus strain. Vaccine effectiveness (VE) estimates were needed but unavailable. We explored whether or not laboratory based influenza surveillance can be used to estimate VE.
We carried out a case-control study nested within Danish sentinel surveillance. A case was defined as a person aged 25 or above with A(H3N2)/Fujian/411/02 influenza. Four controls per case, matched on age groups and time, were selected from clients of sentinel practitioners (SP) who reported cases. SPs collected the following data in structured one-page questionnaires: vaccination status, chronic illness and previous pneumococcal vaccination. We sent postal survey questionnaires to participating SPs to assess acceptability and simplicity of data collection.
Twenty four cases were identified. Data from 19 case-control sets were analysed. One control was excluded because information on vaccination status was missing. Two of the 19 cases and 11 of 75 controls had been vaccinated against influenza. The VE adjusted for chronic illness was 33% (95% CI 0%–88%) and 37% (95% CI 0%–89%) when excluding 5 controls with influenza-like illness. Twenty two SPs returned survey questionnaires. Fifteen of 17 SPs reported that it was easy to find controls. SPs collected data through interviews and clinical notes, spending 1 to 5 minutes per case and 5 to 15 minutes for all four controls. Nineteen of 22 SPs considered the amount of time they spent on the study to be acceptable, 17 said that they would like to participate again, and none ruled out further participation.
Le contrôle de l’EV au sein des systèmes de surveillance sentinelle est faisable. Les nombres restreints de notre étude limitent l’interprétation de l’EV. Une étude étendue à l’échelle européenne, comprenant plusieurs pays, pourrait surmonter cette limitation et offrir des évaluations de l’efficacité vaccinale plus tôt dans la saison, pour différents groupes d’âge et pour des souches virales émergentes, incluant les sous-types nouveaux et pandémiques.
Monitoring VE within sentinel surveillance systems is feasible. The small numbers in our study limit interpretation of VE. Expansion to a European multicountry study could overcome this limitation and provide VE estimates earlier in the season, for different age groups and emerging virus strains, including new and pandemic subtypes.
A/H5N1 in the European Union: current levels of risk to humans, and responding to human cases and outbreaks
Authors: De Martin S , Nicoll A , Coulombier D
Published: October 2017

This issue of Eurosurveillance includes a report by Georgia Spala et al of the investigation of a suspected outbreak in Greece of avian influenza (A/H5N1 virus infection) in humans [1]. This took place in the early spring of 2006 when infected wild birds appeared in many European Union (EU) countries. There were confirmed infections in birds in Greece, but after careful investigation, no human infections were found. However, the massive investigation and control that had to take place around the infections and deaths in the outbreak in Turkey in December 2005 and January 2006 [2] is a reminder of what could have been in Greece or other EU countries.
Surveillance of ambulance dispatch data as a tool for early warning
Authors: Bork K H , Klein B M , Mølbak K , Trautner S , Pedersen U B , Heegaard E
Published: October 2017

Early detection of disease outbreaks is essential for authorities to initiate and conduct an appropriate response. A need for an outbreak detection that monitored data predating laboratory confirmations was identified, which prompted the establishment of a novel symptom surveillance system.
The surveillance system monitors approximately 80% of the Danish population by applying an outbreak detection algorithm to ambulance dispatch data. The system also monitors both regional and national activity and has a built-in, switch-on capacity for implementing symptom surveillance reporting in case of an alert.
In an evaluation with outbreak scenarios it was found that decreasing the outbreak detection sensitivity from a prediction limit of 95% to one of 99% moderately reduced the time to detection, but considerably diminished the number of false alerts.
The system was able to detect an increased activity of influenza-like illness in December 2003 in a timely fashion. The system has now been implemented in the national disease surveillance programme.
Epidemiologic surveillance system implemented in the Hautes-Alpes District, France, during the Winter Olympic Games, Torino 2006
Authors: Franke F , Coulon L , Renaudat C , Euillot B , Kessalis N , Malfait P
Published: October 2017

Some of the competitions of the Olympic Winter Games in Torino, 10 to 26 February 2006, were organised in France near the city of Briançon, in the department of Hautes-Alpes.
An epidemiologic surveillance system was set up by the local health authorities. The goals were to detect in a timely fashion any phenomenon which could justify prevention or sanitary control action, and to guide interventions in the case of outbreak or environmental pollution.
Surveillance was implemented from 30 January to15 March 2006 in the Briançon area.
Mortality was tracked using by analysing the number and cause of deaths.
A sentinel network of general practitioners was set up and reported the frequency of acute gastroenteritis, influenza-like illness and measles. Medical laboratories provided data about the analyses they undertook. Hospital emergency department and emergency ambulance service activities were followed up. Statutory notification diseases and toxic effects of carbon monoxide surveillances were reinforced.
Analysed data were transmitted daily to the health authorities. A French/English report was sent weekly to all participants.
The participation rate was close to 100%, and data transmission deadlines were respected. No adverse health event was identified.
The strong acceptability of this surveillance system comes from its good understanding by the participants. This surveillance, structured around routine and ad-hoc systems, allowed the establishment of the foundations of a network to be used in case of outbreak or environmental pollution.
Pertussis surveillance in French hospitals: results from a 10 year period
Authors: Bonmarin I , Lévy-Bruhl D , Baron S , Guiso N , Njamkepo E , Caro V , Renacoq Collective
Published: October 2017

We present 10 years of results from a paediatrician hospital network surveillance in France, set up in 1996 to monitor the trend of pertussis (whooping cough) in children and the impact of the vaccination strategies. Microbiologists from 43 hospitals that participate in the network on a voluntary basis notify pertussis diagnosis, and paediatricians complete a questionnaire for the infants under 6 months that fulfil the microbiological, clinical or epidemiological case definition. The network covers about 30% of pertussis cases seen in French hospitals.
Travel-associated legionnaires’ disease in Europe: 2005
Authors: Ricketts K D , McNaught B , Joseph C A , European Working Group for Legionella Infections Collective
Published: October 2017

In 2005, 755 cases of travel-associated legionnaires’ disease with onset in 2005 were reported to the EWGLINET surveillance scheme by 20 countries. A total of 85.8% of cases were diagnosed by the urinary antigen test, and 37 cultures were obtained. Twenty nine deaths were reported, giving a case fatality rate of 3.8% (down from 5.6% in 2004). Ninety three new clusters were identified, 36.6% of which would not have been detected without the EWGLINET scheme. One hundred and twenty two accommodation sites were investigated and the names of nine sites were published on the EWGLI website.
Pneumococcal conjugate, meningococcal C and varicella vaccination in Italy
Authors: D'Ancona F , Alfonsi V , Caporali M R , Ranghiasci A , Ciofi Degli Atti M L
Published: October 2017

The 7-valent anti-pneumococcal conjugate vaccine (PCV), anti-meningococcal C-conjugate vaccine (MenC) and varicella vaccine have been recently introduced in EU. In Italy, these vaccines have so far been recommended for use in specific groups. Since the health system is decentralised, the Regional Health Authorities (RHAs) can decide to recommend vaccination for other target populations.
We conducted a survey to describe the recommendations on these vaccines currently in place in the 21 Italian regions.
In November 2005, a standardised questionnaire was sent to RHAs, including information on the existence of regional recommendations, vaccination target population, and whether vaccines were provided free of charge, or at a reduced cost compared to pharmacies. Information reported in the questionnaires were followed up in May 2006.
All 21 regions completed and returned the questionnaire and were contacted for follow-up.
Recommendations about at least one of the three vaccines were present in 20 out of 21 regions. All included free of charge PCV offering to specific groups, while MenC and varicella immunisations were recommended in 17 and 19 regions, respectively. Recommendations for other individuals varied greatly by area: free of charge PCV and MenC vaccinations targeting all infants have been recommended in nine regions, and varicella vaccination targeting children in the second year of life in three regions. These different recommendations can lead to marked variation in vaccination coverage rates observed through the country, with a consequent different level of disease control. It is thus crucial to properly monitor vaccination coverage rates for PCV, MenC and varicella, as these are not routinely collected at the national level.